Clinicopathological and Genomic Identification of Breast Cancers with No Impact on Mortality.

BACKGROUND: Implementing mammogram screening means that clinicians are seeing many breast cancers that will never develop metastases. The purpose of this study was to identify subgroups of breast cancer patients who did not present events related to long-term breast cancer mortality, taking into account diagnosis at breast screening, absence of palpability and axillary involvement, and genomic analysis with PAM50. PATIENTS AND METHODS: To identify them, a retrospective observational study was carried out selecting patients without any palpable tumor and without axillary involvement, and a genomic analysis was performed with PAM50. RESULTS: The probability of distant metastasis-free interval (DMFI) of 337 patients was 0.92 (95% CI, 0.90-0.93) at 20 years and 0.96 (95% CI, 0.92-1.00) in 95 patients (28%) with available PAM50 tests. In 22 (23.15%) luminal A tumors and in 9 (9.47%) luminal B tumors smaller than 1 cm, and in HER2 and basal type tumors, there were no metastatic events (20-year DMFI of 1.00). CONCLUSION: Patients with nonpalpable breast cancer found at screening with negative nodes are at very low risk. It is possible to identify subgroups without metastatic events by determining the intrinsic subtype and tumor size less than 1 cm. Therefore, de-escalation of treatment should be considered.

Asociación entre la historia reproductiva, el subtipo de cáncer de mama y la supervivencia de mujeres premenopáusicas / Association between reproductive history, breast cancer subtype, and survival in premenopausal women

Antecedentes y objetivo: La historia reproductiva influye en el riesgo de cáncer de mama. Hemos analizado su asociación con el subtipo tumoral y la supervivencia en mujeres premenopáusicas. Pacientes y métodos: Estudio observacional, retrospectivo, de mujeres premenopáusicas con carcinoma de mama, estadios I-III, en los últimos 20 años. Revisión de la historia reproductiva, de los datos clínicos y de los tratamientos en las historias de salud. Resultados: En 661 mujeres premenopáusicas (32,40% de 1.377 totales), la mediana de edad fue de 47 años (19-53), de la menarquia 12 (7-17), del primer parto 28 (16-41) y de número de partos 2 (0-9). Fueron nulíparas 111 (18,20%). Emplearon lactancia natural 359 (58,80%) con mediana de duración de 6 meses. Consumieron anovulatorios 271 (44,40%), con mediana de 36 meses. Se halló asociación entre menarquia <10 años y menos riesgo de subtipo luminal (OR: 0,52; IC 95%: 0,28-0,94; p=0,03), entre menarquia >11 años y menos riesgo de subtipo HER2 (OR: 0,50; IC 95%: 0,26-0,97; p=0,04) y entre primer parto >30 años y menos riesgo de subtipo triple negativo (OR: 0,40; IC 95%: 0,17-0,93; p=0,03). La probabilidad de supervivencia global y libre de enfermedad a 20 años fue de 0,80 (IC 95%: 0,71-0,90) y 0,72 (IC 95%: 0,64-0,79), respectivamente. Las pacientes con uno o más de un parto presentaron mejor supervivencia global que las nulíparas (HR: 0,51; IC 95%: 0,27-0,96, p=0,04). Conclusiones: Los hallazgos sugieren que existe asociación entre edad de la menarquia y del primer parto y subtipo de cáncer de mama. La nuliparidad está asociada con peor supervivencia.(AU)

Background and objective: Reproductive history influences breast cancer risk. We analysed its association with tumour subtype and survival in premenopausal women. Patients and methods: Retrospective, observational study of premenopausal women with stage I-III breast carcinoma in the last 20 years. Review of reproductive history, clinical data, and treatments in health records.Results: In 661 premenopausal women (32.40% of 1377 total cases), median age was 47 years (19-53), menarche 12 (7-17), first delivery 28 (16-41) and number of deliveries 2 (0-9). One hundred and eleven (18.20%) were nulliparous. Three hundred and fifty-nine (58.80%) used natural lactation, with a median duration of 6 months. Anovulatory drugs were used by 271 (44.40%), with a median duration of 36 months. Associations were found between menarche <10 years and lower risk of luminal subtype (OR: 0.52, 95% CI: 0.28-0.94; P=.03), between menarche >11 years and lower risk of HER2 subtype (OR: 0.50, 95% CI: 0.26-0.97; P=.04) and between first birth >30 years and lower risk of triple negative subtype (OR: 0.40, 95% CI: 0.17-0.93; P=.03). The 20-year overall and disease-free survival probabilities were 0.80 (95% CI: 0.71–0.90) and 0.72 (95% CI: 0.64-0.79) respectively. Patients with ≥1 delivery had better overall survival than nulliparous patients (HR: 0.51, 95% CI: 0.27-0.96, P=.04). Conclusions: The findings suggest an association between age at menarche and age at first delivery and breast cancer subtype. Nulliparity is associated with worse survival.(AU)

Association between reproductive history, breast cancer subtype, and survival in premenopausal women. / Asociación entre la historia reproductiva, el subtipo de cáncer de mama y la supervivencia de mujeres premenopáusicas.

BACKGROUND AND OBJECTIVE: Reproductive history influences breast cancer risk. We analysed its association with tumour subtype and survival in premenopausal women. PATIENTS AND METHODS: Retrospective, observational study of premenopausal women with stage I-III breast carcinoma in the last 20 years. Review of reproductive history, clinical data, and treatments in health records. RESULTS: In 661 premenopausal women (32.40% of 1377 total cases), median age was 47 years (19-53), menarche 12 (7-17), first delivery 28 (16-41) and number of deliveries 2 (0-9). One hundred and eleven (18.20%) were nulliparous. Three hundred and fifty-nine (58.80%) used natural lactation, with a median duration of 6 months. Anovulatory drugs were used by 271 (44.40%), with a median duration of 36 months. Associations were found between menarche <10 years and lower risk of luminal subtype (OR: 0.52, 95% CI: 0.28-0.94; P=.03), between menarche >11 years and lower risk of HER2 subtype (OR: 0.50, 95% CI: 0.26-0.97; P=.04) and between first birth >30 years and lower risk of triple negative subtype (OR: 0.40, 95% CI: 0.17-0.93; P=.03). The 20-year overall and disease-free survival probabilities were 0.80 (95% CI: 0.71-0.90) and 0.72 (95% CI: 0.64-0.79) respectively. Patients with ≥1 delivery had better overall survival than nulliparous patients (HR: 0.51, 95% CI: 0.27-0.96, P=.04). CONCLUSIONS: The findings suggest an association between age at menarche and age at first delivery and breast cancer subtype. Nulliparity is associated with worse survival.

Características clínico-patológicas y supervivencia de pacientes con cáncer de mama de riesgo muy bajo / Clinicopathological characteristics and survival results of patients with ultralow risk breast cancer

Antecedentes y objetivo: La universalización del cribado mamográfico ha incrementado el diagnóstico de cánceres de mama con pronóstico excelente. La ausencia de tumor palpable les confiere un riesgo muy bajo de mortalidad por cáncer de mama. El objetivo del estudio fue identificar subgrupos con muy buena evolución a largo plazo.Pacientes y métodosIdentificamos pacientes con muy buena evolución mediante estudio descriptivo, observacional y retrospectivo. Los criterios de riesgo muy bajo fueron la procedencia del cribado mamográfico, sin tumor palpable, el fenotipo tumoral y la afectación ganglionar.ResultadosDe 746 pacientes con carcinoma de mama, con ganglios negativos, entre 2001 y 2015, 110 (14,75%) procedían del cribado con tumores no palpables. Ochenta y ocho (80%) eran hormonosensibles, 10 (9,10%) triples negativos y 11 (10%) HER2. La mediana de seguimiento fue 10 años (3,5-17). Solo tres pacientes desarrollaron metástasis, no hubo recidivas loco-regionales, siete presentaron segundos tumores primarios y hubo cuatro muertes, dos por cáncer de mama y dos por otras causas. El intervalo libre de metástasis a distancia (ILMD) fue 95,60% (intervalo de confianza (IC) 95% 90,70-100,50); 96,30% (IC 95% 91,21-99,39) en 88 tumores hormonosensibles, 100% en 34 hormonosensibles de grado histológico 1 (aproximación a luminales A) y 94,40% (IC 95% 86,76-102,04) en 54 de grado 2-3 (luminales B). En los triples negativos y HER2 fue 100%. En tumores menores y mayores de 1 cm fue 100% y 95,50% (IC 95% 89, 42-101,58).ConclusionesLas pacientes con tumores no palpables, detectados en el cribado mamográfico tienen un riesgo de recurrencia muy bajo. La buena evolución en los subgrupos luminal A, triple negativo, HER2 y menores de 1 cm puede explicar la eficacia del tratamiento, pero también los hace candidatos a desescalar su tratamiento. (AU)

Background and objective: To identify subgroups with good progress over an extended period, we used diagnostic screening, tumour palpability, tumour phenotype, and node involvement.Patients and methodsWe identified patients with good progress by means of a descriptive, observational and retrospective study.ResultsOf 746 patients diagnosed with node-negative breast cancer between 2001 and 2015: 110 (14.75%) had non-palpable screening-diagnosed tumours; 88 (80%) were endocrine-sensitive, 10 (9.10%) were triple-negative and 11 (10%) were HER2. Only 3 patients developed metastases, and there were 4 deaths: 2 from breast cancer and 2 from other causes. The distant recurrence-free interval (DRFI) was 95.60%: 100% in 34 endocrine-sensitive histological grade 1 (equivalent to luminal A) tumours, and 94.40% (95% CI 86.76–102.04) in 54 grade 2–3 (luminal B) tumours. In triple-negative and HER2 cases, it was 100%. In tumours <1 cm it was 100%, and >1 cm it was 95.50% (95% CI 79.42–100.98).ConclusionsPatients with non-palpable tumours detected by mammogram screening have ultralow risk. The good progress in the luminal A, triple-negative, HER2, and less than 1 cm subgroups may explain the efficacy of the treatment but it also makes them candidates to de-escalation of their treatment. (AU)

Clinicopathological characteristics and survival results of patients with ultralow risk breast cancer. / Características clínico-patológicas y supervivencia de pacientes con cáncer de mama de riesgo muy bajo.

BACKGROUND AND OBJECTIVE: To identify subgroups with good progress over an extended period, we used diagnostic screening, tumour palpability, tumour phenotype, and node involvement. PATIENTS AND METHODS: We identified patients with good progress by means of a descriptive, observational and retrospective study. RESULTS: Of 746 patients diagnosed with node-negative breast cancer between 2001 and 2015: 110 (14.75%) had non-palpable screening-diagnosed tumours; 88 (80%) were endocrine-sensitive, 10 (9.10%) were triple-negative and 11 (10%) were HER2. Only 3 patients developed metastases, and there were 4 deaths: 2 from breast cancer and 2 from other causes. The distant recurrence-free interval (DRFI) was 95.60%: 100% in 34 endocrine-sensitive histological grade 1 (equivalent to luminal A) tumours, and 94.40% (95% CI 86.76-102.04) in 54 grade 2-3 (luminal B) tumours. In triple-negative and HER2 cases, it was 100%. In tumours <1 cm it was 100%, and >1 cm it was 95.50% (95% CI 79.42-100.98). CONCLUSIONS: Patients with non-palpable tumours detected by mammogram screening have ultralow risk. The good progress in the luminal A, triple-negative, HER2, and less than 1 cm subgroups may explain the efficacy of the treatment but it also makes them candidates to de-escalation of their treatment.

Experiences with Prescribing Large Quantities of Systemic Anticancer Therapy Near Death.

Background: The most important decision after diagnosing terminal cancer is whether to provide active therapy or withhold treatment. Objective: To analyze the aggressiveness of care by evaluating systemic anticancer therapy (SACT) given near to death, describing this care and identifying factors that determine its use. Design: This involves retrospective observational cohorts study. Setting/Subjects: This involves patients with metastatic tumors who died at a University Hospital in Spain between 2015 and 2016. Measurements: Data obtained from prescribing oncologists and patients' clinical records, type of cancer, and information on treatment. The dependent variable used was the interval between the date of the last dose and date of death. Results: Ninety-four (32.60%) of 288 patients received SACT in the last month of life. This cohort had a higher frequency of lung cancer (OR: 1.58; CI 95%: 1.14-2.18), received more care from oncologist 2 (OR: 1.50; CI 95%: 1.08-2.08), had fewer last-line treatment cycles (OR: 1.28; CI 95%: 1.13-1.45), a lower subjective response (OR: 3.13; CI 95%: 1.34-7.29), less clinical benefit (OR: 2.38; CI 95%: 1.04-5.55), more visits to the Emergency Department (OR: 1.59; CI 95%: 1.06-2.38), and less care from the Palliative Care Unit (OR: 4.55; CI 95%: 2.69-7.70). In multivariate analysis, the predictors of having received SACT close to death remained: receiving fewer cycles of treatment (OR: 1.28; CI 95%: 1.12-1.47) and less palliative care (OR: 4.54; CI 95%: 2.56-7.69). Conclusions: A third of cancer patients received SACT in the last month of life with less efficacy and poorer quality of care than patients not receiving it.