Treatment Of Nonmetastatic Breast Cancer Research Articles

Use of psychological interventions in women diagnosed and under treatment for non-metastatic breast cancer

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Jassim GA, Doherty S, Whitford DL, Khashan AS. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database of Systematic Reviews 2023, Issue 1. Art. No.: CD008729. DOI: 10.1002/14651858.CD008729.pub3.

Association of Race, Ethnicity, Language, and Insurance with Time to Treatment Initiation Among Women with Breast Cancer at an Urban, Academic, Safety-Net Hospital.

Initial treatment for nonmetastatic breast cancer is resection or neoadjuvant systemic therapy, depending on tumor biology and patient factors. Delays in treatment have been shown to impact survival and quality of life. Little has been published on the performance of safety-net hospitals in delivering timely care for all patients. We conducted a retrospective study of patients with invasive ductal or lobular breast cancer, diagnosed and treated between 2009 and 2019 at an academic, safety-net hospital. Time to treatment initiation was calculated for all patients. Consistent with a recently published Committee on Cancer timeliness metric, a treatment delay was defined as time from tissue diagnosis to treatment of greater than 60 days. A total of 799 eligible women with stage 1-3 breast cancer met study criteria. Median age was 60 years, 55.7% were non-white, 35.5% were non-English-speaking, 18.9% were Hispanic, and 49.4% were Medicaid/uninsured. Median time to treatment was 41 days (IQR 27-56 days), while 81.1% of patients initiated treatment within 60 days. The frequency of treatment delays did not vary by race, ethnicity, insurance, or language. Diagnosis year was inversely associated with the occurrence of a treatment delay (OR: 0.944, 95% CI 0.893-0.997, p value: 0.039). At our institution, race, ethnicity, insurance, and language were not associated with treatment delay. Additional research is needed to determine how our safety-net hospital delivered timely care to all patients with breast cancer, as reducing delays in care may be one mechanism by which health systems can mitigate disparities in the treatment of breast cancer.

Pre-operative Radiation and Immunotherapy in the Treatment of Non-metastatic Breast Cancer

Pre-operative Radiation and Immunotherapy in the Treatment of Non-metastatic Breast Cancer

Metachronous Contralateral Breast Cancer in Ahmadu Bello University Teaching Hospital, Zaria, Northwestern Nigeria.

Breast cancer is the most frequent cancer of women. Metachronous contralateral breast cancer (MCBC) is a cancer in the contralateral breast after 6 months of the initial diagnosis of the first breast cancer. It is an important public health issue because of an increased incidence of a primary breast cancer and improved survival. There is a paucity of data in the Northwestern region of the country. The study was to document the incidence, the method of detection, clinicopathological features, and the treatment of MCBC in our hospital. It was a 7-year prospective study from January 2011 to December 2017. Patients who had treatment for nonmetastatic breast cancer, American Joint Committee on Cancer (AJCC) Stages 1-111, were followed up. Those that developed MCBC were studied. Age, the method of detection, stage at presentation, pathological types, hormone receptor status, and treatment were documented. Data obtained were analysed using SPSS version 21.0. Results were presented as simple percentages and charts. Of 1285 women with nonmetastatic breast cancer, 47 had MCBC (incidence of 3.7%); 30 (63.8%) were aged 21-50 years; 23 (48.9%) detected by self-breast examination; 13 (27.7%) by clinical breast examination; seven (14.9%) by mammography; and four (8.5%) by breast ultrasound scan. Fourteen (29.8%) were AJCC stage I; 23 (48.9%), stage II; seven (14.9%), stage III; and three (6.4%), stage IV. Thirty-nine (83%) were invasive ductal carcinoma; 22 (50.0%) were estrogen receptor/progesterone receptor (ER/PR) positive, human epidermal receptor (HER)-2 neu negative; nine were (20.5%) ER/PR and HER-2 neu positive; six (13.6%) were ER/PR negative, HER-2 neu positive, whereas seven (15.9%) were triple negative. Forty-three (91.5%) had modified radical mastectomy and 19 (40.4%) had cytotoxics. With an average of six cases in a year, MCBC is common in our hospital. Majority (63.8%) were young. The commonest method of detection was by self-breast examination. Majority (78.3%) presented at an early stage. Most (91.5%) still had modified radical mastectomy.

Curative Treatment for Non-Metastatic Breast Cancer in Sub-Saharan Africa: Guideline Concordance, Initiation, and Abandonment in the Prospective ABC-DO Cohort

Curative Treatment for Non-Metastatic Breast Cancer in Sub-Saharan Africa: Guideline Concordance, Initiation, and Abandonment in the Prospective ABC-DO Cohort

Prepectoral Breast Reconstruction and Quality of Life: One Step Further

Surgery remains the cornerstone of the treatment of non-metastatic breast cancer but is also a major determinant of the quality of life (QoL) of breast cancer survivors, as is often associated - am...

A Novel Technique to Identify the Latissimus Dorsi Muscle During Modified Radical Mastectomy

Breast cancer is the most common cancer affecting women in India and worldwide. Surgery is the primary treatment of nonmetastatic breast cancer. Modified radical mastectomy (MRM) is a very important aspect of the surgical training in general surgery and surgical oncology. The lateral limit of the dissection is the latissimus dorsi (LD) muscle. In the early part of the learning curve, many trainees tend to overshoot the border of the LD muscle and enter into the posterior plane. The technique described is a simple anatomical method of identifying the anterior border of the LD during MRM.

Association of Endocrine Therapy and Dementia in Women with Breast Cancer.

PurposePrior studies have reported differing results regarding the association between endocrine therapy (ET) in the treatment of breast cancer and dementia risk. However, existing findings may be limited by common sources of bias and confounding. Here we investigate the association of ET utilized in the definitive setting to treat non-metastatic breast cancer with dementia risk accounting for multiple potential sources of bias and confounding.Patients and MethodsWe conducted a retrospective study in SEER-Medicare of women aged ≥ 66 years with non-metastatic breast cancer. We examined the risk of all-cause dementia among ET users versus non-ET users using multivariable regression models, accounting for the competing risk of death, and using a start of the follow-up period as 12-months following breast cancer diagnosis for both groups to avoid immortal time bias.ResultsAmong 25,777 individuals there were 2,869 incident dementia cases. We found a statistically significantly decreased risk of any dementia among ET users in unadjusted and adjusted models that completely attenuated when accounting for the competing risk of death (hazard ratio, 0.98; 95% confidence interval, 0.90–1.07).ConclusionWhen accounting for common sources of bias and confounding we did not find evidence to support an association between ET in the definitive treatment of non-metastatic breast cancer and dementia risk. These results suggest that ET may not be associated with dementia risk.

Factors associated with cognitive impairment during the first year of treatment for nonmetastatic breast cancer.

BackgroundWomen with breast cancer are more likely to develop cognitive impairment (CI), insomnia, fatigue, and mood disturbance than individuals with other cancers. The main objectives of this study were to establish the prevalence of CI and examine the relationships between CI, insomnia, fatigue, and mood over the first year of breast cancer treatment.MethodsParticipants were recruited after diagnosis and completed validated measures of insomnia, objective and perceived CI, fatigue, and mood disturbance at four time points during the first year of treatment. A random intercepts cross‐lagged panel model assessed relationships among symptoms over time.ResultsThe sample included 98 women. Prevalence of objective CI ranged from 3.1% to 8.2% throughout the year, whereas 36.7% demonstrated a clinically meaningful decline in perceived CI from baseline to 4 months, which remained relatively stable. Greater perceived CI was associated with more fatigue (β = −0.78, z = 17.48, p < .01) and symptoms of insomnia (β = −0.58, z = 5.24, p < .01). Short‐term fluctuations in perceived CI (p < .05), but not fatigue or insomnia, predicted future perceived CI. Fatigue (p < .001) was a significant predictor of future reported symptoms of fatigue and insomnia.ConclusionSubjective CI is more prevalent than objective impairments. Fatigue, insomnia, and perceived CI remain stable and are associated during the first year of treatment. Changes in insomnia and fatigue may have little effect on future perceived cognition. Women with breast cancer likely require targeted intervention for these side effects.

How breast cancer treatments affect the quality of life of women with non-metastatic breast cancer one year after surgical treatment: a cross-sectional study in Greece

BackgroundThe continuously increasing survivorship of female breast cancer makes the monitoring and improvement of patients’ quality of life ever so important. While globally there is a growing body of research on health-related quality of life 1 year after surgical treatment for non-metastatic breast cancer, up-to-date information regarding Greek patients is scarce.ObjectiveTo measure the level of QoL of non-metastatic BC survivors in Greece 1 year after surgery.MethodsA sample of 200 female breast cancer survivors aged 18 to 75, who followed up as outpatients in five public hospitals were included in this cross-sectional study. All recruited patients agreed to participate in the study (100% response rate). Quality of life data were collected through the EORTC QLQ-C30 as well as BR23 questionnaires.ResultsCronbach’s alpha for all scales of the two questionnaires was from 0.551 to 0.936 indicating very good reliability. According to the Multiple Linear Regression, older patients showed a lower future perspective (p = .031), with those living in rural areas, which was associated with more financial difficulties (p = .001). Women with tertiary education and those who had been hospitalized in a university hospital recorded better on global health status (p = .003 and .000 respectively). Patients who underwent chemotherapy reported better scores in the emotional function sub-scale (p = .025). Women with reconstruction and at least one complication appeared to have significantly better scores in future perspective and social function (p = .005, .002 respectively).ConclusionsBreast cancer survivors were found to have an overall good quality of life, functioning/symptoms scores and were satisfied with the provided care.

Self Reported Pain in Women While Undergoing Treatment for Non-metastatic Breast Cancer

Self Reported Pain in Women While Undergoing Treatment for Non-metastatic Breast Cancer

Abstract P5-13-18: Barriers to adjuvant radiotherapy treatment for breast cancer in a teaching hospital in Brazil

Abstract BACKGROUND: Adjuvant treatment of non-metastatic breast cancer (BC) represents an important paradigm of multimodality approach in oncology practice, with an established role for radiotherapy (RT). A delay of adjuvant radiotherapy can lead to poorer results. When chemotherapy (CT) is not indicated, RT should be initiated within 8 weeks after surgery. If CT is administered first, RT should be started within 7 months from surgery, since there is a continuous relation between time to radiotherapy and local recurrence. Brazil's public healthcare system, SUS, faces many challenges caring for cancer patients: inadequate funding, inequitable distribution of resources and services, among others. According to research done by Lins et al, around 458 linear accelerators would be necessary to supply the Brazilian public health demand and end the waiting line for radiation therapy. Currently, our healthcare system has 283 machines, which are responsible for more than 70% of our population. Furthermore, patients lack understanding of treatment windows, which is an additional hurdle. METHODS: We randomly selected 122 charts of female BC patients submitted to treatment with curative intent from 2003-2017 in Hospital das Clínicas da UFMG, the biggest teaching hospital of the 3rd largest city in Brazil. Primary endpoint was to determine median time from surgery to adjuvant radiotherapy, and second point was to determine median radiotherapy time. RESULTS: Twenty eight patients were not included in the analysis, 26 due to lack of information in the charts and two for not having received the proposed radiotherapy. Ninety four patients were included: median age was 49 years old (21-90), 21.5% were stage I, 41.9% stage II and 34.4% stage III at diagnosis. Patients received chemotherapy (neo or adjuvant), hormonotherapy, or both, according to oncologists discretion. All patients were submitted to surgery and radiotherapy. Long median times from referral to RT initiation and to radiotherapy completion were identified: 54 days and 97 days, respectively, as well as 7 months from surgery to beginning of RT (1-16) and 9 months from diagnosis to its completion (2-29).Biopsies were performed in 27 different sites and RT in 12. IntervalMedian Time (days)Biopsy to results13 (1-77)Referral to RT initiation54 (1-238)Referral to RT completion97 (43-238)RT initiation to RT completion42 (20-80) IntervalMedian Time (months)Surgery to RT initiation7 (1-16)Diagnosis to RT completion9 (2-29) CONCLUSIONS: This study shows that intervals for completion of adjuvant radiotherapy are well above recommended, mostly due to long delays in initiating radiotherapy. Although in our study all patients were conducted by the same oncology team, the system is fragmented, making it even more difficult for patients to receive multidisciplinary care and improve prognosis. There is undeniable need for more radiotherapy machines, but since their acquisition depends on costly governmental actions, we need to think about strategies that may allow us to better use the resources already available. We believe that Patient Navigation plays an important role here and were are establishing this program in our institution with Global Cancer Institute support. Citation Format: Vieira CM, Nogueira-Rodrigues A, Sousa CF, Krush L, Goss PE. Barriers to adjuvant radiotherapy treatment for breast cancer in a teaching hospital in Brazil [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 P5-13-18.

Postoperative radiotherapy after nipple- or skin-sparing mastectomy: a review of recent institutional and pooled data.

The increasing use of nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) in the treatment of nonmetastatic breast cancer is justified by considerations linked to their therapeutic index. In selected patients, efficacy results tend to be similar to those observed after radical modified mastectomy and at the same time, subcutaneous mastectomies preserve the patient’s body image. Yet the oncologic safety of the two former surgical approaches is still a matter of debate, also in consideration of the almost complete absence of clinical studies directed to prospective, controlled comparisons between subcutaneous and radical modified mastectomies. In addition, no clear statement—and consequently no consensus—emerges from the rather rare reports addressing the issue of whether or not there exist robust algorithms for guiding decision-making in delivering postoperative radiotherapy after NSM or SSM. The objective of the present review article is to revisit the dataset recently provided by the literature, which might help oncology teams optimise local treatment in this patient population.

Barriers to Timely Surgery for Breast Cancer in Rwanda

Abstract 81 Purpose Surgery is the mainstay of treatment for nonmetastatic breast cancer. Little is known about the quality of breast surgical care in sub-Saharan Africa. Research at the Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer center, has suggested that access to timely surgery is inadequate, but barriers have not been systematically examined. The aim of the current study was to gain an understanding of the barriers to breast cancer surgery among patients who were diagnosed at BCCOE by investigating delays and interruptions in care. Methods We used a standardized chart abstraction instrument to collect demographic, treatment, and outcome data as of November 2017 for all patients who were diagnosed with breast cancer at BCCOE in 2014 and 2015. We recorded all visits and treatments received until surgery, disease progression, or loss to follow-up for all patients with stage I to III breast cancer. Results During 2014 and 2015, 91 patients were diagnosed with stage I to III breast cancer and were treated with curative intent—67 patients (74%) underwent surgery, with 22 undergoing surgery at BCCOE and 45 elsewhere. Of the 24 patients with no surgery, 16 were lost to follow-up and eight experienced disease progression before surgical evaluation. Median time from diagnosis to surgery was 103 days (range, 30 to 826 days) for patients without neoadjuvant chemotherapy (NAC) and 268 days (range, 108 to 794 days) for patients with NAC. We defined surgical delays as &gt; 120 days from diagnosis without NAC or &gt; 365 days from diagnosis if NAC was administered. Of the 67 patients who had surgery, 26 patients (39%) experienced delays. When documented, reasons for delay included patient factors, such as social and/or financial issues (n = 5), seeking alternate treatment (n = 2), refusing referral to Kigali (n = 3), or any surgery (n = 1); system factors, such as surgeon nonavailability (n = 1); and changes in clinical status, such as pregnancy (n = 5), treatment-associated adverse events (n = 4), or the need for a second surgical opinion (n = 2). Unexplained failure to complete the initial surgical referral (n = 5) and missed NAC treatment appointments (n = 6) were frequent contributors. Some patients had multiple reasons for delay. For five patients, there was no documented explanation. Conclusion We observed high rates of loss to follow-up, surgical delays, and lapses in care at the point of surgical referral. Identification of the barriers to completing referrals could guide strategies for improving access to timely surgery. Efforts are needed to address social and financial barriers and explore patients’ refusals to undergo surgery. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Tamoxifen treatment and occurrence of dural arteriovenous fistulas: An observational study on a series of patients presenting tamoxifen history and diagnosis of DAVf

BackgroundTamoxifen is an estrogen-receptor modulator frequently used in the treatment of non-metastatic breast cancer. Side effects of this treatment are well evaluated but unproven side effects are suspected by case reports. Only one case report evokes a possible association between tamoxifen and dural arteriovenous fistula (dAVF). Authors report in this study their experience on dAVF in women exposed to tamoxifen. MethodsFrom 2005 to 2015, 294 patients with a dural arteriovenous fistula were referred to our department. Among these cases, 10 women who harbored 12 dAVFs were under a treatment of tamoxifen at the time of the diagnosis of the dAVF or had a treatment of tamoxifen in the past. There is no exclusion criterion for this observational study. ResultsTen women were included in this series (mean age: 64). Seven women were under treatment when the first symptom occurred and the three others had already finished their treatment. The mean delay between the initiation of tamoxifen and the occurrence of symptom was 32months. The most frequent clinical symptom was a tinnitus (8 patients, 80%) followed by headache (3 cases, 30%), chemosis (2 cases, 20%), oculomotor palsy (2 patients, 20%), and ocular hypertension (1 case, 10%). One patient presented a cerebellar hemorrhage and arrived in a comatose state. The fistulous point was located in the transverse sinus (TS) in 9 cases (75%) and in the cavernous sinus in 3 cases (25%). ConclusionsOur observational study suggests that the occurrence of cranial dAVF could be influenced by tamoxifen. It will be very difficult to establish a causal link between them but a larger comparative study could help.

Relationship between preoperative breast MRI and surgical treatment of non-metastatic breast cancer.

More extensive surgical treatments for early stage breast cancer are increasing. The patterns of preoperative MRI overall and by stage for this trend has not been well established. Using Breast Cancer Surveillance Consortium registry data from 2010 through 2014, we identified women with an incident non-metastatic breast cancer and determined use of preoperative MRI and initial surgical treatment (mastectomy, with or without contralateral prophylactic mastectomy (CPM), reconstruction, and breast conserving surgery ± radiation). Clinical and sociodemographic covariates were included in multivariable logistic regression models to estimate adjusted odds ratios and 95% confidence intervals. Of the 13 097 women, 2217 (16.9%) had a preoperative MRI. Among the women with MRI, results indicated 32% higher odds of unilateral mastectomy compared to breast conserving surgery and of mastectomy with CPM compared to unilateral mastectomy. Women with preoperative MRI also had 56% higher odds of reconstruction. Preoperative MRI in women with DCIS and early stage invasive breast cancer is associated with more frequent mastectomy, CPM, and reconstruction surgical treatment. Use of more extensive surgical treatment and reconstruction among women with DCIS and early stage invasive cancer whom undergo MRI warrants further investigation.

Care patterns and changes in treatment for nonmetastatic breast cancer in 2013-2014 versus 2005: a population-based high-resolution study.

Studies on recent trends in patterns of care for breast cancer patients are scarce. This study aims to examine the patterns and trends in the treatment of women with nonmetastatic breast cancer according to major recommended treatment options. A population-based study was carried out in Navarra, Spain, including all women with a primary invasive nonmetastasized breast cancer, diagnosed in 2005 and in 2013-2014. We compared patients' characteristics and treatment patterns between periods. Factors associated with receipt of recommended treatment were examined by multivariate logistic regression. Of the 719 patients included, 90% received guideline-adherent locoregional treatment. Over the two periods, there was an increasing use of sentinel lymph node biopsy as opposed to axillary lymph node dissection as the first axillary procedure. Among women with oestrogen receptor-positive tumours, 96% received endocrine therapy. The proportion of high-risk patients who were treated with chemotherapy increased between the two periods from 65 to 74% (P=0.079) and, among patients with human epidermal growth factor receptor 2-positive tumours, the receipt of targeted treatment increased from 37 to 72% (P<0.001). The main factors associated independently with a lower probability of receiving recommended treatment were age 70 years or older for all treatment modalities and comorbidity for locoregional treatment and chemotherapy. The proportion of women with breast cancer who received treatment according to recent European guidelines in Navarra has increased from 2005 to 2013-2014, resulting in a high level of adherence to standard care. Most failures in adherence to these standards are related to older age or comorbidities.

How changes in physical activity relate to fatigue interference, mood, and quality of life during treatment for non-metastatic breast cancer.

Physical activity (PA) following surgery for breast cancer may improve depressive symptoms and quality of life (QoL) via reduction in fatigue-related daily interference (FRDI). Less is known about how change in PA may relate to these psychosocial factors throughout the course of treatment. In a secondary analysis of a previous psychosocial intervention trial, we examined relationships between change in PA, depressive symptoms, and functional QoL, as mediated by change in FRDI, and whether naturally occurring change in PA provided benefit independent of the intervention. Women (N=240) with non-metastatic stage 0-III breast cancer were randomized to cognitive-behavioral stress management (CBSM) or a control 2-10weeks post-surgery. PA, FRDI, clinician-rated depressive symptoms, self-reported depressed mood, and functional QoL were assessed at baseline and three months post-intervention. Increased PA was associated with reductions in clinician-rated depressive symptoms, depressed mood, and improved QoL, mediated by a reduction in FRDI. This was above and beyond the effect of CBSM. Increased PA may mitigate FRDI and improve depressive symptoms and functional QoL for women undergoing breast cancer treatment, beyond effects of a psychosocial intervention. Benefits of an integrated PA and psychosocial approach should be investigated further.

Post-surgical depressive symptoms and long-term survival in non-metastatic breast cancer patients at 11-year follow-up.

Mild to moderate depressive symptoms are common during treatment for non-metastatic breast cancer. The goal of this secondary analysis was to determine if depressive symptoms predict clinical outcomes at long-term follow-up. From 1998 to 2005, we interviewed 231 women with the Hamilton Rating Scale for Depression who were participating in a psychosocial study 2-10weeks post-surgery for non-metastatic breast cancer (Stage 0-IIIb). We conducted Kaplan Meier (K-M) curves and Cox proportional hazards (PH) models to examine associations between depressive symptoms, overall survival, and disease-free survival at 8-15-year follow-up. A total of 95 women (41.1%) scored in the mild-moderately depressed range. Non-depressed women had longer overall survival (M=13.56years; SE=0.26) than those in the mild/moderate depressed group (M=11.45years; SE=0.40), Log-rank χ2(1)=4.41, p=0.036. Cox PH models, adjusting for covariates, showed comparable results: mild/moderate depressive symptoms hazard ratio=2.56, [95% CI, 1.11 to 5.91], p=0.027. Similar results were observed in a subsample with invasive disease (n=191). Depression category did not predict disease-free survival in the overall or invasive sample. Screening and referrals for treatment of depressive symptoms, even at subclinical levels, is important early in treatment. A randomized trial is warranted to determine effects of depressive symptoms on clinical outcomes.

Circulating Tumor Cells and Cancer Stem Cells: Clinical Implications in Nonmetastatic Breast Cancer.

PurposeDespite the therapeutic advances, disease recurrence remains an ever-present threat to the health and well-being of breast cancer survivors. Assessment of circulating tumor cells (CTCs) and cancer stem cells (CSCs) during and after treatment may be of value in refining treatment.MethodsThree 5 mL blood samples were taken from each patient: the first, at diagnosis; the second, after completion of neoadjuvant anthracyclin-based chemotherapy; and the third, a month after surgery and completion of adjuvant radiotherapy. The absolute numbers of CTCs were identified as CD45-cytokeratin+ cells. CTCs per 5 mL of blood were determined by recording all events in the whole suspension. CSCs were identified as cytokeratin+CD44+CD24-/CD45- cells. The CSCs were expressed as a percentage of CTCs.ResultsUnivariate analysis identified the measurements of baseline CTCs and CSCs, taken after chemotherapy and one month after the cessation of radiotherapy, as prognostic factors for both four-year disease-free survival and four-year overall survival. Multivariable analysis identified the third measurement of CSCs, taken one month after the completion of radiotherapy, as the only independent prognostic factor for the four-year disease-free survival (P < 0.002, hazard ratio [HR] = 1.231, 95% CI 1.077–1.407). The initial CTC measurement was the one factor that reached significance on multivariate analysis (P < 0.03, HR 1.969, 95% CI 1.092–3.551) for the four-year overall survival. Correlation was higher between CTC and CSC counts at diagnosis (r = 0.654, P < 0.001) than after chemotherapy (r = 0.317, P < 0.03), because of the more rapid decrease in the mean CTC count with chemotherapy.ConclusionThe CTC count could be suitable as one of the measures for monitoring response to chemotherapy, while persistence of CSC after cessation of the treatment of nonmetastatic breast cancer, except hormonal therapy when indicated, may be a reason to consider additional therapy in the future. These findings need confirmation in larger randomized trials.