Stage Breast Cancer In Women Research Articles

Cost-Effectiveness Analysis of Ultra-Hypofractionated Whole Breast Radiation Therapy Alone Versus Hormone Therapy Alone or Combined Treatment for Low-Risk ER-Positive Early Stage Breast Cancer in Women Aged 65 Years and Older

The optimal management of early-stage, low-risk, hormone-positive breast cancer in older women remains controversial. Recent trials have shown that 5-fraction ultrahypofractionated whole-breast irradiation (U-WBI) has similar outcomes to longer courses, reducing the cost and inconvenience of treatment. We performed a cost-utility analysis to compare U-WBI to hormone therapy alone or their combination. We simulated 3 different treatment approaches for women age 65 years or older with pT1-2N0 ER-positive invasive ductal carcinoma treated with lumpectomy with negative margins using a Markov microsimulation model. The strategies were U-WBI performed with a 3-dimensional conformal technique over 5 fractions without a boost ("radiation therapy [RT] alone"), adjuvant hormone therapy (anastrozole for 5 years) without RT ("aromatase-inhibitor [AI] alone"), or the combination of the 2. The combination strategy was calibrated to match trial results, and the relative effectiveness of the RT alone and AI alone strategies were inferred from previous randomized trials. The primary endpoint was the cost-effectiveness of the 3 strategies over a lifetime horizon as measured by the incremental cost-effectiveness ratio (ICER), with a value of $100,000/quality-adjusted life-year deemed "cost-effective." The model results compared with the prespecified target outcomes. On average, RT alone was the least expensive strategy ($14,775), with AI alone slightly more ($14,998), and combination therapy the costliest ($19,802). RT alone dominated AI alone (the incremental cost-effectiveness ratio [ICER] -$5089). Combination therapy, compared with RT alone, was slightly more expensive than our definition of cost-effective (ICER $113,468) but was cost-effective compared with AI alone (ICER $54,451). Probabilistic sensitivity analysis demonstrated RT alone to be cost-effective in 50% of trials, with combination therapy in 36% and AI alone in 14%. U-WBI alone appears the more cost-effective de-escalation strategy for these low-risk patients, compared with AI alone. Combining U-WBI and AI appears more costly but may be preferred by some patients.

The Lived Experience of Chemo Brain in Early Stage Breast Cancer in Women 50 and Under

The Lived Experience of Chemo Brain in Early Stage Breast Cancer in Women 50 and Under

Outcomes after Surgery for Early Stage Breast Cancer in Women Staged With Preoperative Breast Magnetic Resonance Imaging According to Breast Tissue Density.

To determine surgical outcomes and breast cancer disease-free survival outcomes of women with early stage breast cancer with and without use of preoperative breast MRI according to breast tissue density. Women with early stage breast cancer diagnosed from 2004 to 2009 were classified into 2 groups: 1) those with dense and heterogeneously dense breasts (DB); 2) those with nondense breasts (NDB) (scattered fibroglandular and fatty replaced tissue). The 2 groups were reviewed to determine who underwent preoperative MRI. Breast tissue density was determined with mammography according to ACR BI-RADS. Patients were compared according to tumor size, grade, stage, and treatment. Survival analysis was performed using Kaplan-Meier estimates. In total, 261 patients with mean follow-up of 85 months (25-133) were included: 156 DB and 105 NDB. Disease-free survival outcomes were better in the DB group in patients with MRI than in those without MRI: patients with MRI had significantly fewer local recurrences (P < 0.016) and metachronous contralateral breast cancers (P < 0.001), but this was not the case in the NDB group. Mastectomies were higher in the DB group with preoperative MRI than in those without MRI (P < 0.01), as it was in the NDB group (P > 0.05). Preoperative breast MRI was associated with reduced local recurrence and metachronous contralateral cancers in the DB group, but not in the NDB group; however, the DB patients with MRI had higher mastectomy rates.

Abstract P6-02-12: Artificial Intelligence over thermal images for radiation-free breast cancer screening

Abstract Introduction: Breast cancer is the largest cause of cancer deaths in women today. NIRAMAI has developed a novel solution for detecting early stage breast cancer in women of all age groups. It is low cost, non-contact and portable solution. This radiation-free solution also works on dense breasts and hence is applicable beyond developing countries. The core of the solution is a Computer Aided Diagnostics engine called Thermalytix, which uses Artificial Intelligence algorithms on high resolution thermal images. In this paper, we present a comparative analysis of Thermalytix solution with Mammography, the standard screening modality, in a retrospective trial that was conducted across 3 reputed cancer hospitals in India. Aim: To compare the sensitivity, specificity, NPV and PPV of Thermalytix with Mammography. Methods: A multisite comparative study was performed on 194 patients across 3 reputed cancer hospitals in India with informed consent from subjects and ethics committee approval of respective hospitals. Every person who was going for a mammography test was made to undergo the non-invasive Thermalytix test prior to mammography examination. As per standard of care in India, all women who had a suspicious lesion in Mammo was sent to Ultrasound and then biopsy. 93 of the 194 subjects enrolled were found to be malignant by this standard procedure (9 of them did not have a biopsy report). Niramai Thermaytix test gave the automated reports detecting patients with suspected malignancy and those results were compared with ground truth derived from mammography, sono-mammography and biopsy. In a similar manner, standalone mammography observation was compared with the above ground truth to compare the two modalities as individual modalities. Results: Out of the 194 subjects, 93 positive cases and Niramai accurately detected 91 cases and called out one as boundary case. Sensitivity of Thermalytix was 98% and NPV was 97%, while sensitivity of Mammography was 94% with an NPV of 94%. NIRAMAI Thermalytix detected 4 more malignant patients compared to Mammography. On the other hand, mammography scored over Thermalytix in PPV and Specificity by 10%. These results are tabulated at Comparing NIRAMAI Thermalytix with Mammography NIRAMAIMammographySensitivity98%94%Specificity76%89%PPV79%89%NPV97%94%Accuracy87%91%Number of subjects = 194 high risk patients Among the 194 patients, 39 women were found to have dense breasts and 19 with heterogenous dense breasts – on whom ultrasound and elastography was performed by the Radiologist to correlate with mammography results and make the final observations. Niramai test alone was effective in these patients. The results show that Thermalytix is an emerging, radiation-free diagnostic modality that has comparable accuracy to Mammography. We conclude that NIRAMAI Thermalytix can be complementary modality to mammography as it works well on women of all age groups, including women with dense breasts. Its higher sensitivity and NPV adds to its potential to be the first screening test for early detection of breast cancer. Citation Format: Manjunath G, Sudhakar S, Kakileti S, Madhu H, Singh A. Artificial Intelligence over thermal images for radiation-free breast cancer screening [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-12.

The need for supplemental breast cancer screening modalities: a perspective of population-based breast cancer screening programs in Japan.

This article discusses possible supplemental breast cancer screening modalities for younger women with dense breasts from a perspective of population-based breast cancer screening program in Japan. Supplemental breast cancer screening modalities have been proposed to increase the sensitivity and detection rates of early stage breast cancer in women with dense breasts; however, there are no global guidelines that recommend the use of supplemental breast cancer screening modalities in such women. Also, no criterion standard exists for breast density assessment. Based on the current situation of breast imaging in Japan, the possible supplemental breast cancer screening modalities are ultrasonography, digital breast tomosynthesis, and breast magnetic resonance imaging. An appropriate population-based breast cancer screening program based on the balance between cost and benefit should be a high priority. Further research based on evidence-based medicine is encouraged. It is very important that the ethnicity, workforce, workflow, and resources for breast cancer screening in each country should be considered when considering supplemental breast cancer screening modalities for women with dense breasts.

Outcomes of invasive ductal (ID) or invasive lobular (IL) early stage breast cancer in women treated with anastrozole or exemestane in the Canadian cancer trials Group MA.27.

521Background: Previous data suggest histologic subtype, invasive ductal (ID) versus (vs) invasive lobular (IL), might be a marker for response to hormone therapy in receptor positive (HR+) breast cancer [Metzger O, et al: Cancer Res 2012, 72:S1-1]. Methods: MA.27 compared five years of adjuvant anastrozole (A) or exemestane (E) in patients with HR+ early breast cancer. We evaluated ID versus IL histology (based on original pathology reports) as a prognostic marker for outcomes. Results: We were able to include 5,709 patients (5,021 with ID and 688 with IL histology, out of 7,576 patients in MA.27) who had a median follow-up of 4.1 years. Histologic subtype did not influence overall survival (OS) or event-free survival (EFS) in the overall study cohort (HR 1.04, P = 0.81 and HR 1.14, P = 0.49, respectively). In univariable analysis of OS, there was no significant difference between treatment with E vs A in the ID group (HR = 0.92, P = 0.46). In the IL group, a marginally significant difference in favor of...

Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes

To evaluate the long-term results of tumorectomy and concomitant bilateral oncoplastic reduction mammoplasty (ORM) for early stage breast cancer patients with macromastia in terms of local disease control and long-term oncological results. Data of 82 patients with macromastia undergoing ORM for breast cancer between 1996 and 2011 were retrospectively examined and evaluated with regard to oncological results. The median age was 50 years. The median follow-up was 121 months (range 28-212 months). The median breast volume was 1402cm3 and the median weight of excised breast material was 679g. The median surgical margin was 16mm. Ten-year local recurrence rate was 8.7%. The 10-year overall survival rate was 82.2% and the disease-free survival rate was 73.2%. Early and late complication rates were 12.2% and 14.6%, respectively. From the standpoint of local disease control and long-term observation, ORM can be considered a very safe and acceptable treatment for early stage breast cancer in women with macromastia.

Abstract P1-15-02: Utilization of hypofractionated radiation therapy for early stage breast cancer in women over 50 years of age

Abstract Purpose: Hypofractionated whole breast irradiation (HF-WBI) following breast conserving surgery for early stage breast cancer is now recommended for women over 50 years of age by the American Society for Radiation Oncology (ASTRO). Herein, we explored the rate of HF-WBI utilization and its associated patterns of care using the National Cancer Data Base (NCDB), a comprehensive oncology outcomes database which captures 70% of all newly diagnosed cancer patients in the US. Methods: We utilized NCDB to identify women aged ≥50 diagnosed with T1N0/T1Nx invasive breast cancer or Tis (DCIS) who underwent breast conserving surgery and adjuvant whole breast external beam radiation therapy. HF-WBI was defined when a definitive radiation dose (≥40 Gy) was delivered in ≤23 fractions. We evaluated factors associated with the use of HF-WBI through exploratory univariate and multivariable analyses. Results: A total of 311,071 patients from 1998-2011 met inclusion criteria. The commonest HF-WBI regimen was 42.56 Gy in 16 fractions. The rate of HF-WBI utilization increased over time from 0.4% in 1998 to 16.5% in 2011 (p&amp;lt;0.001). HF-WBI was delivered more often for women of advancing age. In 2011, HF-WBI was delivered in 10.0%, 14.2%, 24.2% and 35.6% of women in their 50’s, 60’s, 70’s and 80+ (p&amp;lt;0.001). Multivariable analysis correlated significantly increased use of HF-WBI with (in order of association): later year of diagnosis, advancing age (decade), treatment in academic center, regional location in US, lower grade of disease, white race, residence in a higher income area (p&amp;lt;0.001), greater comorbidity score (p&amp;lt;0.03), presence of invasive cancer (p&amp;lt;0.01), right-sided disease (p&amp;lt;0.01), and greater distance from reporting facility (p&amp;lt;0.001). Factors Associated with Increased Use of HF-WBIAssociation with HF-WBIOdds Ratio of HF-WBI Use (95% confidence interval)Year of Diagnosis (2011 vs. prior to 2009)7.14 (6.85-7.52)Age (Decade, 80+ years)6.45 (6.06-6.90)Facility Type: Academic4.00 (3.69-4.33)Location (Mountain Region)1.82 (1.68-1.97)Grade 11.40 (1.33-1.47)Race: White1.38 (1.25-1.53)Income Quartile 4 (&amp;gt;$46K/year)1.30 (1.21-1.40)Comorbidity Index (High, 2)1.15 (1.02-1.31)Invasive Cancer1.09 (1.04-1.14)Laterality (Right Side)1.05 (1.02-1.09)Distance from Treatment Facility1.002 per mile (1.002-1.002) Conclusions: This comprehensive patterns of care study of HF-WBI in women ≥50 years old with early stage breast cancer from a national database identified a substantial increase in the utilization of this technique with time. Advancing patient age and treatment at academic facility were also strong predictors of delivery of HF-WBI. Disparities in utilization of HF-WBI and overall employment of this technique, even in later years, remain suboptimal. Strategies to identify and break barriers to the adoption of HF-WBI should be explored. Citation Format: Malolan S Rajagopalan, Craig Lehocky, John C Flickinger, Dwight E Heron, Paniti Sukumvanich, Joseph L Kelley, Gretchen M Ahrendt, Sushil Beriwal. Utilization of hypofractionated radiation therapy for early stage breast cancer in women over 50 years of age [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-15-02.

LDR brachytherapy implants as a boost in early stage breast cancer in women with cilastic implants

LDR brachytherapy implants as a boost in early stage breast cancer in women with cilastic implants