Highlights from the 2014 Breast Cancer Symposium

Oct 24, 2014

  Elisa K. Chan, MD, discusses Abstract 1: “Improving screening mammography return rates in overdue women: A randomized study of signed reminder letters from family physicians.” 

The September 2014 meeting markedthe eighth anniversary of the BreastCancer Symposium, which focusedon “Enhancing Clinical Care ThroughCollaboration.” The Symposiumbrought together surgical, medical,and radiation specialists from theUnited States and abroad to exchangeideas, best practices, and research thatwill lead to future progress in breastcancer.

The Angelina effect

Angelina Jolie’s public announcementof her preventive double mastectomybecause of her BRCA mutation mayhave influenced a rise in BRCA testingrates at one Canadian Cancer Center(Abstract 44). That’s according to astudy that assessed the number ofgenetic counseling referrals made sixmonths before and after Ms. Jolie’sannouncement in May 2013. Thestudy found that post-announcement,the number of women referred forgenetic counseling increased by90% (from 483 to 916 patients),and the number of women who wenton to qualify for genetic testingincreased by 105% (from 213 to 437patients). Furthermore, the number ofBRCA1/2 carriers who were identifiedincreased by 110%, from 29 before theannouncement to 61 after.

Double mastectomy has higher riskof several complications

A study that looked at 30-daypostop complications in more than18,000 women with breast cancerundergoing bilateral mastectomy withreconstruction (BM/R) and unilateralmastectomy with breast reconstruction(UM/R) found that complications arerare (5.3%) for either type of surgery(Abstract 62). However, BM/R wasassociated with relatively highercomplication rates compared withsingle mastectomy. Among patientswho underwent implant-basedreconstruction, BM/R was associatedwith higher rates of implant loss (1%versus 0.7%) (adjusted odds ratio[aOR] 1.55; p = 0.02), transfusion (aOR2.20; p < 0.001), and reoperation (aOR 1.14; p = 0.05) compared toUM/R. Among patients who underwentautologous reconstruction, BM/Rwas associated with higher rates oftransfusion (aOR 2.34; p < 0.001)compared to UM/R.

“The era of genetic testing hasraised awareness about inheritedforms of breast cancer. However,for the average-risk patient withbreast cancer who does not have aninherited mutation, there is often anoverestimation of future risk, whichmay result in more extensive surgicalprocedures than are warranted,”said Julie Margenthaler, MD, ofWashington University School ofMedicine in St. Louis. “Women alsoneed to be informed about theincreased rates of implant loss,transfusion, and reoperation that areassociated with bilateral mastectomyand reconstruction versus unilateralmastectomy with reconstruction.”

Eleftherios P. Mamounas, MD, MPH, discusses
Abstract 61 “Locoregional recurrence (LRR) after
neoadjuvant chemotherapy (NAC): Pooled–
analysis results from the collaborative trials in
neoadjuvant breast cancer (CTNeoBC).” 

Improving return rates forwomen overdue for screeningmammography

A study out of the BC Cancer Agencyin British Columbia, Canada, found thatadding a signed letter from a familyphysician—in addition to the standardschedule of postcard reminders—improved the rates at which womenwho were overdue for mammographyreturned for screening (Abstract 1).The study randomly assigned 5,385women to two groups: those whoreceived the postcards only and thoseEleftherios P. Mamounas, MD, MPH, discusses Abstract 61 “Locoregional recurrence (LRR)after neoadjuvant chemotherapy (NAC): Pooled–analysis results from the collaborative trialsin neoadjuvant breast cancer (CTNeoBC).”who received the postcards plus thesigned letter. Within six months of thenotices being sent, 22.3% of patients(600) in the postcards arm returnedfor mammography, while 33.2%of patients (894) in the postcardsand letter arm returned (OR 1.7; p <0.0001).

Response to neoadjuvantchemotherapy and tumor subtypepredict loco-regional breast cancerrecurrence

An analysis of data on 11,995 womenfrom 12 large clinical trials foundthat tumor subtype and the cancer’spathologic response to neoadjuvantchemotherapy are strong predictorsof loco-regional recurrence (LRR) inwomen with stage I-III breast cancer(Abstract 61). Women with residualdisease in the breast and no cancerin the axillary lymph nodes afterneoadjuvant therapy had a 1.59 times(95% CI:1.15, 2.19) higher risk ofLRR, compared to women who had apathologic complete response (pCR)in the breast with negative axillarynodes; women with residual cancer inthe axillary lymph nodes had a 2.72times (95% CI: 2.03, 3.66) higher riskof LRR, compared to women who had apCR (p < 0.0001). Five-year cumulativeincidence of LRR varied significantly bybreast cancer subtype: 4.2% for HR+/HER2- and grade 1/2 tumors, 9.2% forHR+/HER2- and grade 3 tumors, 14.8%for HR-/HER2+ tumors, 9.7% for HR+/HER2+ tumors, and 12.2% for HR-/HER2- tumors.

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