Breast Cancer Patients Still Have Risk of Relapse After Five Years of Systemic Therapy
J. Natl. Cancer Inst. 2008 100: 1119
Abenaa M. Brewster, Gabriel N. Hortobagyi, Kristine R. Broglio, Shu-Wan Kau, Cesar A. Santa-Maria, Banu Arun, Aman U. Buzdar, Daniel J. Booser, Vincente Valero, Melissa Bondy, and Francisco J. Esteva
Link to Journal
Adjuvant and neoadjuvant systemic therapy (AST) improves the survival of breast cancer patients, but there is still a risk that the disease will recur years later.
Disease recurrence among breast cancer patients who were disease free 5 years after AST (the landmark) was estimated 5 and 10 years after landmark. Multivariable analysis was used to identify factors associated with recurrence.
Rates of recurrence-free survival at 5 years and 10 years after landmark were 89% and 80%, respectively. The risk of recurrence 5 years after therapy increased with tumor stage (stage 1: 7%, stage II: 11%, and stage 3: 13%) and was also associated with tumor grade, hormone receptor status, and endocrine therapy.Breast cancer patients who undergo AST are at risk of late recurrences, and this risk is associated with certain characteristics of the original tumor.
Limitations
HER2/neu status was not included in the analysis because the data were not available; aromatase inhibitor treatment was not included because too few women received it.
Tuesday, 19 August 2008
Tuesday, 12 August 2008
Two Different Breast Cancer Screening Strategies Are Equally Effective
Comparing Screening Mammography for Early Breast Cancer Detection in Vermont and Norway
Solveig Hofvind, Pamela M. Vacek, Joan Skelly, Donald L. Weaver, and Berta M. Geller
J Natl Cancer Inst 2008 100: 1082-1091
Link to Journal
Most screening mammography in the United States differs from that in countries with formal screening programs by having a shorter screening interval and interpretation by a single reader vs independent double reading. We examined how these differences affect early detection of breast cancer by comparing performance measures and histopathologic outcomes in women undergoing opportunistic screening in Vermont and organized screening in Norway.
The age-adjusted recall rate was 9.8% in Vermont and 2.7% in Norway (P < .001). The age-adjusted screen detection rate per 1000 woman-years after 2 years of follow-up was 2.77 in Vermont and 2.57 in Norway (P = .12), whereas the interval cancer rate per 1000 woman-years was 1.24 and 0.86, respectively (P < .001). Larger proportions of invasive interval cancers in Vermont than in Norway were 15 mm or smaller (55.9% vs 38.2%, P < .001) and had no lymph node involvement (67.5% vs 57%, P = .01). The prognostic characteristics of all invasive cancers (screen-detected and interval cancer) were similar in Vermont and Norway.
Screening mammography detected cancer at about the same rate and at the same prognostic stage in Norway and Vermont, with a statistically significantly lower recall rate in Norway. The interval cancer rate was higher in Vermont than in Norway, but tumors that were diagnosed in the Vermont women tended to be at an earlier stage than those diagnosed in the Norwegian women
Solveig Hofvind, Pamela M. Vacek, Joan Skelly, Donald L. Weaver, and Berta M. Geller
J Natl Cancer Inst 2008 100: 1082-1091
Link to Journal
Most screening mammography in the United States differs from that in countries with formal screening programs by having a shorter screening interval and interpretation by a single reader vs independent double reading. We examined how these differences affect early detection of breast cancer by comparing performance measures and histopathologic outcomes in women undergoing opportunistic screening in Vermont and organized screening in Norway.
The age-adjusted recall rate was 9.8% in Vermont and 2.7% in Norway (P < .001). The age-adjusted screen detection rate per 1000 woman-years after 2 years of follow-up was 2.77 in Vermont and 2.57 in Norway (P = .12), whereas the interval cancer rate per 1000 woman-years was 1.24 and 0.86, respectively (P < .001). Larger proportions of invasive interval cancers in Vermont than in Norway were 15 mm or smaller (55.9% vs 38.2%, P < .001) and had no lymph node involvement (67.5% vs 57%, P = .01). The prognostic characteristics of all invasive cancers (screen-detected and interval cancer) were similar in Vermont and Norway.
Screening mammography detected cancer at about the same rate and at the same prognostic stage in Norway and Vermont, with a statistically significantly lower recall rate in Norway. The interval cancer rate was higher in Vermont than in Norway, but tumors that were diagnosed in the Vermont women tended to be at an earlier stage than those diagnosed in the Norwegian women
Wednesday, 18 June 2008
Mammography Facility Characteristics Associated with Accuracy of Screening
Mammography Facility Characteristics Associated With Interpretive Accuracy of Screening Mammography
Stephen Taplin, Linn Abraham, William E. Barlow, Joshua J. Fenton, Eric A. Berns, Patricia A. Carney, Gary R. Cutter, Edward A. Sickles, D'Orsi Carl, and Joann G. Elmore
J. Natl. Cancer Inst. 2008 100: 876-887
Link to Journal (Open Access Article)
Previous studies have suggested that patient characteristics, such as age, are associated with variations in the accuracy of screening mammograms. Similarly, characteristics of the radiologist who interprets the mammograms, such as his or her reading experience, are associated with variations in accuracy.
Stephen Taplin, M.D., of the National Cancer Institute in Bethesda, Md., and colleagues surveyed 53 mammography facilities between 1992 and 2002 to look for associations between facility characteristics and interpretive accuracy. The researchers were able to analyze data from 44 facilities, which altogether performed 484,463 screening mammograms on 237,669 women. Of those, 2,686 women were diagnosed with breast cancer.
Several facility characteristics were associated with a higher measure of accuracy that combines sensitivity and specificity, including those that offered screening mammograms alone versus those that offered diagnostic and screening mammograms, and those that had a breast imaging specialist reading the mammograms versus those that did not.
The facilities varied statistically significantly in specificity (P < .001), PPV1 (P < .001), and PPV2 (P = .002) but not in sensitivity (P = .99). AUC was higher among facilities that offered screening mammograms alone vs those that offered screening and diagnostic mammograms (0.943 vs 0.911, P = .006), had a breast imaging specialist interpreting mammograms vs not (0.932 vs 0.905, P = .004), did not perform double reading vs independent double reading vs consensus double reading (0.925 vs 0.915 vs 0.887, P = .034), or conducted audit reviews two or more times per year vs annually vs at an unknown frequency (0.929 vs 0.904 vs 0.900, P = .018).
Stephen Taplin, Linn Abraham, William E. Barlow, Joshua J. Fenton, Eric A. Berns, Patricia A. Carney, Gary R. Cutter, Edward A. Sickles, D'Orsi Carl, and Joann G. Elmore
J. Natl. Cancer Inst. 2008 100: 876-887
Link to Journal (Open Access Article)
Previous studies have suggested that patient characteristics, such as age, are associated with variations in the accuracy of screening mammograms. Similarly, characteristics of the radiologist who interprets the mammograms, such as his or her reading experience, are associated with variations in accuracy.
Stephen Taplin, M.D., of the National Cancer Institute in Bethesda, Md., and colleagues surveyed 53 mammography facilities between 1992 and 2002 to look for associations between facility characteristics and interpretive accuracy. The researchers were able to analyze data from 44 facilities, which altogether performed 484,463 screening mammograms on 237,669 women. Of those, 2,686 women were diagnosed with breast cancer.
Several facility characteristics were associated with a higher measure of accuracy that combines sensitivity and specificity, including those that offered screening mammograms alone versus those that offered diagnostic and screening mammograms, and those that had a breast imaging specialist reading the mammograms versus those that did not.
The facilities varied statistically significantly in specificity (P < .001), PPV1 (P < .001), and PPV2 (P = .002) but not in sensitivity (P = .99). AUC was higher among facilities that offered screening mammograms alone vs those that offered screening and diagnostic mammograms (0.943 vs 0.911, P = .006), had a breast imaging specialist interpreting mammograms vs not (0.932 vs 0.905, P = .004), did not perform double reading vs independent double reading vs consensus double reading (0.925 vs 0.915 vs 0.887, P = .034), or conducted audit reviews two or more times per year vs annually vs at an unknown frequency (0.929 vs 0.904 vs 0.900, P = .018).
Friday, 4 April 2008
Increased Risk of Recurrence After Hormone Replacement Therapy in Breast Cancer Survivors
Lars Holmberg, Ole-Erik Iversen, Carl Magnus Rudenstam, Mats Hammar, Eero
Kumpulainen, Janusz Jaskiewicz, Jacek Jassem, Daria Dobaczewska, Hans E. Fjosne, Octavio Peralta, Rodrigo Arriagada, Marit Holmqvist, and Johanna Maenpa
On behalf of the HABITS Study Group
J. Natl. Cancer Inst. 2008 100: 475-482.
Link to the article
Hormone replacement therapy (HT) is known to increase the risk of breast cancer in healthy women, but its effect on breast cancer risk in breast cancer survivors is less clear. The randomized HABITS study, which compared HT for menopausal symptoms with best management without hormones among women with previously treated breast cancer, was stopped early due to suspicions of an increased risk of new breast cancer events following HT.
Conclusion: After extended follow-up, there was a clinically and statistically significant increased risk of a new breast cancer event in survivors who took HT.
Kumpulainen, Janusz Jaskiewicz, Jacek Jassem, Daria Dobaczewska, Hans E. Fjosne, Octavio Peralta, Rodrigo Arriagada, Marit Holmqvist, and Johanna Maenpa
On behalf of the HABITS Study Group
J. Natl. Cancer Inst. 2008 100: 475-482.
Link to the article
Hormone replacement therapy (HT) is known to increase the risk of breast cancer in healthy women, but its effect on breast cancer risk in breast cancer survivors is less clear. The randomized HABITS study, which compared HT for menopausal symptoms with best management without hormones among women with previously treated breast cancer, was stopped early due to suspicions of an increased risk of new breast cancer events following HT.
Conclusion: After extended follow-up, there was a clinically and statistically significant increased risk of a new breast cancer event in survivors who took HT.
Disparities and Trends in Sentinel Lymph Node Biopsy Among Early-Stage Breast Cancer Patients (1998-2005)
Amy Y. Chen, Michael T. Halpern, Nicole M. Schrag, Andrew Stewart, Marilyn Leitch, and Elizabeth Ward
J. Natl. Cancer Inst. 2008 100: 462-474
Link to journal
The use of sentinel lymph node biopsy (SLNB) during breast cancer surgery increased substantially from 1998 through 2005, according to an article published online March 25 in the Journal of the National Cancer Institute. However, non-white women, older women, and those living in poorer areas of the U.S. were less likely to receive SLNB than their counterparts who are white, younger, or from more affluent areas, respectively.
Conclusions: Although use of SLNB increased from 1998 to 2005, disparities persisted in receipt of SLNB that are based on nonclinical factors, including sociodemographic characteristics and insurance status.
J. Natl. Cancer Inst. 2008 100: 462-474
Link to journal
The use of sentinel lymph node biopsy (SLNB) during breast cancer surgery increased substantially from 1998 through 2005, according to an article published online March 25 in the Journal of the National Cancer Institute. However, non-white women, older women, and those living in poorer areas of the U.S. were less likely to receive SLNB than their counterparts who are white, younger, or from more affluent areas, respectively.
Conclusions: Although use of SLNB increased from 1998 to 2005, disparities persisted in receipt of SLNB that are based on nonclinical factors, including sociodemographic characteristics and insurance status.
Subscribe to:
Posts (Atom)
