Prior Diagnosis Of Breast Cancer Research Articles

Demographics and Clinical Decision Making in Patients with Germline Moderate Penetrance Non-BRCA Mutations in Breast Cancer Related Genes.

Management of pathogenic variants in high penetrance genes related to breast cancer (BC), such as BRCA1 and BRCA2, are well established. However, moderate penetrance mutations are understudied. We aim to compare risk reduction decision-making patterns in patients with a moderate penetrance BC-related genetic mutations, without a prior BC diagnosis. Female patients aged ≥ 18 years who tested positive for a BRCA1/2, high penetrance, or moderate penetrance mutation related to BC between 1996 and 2023 without a concurrent or prior BC diagnosis were retrospectively identified from a single academic center's database. Groups were stratified by mutation type: BRCA1/2 mutations (BRCA1, BRCA2), high penetrance mutations (HPM; CDH1, PALB2, PTEN, STK11, TP53), or moderate penetrance mutations (MPM; ATM, BARD1, CHEK2, NF1, RAD51C, RAD51D). Demographics and clinical outcomes were compared. A total of 528 patients met the inclusion criteria, with 66% (n = 350) having a BRCA1/2 mutation, 8% (n = 44) having HPM, and 25% (n = 134) having MPM; the median follow-up was 56.0 months. In our cohort, 20.9% of patients with BRCA mutations, 9.1% with HPM, and 7.5% with MPM chose to undergo risk-reducing mastectomies (RRM). Within the moderate penetrance cohort, patients who chose to undergo RRM were younger at the time of genetic testing (39.4 vs. 47.5 years, p = 0.03) and had a higher number of family members with BC (2 vs. 1, p = 0.05). Our findings provide insights into the demographic characteristics and family history of patients with moderate penetrance mutations and those who pursue risk-reducing surgery.

Radial Scars on Screening Digital Breast Tomosynthesis: Upstaging Rates and Management Strategies.

BACKGROUND. Radial scars are more commonly identified on digital breast tomosynthesis (DBT) than on digital mammography (DM). Nonetheless, universal guidelines for radial scar management in the current era of DBT are lacking. OBJECTIVE. The purpose of this study was to determine the upstaging rates of screening DBT-detected radial scars with and without atypia and to identify features related to upstaging risk. METHODS. This retrospective study included patients who underwent core needle biopsy (CNB) showing a radial scar after screening DBT and DM from January 1, 2013, to December 31, 2020. Patients without surgical excision or at least 2 years of imaging follow-up after CNB were excluded. Rates of upstaging to breast cancer (ductal carcinoma in situ [DCIS] or invasive disease) were compared between radial scars with and without atypia at CNB. Associations of upstaging with patient, imaging, and pathologic variables were explored using standard statistical tests. RESULTS. Of 165 women with 171 radial scars, the final study sample included 153 women (mean age, 56 years; range, 33-83 years) with 159 radial scars that underwent surgical excision (80.5%, 128/159) or at least 2 years of imaging follow-up (19.5%, 31/159). Seven radial scars were upstaged to DCIS and one to invasive disease. Therefore, the up-staging rate of radial scars to cancer was 5.0% (8/159). The upstaging rate of radial scars without atypia at CNB was 1.6% (2/129) and that of radial scars with atypia was 20.0% (6/30) (p < .001). On multivariable analysis, features associated with higher upstaging risk included a prior breast cancer diagnosis (62.5% vs 4.8%; p = .01) and the presence of atypia at CNB (75.0% vs 15.9%; p = .02). The upstaging rate according to mammographic finding type was 7.1% (1/14) for asymmetries, 12.5% (2/16) for masses, 5.3% (5/95) for architectural distortion, and 0.0% (0/34) for calcifications. CONCLUSION. Screening-detected radial scars without atypia at CNB have a low upstaging rate to breast cancer of 1.6%. CLINICAL IMPACT. Imaging surveillance rather than surgery is a reasonable approach for radial scars without atypia, particularly for those presenting as calcifications.

Women’s insights on sexual health after breast cancer (WISH-BREAST).

12132 Background: Sexual health is a prevalent and distressing toxicity in women after cancer treatment. Sexual health needs and treatment require multidisciplinary management and despite the existence of guidelines on the management of sexual health, are often overlooked in the clinical setting. Methods: An anonymous online survey regarding sexual health for people with a current or prior breast cancer diagnosis was distributed through a social media platform (Instagram) and e-mail. Questions included demographics, breast cancer history and treatment, sexual health symptoms, and experience with medical care for sexual health symptoms. Results: Out of 1775 respondents, 1462 answered the question of whether or not sexual health changed after breast cancer diagnosis or treatment &amp; were included in this analysis. Mean age: 47.7 years. 87.3% of respondents identified as white and 1.6% as Black. Stage: 0 (8.5%), 1 (38.4%), 2 (34.2%), 3 (14.8%) &amp; 4 (2.9%). Estrogen receptor positive (81.5%), HER2 positive (27%), triple negative (12.9%). Breast cancer diagnosis or treatments caused a moderate to great deal of change to sexual health in 89.5% of respondents and a moderate to great deal of distress in 85%. The sexual health concerns are summarized in the table. 73% of participants did not receive information about sexual health from their healthcare team. Among participants who reported a change to sexual health, only 12% were satisfied with how their sexual health concerns were addressed. Treatment was not offered for sexual health concerns to 39% of respondents and 63% had not been referred to any specialists for sexual health concerns. 46% of participants had not been offered non-hormonal treatments for genitourinary concerns, 55% were told vaginal hormones were not an option, and 83% were not offered treatment for low libido despite lower sexual desire. 80% of respondents received information about sexual health from social media. Of those, 62% stated that their primary source of information on social media were health care professional accounts. Conclusions: In this online survey, sexual health concerns were highly prevalent and distressing after breast cancer diagnosis. There was a very low level of discussion with medical professionals and treatments were infrequently offered to patients, despite the existence of medical guidelines on sexual health care for women after cancer. Patients are turning to social media, &amp; specifically to medical professional accounts, for information. Future efforts to address sexual needs for breast cancer survivors and thrivers are warranted. [Table: see text]

Contribution of mammography to breast cancer detection among pathogenic germline BRCA carriers by age and mutated gene.

10615 Background: Healthy carriers of pathogenic germline BRCA 1/2 (gBRCA) may choose between risk reducing mastectomy and intensive screening surveillance. Current international guidelines recommend both annual breast MRI and annual mammography. The aim of this study was to investigate the added contribution of annual mammography in gBRCA carriers to the annual breast MRI. Methods: A retrospective study from 2 large centers comprising gBRCA carriers who were diagnosed with breast cancer between 2000-2022 and were aware of their gBRCA status prior breast cancer diagnosis. Collected data included age at diagnosis, mutated gene and mode of breast cancer diagnosis (MRI, mammography, ultrasound [US], or other means [including clinical or incidental findings]). Data on pregnancy and breastfeeding at the time of breast cancer diagnosis were also collected. Differences in the mode of diagnosis were analyzed by age (≤40y vs. &gt;40y) and mutated gene (BRCA1 vs. BRCA2). Results: The cohort included 200 gBRCA carries: 134 (67%) BRCA1, 62 (31%) BRCA2 and 4 (2%) with both BRCA1 and BRCA2 mutations. The median age at the time of breast cancer diagnosis was 41 (24-88). Most cancers (68%) were diagnosed by MRI, followed by mammography (14.5%), US (7%) and other means (10.5%). While MRI was the most common diagnosis modality in both age groups, the distribution of mode of diagnosis was significantly different in younger women (≤40y) where breast cancer detection was more commonly by US or following clinical findings, compared to older women, p&lt; 0.001 (see Table). Five women were pregnant and 9 women were breastfeeding at the time of breast cancer diagnosis, all age 40 or younger. Four (80%) of pregnant carriers and 5 (55.6%) of breastfeeding carriers were diagnosed by US. There was no difference in mode of diagnosis between BRCA1 to BRCA2 carriers, p=0.974. There were only 16 women under age 30 that were diagnosed with breast cancer, 2 (12.5%) of whom were diagnosed with mammography. Conclusions: MRI is the most common modality for breast cancer diagnosis in gBRCA carriers who were aware if there gBRCA prior breast cancer diagnosis. Annual mammography also has a meaningful role in this population. We did not identify a subgroup in which it could be omitted. The increased utility of US among younger women is attributed to reduced utilization of MRI/mammography during pregnancy and breastfeeding. This finding strengthens the role of US screening in gBRCA carriers who are not eligible for other methods of imaging. [Table: see text]

Abstract PO4-02-10: Predictive Factors of Nodal Upstaging at Time of Surgery in Clinically Node Negative Patients Undergoing Neoadjuvant Chemotherapy

Abstract Introduction: Neoadjuvant chemotherapy (NAC) can be given with the intent of downstaging breast cancer or to provide prognostic information prior to any surgical intervention in both node negative (N0) and node positive patients (pts). Residual nodal disease following neoadjuvant chemotherapy generally indicates poorer overall prognosis relative to those who are node negative. Several risk factors have been postulated to predict the presence of occult lymph node metastasis: age at diagnosis, tumor size, status of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor (HER-2), and BMI. NAC has been shown to eradicate axillary lymph node metastasis in up to 40% of pts. This study aims to evaluate characteristics of clinically N0 pts who underwent NAC and were upstaged to node positive status at the time of surgery. We hope to identify patient related factors that may help predict the presence of occult nodal disease as well compare pathological complete response rate (PCR) in the breast between N0 and patients who were upstaged. Methods: Data was collected through retrospective chart review of the Stroger Cook County electronic medical records system (CERNER). Pts treated at John H. Stroger Hospital from 2017-2021 with a new diagnosis of cT2-T3 invasive breast cancer who were clinically and radiologically node negative and received NAC were included. We compared demographic data, staging information, cancer characteristics and pathologic complete response rates (PCR) in the breast between those who remained node negative and those who had positive sentinel lymph nodes at the time of surgery. Pts with prior breast cancer diagnosis and those who underwent treatments at an outside institution were excluded. Statistical analysis included 2-tailed t-test and 2-tailed fisher’s (p&amp;lt; 0.05). Results: A total of 98 pts were identified, 62 with complete data for analysis,11 were upstaged at the time of surgery. When comparing pts who had nodal upstaging to those that remained node negative at time of surgery there was no significant difference between average BMI (28.5), age of diagnosis (58 years). Most pts (73%) were T2 at presentation, of those with nodal upstaging at time of surgery, 20% were T3 or higher, while only 5% of those who were not upstaged at surgery were greater than T3 (NS). Upstaged pts had an average tumor size of 4.16 cm while non-upstaged on average were 2.85 cm (P&amp;lt; 0.01). ER positive pts (ER+) and PR positive (PR+) were more likely to have nodal upstaging post op (P&amp;lt; 0.0012, P&amp;lt; 0.0013) when compared to ER negative (ER-) and PR negative (PR-) respectively. The distribution of receptor status was significantly different between groups, the most common receptor status in upstaged patients was triple positive (63%) while triple negative was most common in non-upstaged (41%). Triple positive pts were more likely to be upstaged than those with other receptor statuses (64% vs 40%, p 0.0004). There was a 100% PCR rate in the breast among non-upstaged pts compared to 10% of upstaged patients (P&amp;lt; 0.0001). Among all triple negative pts, 42% had PCR, of ER-/PR-/HER2+, 60% had a PCR, ER+/HER 2 negative had a 40% PCR. Conclusion: Pts with larger presenting tumor size who are node negative at presentation and have undergone chemotherapy are more likely to have occult positive nodes at the time of surgery. ER positive pts and triple positive pts are also more likely to have occult positive nodes at time of surgery. While our sample is small, our breast PCR rate is consistent with other published literature. Further investigation confirming this with larger samples and multi-institutional investigation may help to establish these relationships and elucidate a predictive model. The optimal management of these patients is worthy of further study. Citation Format: Rangel Melissa, Julia Alexieva, Alison Coogan, Elizabeth Marcus, Julie Wecsler. Predictive Factors of Nodal Upstaging at Time of Surgery in Clinically Node Negative Patients Undergoing Neoadjuvant Chemotherapy [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 PO4-02-10.

IJCM_229A: A Community-based screening programme for oral, breast, and cervical cancer in the rural area of Dakshin Kannada

Background: Karnataka recorded 87304 new cancer cases in the year 2021. Breast, lip and oral cavity, cervix were the top cancer sites amongst all sexes and are preventable. Despite the nation-wide launch of Population-based screening (PBS) in 2016, the reported coverage of individuals who were screened for these three cancers in Dakshin Kannada was 0.4% (NFHS-5). The study introduces on-site screening for oral and breast cancer in the community. Objectives: To estimate the proportion of pre-cancerous lesions of oral, breast, and cervical cancer, through community-based screening in adults aged 18 to 65 years, in the catchment area of a medical college in Dakshina Kannada Methodology: This observational study was conducted among all persons aged 18 to 65years, residing in the rural catchment area of a medical college in Mangalore taluk of Dakshina Kannada and consenting for the study. Pregnant women and persons with prior diagnosis of oral, breast or cervical cancer were excluded. Two-stage cluster sampling was used to enrol an estimated sample of 1120 beneficiaries. The study comprised of house-to-house survey, cancer awareness sessions, and community-based screening. Screening tests included Oral visual examination, clinical breast examination, iBreast examination (iBE; electronic palpation by ibreast device), and Pap smear tests. Participants who screened positive were referred for diagnostic tests and management. Results: The study was completed with survey of 556 households, 3 cancer awareness sessions, and screening of 525 beneficiaries (325 females and 200 males) for oral, breast, and cervical cancer. Three participants screened positive for oral cancer, and one participant for breast cancer, who were referred for management to tertiary care hospital attached to the medical college. 25% of female participants underwent cervical cancer screening, with no one detected with pre-cancerous lesions. Conclusion: A combination of house-to-house and camp-based approaches along with awareness sessions results in improved coverage of PBS in the community.

Performance Metrics of Screening Digital Breast Tomosynthesis Based on Years Since a Prior Breast Cancer Diagnosis.

BACKGROUND. Mammography surveillance protocols after breast cancer treatment vary widely. Some practices recommend performing diagnostic mammography for a certain number of years or indefinitely, whereas others recommend returning immediately to screening. OBJECTIVE. This study's objective was to determine performance metrics of screening digital breast tomosynthesis (DBT) in patients who resume screening mammography immediately after breast cancer treatment, based on the number of years since the breast cancer diagnosis. METHODS. This retrospective study included screening DBT examinations performed from January 2013 to June 2019 in patients who resumed screening mammography immediately after a prior breast cancer diagnosis. Multivariable logistic regression models with generalized estimating equations were used to evaluate associations between screening performance metrics and years since the prior breast cancer diagnosis, controlling for age, race and ethnicity, breast density, presence of a prior screening mammogram, and interpreting radiologist. RESULTS. The study included 8090 patients (mean age, 65 ± 11 [SD] years) with a prior breast cancer diagnosis who underwent 30,812 screening DBT examinations during the study period. The cancer detection rate (CDR) was 8.6 per 1000 examinations (265/30,812), abnormal interpretation rate (AIR) was 5.7% (1750/30,812), PPV1 was 15.1% (265/1750), sensitivity was 80.3% (265/330), specificity was 95.1% (28,997/30,482), and false-negative rate was 2.1 per 1000 examinations (65/30,812). CDR showed a significant independent positive association with years since breast cancer diagnosis (adjusted OR, 1.03; 95% CI, 1.01-1.05; p < .001), being lowest more than 2 to up to 3 years after diagnosis (4.9 per 1000 examinations) and highest more than 8 to up to 9 years after diagnosis (11.2 per 1000 examinations). AIR showed a significant independent negative association with years since breast cancer diagnosis (adjusted OR, 0.99; 95% CI, 0.98-1.00; p = .01), being highest 1 year or less after diagnosis (7.5%) and lowest more than 5 to up to 6 years after diagnosis (5.0%). CONCLUSION. Among 8090 patients with a prior breast cancer diagnosis, even though the AIR was higher during the year after diagnosis compared with subsequent years, the AIR remained acceptably low (< 10%) in all years. CLINICAL IMPACT. These results support the study institution's mammographic surveillance protocol for patients with a prior breast cancer diagnosis of returning immediately to DBT screening.

The Military Health System: Minimizing Disparities inBreast Cancer Treatment.

The Military Health System (MHS) is a universal health care system, in which health care disparities are theoretically minimized. This study aimed to identify disparities and assess their impact on the initiation of timely treatment for breast cancer within a universally insured population. A retrospective cohort study was performed to evaluate the treatment of female breast cancer patients ≥18 years of age within the MHS from January 1, 2014, to December 31, 2018. Incident breast cancer was defined as ≥2 breast cancer diagnoses without a prior diagnosis of breast cancer during the three continuous years before index diagnosis. Time from index diagnosis to initial treatment was calculated and dichotomized as receiving treatment within a clinically acceptable time course. Poisson regression was used to estimate relative risk (RR) with 95% CIs. Among the 30,761 female breast cancer patients identified in the MHS, only 6% of patients had a prolonged time to initial treatment. Time to initial treatment decreased during the study period from a mean (SD) of 63.2 (152.0) days in 2014 to 37.1 (28.8) days in 2018 (P < 0.0001). Age, region, and military characteristics remained significantly associated with receiving timely treatment even after the adjustment of confounders. Patients 70-79 years old were twice as likely as 18-39 years olds to receive timely treatment (RR: 2.0100, 95% CI, 1.52-2.6563, P < 0.0001). Senior officers and their dependents were more likely to receive timely initial treatment compared to junior enlisted patients and their dependents (RR: 1.5956, 95% CI, 1.2119-2.1005, P = 0.004). There have been significant improvements in the timely initiation of breast cancer treatment within the MHS. However, demographic and socioeconomic disparities can be identified that affect the timely initiation of therapy.

Causal relationships between breast cancer risk factors based on mammographic features

BackgroundMammogram risk scores based on texture and density defined by different brightness thresholds are associated with breast cancer risk differently and could reveal distinct information about breast cancer risk. We aimed to investigate causal relationships between these intercorrelated mammogram risk scores to determine their relevance to breast cancer aetiology.MethodsWe used digitised mammograms for 371 monozygotic twin pairs, aged 40–70 years without a prior diagnosis of breast cancer at the time of mammography, from the Australian Mammographic Density Twins and Sisters Study. We generated normalised, age-adjusted, and standardised risk scores based on textures using the Cirrus algorithm and on three spatially independent dense areas defined by increasing brightness threshold: light areas, bright areas, and brightest areas. Causal inference was made using the Inference about Causation from Examination of FAmilial CONfounding (ICE FALCON) method.ResultsThe mammogram risk scores were correlated within twin pairs and with each other (r = 0.22–0.81; all P < 0.005). We estimated that 28–92% of the associations between the risk scores could be attributed to causal relationships between the scores, with the rest attributed to familial confounders shared by the scores. There was consistent evidence for positive causal effects: of Cirrus, light areas, and bright areas on the brightest areas (accounting for 34%, 55%, and 85% of the associations, respectively); and of light areas and bright areas on Cirrus (accounting for 37% and 28%, respectively).ConclusionsIn a mammogram, the lighter (less dense) areas have a causal effect on the brightest (highly dense) areas, including through a causal pathway via textural features. These causal relationships help us gain insight into the relative aetiological importance of different mammographic features in breast cancer. For example our findings are consistent with the brightest areas being more aetiologically important than lighter areas for screen-detected breast cancer; conversely, light areas being more aetiologically important for interval breast cancer. Additionally, specific textural features capture aetiologically independent breast cancer risk information from dense areas. These findings highlight the utility of ICE FALCON and family data in decomposing the associations between intercorrelated disease biomarkers into distinct biological pathways.

Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis

Despite increasing evidence on the safety of pregnancy after anticancer treatments in breast cancer survivors, many physicians and patients remain concerned about a potential risk of pregnancy specifically in the case of hormone receptor-positive breast cancer. A systematic literature search of Medline, Embase and Cochrane library with no language or date restriction up to 31 March 2023 was carried out. To be included, articles had to be retrospective and prospective case-control and cohort studies as well as clinical trials comparing survival outcomes of premenopausal women with or without a pregnancy after prior diagnosis of hormone receptor-positive breast cancer. Disease-free survival (DFS) and overall survival (OS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Study protocol is registered in PROSPERO (n. CRD42023394232). Out of 7796 screened studies, 8 were eligible to be included in the final analysis. A total of 3805 patients with hormone receptor-positive invasive early breast cancer were included in these studies, of whom 1285 had a pregnancy after breast cancer diagnosis. Median follow-up time ranged from 3.8 to 15.8 years and was similar in the pregnancy and non-pregnancy cohorts. In three studies (n= 987 patients) reporting on DFS, no difference was observed between patients with and those without a subsequent pregnancy (HR 0.96, 95% CI 0.75-1.24, P= 0.781). In the six studies (n= 3504 patients) reporting on OS, patients with a pregnancy after breast cancer had a statistically significant better OS than those without a pregnancy (HR 0.46, 95% CI 0.27-0.77, P < 0.05). This systematic review and meta-analysis of retrospective cohort studies provides updated evidence that having a pregnancy in patients with prior history of hormone receptor-positive invasive early breast cancer appears safe without detrimental effect on prognosis.

Big advocacy, little recognition: the hidden work of Black patients in precision medicine

As cost-effective next-generation genome sequencing rapidly develops, calls for greater inclusion of Black people in genomic research, policy, and practice are necessary for effective translation of genomic science into precision population health and medicine. Employing a community-based participatory mixed methods research design, we developed a semi-structured survey that was disseminated to three cancer advocacy organizations. Of the 81 survey respondents 49 (60%) self-identified as Black, and 26 (32%) indicated a prior breast cancer diagnosis. Black participants’ expressed concerns about genetic testing were evenly distributed between concerns that could be addressed through genetic counseling (24%) and concerns about subsequent use of their genetic data (27%). Patient advocates contributed to contextualization of respondent concerns in terms of community experiences. Although genetic counseling services and policies governing genomic data use are not always accessible to many Black communities, advocates on our research team provided a bridge to discussion of the intersection between respondent concerns and the roles advocates play in filling gaps in access to genetic counseling and data governance. Concerns expressed by Black patients underscore a shared need among all patients for access to education, inclusion in research, and assurances regarding the use and handling of genetic data. Black cancer patients have joined in patient-led efforts to overcome systemic inequities in cancer care to improve their health outcomes through representation. Often their efforts are overshadowed by a relentless burden of continued health disparities. Future research should support their hidden work as a means to reduce barriers and improve representation in genomic databases.

Secondary Breast Angiosarcoma After a Primary Diagnosis of Breast Cancer: A Retrospective Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database.

Angiosarcoma is a rare complication of breast-conserving therapy. This study evaluated the change in incidence between 1992 and 2016 of secondary breast angiosarcoma (SBA) in patients with a history of breast cancer and the impact of management strategies for the original breast carcinoma on angiosarcoma treatment. Breast cancer and angiosarcoma cases were abstracted from the Surveillance, Epidemiology, and End Result (SEER) database. SBAs were defined as angiosarcomas located in the breast occurring after a prior breast cancer diagnosis. Primary breast angiosarcomas (PBAs) were defined as an angiosarcoma diagnosis listed as "one primary only." Incidence rates were estimated using a proportion of the US total population. Survival was analyzed by the Kaplan-Meier method, and Cox proportional hazard models were used to assess the association of clinicopathologic characteristics on overall survival. Between 1992 and 2016, 193 cases of SBA were reported in the SEER dataset in patients with a prior history of breast cancer. The incidence of breast angiosarcoma in patients with a prior diagnosis of breast cancer increased 3-fold from about 10 cases per 100,000 person-years to about 30 cases per 100,000 person-years over this same period ( P =0.0037). For treatment of SBA (n=193), almost all (95%) had surgery. Nine percent received radiation (compared with 35% of patients with PBA, P <0.001) and 23% received chemotherapy (vs. 45% for PBA, P =0.11). We demonstrate an increasing incidence of SBA over the study period. These data can help inform shared decision-making for optimal management of locoregional breast cancer and raise awareness of secondary angiosarcoma.

Benefits and harms of breast cancer screening: Cohort study of breast cancer mortality and overdiagnosis.

Quantifying the benefits and harms of breast cancer screening accurately is important for planning and evaluating screening programs and for enabling women to make informed decisions about participation. However, few cohort studies have attempted to estimate benefit and harm simultaneously. We aimed to quantify the impact of mammographic screening on breast cancer mortality and overdiagnosis using a cohort of women invited to attend Australia's national screening program, BreastScreen. In a cohort of 41,330 women without prior breast cancer diagnosis, screening, or diagnostic procedures invited to attend BreastScreen Western Australia in 1994-1995, we estimated the cumulative risk of breast cancer mortality and breast cancer incidence (invasive and ductal carcinoma in situ) from age 50 to 85 years for attenders and non-attenders. Data were obtained by linking population-based state and national health registries. Breast cancer mortality risks were estimated from a survival analysis that accounted for competing risk of death from other causes. Breast cancer risk for unscreened women was estimated by survival analysis, while accounting for competing causes of death. For screened women, breast cancer risk was the sum of risk of being diagnosed at first screen, estimated using logistic regression, and risk of diagnosis following a negative first screen estimated from a survival analysis. For every 1,000 women 50 years old at first invitation to attend BreastScreen, there were 20 (95% CI 12-30) fewer breast cancer deaths and 25 (95% CI 15-35) more breast cancers diagnosed for women who attended than for non-attendees by age 85. Of the breast cancers diagnosed in screened women, 21% (95% CI 13%-27%) could be attributed to screening. The estimated ratio of benefit to harm was consistent with, but slightly less favourable to screening than most other estimates from cohort studies. Women who participate in organised screening for breast cancer in Australia have substantially lower breast cancer mortality, while some screen-detected cancers may be overdiagnosed.

P443 Risk of incident Cancer in Patients with Inflammatory Bowel Disease with Prior Breast Cancer: a Multicentre Cohort Study

Abstract Background Breast cancer is the most common malignancy observed in patients with inflammatory bowel diseases (IBD) unrelated to the disease or its treatment (Poullenot F et al. JCC 2022). The main aim of our study was to assess the risk of incident cancer according to the IBD treatment given in patients with prior breast cancer. Methods Consecutive IBD patients with prior breast cancer diagnosis were included in a multicenter retrospective cohort from 25 tertiary centres. Inclusion date corresponded to the diagnosis of index cancer. Follow up was calculated from the first administration of immunomodulator after cancer diagnosis (or cancer diagnosis date in absence of treatment) to the occurrence of incident cancer, corresponding to recurrence of breast cancer or de novo cancer, or to the last follow-up visit. Patients were categorized according to the use or not of immunomodulator after cancer diagnosis: thiopurines, methotrexate, anti-TNF, vedolizumab, ustekinumab. Crude incidence rates were compared between patients receiving at least one immunomodulator and those without immunomodulator before and after matching on age, lymph node, and metastasis extension and tumor’s grade, using a propensity-score analysis with a 1:1 ratio. Results Among the 151 identified patients, 80 patients with full available data were analyzed: 76 (95%) women; mean age at index cancer diagnosis: 51.5 years [standard deviation (SD): 11.5 years]; 44 (55%) with Crohn’s disease, 35 (44 %) ulcerative colitis and 1 (1 %) indeterminate colitis; median IBD duration at inclusion was 13 years [interquartile range (IQR) 6-21]. After a median follow up of 84 months [IQR 49-154], 16 (20%) incident cancers were observed: 12 (15%) recurrences and 4 (5%) cancer de novo. Three (4%) patients died from cancer related cause during the follow up. 39 (49%) patients received no immunomodulator and, 11 (14%) were treated with thiopurines, 6 (7.5%) with methotrexate, 18 (22.5%) with anti-TNF, 5 (6%) with vedolizumab and one (1%) with ustekinumab. Those treatments were initiated with a median interval of 24 months [IQR 7-48] after cancer diagnosis. Crude incidence rate per 1000 person-years were 47.97 for patients not exposed to any immunomodulator and 12.61 for the others (p=0.0248). After matching, adjusted crude incidence rates per 1000 person-years were 50 and 27.27, respectively (p=0.3798). Rates of survival without incident cancer were not different between the two groups after matching on age, lymph node, metastasis extension, and tumor’s grade (p=0.17) (Figure 1). Conclusion In the present multicenter retrospective cohort, incident cancer risk among patient with IBD and prior breast cancer was not increased in patients subsequently exposed to immunomodulators.

The effect of thyroid dysfunction on breast cancer risk: an updated meta-analysis.

In a previous systematic review and meta-analysis of studies reporting associations between hyper-/hypothyroidism and breast cancer incidence published through 29 January 2019, we identified a higher risk with diagnosed hyperthyroidism compared to euthyroidism, but no association with diagnosed hypothyroidism. This 2-year updated meta-analysis aims to investigate the role of menopause in this association and the dose-response relationship with blood levels of thyroid-stimulating hormone (TSH) and thyroid hormones. After the exclusion of studies with only mortality follow-up, with thyroid dysfunction evaluated as a cancer biomarker or after prior breast cancer diagnosis, we reviewed 25 studies that were published up to 01 December 2021 and identified in MEDLINE, the COCHRANE library, Embase, or Web of Science; of these, 9 were included in the previous meta-analysis. Risk estimates from 22 of the 25 studies were included in the meta-analysis and pooled using random-effects models. Compared to euthyroidism, hyperthyroidism and hypothyroidism diagnoses were associated with higher (pooled risk ratio (RR): 1.12, 95% CI: 1.06-1.18, 3829 exposed cases) and lower risks (RR = 0.93, 95% CI: 0.86-1.00, 5632 exposed cases) of breast cancer, respectively. The increased risk after hyperthyroidism was greater among postmenopausal women (RR = 1.19, 95% CI 1.09-1.30) and the decreased risk after hypothyroidism was more pronounced among premenopausal women (RR = 0.69, 95% CI 0.53-0.89). Among women with no prior history of thyroid disease, every 1 mIU/L increase in TSH level was associated with a 0.8% (95% CI > 0-1.5%) lower risk of breast cancer. In conclusion, this meta-analysis supports an association between thyroid hormone levels and breast cancer risk, which could be modified by menopausal status.

Abstract C116: Racial/ethnic disparities in perceived quality of breast cancer survivorship care among older women by general health status: A SEER-CAHPS study

Abstract Purpose: We aimed to outline the extent of racial/ethnic disparities in perceived quality of cancer survivorship care among older breast cancer survivors in the United States. Methods: We utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Results program (SEER) and the Center for Medicare and Medicaid Services Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data linkage from 2000-2019. 19,017 female breast cancer survivors aged ≥65 years at survey with a prior diagnosis of primary invasive breast cancer were included. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression to determine the relationship between race/ethnicity (non-Hispanic white [NHW; referent], non-Hispanic Black [NHB], non-Hispanic Asian [NHA], Hispanic) and perceived quality of survivorship care (excellent in Getting Care Quickly, Getting Needed Care, Physician Communication, Getting Needed Prescription Drugs, and Overall Care, Health Plan, and Physician ratings), and usually/always having Enough Time with Physician, overall and by perceived general health status (excellent/very good, good, fair/poor). Results: Most survivors were NHW (78.1%) while the minority were NHB (8.1%), NHA (6.5%), or Hispanic (6.2%). Survivors reported an average of 76.3 years at survey (SD=7.14) and 4.65 years (SD=3.51) since diagnosis. Overall, NHB survivors were significantly less likely to report excellent for Overall Care (aOR, 0.80, 95% CI, 0.71-0.91) and usually/always having Enough Time with Physician (aOR, 0.74, 95% CI, 0.58-0.93) compared to NHW survivors. NHA survivors were significantly less likely to report excellent Getting Care Quickly (aOR, 0.75, 95% CI, 0.63-0.88), Getting Needed Care (aOR, 0.79, 95% CI, 0.63-0.99), Physician Communication (aOR, 0.84, 95% CI, 0.73-0.97), and Overall Care rating (aOR, 0.76, 95% CI, 0.67-0.87) compared to NHW survivors. The aORs for Hispanic survivors varied depending on outcome. When stratified by general health status, NHB compared to NHW survivors were significantly more likely (aOR, 1.30, 95% CI, 1.05-1.62) to report excellent in Getting Needed Care among those who reported good general health, but this disparity was not observed among those who reported excellent/very good general health (p-interaction=0.04). Compared to NHW survivors, NHB were significantly more likely (aOR, 1.54, 95% CI, 1.14-2.08) to report excellent Health Plan ratings among those who reported excellent/very good general health but not among those who reported good (p-interaction=0.03) or fair/poor general health (p-interaction=0.01). There were no significant interactions between general health status and NHA or Hispanic group for any outcome. Conclusion: These findings can be used to inform future interventions, care, and physician education throughout breast cancer survivorship. Citation Format: Kate E. Dibble, Zhengyi Deng, Avonne E. Connor. Racial/ethnic disparities in perceived quality of breast cancer survivorship care among older women by general health status: A SEER-CAHPS study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C116.

Background Parenchymal Enhancement at Postoperative Surveillance Breast MRI: Association with Future Second Breast Cancer Risk.

Background Background parenchymal enhancement (BPE) is a known risk factor for breast cancer. However, studies on the association between BPE and second breast cancer risk are still lacking. Purpose To investigate whether BPE at surveillance breast MRI is associated with subsequent second breast cancer risk in women with a personal history of breast cancer. Materials and Methods A retrospective search of the imaging database of an academic medical center identified consecutive surveillance breast MRI examinations performed between January 2008 and December 2017 in women who underwent surgery for primary breast cancer and had no prior diagnosis of second breast cancer. BPE at surveillance breast MRI was qualitatively assessed using a four-category classification of minimal, mild, moderate, or marked. Future second breast cancer was defined as ipsilateral breast tumor recurrence or contralateral breast cancer diagnosed at least 1 year after each surveillance breast MRI examination. Factors associated with future second breast cancer risk were evaluated using the multivariable Fine-Gray subdistribution hazard model. Results Among the 2668 women (mean age at baseline surveillance breast MRI, 49 years ± 8 [SD]), 109 developed a second breast cancer (49 ipsilateral, 58 contralateral, and two ipsilateral and contralateral) at a median follow-up of 5.8 years. Mild, moderate, or marked BPE at surveillance breast MRI (hazard ratio [HR], 2.1 [95% CI: 1.4, 3.1]; P < .001), young age (<45 years) at initial breast cancer diagnosis (HR, 3.4 [95% CI: 1.7, 6.4]; P < .001), positive results from a BRCA1/2 genetic test (HR, 6.5 [95% CI: 3.5, 12.0]; P < .001), and negative hormone receptor expression in the initial breast cancer (HR, 1.6 [95% CI: 1.1, 2.6]; P = .02) were independently associated with an increased risk of future second breast cancer. Conclusion Background parenchymal enhancement at surveillance breast MRI was associated with future second breast cancer risk in women with a personal history of breast cancer. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Niell in this issue.

Update on Pregnancy Following Breast Cancer Diagnosis and Treatment.

Survivorship has become a crucial component in breast cancer care. For women who have not completed their family planning, conceiving at the end of anticancer treatments should not be discouraged but might be challenging. Oncofertility counseling should be offered at the time of diagnosis to all patients, in order to inform them about the potential treatment-induced gonadotoxicity as well as the available strategies for fertility preservation, thus allowing to increase the chances of a future pregnancy. This article reports an updated overview on the current state of the art on pregnancy in women with prior breast cancer diagnosis and treatment, with a main focus on the issues faced by patients with history of hormone receptor-positive disease and BRCA carriers.

Abstract P5-14-03: National claims data analysis of breast cancer diagnosis and treatment before versus during the COVID-19 pandemic

Abstract Background: The COVID-19 pandemic imposed great burden on the healthcare system and required patients and their physicians to make unprecedented choices about cancer care. Hospital-based retrospective reviews suggested changes in breast cancer management during 2020 compared to previous years, including greater use of preoperative therapy. We used insurance claims data to understand the impact of the pandemic on breast cancer diagnosis and treatment at a national level. Methods: We identified new diagnoses of breast cancer from 2017-2020 in the Optum data set, consisting of claims records linked to electronic health records. The overall population (enrolled in Optum for at least 6 months with at least one diagnosis of any condition and no prior breast cancer diagnosis) included an average of 8 million adult Americans per year. A breast cancer diagnosis was defined as a first-ever ICD code for breast cancer with a breast diagnostic biopsy procedure code (considered the cancer diagnosis date) within 6 months before to 3 months after that ICD code. Each year’s cohort of breast cancer cases was limited to those diagnosed between February 1 and May 30, with follow-up through June 30 of the diagnosis year. First treatment after diagnosis was classified as either endocrine therapy, chemotherapy, or surgery. Geographic area was defined by the 9 Census Bureau regions. We used a Poisson regression to compare the rate of breast cancer diagnosis in 2020 versus 2017-2019 and a Chi-squared test to compare the distributions of first treatment. To investigate differences in the impact of the pandemic on rate of diagnosis (Poisson regression) or use of preoperative therapy (logistic regression) by race/ethnicity, income, or geographic area, we included each of these covariates as well as its interaction with year (2020 vs 2017-2019) in separate models. Results: There were 2,841 breast cancer diagnoses February-May 2020 (0.037% of overall population), compared to 3,880 in 2019 (0.045%), 3,509 in 2018 (0.043%), and 2,999 in 2017 (0.041%). In 2020 compared to 2017-2019, new breast cancer diagnoses decreased by 12.3% (95% CI 8.6%-15.9%; p &amp;lt; 0.0001). No significant differences were observed in this reduction in diagnoses by race/ethnicity, income level, or geographic area. Median date of diagnosis was earlier in 2020 (March 11) compared to 2017-2019 (March 29-April 1), a result of the diagnosis rate dropping more in later months. Among patients who received treatment during follow-up (83.1% in 2017-2019 vs 86.2% in 2020, a difference likely reflecting this shift in diagnosis date), there was a marked reduction in surgery as first treatment in 2020 compared to previous years (88.7% in 2017-2019 vs 69.3% in 2020), while both preoperative chemotherapy (6.1% in 2017-2019 vs 10.7% in 2020) and preoperative endocrine therapy (5.2% in 2017-2019 vs 20.1% in 2020) increased (p &amp;lt; 0.0001). There were no differences in the shift toward preoperative therapy by race/ethnicity or income, but there was a significant difference by geographic area (p=0.0003): the Mountain region had the least change in use of preoperative therapy (odds ratio 2.46 [95% CI 1.75-3.47] of preoperative therapy during vs before the pandemic) while the Middle Atlantic region had the greatest (odds ratio 5.64 [95% CI 3.79-8.38]). Conclusions: Among insured U.S. patients, new breast cancer diagnoses decreased by 12.3% during February-May 2020 compared to the same period in the previous three years, and use of preoperative therapy, largely endocrine, increased by 2.7-fold. The impact of the pandemic on choice of first treatment differed by geographic area, but not by race/ethnicity or income in this insured population. We will monitor with continued follow-up of claims data to assess the longer-term impact of these pandemic-related changes on treatment patterns, cost, and patient outcomes. Citation Format: Jennifer L Caswell-Jin, Maryam N Shafaee, Lan Xiao, Mina Liu, Natasha Purington, Esther M John, Melissa L Bondy, Allison W Kurian. National claims data analysis of breast cancer diagnosis and treatment before versus during the COVID-19 pandemic [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-03.

Abstract P5-14-01: National claims data analysis of breast cancer diagnosis and treatment before versus during the COVID-19 pandemic

Abstract Background: The COVID-19 pandemic imposed great burden on the healthcare system and has required patients and their physicians to make unprecedented choices about cancer care. Hospital-based retrospective reviews have suggested changes in breast cancer management during 2020 compared to previous years, including greater use of preoperative therapy. We used insurance claims data to understand the impact of the pandemic on breast cancer diagnosis and treatment at a national level. Methods: We identified new diagnoses of breast cancer from 2017-2020 in the Optum Clinformatics claims data set, consisting of claims records linked to electronic health records. The overall population (enrolled in Optum for at least 6 months with at least one diagnosis of any condition and no prior breast cancer diagnosis) included an average of 8 million adult Americans per year. A new breast cancer diagnosis was defined as a first-ever ICD code for breast cancer with a breast diagnostic biopsy procedure code (considered the cancer diagnosis date) within 6 months before to 3 months after that ICD code. Each year’s cohort of breast cancer cases was limited to those diagnosed between February 1 and May 30, with follow-up through June 30 of the diagnosis year. First treatment after diagnosis was classified as either endocrine therapy, chemotherapy, or surgery. Geographic area was defined by the 9 Census Bureau regions. We used a Poisson regression to compare the rate of breast cancer diagnosis in 2020 compared to 2017-2019 and a Chi-squared test to compare the distribution of first treatment in 2020 compared to 2017-2019. To investigate differences in the impact of the pandemic on rate of diagnosis (Poisson regression) or use of preoperative therapy (logistic regression) by race/ethnicity, income, or geographic area, we included each of these covariates as well as its interaction with year (2020 vs 2017-2019) in separate models. Results: There were 2,841 breast cancer diagnoses February-May 2020 (0.037% of overall population), compared to 3,880 in 2019 (0.045%), 3,509 in 2018 (0.043%), and 2,999 in 2017 (0.041%). In 2020 compared to 2017-2019, new breast cancer diagnoses decreased by 12.3% (95% CI 8.6%-15.9%; p &amp;lt; 0.0001). No significant differences were observed in this reduction in diagnoses by race/ethnicity, income level, or geographic area. Median date of diagnosis was earlier in 2020 (March 11) compared to 2017-2019 (March 29, April 1, and April 1 respectively), a result of a larger drop in diagnoses later in the time interval in 2020. Among patients who received treatment during follow-up (83.1% in 2017-2019 vs 86.2% in 2020, a difference likely reflecting this shift in diagnosis date), there was a marked reduction in surgery as first treatment in 2020 compared to previous years (88.7% in 2017-2019 vs 69.3% in 2020), while both preoperative chemotherapy (6.1% in 2017-2019 vs 10.7% in 2020) and preoperative endocrine therapy (5.2% in 2017-2019 vs 20.1% in 2020) increased (p &amp;lt; 0.0001). There were no differences in the shift toward preoperative therapy by race/ethnicity or income, but there was a significant difference by geographic area (p=0.0003): the Mountain region had least change in use of preoperative therapy (odds ratio 2.46 [95% CI 1.75-3.47] of preoperative therapy during vs before the pandmic) while the Middle Atlantic region had the greatest (odds ratio 5.64 [95% CI 3.79-8.38]). Conclusions: Among insured U.S. patients, new breast cancer diagnoses decreased by 12.3% during February-May 2020 compared to the same period in the previous three years, and use of preoperative therapy, largely endocrine, increased by 2.7-fold. The impact of the pandemic on choice of first treatment differed by geographic area, but not by race/ethnicity or income in this insured population. We will monitor with continued follow-up of claims data to assess the longer-term impact of these pandemic-related changes on treatment patterns, cost, and patient outcomes. Citation Format: Jennifer L Caswell-Jin, Maryam N Shafaee, Lan Xiao, Mina Liu, Natasha Purington, Esther M John, Melissa L Bondy, Allison W Kurian. National claims data analysis of breast cancer diagnosis and treatment before versus during the COVID-19 pandemic [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-01.