Breast Cancer Stage Distribution Research Articles

Global Stage Distribution of Breast Cancer at Diagnosis

Stage at diagnosis is a key prognostic factor for cancer survival. To assess the global distribution of breast cancer stage by country, age group, calendar period, and socioeconomic status using population-based data. A systematic search of MEDLINE and Web of Science databases and registry websites and gray literature was conducted for articles or reports published between January 1, 2000, and June 20, 2022. Reports on stage at diagnosis for individuals with primary breast cancer (C50) from a population-based cancer registry were included. Study characteristics and results of eligible studies were independently extracted by 2 pairs of reviewers (J.D.B.F., A.D.A., A.M., R.S., and F.G.). Stage-specific proportions were extracted and cancer registry data quality and risk of bias were assessed. National pooled estimates were calculated for subnational or annual data sets using a hierarchical rule of the most relevant and high-quality data to avoid duplicates. The proportion of women with breast cancer by (TNM Classification of Malignant Tumors or the Surveillance, Epidemiology, and End Results Program [SEER]) stage group. Data were available for 2.4 million women with breast cancer from 81 countries. Globally, the proportion of cases with distant metastatic breast cancer at diagnosis was high in sub-Saharan Africa, ranging from 5.6% to 30.6% and low in North America ranging from 0.0% to 6.0%. The proportion of patients diagnosed with distant metastatic disease decreased over the past 2 decades from around 3.8% to 35.8% (early 2000s) to 3.2% to 11.6% (2015 onwards), yet stabilization or slight increases were also observed. Older age and lower socioeconomic status had the largest proportion of cases diagnosed with distant metastatic stage ranging from 2.0% to 15.7% among the younger to 4.1% to 33.9% among the oldest age group, and from 1.7% to 8.3% in the least disadvantaged groups to 2.8% to 11.4% in the most disadvantaged groups. Effective policy and interventions have resulted in decreased proportions of women diagnosed with metastatic breast cancer at diagnosis in high-income countries, yet inequality persists, which needs to be addressed through increased awareness of breast cancer symptoms and early detection. Improving global coverage and quality of population-based cancer registries, including the collection of standardized stage data, is key to monitoring progress.

Morbidity and mortality among patients with breast cancer receiving anticancer treatment before and during the COVID-19 pandemic: A single tertiary center experience.

Breast cancer is the most common cancer type in women in Saudi Arabia (SA). Globally, cancer treatment has been affected by the recent COVID-19 pandemic. The present retrospective study reviews the 30-day morbidity and mortality rates of patients with breast cancer receiving anticancer systemic treatment before (group1) and during the peak of the COVID-19 (group 2) pandemic at a tertiary center, King Abdulaziz University Hospital (Jeddah, SA). There were no differences between the two groups regarding sex, age, breast cancer stage distribution, intention to treat or class of anticancer treatment received. Patients treated during the peak pandemic period received delayed treatment. No statistically significant difference was observed in the 30-day morbidity or mortality rates, although there was a trend towards higher rates of morbidity among patients treated during the peak of the pandemic period. In group 2, only 2.3% of the patients tested positive for COVID-19, and there was no significant difference in the 30-day morbidity and mortality rates between COVID-positive and COVID-negative patients receiving anticancer treatment. Individuals with breast cancer are a vulnerable group of patients that should be treated with special care during pandemics or other crises that affect the health care system.

The OncoSim-Breast Cancer Microsimulation Model.

Background: OncoSim-Breast is a Canadian breast cancer simulation model to evaluate breast cancer interventions. This paper aims to describe the OncoSim-Breast model and how well it reproduces observed breast cancer trends. Methods: The OncoSim-Breast model simulates the onset, growth, and spread of invasive and ductal carcinoma in situ tumours. It combines Canadian cancer incidence, mortality, screening program, and cost data to project population-level outcomes. Users can change the model input to answer specific questions. Here, we compared its projections with observed data. First, we compared the model’s projected breast cancer trends with the observed data in the Canadian Cancer Registry and from Vital Statistics. Next, we replicated a screening trial to compare the model’s projections with the trial’s observed screening effects. Results: OncoSim-Breast’s projected incidence, mortality, and stage distribution of breast cancer were close to the observed data in the Canadian Cancer Registry and from Vital Statistics. OncoSim-Breast also reproduced the breast cancer screening effects observed in the UK Age trial. Conclusions: OncoSim-Breast’s ability to reproduce the observed population-level breast cancer trends and the screening effects in a randomized trial increases the confidence of using its results to inform policy decisions related to early detection of breast cancer.

Adverse consequences of the COVID-19 pandemic on breast cancer stage distribution and breast cancer disparities.

10555 Background: The COVID-19 surge in March 2020 resulted in a hiatus placed on screening mammography programs in support of shelter-in-place mandates and diversion of medical resources to pandemic management. The COVID-related economic recession and ongoing social distancing policies continued to influence screening practices after the hiatus was lifted. We evaluated the effect of the hiatus on breast cancer stage distribution on the diverse patient population of a health care system in New York City, the first pandemic epicenter in the United States. Methods: Breast cancer patients diagnosed January 1, 2019 to December 31, 2020 were analyzed, with comparisons of stage distribution and mammography screen-detection for three intervals: Pre-Hiatus, During Hiatus (March 15, 2020 to June 15, 2020), and Post-Hiatus. Results were stratified by African American (AA), White American (WA), Asian (As) and Hispanic/Latina (Hisp) self-reported racial/ethnic identity. Results: A total of 894 patients were identified; of these, 549 WA, 100 AA, 104 As, and 93 Hisp comprised the final race/ethnicity-stratified study population. Overall, 588 patients were diagnosed Pre-Hiatus, 61 During-Hiatus, and 245 Post-Hiatus. Nearly two-thirds (65.5%) of the Pre-Hiatus cases were screen-detected versus 49.2% During-Hiatus and 54.7% Post-Hiatus (p = 0.002). Frequency of tumors diagnosed < 1 cm declined from 41.9% Pre-Hiatus to 31.7% Post-Hiatus (p = 0.035). WA patients were more likely to have screen-detected disease compared to AA in the Pre-Hiatus period (69.1% vs. 56.1%; p = 0.05) but non-significantly more likely to have screen-detected disease compared to As and Hisp patients (66.2% vs. 56.9%; p = 0.08). In the Post-Hiatus period, the frequency of screen-detected disease was highest among WA patients (63.0%) compared to all other racial/ethnic groups (AA; 48.1%, As-33.3%, and Hisp-40%; p = 0.007). Similar patterns were observed for frequency of tumors diagnosed ≤1cm Pre-Hiatus (WA-44.3% vs AA-26%, p = 0.02; and vs. As-41.3%, Hisp-48%; p = 0.09), and Post-Hiatus (WA-37.7% vs. AA-18.2%, As-30.8%, Hisp-23.5%; p = 0.25). Conclusions: The 3-month pandemic-related mammography screening hiatus resulted in a more advanced stage distribution for New York City breast cancer patients, and worsened pre-existing race/ethnicity-associated disparities, especially for AA pts.

Abstract PS7-62: Tumor characteristics of young age breast cancer patients using a nationally representative sample of the Korea central cancer registry (KCCR)

Abstract BACKGROUND The incidence of breast cancer is increasing in Korea. Breast cancer in young Korean women (< 40 years) is rare, but the rate of young age breast cancer incidence in Korea is higher than that in western countries. This study was aimed to evaluate the tumor characteristics of young age breast cancer patients (< 40 years) among Korean women. METHODS Among the Korean women, who were diagnosed with breast cancer from 2010 to 2015, we identified 10,897 cases of nationally representative sample data. The data was made through 10% systematic sampling of the Korea Central Cancer Registry (KCCR). We conducted a chart review survey to collect the data about tumor size, regional lymph node status, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status according to the Collaborative Stage version 2 (CSv2) Data Collection System. We described the number and percentage of the breast cancer stage distribution, tumor grade and intrinsic subtypes by the patient age groups (< 40 years, 40-49 years, 50-59 years, and ≥ 60 years), and evaluated the tumor characteristics in young age breast cancer patients (< 40 years). RESULTS The number of young age breast cancer patients was 1,245 (11.4% of < 40 years vs 35.4% of 40~49 years vs 30.8% of 50~59 years vs 22.4% of ≥ 60 years; P<.001). Young age breast cancer patients were more likely to be diagnosed with larger tumors (T2: 41.6% vs 36.4% vs 36.5% vs 38.4%; T3: 10.1% vs 7.3% vs 6.5% vs 6.2 %; P<.0001), more positive lymph node status (41.2% vs 32.7% vs 35.7% vs 32.5%; P<.0001), and higher tumor grade (grade 3, 26.8% vs 19.4% vs 23.5% vs 22.1%; P<.0001). According to intrinsic subtypes using ER, PR, and HER2, triple negative subtype was found more in young age breast cancer (18.2% vs 11.0% vs 12.2% vs 13.5%; P<.0001). CONCLUSION This study shows that young age breast cancer patients (< 40 years) in Korea have more aggressive tumor including advanced cancer stage at diagnosis, higher tumor grade, and triple negative intrinsic subtype. Therefore, we need to identify high risk group for young age breast cancer (< 40 years) and support their active surveillance. These findings using national cohort provide important information for establishing a national strategy of cancer care to manage young age breast cancer patients. Citation Format: Junyup Kim, So-Youn Jung, Eun-Gyeong Lee, Eun Sook Lee, Han-Sung Kang, See Youn Lee, Jai Hong Han, Heein Jo, Hyun hee Kim, Young-Joo Won, Seri Hong, Jae Jun Lee. Tumor characteristics of young age breast cancer patients using a nationally representative sample of the Korea central cancer registry (KCCR) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-62.

Precision prophylaxis: Identifying the optimal timing for risk-reducing salpingo-oophorectomy based on type of BRCA1 and BRCA2 cluster region mutations

ObjectivesCurrent risk-reducing salpingo-oophorectomy (RRSO) guidelines for individuals with BRCA1/2 mutations do not account for risk variability due to BRCA1/2 cluster region mutations that are associated with varying risks for the development of breast and ovarian cancer. We assessed whether current recommendations are appropriate for individual patients considering mutation-specific risks. MethodsUsing a hypothetical cohort of patients with BRCA1/2 mutations, we constructed Markov models allowing for the estimation of mean life expectancy based upon BRCA1/2 mutation, the presence of a cluster region mutation (Ovarian Cancer Cluster Region (OCCR), Breast Cancer Cluster Region (BCCR), or non-BCCR/OCCR), age at time of BRCA1/2 diagnosis (20–65), and age at time of RRSO (21–80). ResultsFor all BRCA1/2 mutation types, the optimal strategy was to undergo RRSO as early as possible. For BRCA1/2 carriers who delayed RRSO or who were identified with a mutation later in life, the OCCR mutation tended to be associated with lower life expectancy estimates than the BCCR and non-BCCR/OCCR mutations. Minimal delays in RRSO (i.e., neighboring 5-year intervals) were associated with minor losses in life expectancy. Variables associated with greatest impact on life expectancy included ovarian cancer risk after RRSO, breast cancer mortality rate, non-cancer mortality associated with RRSO, and breast cancer stage distribution. ConclusionsBRCA1/2 cluster regions may provide more precise estimates of life expectancy in counselling and shared decision-making. The most appropriate timing for RRSO is a complex decision and must be individualized for each patient.

The Structure and Parameterization of the Breast Cancer Transition Model Among Chinese Women

ObjectivesMarkov model simulation based on the natural history of disease is commonly employed for the comparative research of health interventions. The present study aims to simulate the natural progression of breast cancer and parameterize the initial and transition probabilities of multiple states of breast cancer development among Chinese women. MethodsThe age-specific incidence, mortality, and clinical stage distribution of breast cancer; and relapse rate of each clinical stage were collected from China's cancer registry yearbooks and clinical epidemiological studies to simulate the process from full health to breast cancer to death among Chinese women aged 30 to 80 through a Markov cohort study. The validity analysis was conducted to evaluate the accuracy of the model estimation. ResultsA Markov transition model with 7 states (no breast cancer, clinical stages 0-IV breast cancer, and death) was constructed for Chinese women. The age-specific incidence, mortality, and clinical stage distribution of breast cancer estimated by the initial and transition probabilities among different Markov states were highly consistent with the registered data and observed studies. ConclusionA breast cancer transition model for Chinese women has been established with validity. It could be a point of reference for further economic evaluations and breast cancer screening policy formulation.

Downstaging in opportunistic breast cancer screening in Brazil: a temporal trend analysis

BackgroundBreast cancer is the most common female cancer in Brazil with an estimated 60 thousand new cases per year. Widespread use of mammography opportunistic screening has been observed in the last 20 years, including women under 50 years old. The present study aimed to analyse the trends in breast cancer stage distribution at diagnosis as a function of age in the study period.MethodsThis paper examined temporal trends of stage distribution in women with breast cancer diagnosed between 2000 and 2015 in São Paulo state, Brazil. Data from the Hospital Cancer Registry of the region were utilized. Completeness was high. The sample was described according to age, stage and date of diagnosis using absolute frequency and proportions (%). For trends, the Cochran-Armitage test was used with a 5% level of significance (P-value< 0.05).ResultsA total of 93,674 women were included in the analysis with a median age of 56 years old. One-third (34.4%) of the women were younger than 50 years old, and stage II was the most frequent stage (36.4%), even when analysed by age groups. Stage 0 corresponded to 7.7% (7247 women) of cases. In the study period, there was a significant trend towards an increase in Stages 0, I and IV (P < 0.01) and a trend towards a decrease in Stages IIA, IIB and IIIB (P < 0.001). Stage IIA was more prevalent until 2009, and stage I was more prevalent thereafter. The trends to increase the proportion of Stages 0 and I and to decrease the proportion of stages IIA, IIB and IIIB were significant in all age groups.ConclusionsBreast cancer cases are diagnosed mainly at early stages, and approximately one-third of cases are younger than 50 years old. Downstaging has been shown. Opportunistic screening may have supported these results. Further studies are needed to show whether these results will impact the prognosis.

Mammography Coverage and Tumor Stage in the Opportunistic Screening Context

IntroductionThe increment of breast cancer screening coverage should lead to an increase in the proportion of early tumors diagnosed and the decrease of the cancer-related mortality. However, the effectiveness of opportunistic mammography screening is not well documented for public health systems in middle-income countries. Patients and MethodsWe conducted an ecologic study to evaluate the association of mammography coverage with trends in breast cancer stage distribution. We used data from a total of 42,850 breast cancer patients, diagnosed between 2000 and 2016, combined with estimated mammography coverage from 3 surveys (2003, 2008, and 2013). ResultsBiannual mammography coverage increased from 62.4% in 2003 to 73.9% in 2013. From 2000 to 2016, the proportion of in situ tumors increased 6.9%, the proportion of localized tumors increased 3.9%, the proportion of regional tumors decreased 6.9% and the frequency of distant tumors decreased 4% (P < .00001). ConclusionMammography coverage in the context of opportunistic breast cancer screening was associated with the increase of in situ and localized tumors and decrease of regional and distant tumors.

Trends in the clinical stage distribution of breast cancer in Osaka, Japan.

We examined the proportion of screen-detected breast cancer cases and clinical stage distribution by age group among female breast cancer cases in Osaka, Japan using population-based cancer registry from the period 1980 to 2012. The proportion of local cases increased and that of regional cases decreased gradually during the study period. The proportion of distant cases leveled off. The proportion of in situ cases increased rapidly after 2003. This increase was noticeable for women aged 30-39, 40-49, 50-59, and 60-69years. The proportion of in situ cases for women aged 40-49, 50-59, and 60-69years reached 15.4, 11.3, and 9.9% in 2010-2012, respectively. Regarding screening status, the proportion of screen-detected cases before 1988 was under 3%. Between 1989 and 2003, it leveled off at around 5%. After 2003, the proportion increased noticeably, and reached 25.4%:34.0% in aged 40-49years, 32.8% in aged 50-59years, and 26.7% in aged 60-69years. The increase in local cases and decrease in regional cases would be due to awareness of breast cancer, probably a result of developments in medical diagnostic technology. On the other hand, the steep increase of in situ cases might be due to screening. We need careful monitoring of the trends in breast cancer incidence by clinical stage.

Breast Cancer Disparities: Socioeconomic Factors versus Biology.

Disparities in poverty and health care access barriers have a negative impact on the health and wellness of population subsets that bear a disproportionate share of these socioeconomic disadvantages, such as African Americans and Hispanic/Latina Americans. The more advanced stage distribution of breast cancer in these two population subsets is likely related to imbalance in distribution of socioeconomic resources in the United States. However, differences in the breast cancer burden of population subsets defined by racial/ethnic identity are also influenced by race/ethnicity-associated variation in tumor biology and hereditary susceptibility. Compared with white Americans, African-American women have higher population-based breast cancer mortality rates, which are at least partly explained by an increased risk for the biologically aggressive triple-negative phenotype. International studies correlate West African ancestry with predisposition for triple-negative breast cancer. In contrast, Hispanic/Latina Americans have lower population-based incidence and mortality rates for breast cancer despite their increased rates of socioeconomic challenges. Genetic studies suggest that extent of Native American ancestry among Hispanic/Latina women may reduce breast cancer risk. Eradication of disparate access to breast cancer early detection and treatment strategies is a public health imperative, but research to elucidate the genetics of breast cancer related to racial/ethnic identity is equally important as we strive to comprehensively define this complex disease.

Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project.

We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (2009-2019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey. Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP. A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $677.171, which implies an incremental cost-effectiveness ratio (ICER) of $2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis. Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.

Uptake and Performance of Clinical Breast Exam Screening Program by Trained Laywomen in Malawi

Abstract 2 Background: Breast cancer mortality is high in sub-Saharan Africa (SSA) partly due to limited breast cancer awareness and challenges in early detection. We trained laywomen to promote breast cancer awareness and perform screening - clinical breast exam (CBE) - in urban clinics. This is the first breast cancer screening study in Malawi, and the first study in SSA to assess CBE delivered by laywomen with other health services. Methods: Four laywomen were trained to deliver breast cancer educational talks and conduct CBE. After training, screening was implemented in diverse urban health clinics. Women eligible to undergo CBE were ≥30 years, with no prior breast cancer or breast surgery, and clinic attendance for reasons other than a breast concern. Women with abnormal CBE were referred to a study surgeon. All palpable masses confirmed by surgeon exam were pathologically sampled. Patients with abnormal screening CBE but normal surgeon exam underwent breast ultrasound confirmation. Additionally, 50 randomly selected women with normal screening CBE underwent breast ultrasound, and 45 different women with normal CBE were randomly assigned to surgeon exam. Results: 175 educational talks were delivered to 4,295 people across 5 clinics. Among 1,220 eligible women, 1,000 (82%) agreed to CBE. Lack of time (68%) was the most common reason for refusal. CBE agreement varied across clinics from 71% to 86% (p=0.001). Women who attended the talk were more likely to accept CBE than women who did not (83% vs 77%, p=0.012). Among 1,000 women screened, 7% had abnormal CBE. All 50 women with normal CBE randomized to ultrasound had normal findings. Of 45 women with normal CBE randomized to surgeon exam, 43 had normal surgeon exams and 2 had axillary lymphadenopathy not detected by screening CBE. Sixty of 67 women (90%) with abnormal CBE attended the referral visit. Of these, 29 (48%) had concordant abnormal surgeon exam, and 15 were recommended to have pathologic sampling. Fourteen women had nipple discharge or breast pain identified by both CBE and surgeon exam, which did not require further work-up after surgeon review. Thirty-one women (52%) had discordant normal surgeon exam, all of whom had normal breast ultrasounds. Compared to surgeon exam, sensitivity for CBE by laywomen was 94% (CI 79-99%), specificity 58% (CI 46-70%), positive predictive value 48% (CI 35-62%), and negative predictive value 96% (CI 85-100%). Of 15 women who underwent pathologic sampling, 2 had cytologic dysplasia and are awaiting surgical excision, 7 had fibroadenomas, 2 normal tissue, 1 galactocele, 1 abscess, 1 lymph node with Kaposi sarcoma, and 1 tumoral calcinosis. Conclusions: Uptake of CBE screening in Lilongwe clinics was high. CBE by laywomen compared favorably with surgeon exam, and follow-up was good. Our intervention can serve as a model for wider implementation. Performance in rural areas, effects on breast cancer stage distribution and mortality, and cost-effectiveness require further evaluation. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

Effect of organised mammography screening on stage-specific incidence in Norway: population study.

Background:We aimed to estimate the effect of organised mammography screening on breast cancer stage distribution by comparing changes in women eligible for screening, based on birth cohort, to the concurrent changes in younger, ineligible women.Methods:In an open cohort study in Norway, which introduced national mammography screening county-by-county from 1995 to 2004, we identified women (n=49 883) diagnosed with in situ or invasive breast cancer (ICD10 codes: D05 or C50) during the period 1987–2011 and born between 1917 and 1980. We estimated relative incidence rate ratios (rIRRs) comparing the development in the screening vs historic group to the younger vs younger historic group.Results:Including the compensatory drop, eligible women experienced a 68% higher increase in localised cancers (rIRR=1.68, 95% confidence interval (CI): 1.51–1.87) than younger women, while the increase in incidence of advanced cancers was similar (rIRR=1.11, 95% CI: 0.90–1.36). Excluding the prevalence round, eligible women experienced a 60% higher increase in localised cancers (rIRR=1.60, 95% CI: 1.42–1.79), while the increase in incidence of advanced cancers remained similar (rIRR=1.08, 95% CI: 0.86–1.35).Conclusions:Introduction of organised mammography screening was followed by a significant increase in localised and no change in advanced-stage cancers in women eligible for screening relative to younger, ineligible women.

Risk of marrow neoplasms after adjuvant breast cancer therapy: the national comprehensive cancer network experience.

Outcomes for early-stage breast cancer have improved. First-generation adjuvant chemotherapy trials reported a 0.27% 8-year cumulative incidence of myelodysplastic syndrome/acute myelogenous leukemia. Incomplete ascertainment and follow-up may have underestimated subsequent risk of treatment-associated marrow neoplasm (MN). We examined the MN frequency in 20,063 patients with stage I to III breast cancer treated at US academic centers between 1998 and 2007. Time-to-event analyses were censored at first date of new cancer event, last contact date, or death and considered competing risks. Cumulative incidence, hazard ratios (HRs), and comparisons with Surveillance, Epidemiology, and End Results estimates were obtained. Marrow cytogenetics data were reviewed. Fifty patients developed MN (myeloid, n = 42; lymphoid, n = 8) after breast cancer (median follow-up, 5.1 years). Patients who developed MN had similar breast cancer stage distribution, race, and chemotherapy exposure but were older compared with patients who did not develop MN (median age, 59.1 v 53.9 years, respectively; P = .03). Two thirds of patients had complex MN cytogenetics. Risk of MN was significantly increased after surgery plus chemotherapy (HR, 6.8; 95% CI, 1.3 to 36.1) or after all modalities (surgery, chemotherapy, and radiation; HR, 7.6; 95% CI, 1.6 to 35.8), compared with no treatment with chemotherapy. MN rates per 1,000 person-years were 0.16 (surgery), 0.43 (plus radiation), 0.46 (plus chemotherapy), and 0.54 (all three modalities). Cumulative incidence of MN doubled between years 5 and 10 (0.24% to 0.48%); 9% of patients were alive at 10 years. In this large early-stage breast cancer cohort, MN risk after radiation and/or adjuvant chemotherapy was low but higher than previously described. Risk continued to increase beyond 5 years. Individual risk of MN must be balanced against the absolute survival benefit of adjuvant chemotherapy.

Trends in breast cancer stage distribution before, during and after introduction of a screening programme in Norway

Screening is intended to advance diagnosis thereby shifting the stage distribution towards more locally confined stages. Consequently we aimed to estimate trends in stage-specific breast cancer in relation to the introduction of population-based screening. From the Cancer Registry of Norway we retrieved cancer stage, age and year of diagnosis on all women aged 20 or older diagnosed with breast cancer during the period 1987-2010 in Norway (approximate source population: 1.8 million). Three calendar-time periods were defined: before (1987-95), during (1996-2004), and after (2005-10) screening was introduced; and two age groups: women eligible for screening (50-69 years) or younger (20-49 years). Poisson regression was used to estimate the incidence of localized (stage I) and more advanced cancer (stages II+), respectively, and logistic regression to estimate the proportion of localized cancer. The annual incidence of localized breast cancer among women aged 50-69 years rose from 63.9 per 100 000 before the introduction of screening to 141.2 afterwards, corresponding to a ratio of 2.21 (95% confidence interval: 2.10; 2.32). The incidence of more advanced cancers increased from 86.9 to 117.3 per 100 000 afterwards, corresponding to a 1.35 (1.29; 1.42)-fold increase. Advanced cancers also increased among younger women not eligible for screening, whereas their incidence of localized cancers remained nearly constant. Incidence of localized breast cancer increased significantly among women aged 50-69 years old after introduction of screening, while the incidence of more advanced cancers was not reduced in the same period when compared to the younger unscreened age group.

Letter to the Editor: Hofvind S, Skaane P. Stage distribution of breast cancer diagnosed before and after implementation of population-based mammographic screening. Fortschr Röntgenstr 2012; 184: 437-442

Letter to the Editor: Hofvind S, Skaane P. Stage distribution of breast cancer diagnosed before and after implementation of population-based mammographic screening. Fortschr Röntgenstr 2012; 184: 437-442

Stage Distribution of Breast Cancer Diagnosed Before and After Implementation of Population-Based Mammographic Screening

The German mammographic screening program is very similar to the Norwegian Breast Cancer Screening Program (NBCSP), which started about 10 years earlier. This study analyzes the stage distribution of invasive breast cancers diagnosed in the pre-screening and screening period, and evaluates the overall mortality in women aged 55-74 in the pilot and non-pilot counties of the NBCSP. The NBCSP invites women aged 50-69 to participate in two-view mammography biennially. Chi-square statistics were used to compare percentages of the stage and treatment of invasive breast cancers diagnosed in women residing in the four pilot counties in the pre-screening (1984-1995) and screening (1996-2007) period. An ecological approach was used to analyze the age-specific mortality in the pilot and non-pilot counties for the period 1970-2007. 50% of the breast cancers diagnosed in the pre-screening period, 70% of the cases detected with screening, 43% of the interval cancers, and 52% of the cancers diagnosed outside the NBCSP were stage I. Stage III+was present in 11% of the cancers in the pre-screening period, and in 1% of the cancers detected with screening. In the screening period, the breast cancer mortality rate decreased substantially more in the pilot counties than in the non-pilot counties. The stage distribution of breast cancer diagnosed in the NBCSP is prognostically favorable compared to cancers diagnosed outside the screening program. The reduction in the breast cancer mortality rate was more pronounced in the four pilot counties compared to the non-pilot counties. It is necessary to evaluate the program based on individual data.

P4-12-11: Myelodysplastic Syndrome Post Primary Breast Cancer Treatment: Cases from a Community Cancer Center: 1990–2010.

Abstract Background: Myelodysplastic syndrome (MDS) has not been well documented or described post breast cancer (BC) treatment. Methods: A cohort of all breast cancer patients from 1989 to 2010 at our institution were followed for incidence of blood disorders of any type by our registry system and by linkage to the Surveillance, Epidemiology and End Results (SEER) registry for our area. All cases of post breast cancer leukemia were reviewed for incidence of MDS from a cohort of 9846 cases diagnosed between 1990 and 2010. Coding of cases was assigned by the SEER registry using ICD-0 codes for type of leukemia from pathology reports. 20 cases of MDS were identified and confirmed using SEER coding for MDS and death certificate review if applicable. Variables of interest included age, race, treatment received, recurrence and treatment for recurrence, time interval from breast cancer diagnosis to leukemia diagnosis and time from leukemia diagnosis to follow up or death. Cytogenetic studies were available on 5 of the 20 patients. Results: Mean age of the patients was 56 years, range 33–79, with 65% &amp;lt; age 65. 90% of the patients were white and 10% Asian. TNM BC stage distribution was stage 0=2, stage I=8, stage II=8, and stage III=2. MDS was diagnosed at a median time post BC diagnosis of 65 months, range 8–205 months including 5 patients treated for recurrence and median 47 months, range 8–205 months excluding patients with recurrence. Nine patients had initial chemotherapy treatment, two without initial adjuvant therapy received chemotherapy for recurrence, and 9 received radiation only. Eight of eleven patients who received chemotherapy were treated with doxorubicin. All eleven received cyclophosphamide. Five of the 20 cases had MDS, not otherwise specified (NOS) (9989), 4 cases had MDSaAML, 3 MDS treatment related (9987), 3 refractory anemia (RA) (9980), 3 refractory anemia with excess blasts (RAEB) (9983), 1 RA with sideroblasts (9982), and 1 MDS with 5q deletion. Three of the five patients with cytogenetics available had chromosome 7 abnormalities and one had 11q21,23. Eleven of the 20 patients (55%) died of MDS or MDSaAML with a mean survival of 17 months, range 0.5-72 months. Six patients were alive at follow up with mean survival 56 months, range 43–89. Two of the surviving patients had stem cell transplants. The remaining three patients died of other causes with mean survival 66 months, range 7–109 months. Mean survival of all patients was 36.26 months, range .53-109 months with a significant difference in survival time between the patients that died of MDS, those alive at follow up and those that died of other causes (F statistic 6.56, p=.008). Discussion: MDS is a significant complication of breast cancer treatment with radiation and/or chemotherapy with a high rate of associated mortality. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-11.

Abstract 1830: Factors associated with fatigue, sleep dysfunction, and joint symptoms in breast cancer survivors

Abstract Background: Fatigue, sleep dysfunction, and joint symptoms may negatively impact quality of life in breast cancer survivors (BCS). Prior studies examining associated factors have yielded inconsistent results. Objective: Determine demographic, medical, exercise-related, body composition and serum inflammatory factors associated with fatigue, sleep dysfunction, and/or joint symptoms in BCS. Methods: Post-hoc analysis of baseline data completed by 37 BCS enrolled in a pre/post intervention study or randomized trial. Self administered survey assessed demographics, medical variables, self-efficacy (i.e., confidence in ability to exercise), fatigue (FSI), sleep dysfunction (PSQI), and joint symptoms (WOMAC). Sleep was also objectively assessed with an accelerometer. Body composition was assessed by body mass index (BMI), waist-to-hip ratio (WHR), and percent body fat (bioelectrical impedance). Cardio respiratory fitness was assessed with sub maximal treadmill test and muscle strength with back/leg extensor dynamometer. Multiplex high sensitivity assay or ELISA was performed on fasting serum samples to determine levels of cytokines or other markers related to body composition. Due to the skewed nature of several variables, Spearman correlations (r) were performed. A significant p value was set at &amp;lt;.05. Results: Participant mean age and education were 55 ± 10.1 and 15 ± 2.8 years, respectively. The majority (87%) were of European heritage with breast cancer stage distribution being I (51%), II (38%) or III (11%). Daily amount of fatigue was significantly associated with months since chemotherapy (r=.43, p = .027), number of comorbidities (r = .33, p = .0497), and fitness (r = -.35, p = .033). Depending on the subscale, self reported sleep dysfunction was associated with income (r = -.36, p = .029), number of comorbidities (r = .37, p = .028), WHR (r = .45, p = .005), tumor necrosis factor (TNF) α (r = .36, p = .029), interleukin (IL)-8 (r = -.45, p = .006), IL-10 (r = -.42, p = .011), TNF α /IL-10 ratio (r = .54, p = &amp;lt;.001), insulin (r = .48, p = .003), and adiponectin (r = -.36, p = .031). Time awake while in bed (accelerometer) was significantly associated with race (r = -.39, p = .019), muscle strength (r = -.35, p = .034), fitness (r = -.48, p = .003), adiponectin (r = -.39, p = .020), and monocytic chemotactic protein (MCP)-1 (r = -.33, p = .047). Time asleep was associated with race (r = .36, p = .031) and leptin (r = -.36, p = .031). Joint symptoms were significantly associated with age (r = .43, p = .008), education (r = -.34, p = .041), number of comorbidities (r = .60, p = &amp;lt;.001), self-efficacy (r = -.55, p = .003) and BMI (r = .33, p = .048). Conclusion: Fatigue and sleep dysfunction were significantly associated with medical factors and fitness. Sleep dysfunction was also associated with demographics, inflammation, strength, and body composition. Joint symptoms were associated with demographics, medical factors, self-efficacy and BMI. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1830. doi:10.1158/1538-7445.AM2011-1830