Breast Cancer

Key clinical point: The overall incidence of synchronous bilateral breast cancer (BBC) and metachronous BBC (MBBC) in patients with a history of lobular carcinoma in situ (LCIS) was 2%, with the risk for MBBC being even lower in women with hormone receptor-positive BC and those receiving endocrine therapy (ET).

Major finding: The estimated 5-year risk of developing MBBC was 6.4% (95% CI 1.9%-10.7%) among women with a remaining contralateral breast at risk, with the risk being lower among those with estrogen (hazard ratio [HR] 0.13; P = .015) or progesterone (HR 0.24; P = .047) receptor-positive BC and those who received ET (HR 0.17; P = .005).

Study details: This study included 1651 women with a history of LCIS, of which 249 women developed unilateral or bilateral BC during a median follow-up of 7 years.

Disclosures: This study was partly supported by the US National Institutes of Health/National Cancer Institute Cancer Center. TA King declared receiving speakers' honoraria and serving on advisory boards for several sources. The other authors declared no conflicts of interest.

Source: Mallory MA et al. Synchronous and metachronous bilateral breast cancer among women with a history of lobular carcinoma in situ. Breast Cancer Res Treat. 2022 (Apr 29). Doi: 10.1007/s10549-022-06532-4 

Key clinical point: The overall incidence of synchronous bilateral breast cancer (BBC) and metachronous BBC (MBBC) in patients with a history of lobular carcinoma in situ (LCIS) was 2%, with the risk for MBBC being even lower in women with hormone receptor-positive BC and those receiving endocrine therapy (ET).

Major finding: The estimated 5-year risk of developing MBBC was 6.4% (95% CI 1.9%-10.7%) among women with a remaining contralateral breast at risk, with the risk being lower among those with estrogen (hazard ratio [HR] 0.13; P = .015) or progesterone (HR 0.24; P = .047) receptor-positive BC and those who received ET (HR 0.17; P = .005).

Study details: This study included 1651 women with a history of LCIS, of which 249 women developed unilateral or bilateral BC during a median follow-up of 7 years.

Disclosures: This study was partly supported by the US National Institutes of Health/National Cancer Institute Cancer Center. TA King declared receiving speakers' honoraria and serving on advisory boards for several sources. The other authors declared no conflicts of interest.

Source: Mallory MA et al. Synchronous and metachronous bilateral breast cancer among women with a history of lobular carcinoma in situ. Breast Cancer Res Treat. 2022 (Apr 29). Doi: 10.1007/s10549-022-06532-4 

Key clinical point: The overall incidence of synchronous bilateral breast cancer (BBC) and metachronous BBC (MBBC) in patients with a history of lobular carcinoma in situ (LCIS) was 2%, with the risk for MBBC being even lower in women with hormone receptor-positive BC and those receiving endocrine therapy (ET).

Major finding: The estimated 5-year risk of developing MBBC was 6.4% (95% CI 1.9%-10.7%) among women with a remaining contralateral breast at risk, with the risk being lower among those with estrogen (hazard ratio [HR] 0.13; P = .015) or progesterone (HR 0.24; P = .047) receptor-positive BC and those who received ET (HR 0.17; P = .005).

Study details: This study included 1651 women with a history of LCIS, of which 249 women developed unilateral or bilateral BC during a median follow-up of 7 years.

Disclosures: This study was partly supported by the US National Institutes of Health/National Cancer Institute Cancer Center. TA King declared receiving speakers' honoraria and serving on advisory boards for several sources. The other authors declared no conflicts of interest.

Source: Mallory MA et al. Synchronous and metachronous bilateral breast cancer among women with a history of lobular carcinoma in situ. Breast Cancer Res Treat. 2022 (Apr 29). Doi: 10.1007/s10549-022-06532-4 

Key clinical point: The combination of ibandronate and endocrine therapy (ET) failed to improve disease-free survival (DFS) compared with ET alone in postmenopausal women with estrogen receptor-positive (ER+) early breast cancer (BC).

Major finding: During a median follow-up of 8.5 years, DFS was not significantly different between the ibandronate+ET and ET treatment arms (hazard ratio [HR] 0.97; log-rank P = .811). Overall, the incidence of adverse events, particularly osteonecrosis (P = .002) and dyspepsia (P < .001), was higher in the ibandronate+ET vs. ET treatment arm.

Study details: This phase 3, TEAM-IIB trial included 1116 postmenopausal women with invasive stage I-III ER+ BC who were randomly assigned to receive ET for 5 years with or without 50 mg adjuvant oral ibandronate once daily for 3 years.

Disclosures: This study was supported by grants from Roche Nederland B.V. and Pfizer Nederland B.V. Some authors declared serving as consultants, advisors, or receiving research funding, honoraria, travel support, or accommodation expenses from several sources, including Roche and Pfizer.

Source: Vliek SB, Noordhoek I, et al. Daily oral ibandronate with adjuvant endocrine therapy in postmenopausal women with estrogen receptor–positive breast cancer (BOOG 2006-04): Randomized phase III TEAM-IIB trial. J Clin Oncol. 2022 Apr 20. doi: 10.1200/JCO.21.00311.

Key clinical point: The combination of ibandronate and endocrine therapy (ET) failed to improve disease-free survival (DFS) compared with ET alone in postmenopausal women with estrogen receptor-positive (ER+) early breast cancer (BC).

Major finding: During a median follow-up of 8.5 years, DFS was not significantly different between the ibandronate+ET and ET treatment arms (hazard ratio [HR] 0.97; log-rank P = .811). Overall, the incidence of adverse events, particularly osteonecrosis (P = .002) and dyspepsia (P < .001), was higher in the ibandronate+ET vs. ET treatment arm.

Study details: This phase 3, TEAM-IIB trial included 1116 postmenopausal women with invasive stage I-III ER+ BC who were randomly assigned to receive ET for 5 years with or without 50 mg adjuvant oral ibandronate once daily for 3 years.

Disclosures: This study was supported by grants from Roche Nederland B.V. and Pfizer Nederland B.V. Some authors declared serving as consultants, advisors, or receiving research funding, honoraria, travel support, or accommodation expenses from several sources, including Roche and Pfizer.

Source: Vliek SB, Noordhoek I, et al. Daily oral ibandronate with adjuvant endocrine therapy in postmenopausal women with estrogen receptor–positive breast cancer (BOOG 2006-04): Randomized phase III TEAM-IIB trial. J Clin Oncol. 2022 Apr 20. doi: 10.1200/JCO.21.00311.

Key clinical point: The combination of ibandronate and endocrine therapy (ET) failed to improve disease-free survival (DFS) compared with ET alone in postmenopausal women with estrogen receptor-positive (ER+) early breast cancer (BC).

Major finding: During a median follow-up of 8.5 years, DFS was not significantly different between the ibandronate+ET and ET treatment arms (hazard ratio [HR] 0.97; log-rank P = .811). Overall, the incidence of adverse events, particularly osteonecrosis (P = .002) and dyspepsia (P < .001), was higher in the ibandronate+ET vs. ET treatment arm.

Study details: This phase 3, TEAM-IIB trial included 1116 postmenopausal women with invasive stage I-III ER+ BC who were randomly assigned to receive ET for 5 years with or without 50 mg adjuvant oral ibandronate once daily for 3 years.

Disclosures: This study was supported by grants from Roche Nederland B.V. and Pfizer Nederland B.V. Some authors declared serving as consultants, advisors, or receiving research funding, honoraria, travel support, or accommodation expenses from several sources, including Roche and Pfizer.

Source: Vliek SB, Noordhoek I, et al. Daily oral ibandronate with adjuvant endocrine therapy in postmenopausal women with estrogen receptor–positive breast cancer (BOOG 2006-04): Randomized phase III TEAM-IIB trial. J Clin Oncol. 2022 Apr 20. doi: 10.1200/JCO.21.00311.

Key clinical point: Palbociclib plus endocrine therapy (ET) demonstrated no survival benefit over capecitabine in postmenopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−), metastatic breast cancer (BC) who progressed on prior aromatase inhibitor (AI) therapy.

Major finding: The median overall survival was not significantly different between the palbociclib+ET and capecitabine groups in the overall population (adjusted hazard ratio [aHR] 1.00; P = .995) and the wild-type estrogen receptor-1 population (aHR 1.06; P = .683). No new safety signals were identified.

Study details: Findings are from the phase 3 PEARL study including 601 postmenopausal women with HR+/HER2− metastatic BC who progressed on prior AI therapy and were randomly assigned to receive capecitabine or palbociclib+ET with exemestane or fulvestrant.

Disclosures: This study was supported by Pfizer Inc. and AstraZeneca. Two authors declared being employees and having stock options in Pfizer, and the other authors reported ties with several sources, including Pfizer and AstraZeneca.

Source: Martin M et al. Overall survival with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer in the PEARL study. Eur J Cancer. 2022;168:12-24 (Apr 14). Doi: 10.1016/j.ejca.2022.03.006

Key clinical point: Palbociclib plus endocrine therapy (ET) demonstrated no survival benefit over capecitabine in postmenopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−), metastatic breast cancer (BC) who progressed on prior aromatase inhibitor (AI) therapy.

Major finding: The median overall survival was not significantly different between the palbociclib+ET and capecitabine groups in the overall population (adjusted hazard ratio [aHR] 1.00; P = .995) and the wild-type estrogen receptor-1 population (aHR 1.06; P = .683). No new safety signals were identified.

Study details: Findings are from the phase 3 PEARL study including 601 postmenopausal women with HR+/HER2− metastatic BC who progressed on prior AI therapy and were randomly assigned to receive capecitabine or palbociclib+ET with exemestane or fulvestrant.

Disclosures: This study was supported by Pfizer Inc. and AstraZeneca. Two authors declared being employees and having stock options in Pfizer, and the other authors reported ties with several sources, including Pfizer and AstraZeneca.

Source: Martin M et al. Overall survival with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer in the PEARL study. Eur J Cancer. 2022;168:12-24 (Apr 14). Doi: 10.1016/j.ejca.2022.03.006

Key clinical point: Palbociclib plus endocrine therapy (ET) demonstrated no survival benefit over capecitabine in postmenopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−), metastatic breast cancer (BC) who progressed on prior aromatase inhibitor (AI) therapy.

Major finding: The median overall survival was not significantly different between the palbociclib+ET and capecitabine groups in the overall population (adjusted hazard ratio [aHR] 1.00; P = .995) and the wild-type estrogen receptor-1 population (aHR 1.06; P = .683). No new safety signals were identified.

Study details: Findings are from the phase 3 PEARL study including 601 postmenopausal women with HR+/HER2− metastatic BC who progressed on prior AI therapy and were randomly assigned to receive capecitabine or palbociclib+ET with exemestane or fulvestrant.

Disclosures: This study was supported by Pfizer Inc. and AstraZeneca. Two authors declared being employees and having stock options in Pfizer, and the other authors reported ties with several sources, including Pfizer and AstraZeneca.

Source: Martin M et al. Overall survival with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer in the PEARL study. Eur J Cancer. 2022;168:12-24 (Apr 14). Doi: 10.1016/j.ejca.2022.03.006

Key clinical point: Neoadjuvant chemotherapy with paclitaxel can be safely omitted in patients with human epidermal growth factor receptor 2-positive (HER2+), hormone receptor-negative (HR−) early breast cancer (BC) who achieved pathological complete response (pCR) with only trastuzumab+pertuzumab.

Major finding: The 5-year invasive disease-free survival (iDFS; hazard ratio [HR] 0.32; P = .15) and overall survival (HR 0.41; P = .43) were achieved by a similar proportion early responders in the trastuzumab+pertuzumab without paclitaxel group and all patients in the trastuzumab+pertuzumab+paclitaxel group, irrespective of an early response, with the achievement of pCR being associated with improvement in iDFS (HR 0.14; P = .011).

Study details: Findings are from the phase 2, WSG-ADAPT-HER2+/HR− trial including 134 women with HER2+/HR− early BC who were randomly assigned to receive trastuzumab+pertuzumab with or without weekly paclitaxel for 12 weeks.

Disclosures: This study was funded by Roche and Bayer. Some authors declared serving as codirectors at the West German Study Group or on data safety monitoring boards or advisory boards or receiving research funding, consulting fees, honoraria, or travel support from several sources.

Source: Nitz U et al. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): Survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol. 2022;23(5):625-635 (Apr 8). Doi: 10.1016/S1470-2045(22)00159-0

Key clinical point: Neoadjuvant chemotherapy with paclitaxel can be safely omitted in patients with human epidermal growth factor receptor 2-positive (HER2+), hormone receptor-negative (HR−) early breast cancer (BC) who achieved pathological complete response (pCR) with only trastuzumab+pertuzumab.

Major finding: The 5-year invasive disease-free survival (iDFS; hazard ratio [HR] 0.32; P = .15) and overall survival (HR 0.41; P = .43) were achieved by a similar proportion early responders in the trastuzumab+pertuzumab without paclitaxel group and all patients in the trastuzumab+pertuzumab+paclitaxel group, irrespective of an early response, with the achievement of pCR being associated with improvement in iDFS (HR 0.14; P = .011).

Study details: Findings are from the phase 2, WSG-ADAPT-HER2+/HR− trial including 134 women with HER2+/HR− early BC who were randomly assigned to receive trastuzumab+pertuzumab with or without weekly paclitaxel for 12 weeks.

Disclosures: This study was funded by Roche and Bayer. Some authors declared serving as codirectors at the West German Study Group or on data safety monitoring boards or advisory boards or receiving research funding, consulting fees, honoraria, or travel support from several sources.

Source: Nitz U et al. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): Survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol. 2022;23(5):625-635 (Apr 8). Doi: 10.1016/S1470-2045(22)00159-0

Key clinical point: Neoadjuvant chemotherapy with paclitaxel can be safely omitted in patients with human epidermal growth factor receptor 2-positive (HER2+), hormone receptor-negative (HR−) early breast cancer (BC) who achieved pathological complete response (pCR) with only trastuzumab+pertuzumab.

Major finding: The 5-year invasive disease-free survival (iDFS; hazard ratio [HR] 0.32; P = .15) and overall survival (HR 0.41; P = .43) were achieved by a similar proportion early responders in the trastuzumab+pertuzumab without paclitaxel group and all patients in the trastuzumab+pertuzumab+paclitaxel group, irrespective of an early response, with the achievement of pCR being associated with improvement in iDFS (HR 0.14; P = .011).

Study details: Findings are from the phase 2, WSG-ADAPT-HER2+/HR− trial including 134 women with HER2+/HR− early BC who were randomly assigned to receive trastuzumab+pertuzumab with or without weekly paclitaxel for 12 weeks.

Disclosures: This study was funded by Roche and Bayer. Some authors declared serving as codirectors at the West German Study Group or on data safety monitoring boards or advisory boards or receiving research funding, consulting fees, honoraria, or travel support from several sources.

Source: Nitz U et al. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): Survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol. 2022;23(5):625-635 (Apr 8). Doi: 10.1016/S1470-2045(22)00159-0

Key clinical point: Digital breast tomosynthesis plus synthesized 2-dimensional (s2D) mammography was superior to standard digital mammography for the detection of invasive breast cancer (BC).

Major finding: Detection rate of all invasive BC (odds ratio 1.48; P < .0001) was higher with digital breast tomosynthesis+s2D mammography vs digital mammography. None of the adverse events were classified as serious or related to the device used.

Study details: Findings are from the open-label, superiority TOSYMA trial including 99,689 women who were randomly assigned to undergo BC screening with digital breast tomosynthesis+s2D mammography or digital mammography.

Disclosures: This study was funded by Deutsche Forschungsgemeinschaft. Some authors declared running a third-party funded project at the University of Münster or receiving grants, honoraria, or payments from several sources.

Source: Heindel W et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): A multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022;23(5):601-611 (Apr 12). Doi: 10.1016/S1470-2045(22)00194-2

Key clinical point: Digital breast tomosynthesis plus synthesized 2-dimensional (s2D) mammography was superior to standard digital mammography for the detection of invasive breast cancer (BC).

Major finding: Detection rate of all invasive BC (odds ratio 1.48; P < .0001) was higher with digital breast tomosynthesis+s2D mammography vs digital mammography. None of the adverse events were classified as serious or related to the device used.

Study details: Findings are from the open-label, superiority TOSYMA trial including 99,689 women who were randomly assigned to undergo BC screening with digital breast tomosynthesis+s2D mammography or digital mammography.

Disclosures: This study was funded by Deutsche Forschungsgemeinschaft. Some authors declared running a third-party funded project at the University of Münster or receiving grants, honoraria, or payments from several sources.

Source: Heindel W et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): A multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022;23(5):601-611 (Apr 12). Doi: 10.1016/S1470-2045(22)00194-2

Key clinical point: Digital breast tomosynthesis plus synthesized 2-dimensional (s2D) mammography was superior to standard digital mammography for the detection of invasive breast cancer (BC).

Major finding: Detection rate of all invasive BC (odds ratio 1.48; P < .0001) was higher with digital breast tomosynthesis+s2D mammography vs digital mammography. None of the adverse events were classified as serious or related to the device used.

Study details: Findings are from the open-label, superiority TOSYMA trial including 99,689 women who were randomly assigned to undergo BC screening with digital breast tomosynthesis+s2D mammography or digital mammography.

Disclosures: This study was funded by Deutsche Forschungsgemeinschaft. Some authors declared running a third-party funded project at the University of Münster or receiving grants, honoraria, or payments from several sources.

Source: Heindel W et al. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): A multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 2022;23(5):601-611 (Apr 12). Doi: 10.1016/S1470-2045(22)00194-2

Key clinical point: Switch to maintenance endocrine therapy (ET)+bevacizumab with an option of reinduction may be a better alternative to continuing weekly paclitaxel+bevacizumab in patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2−) advanced/metastatic breast cancer (BC) who responded to paclitaxel+bevacizumab.

Major finding: After a median follow-up of 21.3 months, the time to failure of the  strategy was longer with ET+bevacizumab vs weekly paclitaxel+bevacizumab among all induction chemotherapy responders (hazard ratio 0.51; log-rank P = .0006). The incidence of grade 3-5 adverse events was 10% lower in the ET+bevacizumab group.

Study details: Findings are from the phase 2, BOOSTER trial including 160 chemotherapy naive patients with ER+/HER2− advanced/metastatic BC who responded to weekly paclitaxel+bevacizumab induction, and were randomly assigned to continue paclitaxel+bevacizumab or switch to ET+bevacizumab.

Disclosures: This study was funded by Chugai Pharmaceutical. Some authors declared contracting clinical trials, serving as board members, or receiving institutional grants, honoraria, or personal fees from several sources.

Source: Saji S et al. Switch maintenance endocrine therapy plus bevacizumab after bevacizumab plus paclitaxel in advanced or metastatic oestrogen receptor-positive, HER2-negative breast cancer (BOOSTER): A randomised, open-label, phase 2 trial. Lancet Oncol. 2022;23(5):636-649 (Apr 8). Doi: 10.1016/S1470-2045(22)00196-6

Key clinical point: Switch to maintenance endocrine therapy (ET)+bevacizumab with an option of reinduction may be a better alternative to continuing weekly paclitaxel+bevacizumab in patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2−) advanced/metastatic breast cancer (BC) who responded to paclitaxel+bevacizumab.

Major finding: After a median follow-up of 21.3 months, the time to failure of the  strategy was longer with ET+bevacizumab vs weekly paclitaxel+bevacizumab among all induction chemotherapy responders (hazard ratio 0.51; log-rank P = .0006). The incidence of grade 3-5 adverse events was 10% lower in the ET+bevacizumab group.

Study details: Findings are from the phase 2, BOOSTER trial including 160 chemotherapy naive patients with ER+/HER2− advanced/metastatic BC who responded to weekly paclitaxel+bevacizumab induction, and were randomly assigned to continue paclitaxel+bevacizumab or switch to ET+bevacizumab.

Disclosures: This study was funded by Chugai Pharmaceutical. Some authors declared contracting clinical trials, serving as board members, or receiving institutional grants, honoraria, or personal fees from several sources.

Source: Saji S et al. Switch maintenance endocrine therapy plus bevacizumab after bevacizumab plus paclitaxel in advanced or metastatic oestrogen receptor-positive, HER2-negative breast cancer (BOOSTER): A randomised, open-label, phase 2 trial. Lancet Oncol. 2022;23(5):636-649 (Apr 8). Doi: 10.1016/S1470-2045(22)00196-6

Key clinical point: Switch to maintenance endocrine therapy (ET)+bevacizumab with an option of reinduction may be a better alternative to continuing weekly paclitaxel+bevacizumab in patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2−) advanced/metastatic breast cancer (BC) who responded to paclitaxel+bevacizumab.

Major finding: After a median follow-up of 21.3 months, the time to failure of the  strategy was longer with ET+bevacizumab vs weekly paclitaxel+bevacizumab among all induction chemotherapy responders (hazard ratio 0.51; log-rank P = .0006). The incidence of grade 3-5 adverse events was 10% lower in the ET+bevacizumab group.

Study details: Findings are from the phase 2, BOOSTER trial including 160 chemotherapy naive patients with ER+/HER2− advanced/metastatic BC who responded to weekly paclitaxel+bevacizumab induction, and were randomly assigned to continue paclitaxel+bevacizumab or switch to ET+bevacizumab.

Disclosures: This study was funded by Chugai Pharmaceutical. Some authors declared contracting clinical trials, serving as board members, or receiving institutional grants, honoraria, or personal fees from several sources.

Source: Saji S et al. Switch maintenance endocrine therapy plus bevacizumab after bevacizumab plus paclitaxel in advanced or metastatic oestrogen receptor-positive, HER2-negative breast cancer (BOOSTER): A randomised, open-label, phase 2 trial. Lancet Oncol. 2022;23(5):636-649 (Apr 8). Doi: 10.1016/S1470-2045(22)00196-6

Patients with nonmetastatic triple-negative breast cancer lacking progressive death–ligand 1 expression are less responsive to neoadjuvant chemotherapy and face a poorer prognosis than patients with PD-L1–positive tumors, according to a study presented at ESMO Breast Cancer 2022, a meeting of the European Society for Medical Oncology.

“The newly distinct quadruple negative breast cancer subtype could be considered the breast cancer subtype with the poorest outcome,” wrote the authors, who were led by Loay Kassem, MD, a clinical oncology consultant at Cairo (Egypt) University.

Triple-negative breast cancer (TNBC) accounts for 15%-20% of all breast cancers. It tends to be more aggressive and difficult to treat than other subtypes.

Prior research has shown the expression of PD-L1 in tumors is predictive of immunotherapy response in patients with metastatic TNBC. The checkpoint inhibitor pembrolizumab (Keytruda, Merck) was approved by the Food and Drug Administration in 2021 for high-risk, early-stage, triple-negative breast cancer in combination with neoadjuvant chemotherapy, and then continued as a single treatment after surgery.

To determine whether PD-L1 expression could also predict response to chemotherapy in with nonmetastatic TNBC, the researchers conducted a systematic review and meta-analysis of 19 studies that included a total of 2,319 patients with nonmetastatic TBNC. The team examined whether PD-L1 expression could predict pathological complete response to neoadjuvant chemotherapy. PD-L1–positive TNBC were found to be significantly associated with a higher probability of achieving a pathological complete response with neoadjuvant chemotherapy. Long-term studies have shown that PD-L1 positivity was associated with better disease-free survival and overall survival than PD-L1–negative patients.

The researchers also examined RNA sequence data, which showed that PD-L1 expression was indicative of higher levels of expression of key immune-related genes that mediate response to chemotherapy in TNBC.

Dr. Kassem and colleagues suggest that quadruple-negative breast cancer defined by a lack of PD-L1 expression is a distinct subtype of breast cancer associated with the poorest outcomes. Another quadruple-negative breast cancer – a subtype of TNBC where patients lack expression of the androgen receptor, has also been associated with more aggressive disease and poorer response to treatment.

The authors report no funding or conflicts of interest.

Patients with nonmetastatic triple-negative breast cancer lacking progressive death–ligand 1 expression are less responsive to neoadjuvant chemotherapy and face a poorer prognosis than patients with PD-L1–positive tumors, according to a study presented at ESMO Breast Cancer 2022, a meeting of the European Society for Medical Oncology.

“The newly distinct quadruple negative breast cancer subtype could be considered the breast cancer subtype with the poorest outcome,” wrote the authors, who were led by Loay Kassem, MD, a clinical oncology consultant at Cairo (Egypt) University.

Triple-negative breast cancer (TNBC) accounts for 15%-20% of all breast cancers. It tends to be more aggressive and difficult to treat than other subtypes.

Prior research has shown the expression of PD-L1 in tumors is predictive of immunotherapy response in patients with metastatic TNBC. The checkpoint inhibitor pembrolizumab (Keytruda, Merck) was approved by the Food and Drug Administration in 2021 for high-risk, early-stage, triple-negative breast cancer in combination with neoadjuvant chemotherapy, and then continued as a single treatment after surgery.

To determine whether PD-L1 expression could also predict response to chemotherapy in with nonmetastatic TNBC, the researchers conducted a systematic review and meta-analysis of 19 studies that included a total of 2,319 patients with nonmetastatic TBNC. The team examined whether PD-L1 expression could predict pathological complete response to neoadjuvant chemotherapy. PD-L1–positive TNBC were found to be significantly associated with a higher probability of achieving a pathological complete response with neoadjuvant chemotherapy. Long-term studies have shown that PD-L1 positivity was associated with better disease-free survival and overall survival than PD-L1–negative patients.

The researchers also examined RNA sequence data, which showed that PD-L1 expression was indicative of higher levels of expression of key immune-related genes that mediate response to chemotherapy in TNBC.

Dr. Kassem and colleagues suggest that quadruple-negative breast cancer defined by a lack of PD-L1 expression is a distinct subtype of breast cancer associated with the poorest outcomes. Another quadruple-negative breast cancer – a subtype of TNBC where patients lack expression of the androgen receptor, has also been associated with more aggressive disease and poorer response to treatment.

The authors report no funding or conflicts of interest.

Patients with nonmetastatic triple-negative breast cancer lacking progressive death–ligand 1 expression are less responsive to neoadjuvant chemotherapy and face a poorer prognosis than patients with PD-L1–positive tumors, according to a study presented at ESMO Breast Cancer 2022, a meeting of the European Society for Medical Oncology.

“The newly distinct quadruple negative breast cancer subtype could be considered the breast cancer subtype with the poorest outcome,” wrote the authors, who were led by Loay Kassem, MD, a clinical oncology consultant at Cairo (Egypt) University.

Triple-negative breast cancer (TNBC) accounts for 15%-20% of all breast cancers. It tends to be more aggressive and difficult to treat than other subtypes.

Prior research has shown the expression of PD-L1 in tumors is predictive of immunotherapy response in patients with metastatic TNBC. The checkpoint inhibitor pembrolizumab (Keytruda, Merck) was approved by the Food and Drug Administration in 2021 for high-risk, early-stage, triple-negative breast cancer in combination with neoadjuvant chemotherapy, and then continued as a single treatment after surgery.

To determine whether PD-L1 expression could also predict response to chemotherapy in with nonmetastatic TNBC, the researchers conducted a systematic review and meta-analysis of 19 studies that included a total of 2,319 patients with nonmetastatic TBNC. The team examined whether PD-L1 expression could predict pathological complete response to neoadjuvant chemotherapy. PD-L1–positive TNBC were found to be significantly associated with a higher probability of achieving a pathological complete response with neoadjuvant chemotherapy. Long-term studies have shown that PD-L1 positivity was associated with better disease-free survival and overall survival than PD-L1–negative patients.

The researchers also examined RNA sequence data, which showed that PD-L1 expression was indicative of higher levels of expression of key immune-related genes that mediate response to chemotherapy in TNBC.

Dr. Kassem and colleagues suggest that quadruple-negative breast cancer defined by a lack of PD-L1 expression is a distinct subtype of breast cancer associated with the poorest outcomes. Another quadruple-negative breast cancer – a subtype of TNBC where patients lack expression of the androgen receptor, has also been associated with more aggressive disease and poorer response to treatment.

The authors report no funding or conflicts of interest.

Mastectomies among younger women with nonmetastatic invasive breast cancer may not always be necessary, according to a new study that shows survival outcomes are similar to those of women who had a lumpectomy.

The results come as an increasing number of women under 40 choose mastectomy. “A lot of times, there’s this assumption that removal of the entire breast is going to prevent cancer from returning in that breast. That makes complete sense, it’s intuitive, so I think a lot of patients are surprised to find that less extensive surgery provides the same overall survival as a really extensive surgery,” said Christine Pestana, MD, a fellow in breast surgical oncology with the Atrium Health Levine Cancer Institute, Charlotte, N.C. Dr. Pestana presented the study at the annual meeting of the American Society of Breast Surgeons earlier this year.

In fact, it has been well-demonstrated among women over age 50 with breast cancer that lumpectomy and mastectomy result in similar outcomes, but efforts to show similar efficacy by analyzing data from randomized trials have been limited by small numbers of women under 40, said the study’s lead author Lejla Hadzikadic-Gusic, MD, who is codirector of the Sandra Levine Young Women’s Breast Cancer Program at Atrium Health. “We’ve done a lot of research since the 1970s to be able to keep a woman’s breasts and just treat her for breast cancer. It’s nice to be able to say the same thing for younger women,” said Dr. Hadzikadic-Gusic, in an interview.

The researchers drew from the Young Women’s Database from the Levine Cancer Institute. The analysis included data from nearly 600 women treated between 2010 and 2018.

The increasing frequency of mastectomies in younger women may be traceable, in part, to high-profile cases of celebrities who have had mastectomies after an early breast cancer diagnosis, with Angelina Jolie being among the most known of examples. But Ms. Jolie had the procedure proactively without a cancer diagnosis because she carried the BRCA1 mutation, which increases breast cancer risk. That information was often lost in press coverage, which can lead to confusion among young women with breast cancer, according to Dr. Hadzikadic-Gusic. “What we’re trying to do is have this data help us educate our patients,” she said.

It’s also important for physicians to help guide patients through these decisions, and family history is a key factor. Dr. Pestana encourages primary care providers to explore family history to help understand cancer risks. “It’s not just breast cancer. It’s also ovarian cancer, colon cancer, prostate cancer. Those all have associations with different genetic mutations. If we start asking those questions, we may be able to identify patients who potentially could have that mutation, refer them to a geneticist, have them tested,” she said.

All of the 591 patients in the study were under age 40, with a median age of 37, and the median follow-up was 67 months. Twelve percent of patients died; 53.3% of patients were HR+/HER2–, 20.8% were HR+/HER2+, 19.3% were triple negative, and 6.6% were HR–/HER2+. There was no association between type of surgery and mortality.

The study was funded by the Levine Family Cancer Institute. Dr. Pestana and Dr. Hadzikadic-Gusic have no relevant financial disclosures.

Mastectomies among younger women with nonmetastatic invasive breast cancer may not always be necessary, according to a new study that shows survival outcomes are similar to those of women who had a lumpectomy.

The results come as an increasing number of women under 40 choose mastectomy. “A lot of times, there’s this assumption that removal of the entire breast is going to prevent cancer from returning in that breast. That makes complete sense, it’s intuitive, so I think a lot of patients are surprised to find that less extensive surgery provides the same overall survival as a really extensive surgery,” said Christine Pestana, MD, a fellow in breast surgical oncology with the Atrium Health Levine Cancer Institute, Charlotte, N.C. Dr. Pestana presented the study at the annual meeting of the American Society of Breast Surgeons earlier this year.

In fact, it has been well-demonstrated among women over age 50 with breast cancer that lumpectomy and mastectomy result in similar outcomes, but efforts to show similar efficacy by analyzing data from randomized trials have been limited by small numbers of women under 40, said the study’s lead author Lejla Hadzikadic-Gusic, MD, who is codirector of the Sandra Levine Young Women’s Breast Cancer Program at Atrium Health. “We’ve done a lot of research since the 1970s to be able to keep a woman’s breasts and just treat her for breast cancer. It’s nice to be able to say the same thing for younger women,” said Dr. Hadzikadic-Gusic, in an interview.

The researchers drew from the Young Women’s Database from the Levine Cancer Institute. The analysis included data from nearly 600 women treated between 2010 and 2018.

The increasing frequency of mastectomies in younger women may be traceable, in part, to high-profile cases of celebrities who have had mastectomies after an early breast cancer diagnosis, with Angelina Jolie being among the most known of examples. But Ms. Jolie had the procedure proactively without a cancer diagnosis because she carried the BRCA1 mutation, which increases breast cancer risk. That information was often lost in press coverage, which can lead to confusion among young women with breast cancer, according to Dr. Hadzikadic-Gusic. “What we’re trying to do is have this data help us educate our patients,” she said.

It’s also important for physicians to help guide patients through these decisions, and family history is a key factor. Dr. Pestana encourages primary care providers to explore family history to help understand cancer risks. “It’s not just breast cancer. It’s also ovarian cancer, colon cancer, prostate cancer. Those all have associations with different genetic mutations. If we start asking those questions, we may be able to identify patients who potentially could have that mutation, refer them to a geneticist, have them tested,” she said.

All of the 591 patients in the study were under age 40, with a median age of 37, and the median follow-up was 67 months. Twelve percent of patients died; 53.3% of patients were HR+/HER2–, 20.8% were HR+/HER2+, 19.3% were triple negative, and 6.6% were HR–/HER2+. There was no association between type of surgery and mortality.

The study was funded by the Levine Family Cancer Institute. Dr. Pestana and Dr. Hadzikadic-Gusic have no relevant financial disclosures.

Mastectomies among younger women with nonmetastatic invasive breast cancer may not always be necessary, according to a new study that shows survival outcomes are similar to those of women who had a lumpectomy.

The results come as an increasing number of women under 40 choose mastectomy. “A lot of times, there’s this assumption that removal of the entire breast is going to prevent cancer from returning in that breast. That makes complete sense, it’s intuitive, so I think a lot of patients are surprised to find that less extensive surgery provides the same overall survival as a really extensive surgery,” said Christine Pestana, MD, a fellow in breast surgical oncology with the Atrium Health Levine Cancer Institute, Charlotte, N.C. Dr. Pestana presented the study at the annual meeting of the American Society of Breast Surgeons earlier this year.

In fact, it has been well-demonstrated among women over age 50 with breast cancer that lumpectomy and mastectomy result in similar outcomes, but efforts to show similar efficacy by analyzing data from randomized trials have been limited by small numbers of women under 40, said the study’s lead author Lejla Hadzikadic-Gusic, MD, who is codirector of the Sandra Levine Young Women’s Breast Cancer Program at Atrium Health. “We’ve done a lot of research since the 1970s to be able to keep a woman’s breasts and just treat her for breast cancer. It’s nice to be able to say the same thing for younger women,” said Dr. Hadzikadic-Gusic, in an interview.

The researchers drew from the Young Women’s Database from the Levine Cancer Institute. The analysis included data from nearly 600 women treated between 2010 and 2018.

The increasing frequency of mastectomies in younger women may be traceable, in part, to high-profile cases of celebrities who have had mastectomies after an early breast cancer diagnosis, with Angelina Jolie being among the most known of examples. But Ms. Jolie had the procedure proactively without a cancer diagnosis because she carried the BRCA1 mutation, which increases breast cancer risk. That information was often lost in press coverage, which can lead to confusion among young women with breast cancer, according to Dr. Hadzikadic-Gusic. “What we’re trying to do is have this data help us educate our patients,” she said.

It’s also important for physicians to help guide patients through these decisions, and family history is a key factor. Dr. Pestana encourages primary care providers to explore family history to help understand cancer risks. “It’s not just breast cancer. It’s also ovarian cancer, colon cancer, prostate cancer. Those all have associations with different genetic mutations. If we start asking those questions, we may be able to identify patients who potentially could have that mutation, refer them to a geneticist, have them tested,” she said.

All of the 591 patients in the study were under age 40, with a median age of 37, and the median follow-up was 67 months. Twelve percent of patients died; 53.3% of patients were HR+/HER2–, 20.8% were HR+/HER2+, 19.3% were triple negative, and 6.6% were HR–/HER2+. There was no association between type of surgery and mortality.

The study was funded by the Levine Family Cancer Institute. Dr. Pestana and Dr. Hadzikadic-Gusic have no relevant financial disclosures.

A relationship between consumption of dairy products and risk of various cancers has been intensively investigated in the past but yielded inconclusive or conflicting results. Now a large new study comparing Chinese dairy consumption with that in the United Kingdom, shows that increased dairy consumption was linked to higher risks of liver cancer and female breast cancer.

The study, by researchers from Oxford University’s department of population health, and Peking University and the Chinese Academy of Medical Sciences in Beijing, used data from the China Kadoorie Biobank Study, a long-term prospective study involving more than over 510,000 participants recruited from 10 geographically diverse areas across China, including both rural and urban regions. They compared this to data from the UK biobank.

Subjects were 59% female, 41% male, aged 30-79 years, and had no history of cancer at recruitment between 2004 and 2008. Food questionnaires were completed at the outset and participants followed for an average of 11 years, using national cancer and death registries and health insurance records to identify new cancer diagnoses, including both fatal and nonfatal events.

Participants were categorized into three groups according to how often they consumed dairy products (primarily milk):

• Regular consumers (at least once a week): 20.4% of the cohort.
• Monthly consumers: 11.1%.
• Nonconsumers who never or rarely consumed dairy products: 68.5%.

Average dairy consumption was 37.9 g/day overall and 80.8 g/day among regular consumers. This compares with an average consumption of around 300 g/day in participants in the UK Biobank cohort.

Over the course of the study, 29,277 new cancer cases were recorded, including 6,282 lung, 2,582 female breast, 3,577 stomach, 3,350 colorectal, and 3,191 liver cancer cases.

Analyses correlating cases with consumption took into account a range of other factors potentially affecting cancer risk, including age, sex, region, family history of cancer, socioeconomic status (education and income), lifestyle factors (alcohol intake, smoking, physical activity, soy consumption, and fresh fruit intake), body mass index, chronic hepatitis B virus infection, and female reproductive factors.

Higher dairy intakes linked with risk of liver and breast cancers

Results revealed that higher regular dairy intake was associated with significantly higher risks of liver cancer and female breast cancer, both common types of cancer in China. Analyses indicated that for each 50-g/day intake, the risks increased by 12% and 17%, respectively.

There was also an increase in total cancer diagnoses, and an increased risk of lymphoma, though this was not statistically significant after correction for confounders. No association was found between dairy products and colorectal cancer, prostate cancer, or any other site-specific cancer.

The research, published in BMC Medicine, is the first major study to investigate dairy consumption and cancer risk in Chinese adults. The results conflict with previous studies on Western populations, which have suggested that dairy products may be associated with a lower risk of colorectal cancer and a higher risk of prostate cancer but have found no clear link for breast or other types of cancer.

Lead researchers Maria Kakkoura, PhD, MSc, and associate professor Huaidong Du, MD, PhD, told this news organization that, although they don’t know the reason for the difference, “there is clear evidence that colorectal cancer has a different incidence pattern in China, compared with Western countries. Other risk factors, like adiposity, may have a stronger effect on the risk of colorectal cancer in Western countries than in China.” Notably, the mean body mass index in the study population was around 23 kg/m², they said – by contrast in the United Kingdom it is 27.6 kg/m2.

Effects not necessarily causal

Ian Givens, PhD, professor of food chain nutrition at the University of Reading (England), said the study was “potentially very important for Chinese people, if it can be confirmed that dairy products affect the risk of breast and/or liver cancer differently in Chinese subjects to those in Western Societies, especially as dairy consumption in China is much lower than in most Western diets.”

He added: “As always it needs to be kept in mind that this type of study can only establish associations with disease risk, not cause.”

Dr. Kakkoura, nutritional epidemiologist at Oxford (England) University’s department of population health, said: “This was the first major study to investigate the link between dairy products and cancer risk in a Chinese population. Further studies are needed to validate these current findings, establish if these associations are causal, and investigate the potential underlying mechanisms involved.”

The researchers said that, while the results do not prove causation, “there are several plausible biological mechanisms that may explain these associations.” They pointed to higher dairy consumption potentially increasing levels of insulinlike growth factor-I, known to promote cell proliferation and associated with higher risks of several types of cancer.

In addition, estrogen and progesterone present in cows’ milk may play a role in increasing breast cancer risk, whilst saturated and trans-fatty acids from dairy products may increase the risk of liver cancer. As many Chinese people are lactase deficient, dairy products may also be broken down into products that affect cancer risk.

No justification for dietary change

Confounding factors may also have influenced the results, commented Duane Mellor, PhD, RD, RNutr, registered dietitian and senior teaching fellow at Aston University, Birmingham, England. “Those in the study who consumed dairy were more likely to live in cities and have other health conditions, including cardiovascular disease and diabetes – although some of these factors were considered in the analysis, not all of these covariates were, which could influence the findings.

“In my view this study alone does not provide strong evidence that reducing dairy intake would reduce cancer risk.”

He added: “Although the paper suggests a 12% increased relative risk for female breast cancer, this does not equate to 12 more cases per 100 individuals – in absolute terms this would be more like 1 or 2 cases per 1,000 people.”

Similarly, Kevin McConway, PhD, emeritus professor of applied statistics at the Open University, Milton Keynes, England, said: “An issue is that there were many differences between the people that consumed different amounts of dairy products, apart from their difference in dairy consumption. For instance, of those who never or rarely consumed dairy products, fewer than a third lived in urban areas, but of regular dairy consumers (at least once a week), 83% lived in urban areas. Regular consumers were considerably more likely to be well educated than those who never or rarely consumed dairy products, and there were other differences too. 

“So if, as the researchers found, a greater proportion of the regular consumers than of the never or rare consumers had a cancer diagnosis, that could have been because of their different dairy consumption, or it could have been (in part or entirely) because of the different places they lived, or their different education levels, or any of the other factors on which the groups differed.

“One can never be sure that all the relevant factors have been adjusted for. That’s why the researchers rightly say that these results can’t establish whether the associations between dairy consumption and the risks of some cancers, that they found, are there because the dairy consumption differences change the cancer risks in a cause-and-effect way. They might, or they might not.”

He cautioned: “I don’t think anyone should decide to change their individual diet solely because of the results of this new study.”

Commenting on the study, Fiona Osgun, senior health information manager at Cancer Research UK, London, told this news organization: “This early-stage study found an association between dairy consumption and the risks of certain cancers, but that doesn’t mean that they’re causing them or that people need to avoid dairy. Dairy products can be part of a healthy balanced diet and, in the U.K., the Food Standards Agency regulates them to make sure they’re safe. There’s good evidence that dairy reduces the risk of bowel cancer, but no clear evidence for other cancer types, and this is no different for people who are lactose intolerant.”

A version of this article first appeared on Medscape UK.

A relationship between consumption of dairy products and risk of various cancers has been intensively investigated in the past but yielded inconclusive or conflicting results. Now a large new study comparing Chinese dairy consumption with that in the United Kingdom, shows that increased dairy consumption was linked to higher risks of liver cancer and female breast cancer.

The study, by researchers from Oxford University’s department of population health, and Peking University and the Chinese Academy of Medical Sciences in Beijing, used data from the China Kadoorie Biobank Study, a long-term prospective study involving more than over 510,000 participants recruited from 10 geographically diverse areas across China, including both rural and urban regions. They compared this to data from the UK biobank.

Subjects were 59% female, 41% male, aged 30-79 years, and had no history of cancer at recruitment between 2004 and 2008. Food questionnaires were completed at the outset and participants followed for an average of 11 years, using national cancer and death registries and health insurance records to identify new cancer diagnoses, including both fatal and nonfatal events.

Participants were categorized into three groups according to how often they consumed dairy products (primarily milk):

• Regular consumers (at least once a week): 20.4% of the cohort.
• Monthly consumers: 11.1%.
• Nonconsumers who never or rarely consumed dairy products: 68.5%.

Average dairy consumption was 37.9 g/day overall and 80.8 g/day among regular consumers. This compares with an average consumption of around 300 g/day in participants in the UK Biobank cohort.

Over the course of the study, 29,277 new cancer cases were recorded, including 6,282 lung, 2,582 female breast, 3,577 stomach, 3,350 colorectal, and 3,191 liver cancer cases.

Analyses correlating cases with consumption took into account a range of other factors potentially affecting cancer risk, including age, sex, region, family history of cancer, socioeconomic status (education and income), lifestyle factors (alcohol intake, smoking, physical activity, soy consumption, and fresh fruit intake), body mass index, chronic hepatitis B virus infection, and female reproductive factors.

Higher dairy intakes linked with risk of liver and breast cancers

Results revealed that higher regular dairy intake was associated with significantly higher risks of liver cancer and female breast cancer, both common types of cancer in China. Analyses indicated that for each 50-g/day intake, the risks increased by 12% and 17%, respectively.

There was also an increase in total cancer diagnoses, and an increased risk of lymphoma, though this was not statistically significant after correction for confounders. No association was found between dairy products and colorectal cancer, prostate cancer, or any other site-specific cancer.

The research, published in BMC Medicine, is the first major study to investigate dairy consumption and cancer risk in Chinese adults. The results conflict with previous studies on Western populations, which have suggested that dairy products may be associated with a lower risk of colorectal cancer and a higher risk of prostate cancer but have found no clear link for breast or other types of cancer.

Lead researchers Maria Kakkoura, PhD, MSc, and associate professor Huaidong Du, MD, PhD, told this news organization that, although they don’t know the reason for the difference, “there is clear evidence that colorectal cancer has a different incidence pattern in China, compared with Western countries. Other risk factors, like adiposity, may have a stronger effect on the risk of colorectal cancer in Western countries than in China.” Notably, the mean body mass index in the study population was around 23 kg/m², they said – by contrast in the United Kingdom it is 27.6 kg/m2.

Effects not necessarily causal

Ian Givens, PhD, professor of food chain nutrition at the University of Reading (England), said the study was “potentially very important for Chinese people, if it can be confirmed that dairy products affect the risk of breast and/or liver cancer differently in Chinese subjects to those in Western Societies, especially as dairy consumption in China is much lower than in most Western diets.”

He added: “As always it needs to be kept in mind that this type of study can only establish associations with disease risk, not cause.”

Dr. Kakkoura, nutritional epidemiologist at Oxford (England) University’s department of population health, said: “This was the first major study to investigate the link between dairy products and cancer risk in a Chinese population. Further studies are needed to validate these current findings, establish if these associations are causal, and investigate the potential underlying mechanisms involved.”

The researchers said that, while the results do not prove causation, “there are several plausible biological mechanisms that may explain these associations.” They pointed to higher dairy consumption potentially increasing levels of insulinlike growth factor-I, known to promote cell proliferation and associated with higher risks of several types of cancer.

In addition, estrogen and progesterone present in cows’ milk may play a role in increasing breast cancer risk, whilst saturated and trans-fatty acids from dairy products may increase the risk of liver cancer. As many Chinese people are lactase deficient, dairy products may also be broken down into products that affect cancer risk.

No justification for dietary change

Confounding factors may also have influenced the results, commented Duane Mellor, PhD, RD, RNutr, registered dietitian and senior teaching fellow at Aston University, Birmingham, England. “Those in the study who consumed dairy were more likely to live in cities and have other health conditions, including cardiovascular disease and diabetes – although some of these factors were considered in the analysis, not all of these covariates were, which could influence the findings.

“In my view this study alone does not provide strong evidence that reducing dairy intake would reduce cancer risk.”

He added: “Although the paper suggests a 12% increased relative risk for female breast cancer, this does not equate to 12 more cases per 100 individuals – in absolute terms this would be more like 1 or 2 cases per 1,000 people.”

Similarly, Kevin McConway, PhD, emeritus professor of applied statistics at the Open University, Milton Keynes, England, said: “An issue is that there were many differences between the people that consumed different amounts of dairy products, apart from their difference in dairy consumption. For instance, of those who never or rarely consumed dairy products, fewer than a third lived in urban areas, but of regular dairy consumers (at least once a week), 83% lived in urban areas. Regular consumers were considerably more likely to be well educated than those who never or rarely consumed dairy products, and there were other differences too. 

“So if, as the researchers found, a greater proportion of the regular consumers than of the never or rare consumers had a cancer diagnosis, that could have been because of their different dairy consumption, or it could have been (in part or entirely) because of the different places they lived, or their different education levels, or any of the other factors on which the groups differed.

“One can never be sure that all the relevant factors have been adjusted for. That’s why the researchers rightly say that these results can’t establish whether the associations between dairy consumption and the risks of some cancers, that they found, are there because the dairy consumption differences change the cancer risks in a cause-and-effect way. They might, or they might not.”

He cautioned: “I don’t think anyone should decide to change their individual diet solely because of the results of this new study.”

Commenting on the study, Fiona Osgun, senior health information manager at Cancer Research UK, London, told this news organization: “This early-stage study found an association between dairy consumption and the risks of certain cancers, but that doesn’t mean that they’re causing them or that people need to avoid dairy. Dairy products can be part of a healthy balanced diet and, in the U.K., the Food Standards Agency regulates them to make sure they’re safe. There’s good evidence that dairy reduces the risk of bowel cancer, but no clear evidence for other cancer types, and this is no different for people who are lactose intolerant.”

A version of this article first appeared on Medscape UK.

A relationship between consumption of dairy products and risk of various cancers has been intensively investigated in the past but yielded inconclusive or conflicting results. Now a large new study comparing Chinese dairy consumption with that in the United Kingdom, shows that increased dairy consumption was linked to higher risks of liver cancer and female breast cancer.

The study, by researchers from Oxford University’s department of population health, and Peking University and the Chinese Academy of Medical Sciences in Beijing, used data from the China Kadoorie Biobank Study, a long-term prospective study involving more than over 510,000 participants recruited from 10 geographically diverse areas across China, including both rural and urban regions. They compared this to data from the UK biobank.

Subjects were 59% female, 41% male, aged 30-79 years, and had no history of cancer at recruitment between 2004 and 2008. Food questionnaires were completed at the outset and participants followed for an average of 11 years, using national cancer and death registries and health insurance records to identify new cancer diagnoses, including both fatal and nonfatal events.

Participants were categorized into three groups according to how often they consumed dairy products (primarily milk):

• Regular consumers (at least once a week): 20.4% of the cohort.
• Monthly consumers: 11.1%.
• Nonconsumers who never or rarely consumed dairy products: 68.5%.

Average dairy consumption was 37.9 g/day overall and 80.8 g/day among regular consumers. This compares with an average consumption of around 300 g/day in participants in the UK Biobank cohort.

Over the course of the study, 29,277 new cancer cases were recorded, including 6,282 lung, 2,582 female breast, 3,577 stomach, 3,350 colorectal, and 3,191 liver cancer cases.

Analyses correlating cases with consumption took into account a range of other factors potentially affecting cancer risk, including age, sex, region, family history of cancer, socioeconomic status (education and income), lifestyle factors (alcohol intake, smoking, physical activity, soy consumption, and fresh fruit intake), body mass index, chronic hepatitis B virus infection, and female reproductive factors.

Higher dairy intakes linked with risk of liver and breast cancers

Results revealed that higher regular dairy intake was associated with significantly higher risks of liver cancer and female breast cancer, both common types of cancer in China. Analyses indicated that for each 50-g/day intake, the risks increased by 12% and 17%, respectively.

There was also an increase in total cancer diagnoses, and an increased risk of lymphoma, though this was not statistically significant after correction for confounders. No association was found between dairy products and colorectal cancer, prostate cancer, or any other site-specific cancer.

The research, published in BMC Medicine, is the first major study to investigate dairy consumption and cancer risk in Chinese adults. The results conflict with previous studies on Western populations, which have suggested that dairy products may be associated with a lower risk of colorectal cancer and a higher risk of prostate cancer but have found no clear link for breast or other types of cancer.

Lead researchers Maria Kakkoura, PhD, MSc, and associate professor Huaidong Du, MD, PhD, told this news organization that, although they don’t know the reason for the difference, “there is clear evidence that colorectal cancer has a different incidence pattern in China, compared with Western countries. Other risk factors, like adiposity, may have a stronger effect on the risk of colorectal cancer in Western countries than in China.” Notably, the mean body mass index in the study population was around 23 kg/m², they said – by contrast in the United Kingdom it is 27.6 kg/m2.

Effects not necessarily causal

Ian Givens, PhD, professor of food chain nutrition at the University of Reading (England), said the study was “potentially very important for Chinese people, if it can be confirmed that dairy products affect the risk of breast and/or liver cancer differently in Chinese subjects to those in Western Societies, especially as dairy consumption in China is much lower than in most Western diets.”

He added: “As always it needs to be kept in mind that this type of study can only establish associations with disease risk, not cause.”

Dr. Kakkoura, nutritional epidemiologist at Oxford (England) University’s department of population health, said: “This was the first major study to investigate the link between dairy products and cancer risk in a Chinese population. Further studies are needed to validate these current findings, establish if these associations are causal, and investigate the potential underlying mechanisms involved.”

The researchers said that, while the results do not prove causation, “there are several plausible biological mechanisms that may explain these associations.” They pointed to higher dairy consumption potentially increasing levels of insulinlike growth factor-I, known to promote cell proliferation and associated with higher risks of several types of cancer.

In addition, estrogen and progesterone present in cows’ milk may play a role in increasing breast cancer risk, whilst saturated and trans-fatty acids from dairy products may increase the risk of liver cancer. As many Chinese people are lactase deficient, dairy products may also be broken down into products that affect cancer risk.

No justification for dietary change

Confounding factors may also have influenced the results, commented Duane Mellor, PhD, RD, RNutr, registered dietitian and senior teaching fellow at Aston University, Birmingham, England. “Those in the study who consumed dairy were more likely to live in cities and have other health conditions, including cardiovascular disease and diabetes – although some of these factors were considered in the analysis, not all of these covariates were, which could influence the findings.

“In my view this study alone does not provide strong evidence that reducing dairy intake would reduce cancer risk.”

He added: “Although the paper suggests a 12% increased relative risk for female breast cancer, this does not equate to 12 more cases per 100 individuals – in absolute terms this would be more like 1 or 2 cases per 1,000 people.”

Similarly, Kevin McConway, PhD, emeritus professor of applied statistics at the Open University, Milton Keynes, England, said: “An issue is that there were many differences between the people that consumed different amounts of dairy products, apart from their difference in dairy consumption. For instance, of those who never or rarely consumed dairy products, fewer than a third lived in urban areas, but of regular dairy consumers (at least once a week), 83% lived in urban areas. Regular consumers were considerably more likely to be well educated than those who never or rarely consumed dairy products, and there were other differences too. 

“So if, as the researchers found, a greater proportion of the regular consumers than of the never or rare consumers had a cancer diagnosis, that could have been because of their different dairy consumption, or it could have been (in part or entirely) because of the different places they lived, or their different education levels, or any of the other factors on which the groups differed.

“One can never be sure that all the relevant factors have been adjusted for. That’s why the researchers rightly say that these results can’t establish whether the associations between dairy consumption and the risks of some cancers, that they found, are there because the dairy consumption differences change the cancer risks in a cause-and-effect way. They might, or they might not.”

He cautioned: “I don’t think anyone should decide to change their individual diet solely because of the results of this new study.”

Commenting on the study, Fiona Osgun, senior health information manager at Cancer Research UK, London, told this news organization: “This early-stage study found an association between dairy consumption and the risks of certain cancers, but that doesn’t mean that they’re causing them or that people need to avoid dairy. Dairy products can be part of a healthy balanced diet and, in the U.K., the Food Standards Agency regulates them to make sure they’re safe. There’s good evidence that dairy reduces the risk of bowel cancer, but no clear evidence for other cancer types, and this is no different for people who are lactose intolerant.”

A version of this article first appeared on Medscape UK.

A study presented at ESMO Breast Cancer 2022 documents a “significant long-term benefit” among women with breast cancer who were treated with tamoxifen.

The study was a secondary analysis of women with estrogen receptor (ER)-positive HER2-negative breast cancer who were treated between 1976 and 1996 in Sweden.

“Our findings suggest a significant long-term tamoxifen treatment benefit among patients with larger tumors, lymph node-negative tumors, PR-positive tumors, and Ki-67 low tumors,” according to Huma Dar, a doctoral candidate at Karolinska Institute, Stockholm, who authored the study.

The analysis found that patients with tumor size T1c, grade 2, lymph node-negative, PR-positive, and Ki-67-low tumors significantly benefited from treatment with tamoxifen for 20 years. And, for patients with tumor size T2-3, benefited significantly after 10 years of treatment with tamoxifen.

It is known that breast cancer patients with ER-positive tumors have a greater risk of distant recurrence – cancer spreading to tissues and organs far from the original tumor site. The selective estrogen receptor modulator tamoxifen, when used as an adjuvant therapy, has been shown to reduce the risk of tumor recurrence and increase survival in patients with ER-positive breast cancer, but not all patients benefit from this therapy.

To examine the long-term benefit of tamoxifen, Ms. Dar and colleagues analyzed data from randomized clinical trials of tamoxifen that took place in Stockholm between 1976 and 1997. The study included 1,242 patients with ER-positive/HER2-negative breast cancer and included a 20-year follow-up. Researchers looked at the relationship between tumor characteristics – including size, grade, lymph node status, the presence of progesterone receptor (PR), and levels of Ki-67, a protein linked with cell proliferation – and patient outcomes. 

In a related study published last year in JAMA Network Open, Ms. Dar and colleagues examined the long-term effects of tamoxifen in patients with low risk, postmenopausal, and lymph-node negative cancer. They found that patients with larger tumors, lower tumor grade and PR-positive tumors appeared to significantly benefit from tamoxifen treatment for up to 25 years. The team has since extended that work by looking at pre- and postmenopausal as well as low- and high-risk patients, Ms. Dar said. 

“We believe that our findings together with other study findings are important to understand the lifetime risk for patients diagnosed with breast cancer,” Ms. Dar said. “One potential clinical implication is related to tamoxifen benefit, which in our study we don’t see for patients with the smallest tumors.” She said that more studies are needed to confirm this result.

A limitation of this study is that clinical recommendations for disease management and treatment have changed since the initiation of the clinical trials. “The STO-trials were performed before aromatase inhibitors or ovarian function suppression became one of the recommended treatment options for ER-positive breast cancer, and when the duration of tamoxifen therapy was shorter than current recommendations,” Ms. Dar said.

The study was funded by the Swedish Research Council, Swedish Research Council for Health, Working life and Welfare, The Gösta Milton Donation Fund, and Swedish Cancer Society. The authors had no relevant disclosures.

A study presented at ESMO Breast Cancer 2022 documents a “significant long-term benefit” among women with breast cancer who were treated with tamoxifen.

The study was a secondary analysis of women with estrogen receptor (ER)-positive HER2-negative breast cancer who were treated between 1976 and 1996 in Sweden.

“Our findings suggest a significant long-term tamoxifen treatment benefit among patients with larger tumors, lymph node-negative tumors, PR-positive tumors, and Ki-67 low tumors,” according to Huma Dar, a doctoral candidate at Karolinska Institute, Stockholm, who authored the study.

The analysis found that patients with tumor size T1c, grade 2, lymph node-negative, PR-positive, and Ki-67-low tumors significantly benefited from treatment with tamoxifen for 20 years. And, for patients with tumor size T2-3, benefited significantly after 10 years of treatment with tamoxifen.

It is known that breast cancer patients with ER-positive tumors have a greater risk of distant recurrence – cancer spreading to tissues and organs far from the original tumor site. The selective estrogen receptor modulator tamoxifen, when used as an adjuvant therapy, has been shown to reduce the risk of tumor recurrence and increase survival in patients with ER-positive breast cancer, but not all patients benefit from this therapy.

To examine the long-term benefit of tamoxifen, Ms. Dar and colleagues analyzed data from randomized clinical trials of tamoxifen that took place in Stockholm between 1976 and 1997. The study included 1,242 patients with ER-positive/HER2-negative breast cancer and included a 20-year follow-up. Researchers looked at the relationship between tumor characteristics – including size, grade, lymph node status, the presence of progesterone receptor (PR), and levels of Ki-67, a protein linked with cell proliferation – and patient outcomes. 

In a related study published last year in JAMA Network Open, Ms. Dar and colleagues examined the long-term effects of tamoxifen in patients with low risk, postmenopausal, and lymph-node negative cancer. They found that patients with larger tumors, lower tumor grade and PR-positive tumors appeared to significantly benefit from tamoxifen treatment for up to 25 years. The team has since extended that work by looking at pre- and postmenopausal as well as low- and high-risk patients, Ms. Dar said. 

“We believe that our findings together with other study findings are important to understand the lifetime risk for patients diagnosed with breast cancer,” Ms. Dar said. “One potential clinical implication is related to tamoxifen benefit, which in our study we don’t see for patients with the smallest tumors.” She said that more studies are needed to confirm this result.

A limitation of this study is that clinical recommendations for disease management and treatment have changed since the initiation of the clinical trials. “The STO-trials were performed before aromatase inhibitors or ovarian function suppression became one of the recommended treatment options for ER-positive breast cancer, and when the duration of tamoxifen therapy was shorter than current recommendations,” Ms. Dar said.

The study was funded by the Swedish Research Council, Swedish Research Council for Health, Working life and Welfare, The Gösta Milton Donation Fund, and Swedish Cancer Society. The authors had no relevant disclosures.

A study presented at ESMO Breast Cancer 2022 documents a “significant long-term benefit” among women with breast cancer who were treated with tamoxifen.

The study was a secondary analysis of women with estrogen receptor (ER)-positive HER2-negative breast cancer who were treated between 1976 and 1996 in Sweden.

“Our findings suggest a significant long-term tamoxifen treatment benefit among patients with larger tumors, lymph node-negative tumors, PR-positive tumors, and Ki-67 low tumors,” according to Huma Dar, a doctoral candidate at Karolinska Institute, Stockholm, who authored the study.

The analysis found that patients with tumor size T1c, grade 2, lymph node-negative, PR-positive, and Ki-67-low tumors significantly benefited from treatment with tamoxifen for 20 years. And, for patients with tumor size T2-3, benefited significantly after 10 years of treatment with tamoxifen.

It is known that breast cancer patients with ER-positive tumors have a greater risk of distant recurrence – cancer spreading to tissues and organs far from the original tumor site. The selective estrogen receptor modulator tamoxifen, when used as an adjuvant therapy, has been shown to reduce the risk of tumor recurrence and increase survival in patients with ER-positive breast cancer, but not all patients benefit from this therapy.

To examine the long-term benefit of tamoxifen, Ms. Dar and colleagues analyzed data from randomized clinical trials of tamoxifen that took place in Stockholm between 1976 and 1997. The study included 1,242 patients with ER-positive/HER2-negative breast cancer and included a 20-year follow-up. Researchers looked at the relationship between tumor characteristics – including size, grade, lymph node status, the presence of progesterone receptor (PR), and levels of Ki-67, a protein linked with cell proliferation – and patient outcomes. 

In a related study published last year in JAMA Network Open, Ms. Dar and colleagues examined the long-term effects of tamoxifen in patients with low risk, postmenopausal, and lymph-node negative cancer. They found that patients with larger tumors, lower tumor grade and PR-positive tumors appeared to significantly benefit from tamoxifen treatment for up to 25 years. The team has since extended that work by looking at pre- and postmenopausal as well as low- and high-risk patients, Ms. Dar said. 

“We believe that our findings together with other study findings are important to understand the lifetime risk for patients diagnosed with breast cancer,” Ms. Dar said. “One potential clinical implication is related to tamoxifen benefit, which in our study we don’t see for patients with the smallest tumors.” She said that more studies are needed to confirm this result.

A limitation of this study is that clinical recommendations for disease management and treatment have changed since the initiation of the clinical trials. “The STO-trials were performed before aromatase inhibitors or ovarian function suppression became one of the recommended treatment options for ER-positive breast cancer, and when the duration of tamoxifen therapy was shorter than current recommendations,” Ms. Dar said.

The study was funded by the Swedish Research Council, Swedish Research Council for Health, Working life and Welfare, The Gösta Milton Donation Fund, and Swedish Cancer Society. The authors had no relevant disclosures.