Breast Cancer

The utilization of neoadjuvant chemotherapy is increasing, and is considered standard of care for the majority of patients with HER2-positive and triple-negative breast cancer subtypes. A significant benefit of neoadjuvant systemic therapy is assessment of the tumor biology via chemotherapy response, which has prognostic implications and additionally can help tailor therapy in the adjuvant setting. In the era of precision medicine, de-escalation strategies are considered to provide patients with efficacious treatment and spare toxicity. Tasoulis et al assessed the accuracy of image-guided biopsy after neoadjuvant therapy to predict residual disease, and found a false negative rate (FNR) of 3.2% and negative predictive value (NPV) of 97.4% when the residual imaging abnormality was 2cm or smaller with a minimum of 6 vacuum-assisted biopsies performed. They also demonstrated a FNR of 4.2% and NPV of 97.2% in the subgroup of patients with ERBB2-positive and triple-negative subtypes, those most likely to achieve a pathologic complete response. These findings suggest that local therapy de-escalation may be a relevant strategy for those patients who have excellent responses to neoadjuvant chemotherapy.

Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) have historically been, and still are, considered important prognostic and predictive factors. Beyond these, the role of genomic assays in breast cancer is evolving, and the 21-gene recurrence score is a valuable prognostic tool to assess chemotherapy benefit in women with early-stage ER-positive, HER2-negative breast cancer. Precision medicine in oncology strives to identify and apply an individualized approach to cancer care based on strong scientific data. Zhang and colleagues demonstrated the prognostic ability of an 8 DNA repair-related gene signature that was constructed from gene expression profiles from over 1,000 women diagnosed with breast cancer. These genes have roles in ER-mediated transactivation, DNA damage repair and cell adhesion processes. Additionally, Kudela et al showed that microRNAs (mRNAs), which are small RNAs that regulate gene expression, are able to classify intrinsic breast cancer subtype, play a role in endocrine resistance, and may also enhance the function of predictive models such as the 21-gene recurrence score (Kudela). Ongoing research in the field of tumor genomics will help advance the field of personalized treatment for breast cancer.

Erin Roesch, MD
The Cleveland Clinic

References:

Killelea BK, Yang VQ, Wang SY, Hayse B, Mougalian S, Horowitz NR, Chagpar AB, Pusztai L, Lannin DR. Racial differences in the use and outcome of neoadjuvant chemotherapy for breast cancer: results from the National Cancer Data Base. J Clin Oncol. 2015;33:4267-76.

Heil J, Schaefgen B, Sinn P, Harcos A, Gomez C, Stieber A, Hennings A, Schuetz F, Sohn C, Schneeweiss A, Golatta M. Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques. Br J Cancer. 2015;113:1565-70.

Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CE Jr, Dees EC, Goetz MP, Olson JA Jr, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez Moreno HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW Jr. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379:111-21.

Emmadi R, Canestrari E, Arbieva ZH, Mu W, Dai Y, Frasor J, Wiley E. Correlative analysis of miRNA expression and Oncotype Dx Recurrence Score in estrogen receptor positive breast carcinomas. PLoS One. 2015;10:e0145346.

The utilization of neoadjuvant chemotherapy is increasing, and is considered standard of care for the majority of patients with HER2-positive and triple-negative breast cancer subtypes. A significant benefit of neoadjuvant systemic therapy is assessment of the tumor biology via chemotherapy response, which has prognostic implications and additionally can help tailor therapy in the adjuvant setting. In the era of precision medicine, de-escalation strategies are considered to provide patients with efficacious treatment and spare toxicity. Tasoulis et al assessed the accuracy of image-guided biopsy after neoadjuvant therapy to predict residual disease, and found a false negative rate (FNR) of 3.2% and negative predictive value (NPV) of 97.4% when the residual imaging abnormality was 2cm or smaller with a minimum of 6 vacuum-assisted biopsies performed. They also demonstrated a FNR of 4.2% and NPV of 97.2% in the subgroup of patients with ERBB2-positive and triple-negative subtypes, those most likely to achieve a pathologic complete response. These findings suggest that local therapy de-escalation may be a relevant strategy for those patients who have excellent responses to neoadjuvant chemotherapy.

Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) have historically been, and still are, considered important prognostic and predictive factors. Beyond these, the role of genomic assays in breast cancer is evolving, and the 21-gene recurrence score is a valuable prognostic tool to assess chemotherapy benefit in women with early-stage ER-positive, HER2-negative breast cancer. Precision medicine in oncology strives to identify and apply an individualized approach to cancer care based on strong scientific data. Zhang and colleagues demonstrated the prognostic ability of an 8 DNA repair-related gene signature that was constructed from gene expression profiles from over 1,000 women diagnosed with breast cancer. These genes have roles in ER-mediated transactivation, DNA damage repair and cell adhesion processes. Additionally, Kudela et al showed that microRNAs (mRNAs), which are small RNAs that regulate gene expression, are able to classify intrinsic breast cancer subtype, play a role in endocrine resistance, and may also enhance the function of predictive models such as the 21-gene recurrence score (Kudela). Ongoing research in the field of tumor genomics will help advance the field of personalized treatment for breast cancer.

Erin Roesch, MD
The Cleveland Clinic

References:

Killelea BK, Yang VQ, Wang SY, Hayse B, Mougalian S, Horowitz NR, Chagpar AB, Pusztai L, Lannin DR. Racial differences in the use and outcome of neoadjuvant chemotherapy for breast cancer: results from the National Cancer Data Base. J Clin Oncol. 2015;33:4267-76.

Heil J, Schaefgen B, Sinn P, Harcos A, Gomez C, Stieber A, Hennings A, Schuetz F, Sohn C, Schneeweiss A, Golatta M. Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques. Br J Cancer. 2015;113:1565-70.

Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CE Jr, Dees EC, Goetz MP, Olson JA Jr, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez Moreno HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW Jr. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379:111-21.

Emmadi R, Canestrari E, Arbieva ZH, Mu W, Dai Y, Frasor J, Wiley E. Correlative analysis of miRNA expression and Oncotype Dx Recurrence Score in estrogen receptor positive breast carcinomas. PLoS One. 2015;10:e0145346.

The utilization of neoadjuvant chemotherapy is increasing, and is considered standard of care for the majority of patients with HER2-positive and triple-negative breast cancer subtypes. A significant benefit of neoadjuvant systemic therapy is assessment of the tumor biology via chemotherapy response, which has prognostic implications and additionally can help tailor therapy in the adjuvant setting. In the era of precision medicine, de-escalation strategies are considered to provide patients with efficacious treatment and spare toxicity. Tasoulis et al assessed the accuracy of image-guided biopsy after neoadjuvant therapy to predict residual disease, and found a false negative rate (FNR) of 3.2% and negative predictive value (NPV) of 97.4% when the residual imaging abnormality was 2cm or smaller with a minimum of 6 vacuum-assisted biopsies performed. They also demonstrated a FNR of 4.2% and NPV of 97.2% in the subgroup of patients with ERBB2-positive and triple-negative subtypes, those most likely to achieve a pathologic complete response. These findings suggest that local therapy de-escalation may be a relevant strategy for those patients who have excellent responses to neoadjuvant chemotherapy.

Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) have historically been, and still are, considered important prognostic and predictive factors. Beyond these, the role of genomic assays in breast cancer is evolving, and the 21-gene recurrence score is a valuable prognostic tool to assess chemotherapy benefit in women with early-stage ER-positive, HER2-negative breast cancer. Precision medicine in oncology strives to identify and apply an individualized approach to cancer care based on strong scientific data. Zhang and colleagues demonstrated the prognostic ability of an 8 DNA repair-related gene signature that was constructed from gene expression profiles from over 1,000 women diagnosed with breast cancer. These genes have roles in ER-mediated transactivation, DNA damage repair and cell adhesion processes. Additionally, Kudela et al showed that microRNAs (mRNAs), which are small RNAs that regulate gene expression, are able to classify intrinsic breast cancer subtype, play a role in endocrine resistance, and may also enhance the function of predictive models such as the 21-gene recurrence score (Kudela). Ongoing research in the field of tumor genomics will help advance the field of personalized treatment for breast cancer.

Erin Roesch, MD
The Cleveland Clinic

References:

Killelea BK, Yang VQ, Wang SY, Hayse B, Mougalian S, Horowitz NR, Chagpar AB, Pusztai L, Lannin DR. Racial differences in the use and outcome of neoadjuvant chemotherapy for breast cancer: results from the National Cancer Data Base. J Clin Oncol. 2015;33:4267-76.

Heil J, Schaefgen B, Sinn P, Harcos A, Gomez C, Stieber A, Hennings A, Schuetz F, Sohn C, Schneeweiss A, Golatta M. Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques. Br J Cancer. 2015;113:1565-70.

Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CE Jr, Dees EC, Goetz MP, Olson JA Jr, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez Moreno HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW Jr. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379:111-21.

Emmadi R, Canestrari E, Arbieva ZH, Mu W, Dai Y, Frasor J, Wiley E. Correlative analysis of miRNA expression and Oncotype Dx Recurrence Score in estrogen receptor positive breast carcinomas. PLoS One. 2015;10:e0145346.

Key clinical point: Differences in microRNAs (mRNAs), a group of small RNAs that regulate gene expression, can be used to distinguish among breast cancer subtypes.

Major finding: Altered expression of microRNAs distinguished between cancer and healthy samples, and also identified breast cancer subtypes including HER2, Luminal A, Luminal B, and triple negative breast cancer, according to a retrospective study of 740 breast cancer cases included in the review.

Study details: The data come from a review of the latest research on the prognostic and predictive value of microRNAs in patients with luminal A breast cancer.

Disclosures: The study was supported by the Scientific Grant Agency of the Ministry of Education of the Slovak Republic, the Slovak Research and Development Agency, and the Operational Programme Research and Innovation funded by the ERDF.

Citation: Kudela E et al. Int J Mol Sci. 2020 Oct 17. doi: 10.3390/ijms21207691.

Key clinical point: Differences in microRNAs (mRNAs), a group of small RNAs that regulate gene expression, can be used to distinguish among breast cancer subtypes.

Major finding: Altered expression of microRNAs distinguished between cancer and healthy samples, and also identified breast cancer subtypes including HER2, Luminal A, Luminal B, and triple negative breast cancer, according to a retrospective study of 740 breast cancer cases included in the review.

Study details: The data come from a review of the latest research on the prognostic and predictive value of microRNAs in patients with luminal A breast cancer.

Disclosures: The study was supported by the Scientific Grant Agency of the Ministry of Education of the Slovak Republic, the Slovak Research and Development Agency, and the Operational Programme Research and Innovation funded by the ERDF.

Citation: Kudela E et al. Int J Mol Sci. 2020 Oct 17. doi: 10.3390/ijms21207691.

Key clinical point: Differences in microRNAs (mRNAs), a group of small RNAs that regulate gene expression, can be used to distinguish among breast cancer subtypes.

Major finding: Altered expression of microRNAs distinguished between cancer and healthy samples, and also identified breast cancer subtypes including HER2, Luminal A, Luminal B, and triple negative breast cancer, according to a retrospective study of 740 breast cancer cases included in the review.

Study details: The data come from a review of the latest research on the prognostic and predictive value of microRNAs in patients with luminal A breast cancer.

Disclosures: The study was supported by the Scientific Grant Agency of the Ministry of Education of the Slovak Republic, the Slovak Research and Development Agency, and the Operational Programme Research and Innovation funded by the ERDF.

Citation: Kudela E et al. Int J Mol Sci. 2020 Oct 17. doi: 10.3390/ijms21207691.

Key clinical point: Over a 12-month period, 15.4% of women with early breast cancer reported losing income. Although stress, anxiety, and depression were not association with household income changes (risk ratios 2.42, 1.12, and 1.41, respectively), the proportion of women reporting high stress was greatest among those who lost income (13.2%, compared to 3.1% among women maintaining an income of $100,000 or higher).

Major finding: Women with a household income below $50,000 had a higher risk of losing household income compared to those with incomes of $50,000 or higher, suggesting that lower income women may be more vulnerable to income loss after diagnosis with breast cancer.

Study details: The data come from a prospective, longitudinal cohort study including 467 women with early breast cancer enrolled in the Young and Strong cohort trial from 2012 to 2013.

Disclosures: The study was supported by an ASCO Improving Cancer Care grant, the National Institutes of Health, an NIH training grants. The researchers had no financial conflicts to disclose.

Citation: Cook EE et al. BMC Public Health. 2020 Oct 6. doi: 10.1186/s12889-020-09562-z.

Key clinical point: Over a 12-month period, 15.4% of women with early breast cancer reported losing income. Although stress, anxiety, and depression were not association with household income changes (risk ratios 2.42, 1.12, and 1.41, respectively), the proportion of women reporting high stress was greatest among those who lost income (13.2%, compared to 3.1% among women maintaining an income of $100,000 or higher).

Major finding: Women with a household income below $50,000 had a higher risk of losing household income compared to those with incomes of $50,000 or higher, suggesting that lower income women may be more vulnerable to income loss after diagnosis with breast cancer.

Study details: The data come from a prospective, longitudinal cohort study including 467 women with early breast cancer enrolled in the Young and Strong cohort trial from 2012 to 2013.

Disclosures: The study was supported by an ASCO Improving Cancer Care grant, the National Institutes of Health, an NIH training grants. The researchers had no financial conflicts to disclose.

Citation: Cook EE et al. BMC Public Health. 2020 Oct 6. doi: 10.1186/s12889-020-09562-z.

Key clinical point: Over a 12-month period, 15.4% of women with early breast cancer reported losing income. Although stress, anxiety, and depression were not association with household income changes (risk ratios 2.42, 1.12, and 1.41, respectively), the proportion of women reporting high stress was greatest among those who lost income (13.2%, compared to 3.1% among women maintaining an income of $100,000 or higher).

Major finding: Women with a household income below $50,000 had a higher risk of losing household income compared to those with incomes of $50,000 or higher, suggesting that lower income women may be more vulnerable to income loss after diagnosis with breast cancer.

Study details: The data come from a prospective, longitudinal cohort study including 467 women with early breast cancer enrolled in the Young and Strong cohort trial from 2012 to 2013.

Disclosures: The study was supported by an ASCO Improving Cancer Care grant, the National Institutes of Health, an NIH training grants. The researchers had no financial conflicts to disclose.

Citation: Cook EE et al. BMC Public Health. 2020 Oct 6. doi: 10.1186/s12889-020-09562-z.

Key clinical point: An exercise and diet intervention had no significant impact on fatigue in women with breast cancer who were undergoing chemotherapy or radiotherapy.

Major finding: Based on the general cancer-related fatigue score using the MFI-20 questionnaire, general fatigue levels were not significantly different between groups of breast cancer patients randomized to an Adapted Physical Activity Diet (APAD) program and controls (P = 0.274).

Study details: The data come from a randomized, controlled trial of 360 adult women with early breast cancer designed to evaluate the impact of an exercise and nutrition intervention on fatigue during 6 months of chemotherapy and radiotherapy.

Disclosures: The study was supported by the INCa-DGOS and by a Montpellier Cancer SIRIC grant. The researchers had no financial conflicts to disclose. 

Citation: Jacot W et al. Nutrients. 2020 Oct 9. doi: 10.3390/nu12103081.

Key clinical point: An exercise and diet intervention had no significant impact on fatigue in women with breast cancer who were undergoing chemotherapy or radiotherapy.

Major finding: Based on the general cancer-related fatigue score using the MFI-20 questionnaire, general fatigue levels were not significantly different between groups of breast cancer patients randomized to an Adapted Physical Activity Diet (APAD) program and controls (P = 0.274).

Study details: The data come from a randomized, controlled trial of 360 adult women with early breast cancer designed to evaluate the impact of an exercise and nutrition intervention on fatigue during 6 months of chemotherapy and radiotherapy.

Disclosures: The study was supported by the INCa-DGOS and by a Montpellier Cancer SIRIC grant. The researchers had no financial conflicts to disclose. 

Citation: Jacot W et al. Nutrients. 2020 Oct 9. doi: 10.3390/nu12103081.

Key clinical point: An exercise and diet intervention had no significant impact on fatigue in women with breast cancer who were undergoing chemotherapy or radiotherapy.

Major finding: Based on the general cancer-related fatigue score using the MFI-20 questionnaire, general fatigue levels were not significantly different between groups of breast cancer patients randomized to an Adapted Physical Activity Diet (APAD) program and controls (P = 0.274).

Study details: The data come from a randomized, controlled trial of 360 adult women with early breast cancer designed to evaluate the impact of an exercise and nutrition intervention on fatigue during 6 months of chemotherapy and radiotherapy.

Disclosures: The study was supported by the INCa-DGOS and by a Montpellier Cancer SIRIC grant. The researchers had no financial conflicts to disclose. 

Citation: Jacot W et al. Nutrients. 2020 Oct 9. doi: 10.3390/nu12103081.

Key clinical point: A prognostic signature including 8 DNA repair-related genes (MDC1, RPA3, MED17, DDB2, SFPQ, XRCC4, CYP19A1, and PARP3) predicted overall survival in breast cancer patients

Major finding: The areas under the curve were for 3-year survival and 5-year survival were 0.717 and 0.772, respectively, in the GSE9893 data set, and 0.691 and 0.718, respectively, in the GSE42568 data set.

Study details: The data come from 1,096 women with breast cancer; gene expression profiles and clinical data were collected from a Chinese health database between October 9, 2019, and February 3, 2020.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Citation: Zhang D et al. JAMA Netw Open. 2020 Oct 5. doi:10.1001/jamanetworkopen.2020.14622.

Key clinical point: A prognostic signature including 8 DNA repair-related genes (MDC1, RPA3, MED17, DDB2, SFPQ, XRCC4, CYP19A1, and PARP3) predicted overall survival in breast cancer patients

Major finding: The areas under the curve were for 3-year survival and 5-year survival were 0.717 and 0.772, respectively, in the GSE9893 data set, and 0.691 and 0.718, respectively, in the GSE42568 data set.

Study details: The data come from 1,096 women with breast cancer; gene expression profiles and clinical data were collected from a Chinese health database between October 9, 2019, and February 3, 2020.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Citation: Zhang D et al. JAMA Netw Open. 2020 Oct 5. doi:10.1001/jamanetworkopen.2020.14622.

Key clinical point: A prognostic signature including 8 DNA repair-related genes (MDC1, RPA3, MED17, DDB2, SFPQ, XRCC4, CYP19A1, and PARP3) predicted overall survival in breast cancer patients

Major finding: The areas under the curve were for 3-year survival and 5-year survival were 0.717 and 0.772, respectively, in the GSE9893 data set, and 0.691 and 0.718, respectively, in the GSE42568 data set.

Study details: The data come from 1,096 women with breast cancer; gene expression profiles and clinical data were collected from a Chinese health database between October 9, 2019, and February 3, 2020.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Citation: Zhang D et al. JAMA Netw Open. 2020 Oct 5. doi:10.1001/jamanetworkopen.2020.14622.

Key clinical point: The use of textured implants in reconstructive surgery after breast cancer mastectomy was significantly associated with lower rates of disease-free survival compared to smooth implants, but no difference was noted in local and regional recurrence-free survival based on implant texture.

Major finding: Rates of disease-free survival were significantly lower among breast cancer patients who received textured breast implants compared to those who received smooth implants (hazard ratio 3.054); the association was even stronger among patients with stage II or III tumors (HR 8.874).

Study details: The data come from a cohort study of 650 women representing 687 cases of breast cancer who were treated at a single center in South Korea between January 1, 2011, and December 31, 2016.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Citation: Lee K-T et al. JAMA Surg. 2020 Oct 7. doi: 10.1001/jamasurg.2020.4124.

Key clinical point: The use of textured implants in reconstructive surgery after breast cancer mastectomy was significantly associated with lower rates of disease-free survival compared to smooth implants, but no difference was noted in local and regional recurrence-free survival based on implant texture.

Major finding: Rates of disease-free survival were significantly lower among breast cancer patients who received textured breast implants compared to those who received smooth implants (hazard ratio 3.054); the association was even stronger among patients with stage II or III tumors (HR 8.874).

Study details: The data come from a cohort study of 650 women representing 687 cases of breast cancer who were treated at a single center in South Korea between January 1, 2011, and December 31, 2016.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Citation: Lee K-T et al. JAMA Surg. 2020 Oct 7. doi: 10.1001/jamasurg.2020.4124.

Key clinical point: The use of textured implants in reconstructive surgery after breast cancer mastectomy was significantly associated with lower rates of disease-free survival compared to smooth implants, but no difference was noted in local and regional recurrence-free survival based on implant texture.

Major finding: Rates of disease-free survival were significantly lower among breast cancer patients who received textured breast implants compared to those who received smooth implants (hazard ratio 3.054); the association was even stronger among patients with stage II or III tumors (HR 8.874).

Study details: The data come from a cohort study of 650 women representing 687 cases of breast cancer who were treated at a single center in South Korea between January 1, 2011, and December 31, 2016.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Citation: Lee K-T et al. JAMA Surg. 2020 Oct 7. doi: 10.1001/jamasurg.2020.4124.

Key clinical point: Vacuum-assisted biopsy accurately predicted residual disease in breast cancer patients after neoadjuvant chemotherapy.

Major finding: The overall false negative rate using vacuum-assisted biopsy (VAB) was 18.7%; in a subgroup of patients with a complete/partial response and imaging abnormalities of 2 cm or smaller, the false negative rate was 3.2% and the negative predictive value was 97.4% for an overall accuracy of 89.5% with VAB.

Study details: The data come from a diagnostic study of 166 women with breast cancer who received neoadjuvant chemotherapy followed by image-guided biopsy.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.  

Citation: Tasoulis MK et al. JAMA Surg. 2020 Oct 7. doi: 10.1001/jamasurg.2020.4103.

Key clinical point: Vacuum-assisted biopsy accurately predicted residual disease in breast cancer patients after neoadjuvant chemotherapy.

Major finding: The overall false negative rate using vacuum-assisted biopsy (VAB) was 18.7%; in a subgroup of patients with a complete/partial response and imaging abnormalities of 2 cm or smaller, the false negative rate was 3.2% and the negative predictive value was 97.4% for an overall accuracy of 89.5% with VAB.

Study details: The data come from a diagnostic study of 166 women with breast cancer who received neoadjuvant chemotherapy followed by image-guided biopsy.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.  

Citation: Tasoulis MK et al. JAMA Surg. 2020 Oct 7. doi: 10.1001/jamasurg.2020.4103.

Key clinical point: Vacuum-assisted biopsy accurately predicted residual disease in breast cancer patients after neoadjuvant chemotherapy.

Major finding: The overall false negative rate using vacuum-assisted biopsy (VAB) was 18.7%; in a subgroup of patients with a complete/partial response and imaging abnormalities of 2 cm or smaller, the false negative rate was 3.2% and the negative predictive value was 97.4% for an overall accuracy of 89.5% with VAB.

Study details: The data come from a diagnostic study of 166 women with breast cancer who received neoadjuvant chemotherapy followed by image-guided biopsy.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.  

Citation: Tasoulis MK et al. JAMA Surg. 2020 Oct 7. doi: 10.1001/jamasurg.2020.4103.

Key clinical point: Outcomes including recurrence, disease-free survival, and overall survival were similar for breast cancer patients who underwent immediate breast reconstruction (IBR) with nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) following neoadjuvant chemotherapy. 

Major finding: Breast cancer patients who underwent IBR with NSM/SSM as surgical treatment showed similar rates of overall survival at 5 years compared to those who underwent conventional mastectomy (92.0% vs. 89.3%).

Study details: The data come from a retrospective, case-control study of 1,266 breast cancer patients who underwent neoadjuvant chemotherapy followed by immediate breast reconstruction or conventional mastectomy at a single center between January 1, 2010, and November 30, 2016.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Citation: Wu Z-Y et al. JAMA Surg. 2020 Oct 14. doi: 10.1001/jamasurg.2020.4132.

Key clinical point: Outcomes including recurrence, disease-free survival, and overall survival were similar for breast cancer patients who underwent immediate breast reconstruction (IBR) with nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) following neoadjuvant chemotherapy. 

Major finding: Breast cancer patients who underwent IBR with NSM/SSM as surgical treatment showed similar rates of overall survival at 5 years compared to those who underwent conventional mastectomy (92.0% vs. 89.3%).

Study details: The data come from a retrospective, case-control study of 1,266 breast cancer patients who underwent neoadjuvant chemotherapy followed by immediate breast reconstruction or conventional mastectomy at a single center between January 1, 2010, and November 30, 2016.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Citation: Wu Z-Y et al. JAMA Surg. 2020 Oct 14. doi: 10.1001/jamasurg.2020.4132.

Key clinical point: Outcomes including recurrence, disease-free survival, and overall survival were similar for breast cancer patients who underwent immediate breast reconstruction (IBR) with nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) following neoadjuvant chemotherapy. 

Major finding: Breast cancer patients who underwent IBR with NSM/SSM as surgical treatment showed similar rates of overall survival at 5 years compared to those who underwent conventional mastectomy (92.0% vs. 89.3%).

Study details: The data come from a retrospective, case-control study of 1,266 breast cancer patients who underwent neoadjuvant chemotherapy followed by immediate breast reconstruction or conventional mastectomy at a single center between January 1, 2010, and November 30, 2016.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Citation: Wu Z-Y et al. JAMA Surg. 2020 Oct 14. doi: 10.1001/jamasurg.2020.4132.

Key clinical point: Breast cancer subtypes may be associated with race and ethnicity; certain subtypes were significantly more common in Black women and infiltrating duct carcinoma compared to White women, but lobular carcinoma, and tubular adenocarcinoma were less common in Hispanic women compared to nonHispanic White women.

Major finding: The incidence of HR-negative and ERBB2-positive; HR-positive and ERBB2-positive; and triple negative breast cancer was significantly higher among Black women compared to nonHispanic White women, but the incidence of the HR-positive and ERBB2-negative subtype in Black women was lower (incidence rate ratios of 1.12, 1.46, 2.07, and 0.86, respectively). 

Study details: The data come from a population-based cohort study of 239,211 women with breast cancer diagnosed between January 1, 2010, and December 31, 2015.

Disclosures: The study was supported by grants to the researchers from several organizations including the Natural Science Foundation of China, the Beijing Municipal Natural Science Foundation, the Special Research Fund for Central Universities, Peking Union Medical College, the Beijing Hope Run Special Fund of Cancer Foundation of China, and the PhD Innovation Fund of Cancer Hospital, Chinese Academy of Medical Sciences. The researchers had no financial conflicts to disclose.

Citation: Kong X et al. JAMA Netw Open. 2020 Oct 19. doi:10.1001/jamanetworkopen.2020.20303.

Key clinical point: Breast cancer subtypes may be associated with race and ethnicity; certain subtypes were significantly more common in Black women and infiltrating duct carcinoma compared to White women, but lobular carcinoma, and tubular adenocarcinoma were less common in Hispanic women compared to nonHispanic White women.

Major finding: The incidence of HR-negative and ERBB2-positive; HR-positive and ERBB2-positive; and triple negative breast cancer was significantly higher among Black women compared to nonHispanic White women, but the incidence of the HR-positive and ERBB2-negative subtype in Black women was lower (incidence rate ratios of 1.12, 1.46, 2.07, and 0.86, respectively). 

Study details: The data come from a population-based cohort study of 239,211 women with breast cancer diagnosed between January 1, 2010, and December 31, 2015.

Disclosures: The study was supported by grants to the researchers from several organizations including the Natural Science Foundation of China, the Beijing Municipal Natural Science Foundation, the Special Research Fund for Central Universities, Peking Union Medical College, the Beijing Hope Run Special Fund of Cancer Foundation of China, and the PhD Innovation Fund of Cancer Hospital, Chinese Academy of Medical Sciences. The researchers had no financial conflicts to disclose.

Citation: Kong X et al. JAMA Netw Open. 2020 Oct 19. doi:10.1001/jamanetworkopen.2020.20303.

Key clinical point: Breast cancer subtypes may be associated with race and ethnicity; certain subtypes were significantly more common in Black women and infiltrating duct carcinoma compared to White women, but lobular carcinoma, and tubular adenocarcinoma were less common in Hispanic women compared to nonHispanic White women.

Major finding: The incidence of HR-negative and ERBB2-positive; HR-positive and ERBB2-positive; and triple negative breast cancer was significantly higher among Black women compared to nonHispanic White women, but the incidence of the HR-positive and ERBB2-negative subtype in Black women was lower (incidence rate ratios of 1.12, 1.46, 2.07, and 0.86, respectively). 

Study details: The data come from a population-based cohort study of 239,211 women with breast cancer diagnosed between January 1, 2010, and December 31, 2015.

Disclosures: The study was supported by grants to the researchers from several organizations including the Natural Science Foundation of China, the Beijing Municipal Natural Science Foundation, the Special Research Fund for Central Universities, Peking Union Medical College, the Beijing Hope Run Special Fund of Cancer Foundation of China, and the PhD Innovation Fund of Cancer Hospital, Chinese Academy of Medical Sciences. The researchers had no financial conflicts to disclose.

Citation: Kong X et al. JAMA Netw Open. 2020 Oct 19. doi:10.1001/jamanetworkopen.2020.20303.

Pregnancy after treatment for breast cancer with BRCA mutations is safe, with “favorable” fetal outcomes and no increase in cancer recurrence, said researchers reporting a review of more than 1,000 young women with breast cancer, mostly in Europe but also Israel and North and South America.

It’s been known that pregnancy after breast cancer treatment, even for hormone receptor–positive disease, is safe overall, the team commented. However, there have been concerns about women who have BRCA mutations because of a lack of data.

The new findings “provide reassurance to patients with BRCA-mutated breast cancer interested in future fertility” and are of “paramount importance for health care providers involved in counseling young patients,” said the researchers, led by Matteo Lambertini, MD, PhD, a medical oncologist at the University of Genoa, Italy.

The review was published in September in the Journal of Clinical Oncology.

The team reviewed reproductive outcomes among 1,252 women who were no older than 40 years when diagnosed with stage I-III BRCA-mutated invasive breast cancer between January 2000 and December 2012.

More than half (65%; n = 811) had BRCA1 mutations, 430 women (34%) had BRCA2 mutations, and 11 women had both.

Overall, 195 women became pregnant, at a median of 4.5 years after the breast cancer diagnosis and at a median age of 36 years.

The miscarriage rate was 10.3%, lower than expected in the general population.

Among the 150 patients who gave birth to 170 infants, delivery complications occurred in 13 of the 112 pregnancies with available data (11.6%), and congenital anomalies were seen in just 2 pregnancies (1.8%). This is a lower rate of anomalies than expected in the general population, the team noted. The rate of preterm delivery was 9.2%, similar to the general population.

There was no difference between the women who became pregnant and those who did not in either disease-free survival (adjusted hazard ratio, 0.87; P = .41) or overall survival (aHR, 0.88; P = .66), over a median follow-up of 8.3 years from diagnosis. In addition to BRCA mutations, the analysis adjusted for age at diagnosis, tumor size, nodal status, hormone receptor status, type of endocrine therapy, and breast surgery.

Over 80% of the subjects had ductal carcinoma, and over 90% of women were HER2-negative. More women in the pregnancy cohort had tumor diameters of 2 cm or less (47.2% vs. 40.9%) and a higher percentage had breast conserving surgery (59% vs. 45.9%).

Chemotherapy was administered to 95.3% of the subjects, most commonly anthracycline and taxane based, and more than 90% received endocrine therapy, most often tamoxifen alone among women who did not become pregnant and tamoxifen plus a luteinizing hormone-releasing hormone agonist among those who did. Endocrine therapy was shorter among women who became pregnant (median, 50 vs. 60 months; P < .001).

The findings held when 176 pregnant cases were matched to 528 nonpregnant controls for year of diagnosis, nodal status, hormone receptor status, and type of BRCA mutation. However, disease-free survival was improved among pregnant women (HR, 0.71; P = .045) who were younger at diagnosis, with median ages of 31 years vs. 36 years (P < .001).

The study was funded by the Italian Association for Cancer Research, among others. Dr. Lambertini reports acting as a consultant for Roche and Novartis and as a speaker for Theramex, Takeda, Roche, Eli Lilly, Novartis. Several coauthors also report relationships with pharmaceutical companies, as detailed in the original article.
 

A version of this article originally appeared on Medscape.com.

Pregnancy after treatment for breast cancer with BRCA mutations is safe, with “favorable” fetal outcomes and no increase in cancer recurrence, said researchers reporting a review of more than 1,000 young women with breast cancer, mostly in Europe but also Israel and North and South America.

It’s been known that pregnancy after breast cancer treatment, even for hormone receptor–positive disease, is safe overall, the team commented. However, there have been concerns about women who have BRCA mutations because of a lack of data.

The new findings “provide reassurance to patients with BRCA-mutated breast cancer interested in future fertility” and are of “paramount importance for health care providers involved in counseling young patients,” said the researchers, led by Matteo Lambertini, MD, PhD, a medical oncologist at the University of Genoa, Italy.

The review was published in September in the Journal of Clinical Oncology.

The team reviewed reproductive outcomes among 1,252 women who were no older than 40 years when diagnosed with stage I-III BRCA-mutated invasive breast cancer between January 2000 and December 2012.

More than half (65%; n = 811) had BRCA1 mutations, 430 women (34%) had BRCA2 mutations, and 11 women had both.

Overall, 195 women became pregnant, at a median of 4.5 years after the breast cancer diagnosis and at a median age of 36 years.

The miscarriage rate was 10.3%, lower than expected in the general population.

Among the 150 patients who gave birth to 170 infants, delivery complications occurred in 13 of the 112 pregnancies with available data (11.6%), and congenital anomalies were seen in just 2 pregnancies (1.8%). This is a lower rate of anomalies than expected in the general population, the team noted. The rate of preterm delivery was 9.2%, similar to the general population.

There was no difference between the women who became pregnant and those who did not in either disease-free survival (adjusted hazard ratio, 0.87; P = .41) or overall survival (aHR, 0.88; P = .66), over a median follow-up of 8.3 years from diagnosis. In addition to BRCA mutations, the analysis adjusted for age at diagnosis, tumor size, nodal status, hormone receptor status, type of endocrine therapy, and breast surgery.

Over 80% of the subjects had ductal carcinoma, and over 90% of women were HER2-negative. More women in the pregnancy cohort had tumor diameters of 2 cm or less (47.2% vs. 40.9%) and a higher percentage had breast conserving surgery (59% vs. 45.9%).

Chemotherapy was administered to 95.3% of the subjects, most commonly anthracycline and taxane based, and more than 90% received endocrine therapy, most often tamoxifen alone among women who did not become pregnant and tamoxifen plus a luteinizing hormone-releasing hormone agonist among those who did. Endocrine therapy was shorter among women who became pregnant (median, 50 vs. 60 months; P < .001).

The findings held when 176 pregnant cases were matched to 528 nonpregnant controls for year of diagnosis, nodal status, hormone receptor status, and type of BRCA mutation. However, disease-free survival was improved among pregnant women (HR, 0.71; P = .045) who were younger at diagnosis, with median ages of 31 years vs. 36 years (P < .001).

The study was funded by the Italian Association for Cancer Research, among others. Dr. Lambertini reports acting as a consultant for Roche and Novartis and as a speaker for Theramex, Takeda, Roche, Eli Lilly, Novartis. Several coauthors also report relationships with pharmaceutical companies, as detailed in the original article.
 

A version of this article originally appeared on Medscape.com.

Pregnancy after treatment for breast cancer with BRCA mutations is safe, with “favorable” fetal outcomes and no increase in cancer recurrence, said researchers reporting a review of more than 1,000 young women with breast cancer, mostly in Europe but also Israel and North and South America.

It’s been known that pregnancy after breast cancer treatment, even for hormone receptor–positive disease, is safe overall, the team commented. However, there have been concerns about women who have BRCA mutations because of a lack of data.

The new findings “provide reassurance to patients with BRCA-mutated breast cancer interested in future fertility” and are of “paramount importance for health care providers involved in counseling young patients,” said the researchers, led by Matteo Lambertini, MD, PhD, a medical oncologist at the University of Genoa, Italy.

The review was published in September in the Journal of Clinical Oncology.

The team reviewed reproductive outcomes among 1,252 women who were no older than 40 years when diagnosed with stage I-III BRCA-mutated invasive breast cancer between January 2000 and December 2012.

More than half (65%; n = 811) had BRCA1 mutations, 430 women (34%) had BRCA2 mutations, and 11 women had both.

Overall, 195 women became pregnant, at a median of 4.5 years after the breast cancer diagnosis and at a median age of 36 years.

The miscarriage rate was 10.3%, lower than expected in the general population.

Among the 150 patients who gave birth to 170 infants, delivery complications occurred in 13 of the 112 pregnancies with available data (11.6%), and congenital anomalies were seen in just 2 pregnancies (1.8%). This is a lower rate of anomalies than expected in the general population, the team noted. The rate of preterm delivery was 9.2%, similar to the general population.

There was no difference between the women who became pregnant and those who did not in either disease-free survival (adjusted hazard ratio, 0.87; P = .41) or overall survival (aHR, 0.88; P = .66), over a median follow-up of 8.3 years from diagnosis. In addition to BRCA mutations, the analysis adjusted for age at diagnosis, tumor size, nodal status, hormone receptor status, type of endocrine therapy, and breast surgery.

Over 80% of the subjects had ductal carcinoma, and over 90% of women were HER2-negative. More women in the pregnancy cohort had tumor diameters of 2 cm or less (47.2% vs. 40.9%) and a higher percentage had breast conserving surgery (59% vs. 45.9%).

Chemotherapy was administered to 95.3% of the subjects, most commonly anthracycline and taxane based, and more than 90% received endocrine therapy, most often tamoxifen alone among women who did not become pregnant and tamoxifen plus a luteinizing hormone-releasing hormone agonist among those who did. Endocrine therapy was shorter among women who became pregnant (median, 50 vs. 60 months; P < .001).

The findings held when 176 pregnant cases were matched to 528 nonpregnant controls for year of diagnosis, nodal status, hormone receptor status, and type of BRCA mutation. However, disease-free survival was improved among pregnant women (HR, 0.71; P = .045) who were younger at diagnosis, with median ages of 31 years vs. 36 years (P < .001).

The study was funded by the Italian Association for Cancer Research, among others. Dr. Lambertini reports acting as a consultant for Roche and Novartis and as a speaker for Theramex, Takeda, Roche, Eli Lilly, Novartis. Several coauthors also report relationships with pharmaceutical companies, as detailed in the original article.
 

A version of this article originally appeared on Medscape.com.