Search

Rates of lumpectomy for breast cancer management in the United States previously declined in favor of more aggressive surgical options, such as mastectomy and contralateral prophylactic mastectomy (CPM).To evaluate longitudinal trends in the rates of lumpectomy and mastectomy, including unilateral mastectomy vs CPM rates, and to determine characteristics associated with current surgical practice using 3 national data sets.Data from the National Surgical Quality Improvement Program (NSQIP), Surveillance, Epidemiology, and End Results (SEER) program, and National Cancer Database (NCDB) were examined to evaluate trends in lumpectomy and mastectomy rates from 2005 through 2017. Mastectomy rates were also evaluated with a focus on CPM. Longitudinal trends were analyzed using the Cochran-Armitage test for trend. Multivariate logistic regression models were performed on the NCDB data set to identify predictors of lumpectomy and CPM.A study sample of 3 467 645 female surgical breast cancer patients was analyzed. Lumpectomy rates reached a nadir between 2010 and 2013, with a significant increase thereafter. Conversely, in comparison with lumpectomy rates, overall mastectomy rates declined significantly starting in 2013. Cochran-Armitage trend tests demonstrated an annual decrease in lumpectomy rates of 1.31% (95% CI, 1.30%-1.32%), 0.07% (95% CI, 0.01%-0.12%), and 0.15% (95% CI, 0.15%-0.16%) for NSQIP, SEER, and NCDB, respectively, from 2005 to 2013 (P .001, P = .01, and P .001, respectively). From 2013 to 2017, the annual increase in lumpectomy rates was 0.96% (95% CI, 0.95%-0.98%), 1.60% (95% CI, 1.59%-1.62%), and 1.66% (95% CI, 1.65%-1.67%) for NSQIP, SEER, and NCDB, respectively (all P .001). Comparisons of specific mastectomy types showed that unilateral mastectomy and CPM rates stabilized after 2013, with unilateral mastectomy rates remaining higher than CPM rates throughout the entire time period.This observational longitudinal analysis indicated a trend reversal with an increase in lumpectomy rates since 2013 and an associated decline in mastectomies. The steady increase in CPM rates from 2005 to 2013 has since stabilized. The reasons for the recent reversal in trends are likely multifactorial. Further qualitative and quantitative research is required to understand the factors driving these recent practice changes and their associations with patient-reported outcomes.

Background Nipple-sparing mastectomy is associated with a higher risk of mastectomy skin-flap necrosis than conventional skin-sparing mastectomy. There are limited prospective data examining modifiable intraoperative factors that contribute to skin-flap necrosis after nipple-sparing mastectomy. Methods Data on consecutive patients undergoing nipple-sparing mastectomy between April 2018 and December 2020 were recorded prospectively. Relevant intraoperative variables were documented by both breast and plastic surgeons at the time of surgery. The presence and extent of nipple and/or skin-flap necrosis was documented at the first postoperative visit. Necrosis treatment and outcome was documented at 8–10 weeks after surgery. The association of clinical and intraoperative variables with nipple and skin-flap necrosis was analysed, and significant variables were included in a multivariable logistic regression analysis with backward selection. Results Some 299 patients underwent 515 nipple-sparing mastectomies (54.8 per cent (282 of 515) prophylactic, 45.2 per cent therapeutic). Overall, 23.3 per cent of breasts (120 of 515) developed nipple or skin-flap necrosis; 45.8 per cent of these (55 of 120) had nipple necrosis only. Among 120 breasts with necrosis, 22.5 per cent had superficial, 60.8 per cent had partial, and 16.7 per cent had full-thickness necrosis. On multivariable logistic regression analysis, significant modifiable intraoperative predictors of necrosis included sacrificing the second intercostal perforator (P = 0.006), greater tissue expander fill volume (P < 0.001), and non-lateral inframammary fold incision placement (P = 0.003). Conclusion Modifiable intraoperative factors that may decrease the likelihood of necrosis after nipple-sparing mastectomy include incision placement in the lateral inframammary fold, preserving the second intercostal perforating vessel, and minimizing tissue expander fill volume.

Background: More than 12,000 new diagnoses of breast cancer occur annually in women Citation Format: Shari B Goldfarb, Bridgette Thom, Cassandra Chang, Nadia Abdo, Andrea Carpio, Rosemary Semler, Catherine Benedict, Patricia Hershberger, Joanne F Kelvin, Mary L Gemignani. Decisions and outcomes of young women with breast cancer regarding fertility preservation before cancer treatment and family building after treatment [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-03.

Background: BREAST-Q is a widely accepted patient reported outcome measure (PROM) for breast surgery patients. BREAST-Q has been challenging to implement for clinical practice, due to insufficient understanding of clinical factors influencing BREAST-Q scores and lack of reference values for score interpretation. As a result, the clinical applicability of the BREAST-Q is limited, and benefits of routine PROM implementation on care quality have not been realized for breast surgery patients. This study finds predictors impacting long-term scores for the BREAST-Q Breast Conserving Therapy (BCT) module and determines reference values to guide score interpretation in clinical practice. Methods: A retrospective review of BCT patients at Memorial Sloan Kettering Cancer Center was conducted. All patients completed at least one BREAST-Q in 2018-2020. Patient characteristics were collected, including age, BMI, race, smoking status, chemotherapy, radiation therapy (RT), and axillary surgery (sentinel lymph node biopsy, axillary lymph node dissection). BREAST-Q was collected routinely during clinical visits as part of standard of care. Linear regression measured the impact of patient characteristics on 1 year and 2 year BREAST-Q scores. Median scores at baseline and 2 weeks, 6 months, 1 year, and 2 years after surgery were determined for RT and No RT patients. Pearson’s Chi-square and Student t-tests were used for categorical and continuous variables, respectively. Based on prior literature, a minimal clinically important difference of 4 points was used (scale 0-100). Results: 1866 BCT patients were included. Average age was 58.9(11.4) with BMI of 27.9(6.4). Patients were primarily white (76.8%) and non-smokers (89.7%); 36.8% had chemotherapy, 74.7% had axillary surgery, and 73.3% had RT. Regression analysis showed age and race as significant predictors of Satisfaction with Breast and Physical Wellbeing scores (Table 1). RT was a clinically significant predictor for Physical Wellbeing, reducing scores by 4.5 points at 1 year and 4.6 points at 2 years. Reference values were then created for RT and No RT patients. (Table 2). Conclusions: This study found factors impacting satisfaction and physical wellbeing after BCT using BREAST-Q scores of a longitudinal cohort of women and presented references values for score interpretation. Separate reference values were created based on RT as it is a significant predictor of BREAST-Q scores and omission of RT is increasingly offered to older women with low-risk breast cancer, given no survival benefit. These reference values can be incorporated into a user-friendly application or integrated into electronic medical records to help patients and physicians interpret BREAST-Q scores in a clinically meaningful way. Future research should assess the impact of early interventions targeting BCT patients below the 25th percentile (e.g. referrals to plastic surgeons or physical therapy) on BREAST-Q scores. Table 1.Multivariate analysis of BREAST-Q score predictors at 1 year and 2 years after surgerySatisfaction with BreastPhysical Wellbeing1 year2 year1 year2 yearScore changeSEp-valueScore changeSEp-valueScore changeSEp-valueScore changeSEp-valueAge0.1533.907p=0.0020.1280.068p=0.0610.2800.041p < 0.0010.2930.054p < 0.001BMI0.0190.0483p=0.821-0.2200.119p=0.065-0.0120.073p=0.867-0.1380.093p=0.141RaceWhiteReference--Reference--Reference--Reference--Black-7.3462.018p < 0.001-11.4652.876p < 0.001-7.4821.748p < 0.001-6.6512.259p=0.003Asian-1.4631.936p=0.450-1.5842.842p=0.578-2.2221.677p=0.185-0.3472.248p=0.878Other-3.7162.998p=0.2150.7904.451p=0.859-7.4672.575p=0.004-4.1963.495p=0.230Unknown1.4962.804p=0.5946.2213.914p=0.1120.2342.410p=0.923-1.9253.074p=0.531Smoking StatusNeverReference--Reference--Reference--Reference--Previous-1.2161.174p=0.300-1.4221.603p=0.375-1.5821.013p=0.119-1.0301.259p=0.414Current-1.7752.584p=0.492-3.3293.946p=0.399-3.8962.238p=0.082-8.0853.099p=0.009Unknown6.7652.384p=0.0059.4784.054p=0.1120.7612.064p=0.7136.1623.183p=0.531ChemotherapyNoReference--Reference--Reference--Reference--Yes-0.7401.148p=0.5190.3961.603p=0.805-3.3750.993p < 0.001-1.8101.262p=0.152Radiation TherapyNoReference--Reference--Reference--Reference--Yes-0.8961.293p=0.488-2.8961.830p=0.114-4.4951.118p < 0.001-4.6431.435p=0.001Axillary SurgeryNoReference--Reference--Reference--Reference--Yes-0.3581.319p=0.786-1.8711.948p=0.337-3.9091.140p < 0.001-3.6461.526p=0.017 Table 2.BREAST-Q reference values at 2 weeks, 6 months, 1 year, and 2 years after surgeryBaseline2 Weeks6 Months1 Year2 YearsRTSatisfaction with Breastsn=445-n=485n=1223n=65325th percentile53-63615950th percentile64-78757275th percentile82-100100100Physical Wellbeingn=483n=843n=486n=1228n=65125th percentile726060606650th percentile857176717675th percentile10082898989Psychosocial Wellbeingn=445-n=487n=1221n=65125th percentile62-66646650th percentile71-83838375th percentile87-100100100Sexual Wellbeingn=417-n=430n=1108n=58025th percentile46-48484850th percentile62-66666675th percentile70-798484No RTSatisfaction with Breastsn=172-n=186n=439n=22925th percentile48-67.5636350th percentile64-88827875th percentile82-100100100Physical Wellbeingn=184n=323n=188n=442n=23025th percentile726066717650th percentile897176828975th percentile1008289100100Psychosocial Wellbeingn=174-n=187n=437n=23025th percentile64-71666950th percentile74-87878775th percentile93-100100100Sexual Wellbeingn=161-n=158n=387n=19925th percentile43-535354.550th percentile62-66666675th percentile74-919191 Citation Format: Jacqueline J Chu, Jonas A Nelson, Paula Garcia, Babak J Mehrara, Andrea L Pusic, Monica Morrow, Mary L Gemignani, Audree B Tadros. Satisfaction and physical wellbeing after breast conserving therapy: Clinical predictors and reference values using the BREAST-Q [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-18-06.

Introduction: Although SSO/ASTRO consensus margin guidelines have led to decrease rate of re-excision, some women require additional surgery. Re-excision surgery may cause psychosocial stress and impact cosmetic outcomes and breast satisfaction. The purpose of this study was to assess patient-reported outcomes using the BREAST-Q breast satisfaction, psychosocial wellbeing, and sexual wellbeing subscales for women with breast cancer following index breast-conserving surgery (BCS). Methods: Women with stage 0 to 3 breast cancer undergoing BCS who completed a BREAST-Q from 2010 to 2016 were identified by retrospective review of a prospective database. The BREAST-Q breast conserving therapy module was used to assess outcomes between women with 1 BCS and those with ≥1 re-excision surgery (R-BCS). Baseline characteristics were compared, and linear mixed models were used to analyze associations with BREAST-Q scores over time. Results: Our study group was initially composed of 2570 women that was narrowed to 2549 women after excluding 21 who ultimately underwent mastectomy; 1982 (78%) had 1 BCS and 567 (22%) had ≥1 R-BCS. The median age of the cohort was 57 years (range 26-97). Women with 1 BCS were more likely to be older (p0.1). Chemotherapy and radiotherapy were associated with lower scores across all subscales (Table). Younger age was associated with lower psychosocial and sexual well-being scores (both p Multivariable analysis of BREAST-Q Subscale scoresEstimateStandard Errorp valueBreast SatisfactionAge at surgery-0.0690.0480.147BMI-0.1380.0810.088Chemotherapy-2.5421.0260.015Adjuvant radiation-3.4371.5830.031Hormonal therapy-0.6511.1700.119≥1 R-BCS vs. 1 BCS-2.5420.8840.008Psychosocial well-beingAge at surgery0.1980.043 Citation Format: Regina Matar, Meghan Flanagan, Sarah Fuzesi, Kathyrn Haglich, Shen Yin, Varadan Sevilimedu, Jonas Nelson, Mary L. Gemignani. The impact of breast conserving surgery re-excision on patient-reported outcomes using the BREAST-Q [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-02.

Pregnancy-associated breast cancer (PABC) and concurrent, or early development of, stage IV disease is uncommon. Given this rarity, and complexities surrounding pregnancy, data are limited regarding PABC treatment and outcomes. We evaluated oncologic, obstetric, and fetal outcomes of women with stage IV PABC in relation to presentation timing and treatment. Our retrospective review of an institutional database identified women with stage IV PABC from 1998 to 2018. PABC was defined as diagnosis during pregnancy or ≤ 1 year postpartum. Clinicopathologic, treatment, and outcome variables were compared between women diagnosed during pregnancy versus postpartum. We identified 77 women (median age 35 years; interquartile range [IQR] 32–37 years): 51 (66%) in the postpartum group and 26 (34%) in the pregnant group, including 9 with therapeutic or spontaneous abortion. Among 17 women who continued pregnancy, no obstetric or fetal complications were noted. Clinicopathologic and treatment variables did not differ between groups. Of 43 women dead from disease, 15 had triple negative (TN) tumors. Median overall survival (OS) of TN tumors was 14 months (range 5−39 months); OS was associated with hormone receptor-positive and human epidermal growth factor receptor 2 (HER2) positive tumors (p < 0.01). At 31 months (range 0−137 months) median follow-up, the 5-year OS was 34% (95% confidence interval 21–46%), and did not differ among pregnant and postpartum groups (p = 0.2). Women with stage IV TN PABC had high mortality rates despite multimodality therapy. Timing of presentation did not affect management decisions or OS, even for women who completed pregnancy. Further research to understand PABC biology, focusing on TN tumors, is warranted

Invasive lobular breast cancers (ILCs) respond poorly to neoadjuvant chemotherapy (NAC). The degree of benefit of NAC among non-classic ILC (NC-ILC) variants compared with classic ILCs (C-ILCs) is unknown.Consecutive patients with Stage I-III ILC treated from 2003 to 2019 with NAC and surgery were identified, and grouped as C-ILC or NC-ILC as per the original surgical pathology report, with pathologist (A.G.) review performed if original categorization was unclear. A subset of similarly treated invasive ductal cancers (IDCs) was identified for comparison. Clinicopathologic characteristics and pathologic complete response (pCR) rates were evaluated.Of 145 patients with ILC, 101 (70%) were C-ILC and 44 (30%) were NC-ILC (IDC cohort: 1157 patients). ILC patients were older, more often cT3/T4 and cN2/N3, and less often high-grade compared to IDC patients. Those with NC-ILC were less often ER+/HER2- (55% versus 93%), and more often HER2 + (25% versus 7%) and TN (21% versus 0%, all p 0.001). Breast pCR was more common among NC-ILC, but most frequent in IDC. Nodal pCR rates were also lowest among C-ILC patients, but similar among NC-ILC and IDC patients. On multivariable analysis, C-ILC (OR 0.09) and LVI (OR 0.51) were predictive of lack of breast pCR; non-ER+/HER2- subtypes and breast pCR were predictive of nodal pCR. When our analysis was repeated with patients stratified by receptor subtype, histology was not independently predictive of either breast or nodal pCR.NC-ILC patients were significantly more likely to achieve breast and nodal pCR compared with C-ILC patients, but when stratified by subtype, histology was not independently predictive of breast or nodal pCR.

Background Neoadjuvant chemotherapy (NAC) is an integral component of T4 breast cancer (BCa) treatment. We compared response to NAC for T4 BCa in the U.S. and Nigeria to direct future interventions. Materials and Methods Cross-sectional retrospective analysis included all patients with non-metastatic T4 BCa treated from 2010 to 2016 at Memorial Sloan Kettering Cancer Center (New York, New York) and Obafemi Awolowo University Teaching Hospitals Complex (Ile Ife, Nigeria). Pathologic complete response (pCR) and survival were compared and factors contributing to disparities evaluated. Results Three hundred and eight patients met inclusion criteria: 157 (51%) in the U.S. and 151 (49%) in Nigeria. All U.S. patients received NAC and surgery compared with 93 (62%) Nigerian patients. Fifty-six out of ninety-three (60%) Nigerian patients completed their prescribed course of NAC. In Nigeria, older age and higher socioeconomic status were associated with treatment receipt. Fewer patients in Nigeria had immunohistochemistry performed (100% U.S. vs. 18% Nigeria). Of those with available receptor subtype, 18% (28/157) of U.S. patients were triple negative versus 39% (9/23) of Nigerian patients. Overall pCR was seen in 27% (42/155) of U.S. patients and 5% (4/76) of Nigerian patients. Five-year survival was significantly shorter in Nigeria versus the U.S. (61% vs. 72%). However, among the subset of patients who received multimodality therapy, including NAC and surgery with curative intent, 5-year survival (67% vs. 72%) and 5-year recurrence-free survival (48% vs. 61%) did not significantly differ between countries. Conclusion Addressing health system, socioeconomic, and psychosocial barriers is necessary for administration of complete NAC to improve BCa outcomes in Nigeria. Implications for Practice This cross-sectional retrospective analysis of patients with T4 breast cancer in Nigeria and the U.S. found a significant difference in pathologic complete response to neoadjuvant chemotherapy (5% Nigeria vs. 27% U.S.). Five-year survival was shorter in Nigeria, but in patients receiving multimodality treatment, including neoadjuvant chemotherapy and surgery with curative intent, 5-year overall and recurrence-free survival did not differ between countries. Capacity-building efforts in Nigeria should focus on access to pathology services to direct systemic therapy and promoting receipt of complete chemotherapy to improve outcomes.

As neoadjuvant chemotherapy (NAC) for breast cancer has become more widely used, so has nipple-sparing mastectomy. A common criterion for eligibility is a 1 cm tumor-to-nipple distance (TND), but its suitability after NAC is unclear. In this study, we examined factors predictive of negative nipple pathologic status (NS−) in women undergoing total mastectomy after NAC. Women with invasive breast cancer treated with NAC and total mastectomy from August 2014 to April 2018 at our institution were retrospectively identified. Following review of pre- and post-NAC magnetic resonance imaging (MRI) and mammograms, the association of clinicopathologic and imaging variables with NS− was examined and the accuracy of 1 cm TND on imaging for predicting NS− was determined. Among 175 women undergoing 179 mastectomies, 74% of tumors were cT1-T2 and 67% were cN+ on pre-NAC staging; 10% (18/179) had invasive or in situ carcinoma in the nipple on final pathology. On multivariable analysis, after adjusting for age, grade, and tumor stage, three factors, namely number of positive nodes, pre-NAC nipple-areolar complex retraction, and decreasing TND, were significant predictors of nipple involvement (p

Background. The American Society of Clinical Oncology guidelines recommend timely referral to reproductive endocrinology and infertility (REI) specialists for young women diagnosed with breast cancer. There is a paucity of data evaluating the impact of FP on oncologic outcomes and timely initiation of chemotherapy. Methods. This retrospective review included all women age ≤ 45y diagnosed with stage I-III unilateral breast cancers at Memorial Sloan Kettering Cancer Center between 2009-2015 who received chemotherapy and consulted with an REI specialist. Factors associated with the decision to undergo FP were analyzed. Survival curves were constructed using the Kaplan-Meier method. Results. A total of 172 women were identified. Median age was 34y (interquartile range 31-37). The majority of women were single (n = 99, 58.1%) and nulliparous (n = 134, 77.9%). Most women underwent FP (n = 121, 70.3%). Tumor characteristics and treatments were similar between women who underwent FP and those who declined (Table 1). While white race was associated with decision to pursue FP, this association did not persist on multivariable analysis (MVA). Young age (p = 0.003), nulliparity (p = 0.001), referral from Breast Surgery (p = 0.009), and private insurance (p < 0.001) were independent predictors of FP on MVA. Timing of chemotherapy (adjuvant vs neoadjuvant) was not associated with decision to undergo FP. FP was not associated with breast cancer treatment delays. A total of 25.5% (n = 44) of women had a biological child following breast cancer treatment (Table 2). Women who underwent FP were more likely to have a biological child after breast cancer treatment. Race and insurance type were also associated with having a biological child after treatment, with white women and women with private insurance being more likely to have a biological child. MVA revealed that undergoing FP, being married, and being white were independent predictors of having a biological child. The 5-year overall survival (OS) was 97.5% (95% CI: 93.5-99.1%) and the 5-year recurrence-free survival (RFS) was 91.4% (95% CI: 85.9%-94.8%) with a median follow-up of 70 months (range 4-127). Five-year overall survival (OS) and recurrence-free survival (RFS) were similar between women who underwent FP and those who declined (OS: FP 98.2%, 95% CI 92.9%-99.5% vs 95.9%, 95% CI 84.6-98.9%, p = 0.20 and RFS: FP 92.1%, 95% CI: 85.4-95.8% vs declined 89.7%, 95% CI 76.9-95.6%, p = 0.42). Disease stage, race, and pregnancy were not associated with differences in OS or RFS. Private insurance was associated with improved OS but not with improved RFS. Conclusions. Most women underwent FP. Women pursued FP at high rates independent of the timing of chemotherapy and oncologic factors. These findings indicate that timely consultation with REI specialists is the key factor in completing FP, and highlight opportunities for improved education and counseling regarding FP. They also identify FP as a possible area of racial disparities within breast cancer care, and serve as a reminder of the complex interplay between socioeconomic factors, reproductive choices, and pregnancy outcomes. Table 1. Factors associated with decision to pursue cryopreservationFactorsDeclined Cryopreservation (n = 51)Cryopreservation (n = 121)p valueMedian Age, years (IQR)37 (32-40)33 (30-37)< 0.001RaceWhite26 (56.5%)86 (78.2%)0.015Black10 (21.7%)7 (6.3%)Asian9 (19.6%)15 (13.6%)Other1 (2.2%)2 (1.8%)Unknown511Insurance TypePrivate39 (76.5%)114 (94.2%)< 0.001Government11 (21.6%)4 (3.3%)Uninsured1 (2.0%)3 (2.5%)Single29 (56.9%)70 (57.9%)> 0.99Nulligravid21 (41.2%)80 (66.1%)0.004Nulliparous31 (60.8%)103 (85.1%)< 0.001Referring ServiceBreast Surgery24 (47.1%)87 (71.9%)0.004Breast Medicine26 (51.0%)33 (27.3%)Genetics/GYN1 (2.0%)1 (0.8%)Tumor GradeI2 (4.0%)2 (1.7%)0.52II7 (14.0%)14 (11.8%)III41 (82.0%)103 (86.6%)Unknown12Receptor ProfileER/PR+ HER2-31 (60.8%)64 (52.9%)0.74ER/PR+ HER2+8 (15.7%)27 (22.3%)ER/PR- HER2+2 (3.9%)4 (3.3%)Triple Negative10 (19.6%)26 (21.5%)StageI12 (23.5%)44 (36.4%)0.074II27 (52.9%)63 (52.1%)III12 (23.5%)14 (11.6%)Breast SurgeryLumpectomy19 (37%)38 (31.4%)0.57Mastectomy32 (63%)83 (68.6%)Systemic TherapyAdjuvant Chemotherapy43 (84.3%)104 (86.0%)0.97Median Time from Surgery to Chemotherapy, weeks (range)7 (4-19)7 (2-18)0.9Delay > 12 Weeks to Chemotherapy2 (4.7%)3 (2.9%)0.63Neoadjuvant Chemotherapy8 (15.7%)17 (14.0%)0.97Median Time from Diagnosis to NAC, weeks (range)3 (1-8)3 (2-12)0.29Delay > 6 weeks to chemotherapy start1 (12.5%)2 (11.8%)> 0.99Endocrine Therapy41 (80.4%)92 (76.0%)0.67Radiation TherapyAdjuvant Whole Breast Radiation Therapy16 (31.4%)38 (31.4%)0.99PMRT16 (31.4%)43 (35.5%)0.73IQR interquartile range, IDC invasive ductal carcinoma, ILC invasive lobular carcinoma, DCIS ductal carcinoma in situ, ER estrogen receptor. “Unknowns” were not included in percentage calculations or in univariate analysis. Table 2. Factors associated with having a biological child after breast cancer treatmentFactorsHad a biological child (n = 44)Did not have a biological child (n = 128)p valueCompleted fertility preservation40 (90.9%)81 (63.3%)0.001RaceWhite36 (90.0%)76 (65.5%)0.029Black1 (2.5%)16 (13.8%)Asian3 (7.5%)21 (18.1%)Other03 (2.6%)Unknown412Insurance TypePrivate40 (90.9%)113 (88.3%)0.020Government1 (2.3%)14 (10.9%)Uninsured3 (6.8%)1 (0.8%)Married30 (68.2%)43 (33.6%) 0.99II5 (11.9%)16 (12.6%)III36 (85.7%)108 (85.0%)Unknown21StageI19 (43.2%)37 (28.9%)0.21II19 (43.2%)71 (55.5%)III6 (13.6%)20 (15.6%)Breast Cancer TreatmentMastectomy32 (72.7%)83 (64.8%)0.44ALND15 (34.1%)51 (39.8%)0.62Systemic TherapyAdjuvant Chemotherapy39 (88.6%)108 (84.4%)0.66Neoadjuvant Chemotherapy5 (11.4%)20 (15.6%)Radiation Therapy26 (59.1%)87 (68.0%)0.38IDC invasive ductal carcinoma, ILC invasive lobular carcinoma, DCIS ductal carcinoma in situ, ER estrogen receptor. “Unknowns” were not included in percentage calculations or in univariate analysis. Citation Format: Angelena Crown, Shirin Muhsen, Varadan Sevilimedu, Joanne Kelvin, Shari B Goldfarb, Mary L Gemignani. Fertility preservation in young women with breast cancer: Impact on treatment and outcomes [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD12-05.

Background: Pregnancy-associated breast cancer (PABC) comprises breast cancer diagnosed during the gestational period or within the first year post-partum. PABC is associated with worse prognosis, especially for women diagnosed in the postpartum period. Methods: This is an IRB-approved retrospective review of an institutional database of women with stage 0-III PABC diagnosed between 1992 and 2019. Clinicopathologic features, treatments, and clinical outcomes were compared between women who were diagnosed with PABC during pregnancy and those who were diagnosed during lactation (1-12 months after delivery). Comparisons were made using Fisher’s exact tests and chi-square tests of independence. Results: A total of 341 women were identified; 131 (38%) diagnosed during pregnancy (pregnancy associated, PA) and 210 (62%) diagnosed post-partum during lactation (lactation associated, LA). Median age for the cohort was 36 (25-46). Median follow-up was 73 months (range, 11-325). Among women with PA diagnoses, 35% (n = 46) presented with breast masses during first trimester, 32% (n = 42) and 33% (n = 43) presented during second and third trimester, respectively; 28% (n = 36) of pregnancies ended in miscarriage or abortion. Fifty-five percent (n = 116) of LA diagnoses were within 6 months of delivery while 44% (n = 92) were between 6-12 months of delivery. The study population was Caucasian (n = 272, 80%), Black (n=26, 7.6%) and Asian (n = 27, 7.9%). Presenting T-stage, N-stage, and AJCC stage were similar between groups. HR+/HER-2-was the most common subtype in both groups (PA n = 49, 37% vs LA n = 71, 34%, p = 0.6). Distribution of other breast cancer receptor profiles were similar between groups (Table). Chemotherapy was administered to 94% (n = 321) of women; 229, 67% as adjuvant and 92, 27% as neoadjuvant (NAC). 72% of women received ddAC-T. Median time to chemo was 3 weeks (range 1-13) for NAC compared to 4 weeks (range 1-16) for adjuvant. Breast cancer treatment was deferred until after delivery for the PA group in 85 women, 65%. Median time from histologic diagnosis to any treatment was 4 weeks (range, 1-22) for PA group and 4 weeks (range 1-17) for LA group. Radiation therapy was received by most women (n = 194, 57%). Endocrine therapy receipt was also common (n = 168, 93% of women with hormone receptor (HR) positive tumors). Patterns of recurrence were similar between groups with most patients in both groups experiencing no recurrence (PA n = 82, 63% vs LA n = 158, 75%, p = 0.10). Differences were observed in disease status with PA having higher rates of women alive with disease (PA n = 16, 12% vs LA n = 12, 5.7%, p = 0.002) and a lower rate of women with no evidence of disease (PA n = 87, 66% vs LA n = 172, 82%, p = 0.002). Conclusions: Clinicopathologic features were similar between women in both PA and LA groups. Despite these similarities, PA appeared to be associated with higher rates of women alive with disease and lower rates of women with no evidence of disease. Although median time from histologic diagnosis to treatment was similar between PA and LA groups, 65% of women in the PA group had treatment delayed until after delivery, which could potentially impact oncologic outcomes. This highlights the balance between fetal and maternal factors in treatment decisions including possible patient or physician reluctance to treat during pregnancy. Further study is necessary to evaluate this finding. Table 1. Clinicopathologic features and outcomes associated with PABCCharacteristicPregnancy Associated, n=131*Lactation Associated, n=210*p-value**Presenting T02 (1.5%)2 (1.0%)0.3147 (36%)98 (47%)267 (51%)85 (40%)310 (7.6%)19 (9.0%)45 (3.8%)6 (2.9%)Presenting N Stage054 (41%)97 (46%)0.2177 (59%)109 (52%)20 (0%)4 (1.9%)AJCC Stage02 (1.5%)2 (1.0%)0.5126 (20%)54 (26%)261 (47%)99 (47%)342 (32%)55 (26%)SubtypeTN45 (34%)59 (28%)0.3HR+/HER2-49 (37%)71 (34%)0.6HR+/HER2+21 (16%)30 (14%)0.8HR-/HER2+10 (7.6%)31 (15%)0.072RecurrenceContralateral Breast3 (2.3%)5 (2.4%)0.10Distant33 (25%)31 (15%)Ipsilateral LRR9 (6.9%)13 (6.2%) No Recurrence82 (63%)158 (75%)Simultaneous LRR and Distant4 (3.1%)3 (1.4%)Disease StatusAWD16 (12%)12 (5.7%)0.002DOC3 (2.3%)0 (0%)DOD25 (19%)26 (12%) NED87 (66%)172 (82%)*Statistics presented: n (%); **Statistical tests performed: Fisher's exact test; chi-square test of independence Citation Format: Angelena Crown, Damian McCartan, Michael Curry, Maya Feldman, Sujata Patil, Sabrina Kamer, Shari B Goldfarb, Mary Gemignani. Pregnancy-associated breast cancer: Does timing of presentation affect outcome? [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-18.

ObjectiveOvarian suppression is recommended to complement endocrine therapy in premenopausal women with breast cancer and high-risk features. It can be achieved by either medical ovarian suppression or therapeutic bilateral salpingo-oophorectomy. Our objective was to evaluate characteristics of patients with stage I–III hormone receptor positive primary breast cancer who underwent bilateral salpingo-oophorectomy at our institution.Materials and methodsPremenopausal women with stage I–III hormone receptor positive primary breast cancer diagnosed between January 2010 and December 2014 were identified from a database. Patients with confirmed BRCA1/2 mutations were excluded. Distribution of characteristics between treatment groups was assessed using χ2 test and univariate logistic regression. A multivariate model was based on factors significant on univariate analysis.ResultsOf 2740 women identified, 2018 (74%) received endocrine treatment without ovarian ablation, 516 (19%) received endocrine treatment plus ovarian ablation, and 206 (7.5%) did not receive endocrine treatment. Among patients undergoing ovarian ablation 282/516 (55%) received medical ovarian suppression, while 234 (45%) underwent bilateral salpingo-oophorectomy. By univariate logistic analyses, predictors for ovarian ablation were younger age (OR 0.97), histology (other vs ductal: OR 0.23), lymph node involvement (OR 1.89), higher International Federation of Gynecology and Obstetrics (FIGO) stage (stage II vs I: OR 1.48; stage III vs I: OR 2.86), higher grade (grade 3 vs 1: OR 3.41; grade 2 vs 1: OR 2.99), chemotherapy (OR 1.52), and more recent year of diagnosis (2014 vs 2010; OR 1.713). Only year of diagnosis, stage, and human epidermal growth factor receptor 2 (HER-2) treatment remained significant in the multivariate model. Within the cohort undergoing ovarian ablation, older age (OR 1.05) was associated with therapeutic bilateral salpingo-oophorectomy. Of 234 undergoing bilateral salpingo-oophorectomy, 12 (5%) mild to moderate adverse surgical events were recorded.ConclusionsBilateral salpingo-oophorectomy is used frequently as an endocrine ablation strategy. Older age was associated with bilateral salpingo-oophorectomy. Perioperative morbidity was acceptable. Evaluation of long-term effects and quality of life associated with endocrine ablation will help guide patient/provider decision-making.

BACKGROUND. The American Society of Clinical Oncology guidelines recommend early referral to reproductive endocrinology and infertility (REI) specialists for young women diagnosed with breast cancer. Current practice patterns demonstrate an increased utilization of neoadjuvant chemotherapy (NAC). Here we evaluate premenopausal women with breast cancer after consultation with a Fertility Nurse Specialist (FNS) and determine factors associated with referral to REI specialists. METHODS. This retrospective review included all premenopausal women diagnosed with stage 0-III unilateral breast cancers between 2009 and 2015 who completed an FNS consultation. Clinicopathologic features and factors associated with referral to REI after FNS consultation were analyzed. RESULTS. A total of 334 women were identified. Median age was 35 years (interquartile range 32-38). The majority of women were single (n=198, 59.3%) and nulliparous (n=239, 71.6%). REI referrals were common (n=237, 71.0%). The Breast Surgery service was the most frequent referring service (n=194, 58.1%), with significantly more REI referrals compared to Breast Medicine and Genetics services (p=0.002). Nulliparity was associated with REI referral (p

Historically, more than one-third of patients with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) underwent additional surgery. The SSO-ASTRO guidelines advise 2 mm margins for patients with DCIS having BCS and whole-breast radiation (WBRT). Here we examine guideline impact on additional surgery and factors associated with re-excision. Patients treated with BCS for pure DCIS from August 2015 to January 2018 were identified. Guidelines were adopted on September 1, 2016, and all patients had separately submitted cavity-shave margins. Clinicopathologic characteristics, margin status, and rates of additional surgery were examined. Among 650 patients with DCIS who attempted BCS, 50 (8%) converted to mastectomy. Of 600 who had BCS as final surgery, 336 (56%) received WBRT and comprised our study group. One hundred twenty-eight (38%) were treated pre-guideline and 208 (62%) were treated post-guideline. Characteristics and margin status were similar between groups. The re-excision rate was 38% pre-guideline adoption and 29% post-guideline adoption (p = 0.09), with 91% having only one re-excision. Re-excision for ≥ 2 mm margins was uncommon (6% pre-guideline vs. 5% post-guideline). On multivariate analysis, younger age (OR 0.97, 95% CI 0.94–0.99, p = 0.02) and larger DCIS size (OR 1.43, 95% CI 1.2–1.8, p

Nipple-sparing mastectomy (NSM) is being performed increasingly for risk reduction in high-risk groups. There are limited data regarding complications and oncological outcomes in women undergoing bilateral prophylactic NSM. This study reviewed institutional experience with prophylactic NSM, and examined the indications, rates of postoperative complications, incidence of occult malignant disease and subsequent breast cancer diagnosis.Women who had bilateral prophylactic NSM between 2000 and 2016 were identified from a prospectively maintained database. Rates of postoperative complications, incidental breast cancer, recurrence and overall survival were evaluated.A total of 192 women underwent 384 prophylactic NSMs. Indications included BRCA1 or BRCA2 mutations in 117 patients (60·9 per cent), family history of breast cancer in 35 (18·2 per cent), lobular carcinoma in situ in 29 (15·1 per cent) and other reasons in 11 (5·7 per cent). Immediate breast reconstruction was performed in 191 patients. Of 384 NSMs, 116 breasts (30·2 per cent) had some evidence of skin necrosis at follow-up, which resolved spontaneously in most; only 24 breasts (6·3 per cent) required debridement. Overall, there was at least one complication in 129 breasts (33·6 per cent); 3·6 and 1·6 per cent had incidental findings of ductal carcinoma in situ and invasive breast cancer respectively. The nipple-areola complex was preserved entirely in 378 mastectomies. After a median follow-up of 36·8 months, there had been no deaths and no new breast cancer diagnoses.These findings support the use of prophylactic NSM in high-risk patients. The nipples could be preserved in the majority of patients, postoperative complication rates were low, and, with limited follow-up, there were no new breast cancers.La mastectomía con preservación del pezón (nipple-sparing mastectomy, NSM) se realiza cada vez más para reducir riesgos en los grupos de pacientes de alto riesgo. Se dispone de pocos datos sobre complicaciones y resultados oncológicos en mujeres sometidas a NSM bilateral profiláctica. Este estudio revisó la experiencia institucional de la NSM profiláctica, y analizó las indicaciones, tasas de complicaciones postoperatorias, incidencia de enfermedad maligna oculta y diagnóstico de subsiguiente cáncer de mama. MÉTODOS: Se identificaron mujeres sometidas a NSM bilateral profiláctica durante el periodo 2000-2016 a partir de una base de datos prospectiva. Se evaluaron tasas de complicaciones postoperatorias, cáncer de mama incidental, recidiva y supervivencia global.Un total de 192 mujeres fueron sometidas a 384 NSMs profilácticas. Las indicaciones incluyeron mutaciones BRCA1 o BRCA2 en 117 (61%) pacientes, historia familiar de cáncer de mama en 35 (18%), carcinoma lobulillar in situ en 29 (15%) y otros motivos en 11 (5,7%). La reconstrucción mamaria inmediata se realizó en 191 pacientes. De las 384 NSMs, 116 (30%) presentaron alguna evidencia de necrosis de la piel durante el seguimiento y la mayoría se resolvieron de forma espontánea, con solo 24 (6,2%) mamas que requirieron desbridamiento. Globalmente hubo al menos una complicación en 129 (34%) mamas; 3,6% y 1,6% tuvieron hallazgos incidentales de carcinoma ductal in situ o cáncer de mama invasivo, respectivamente. El complejo areola-pezón se preservó completamente en 378 mastectomías. Tras una mediana de seguimiento de 36,8 meses, no hubo fallecimientos ni ningún diagnóstico nuevo de cáncer de mama. CONCLUSIÓN: Estos hallazgos apoyan la utilización de la NSM profiláctica en pacientes de alto riesgo. En la mayoría pacientes fue posible la preservación del pezón, las tasas de complicaciones postoperatorias fueron bajas y, con un seguimiento limitado, no hubo nuevos casos de cáncer de mama.

Background Young age at breast cancer diagnosis is associated with negative prognostic outcomes, and breast cancer in black women often manifests at a young age. This study evaluated the effect of age on breast cancer management and outcomes in black women. Methods This was a retrospective cohort study of all black women treated for invasive breast cancer between 2005 and 2010 at a specialized tertiary-care cancer centre. Clinical and treatment characteristics were compared by age. Kaplan–Meier methodology was used to estimate overall survival (OS) and disease-free survival (DFS). Results A total of 666 black women were identified. Median BMI was 30 (range 17–56) kg/m2 and median tumour size was 16 (1–155) mm. Most tumours were oestrogen receptor-positive (66·4 per cent). Women were stratified by age: less than 40 years (74, 11·1 per cent) versus 40 years or more (592, 88·9 per cent). Younger women were significantly more likely to have a mastectomy, axillary lymph node dissection and to receive chemotherapy, and were more likely to have lymphovascular invasion and positive lymph nodes, than older women. The 5-year OS rate was 88·0 (95 per cent c.i. 86·0 to 91·0) per cent and the 5-year DFS rate was 82·0 (79·0 to 85·0) per cent. There was no statistically significant difference in OS by age (P = 0·236). Although DFS was inferior in younger women on univariable analysis (71 versus 88 per cent; P < 0·001), no association was found with age on multivariable analysis. Conclusion Young black women with breast cancer had more adverse pathological factors, received more aggressive treatment, and had worse DFS on univariable analysis. Young age at diagnosis was, however, not an independent predictor of outcome.

National Comprehensive Center Network guidelines recommend radiotherapy (RT) omission in women age ≥ 70 years with estrogen receptor-positive (ER+), cN0, T1 tumors post-lumpectomy if they receive endocrine therapy (ET). However, little is known about the impact of poor adherence on locoregional recurrence (LRR) in elderly women forgoing RT.Women age ≥ 70 years with pT1-2 ER+ breast cancer undergoing lumpectomy without RT from 2004 to 2019 were identified from a prospectively maintained database. ET adherence, calculated as treatment duration over follow-up time up to 5 years, was determined by chart review. We compared clinicopathologic characteristics and rates of LRR between women with high adherence (≥ 80%), low adherence (80%), and no ET.Of 968 women (27 bilateral cancers), adherence was high in 676 (70%) and low in 162 (17%); 130 (13%) took no ET. Younger age and use of aromatase inhibitor were associated with high adherence. On multivariable analysis, tumor size (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.03-2.68, p = 0.04) and high adherence (HR 0.13, 95% CI 0.07-0.26, p0.001) were significantly associated with LRR. At 53 months median follow-up, the 5-year rate of LRR was 3.1% (95% CI 2.4-3.9%) with high adherence, 14.7% (95% CI 11.7-17.7%) with low adherence, and 17.9% (95% CI 13.9-21.8%) with no ET (p0.01).Although adherence to ET was high overall, in the 30% of women with low adherence or no ET, LRR rates were significantly increased. Counseling regarding the distinct toxicities of ET and RT can help patients choose the therapy to which they will likely adhere to.

Nipple-sparing mastectomy (NSM) is increasingly performed for invasive breast cancer. Growing evidence supporting the oncologic safety of NSM has led to its widespread use and broadened indications. In this study, we examine the indications, complications, and long-term outcomes of therapeutic NSM. From 2003 to 2016, women undergoing NSM for invasive cancer or ductal carcinoma in situ (DCIS) were identified from a prospectively maintained database. Patient and disease characteristics were compared by procedure year, while complications were compared by procedure year using generalized mixed-effects models accounting for a random surgeon effect. Overall survival and time to recurrence were examined. Of the 467 therapeutic NSMs, 337 (72%) were invasive cancer, 126 (27%) were DCIS, and 4 (1%) were phyllodes tumors. Median age was 45 years (range 24–75) and median follow-up among survivors was 39.4 months. Three hundred and fifty-seven (76.4%) cases were performed in 2011 or after. When comparing NSMs performed before and after 2011, there was a significant increase in NSMs performed for invasive tumors (58% vs. 77%; p

In the ACOSOG (American College of Surgeons Oncology Group) Z0011 trial and the AMAROS (After Mapping of the Axilla: Radiotherapy or Surgery?) trial, matted nodes with gross extracapsular extension (ECE), a risk factor for locoregional recurrence, were an indication for axillary lymph node dissection (ALND), but the effect of microscopic ECE (mECE) in the sentinel lymph nodes (SLNs) on recurrence was not examined. Between 2010 and 2017, 811 patients with cT1-2N0 breast cancer and SLN metastasis were prospectively managed according to Z0011 criteria, with ALND for those with more than two positive SLNs or gross ECE. Management of mECE was not specified. In this study, we compare outcomes of patients with one to two positive SLNs with and without mECE, treated with SLN biopsy alone (n = 685). Median patient age was 58 years, and median tumor size was 1.7 cm. mECE was identified in 210 (31%) patients. Patients with mECE were older, had larger tumors, and were more likely to be hormone receptor positive and HER2 negative, have two positive SLNs, and receive nodal radiation. At a median follow-up of 41 months, no isolated axillary failures were observed. There were 11 nodal recurrences; two supraclavicular ± axillary, four synchronous with breast, and five with distant failure. The five-year rate of any nodal recurrence was 1.6% and did not differ by mECE (2.3% vs. 1.3%; p = 0.84). No differences were observed in local (p = 0.08) or distant (p = 0.31) recurrence rates by mECE status. In Z0011-eligible patients, nodal recurrence rates in patients with mECE are low after treatment with SLN biopsy alone, even in the absence of routine nodal radiation. The presence of mECE should not be considered a routine indication for ALND.

Younger women (age ≤ 40 years) with breast cancer undergoing neoadjuvant chemotherapy (NAC) have higher rates of pathologic complete response (pCR); however, it is unknown whether axillary or breast downstaging rates differ by age. In this study, we compared pCR incidence and surgical downstaging rates of the breast and axilla post NAC, between patients aged ≤ 40, 41-60, and ≥ 61 years.We identified 1383 women with stage I-III breast cancer treated with NAC and subsequent surgery from November 2013 to December 2018. pCR and breast/axillary downstaging rates were assessed and compared across age groups.Younger women were significantly more likely to have ductal histology, poorly differentiated tumors, and BRCA mutations; 35% of tumors were hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-), 36% were HER2-positive (HER2+), and 29% were triple negative (TN), with similar subtype distribution across age groups (p = 0.6). Overall, pCR rates did not differ by age, however among patients with TN tumors (n = 394), younger women had higher pCR rates (52% vs. 35% among those aged 41-60 years and 29% among those aged ≥61 years; p = 0.007) and were more likely to have tumors with high tumor-infiltrating lymphocyte (TIL) concentrations (p 0.001). Downstaging to breast-conserving surgery (BCS) eligibility post NAC among initially BCS-ineligible patients was similar across age groups; younger women chose BCS less often (p 0.001). Among cN1 patients (n = 813), 52% of women ≤40 years of age avoided axillary lymph node dissection (ALND) with NAC, versus 39% and 37% in the older groups (p 0.001).Younger women undergoing NAC for axillary downstaging were more likely to avoid ALND across all subtypes; however, overall pCR rates did not differ by age. Despite equivalent breast downstaging and BCS eligibility rates across age groups, younger women were less likely to undergo BCS.

The impact of chemotherapy timing on the fertility preservation (FP) decision is poorly understood. Here we evaluate factors associated with FP completion among women age ≤ 45 years with breast cancer who received chemotherapy and consulted with a reproductive endocrinology and infertility (REI) specialist, and report pregnancy and oncologic outcomes.This retrospective review included all women age ≤ 45 years diagnosed with stage I-III unilateral breast cancer at Memorial Sloan Kettering Cancer Center between 2009 and 2015 who received chemotherapy and consulted with an REI specialist. Clinicopathologic features and factors associated with the decision to undergo FP were analyzed, and comparisons were made with the Wilcoxon rank-sum test, Chi-square test, or Fisher's exact test. Survival curves were constructed using the Kaplan-Meier method.Among the 172 women identified, median age was 34 years (interquartile range 31-37 years). The majority of women were single (n = 99, 57.6%) and nulliparous (n = 134, 77.9%). Most women underwent FP (n = 121, 70.3%). Factors associated with the decision to undergo FP included younger median age (33 vs. 37 years, p0.001), having private insurance (p0.001), nulliparity (p0.001), and referral from Breast Surgery (p = 0.004). Tumor characteristics and treatments were similar between women who underwent FP and those who declined. Overall survival and recurrence-free survival were also similar between groups. Women who underwent FP were more likely to have a biological child after breast cancer treatment.Women underwent FP at high rates independent of timing of chemotherapy and oncologic factors. FP is associated with having a biological child and does not compromise oncologic outcomes.

Importance Prospective trials have demonstrated sentinel lymph node (SLN) false-negative rates of less than 10% when 3 or more SLNs are retrieved in patients with clinically node-positive breast cancer rendered clinically node-negative with neoadjuvant chemotherapy (NAC). However, rates of nodal recurrence in such patients treated with SLN biopsy (SLNB) alone are unknown because axillary lymph node dissection (ALND) was performed in all patients, limiting adoption of this approach. Objective To evaluate nodal recurrence rates in a consecutive cohort of patients with clinically node-positive (cN1) breast cancer receiving NAC, followed by a negative SLNB using a standardized technique, and no further axillary surgery. Design, Setting, and Participants From November 2013 to February 2019, a cohort of consecutively identified patients with cT1 to cT3 biopsy-proven N1 breast cancer rendered cN0 by NAC underwent SLNB with dual tracer mapping and omission of ALND if 3 or more SLNs were identified and all were pathologically negative. Metastatic nodes were not routinely clipped, and localization of clipped nodes was not performed. The study was performed in a single tertiary cancer center. Intervention Omission of ALND in patients with cN1 breast cancer after NAC if 3 or more SLNs were pathologically negative. Main Outcome and Measures The primary outcome was the rate of nodal recurrence among patients with cN1 breast cancer treated with SLNB alone after NAC. Results Of 610 patients with cN1 breast cancer treated with NAC (median [IQR] age, 49 [40-58] years), 555 (91%) converted to cN0 and underwent SLNB; 234 (42%) had 3 or more negative SLNs and had SLNB alone. Median age was 49 years. Median tumor size was 3 cm; 144 (62%) wereERBB2(formerlyHER2)-positive, and 43 (18%) were triple negative. Most (212 [91%]) received doxorubicin-based NAC, 205 (88%) received adjuvant radiotherapy (RT), and 164 (70%) also received nodal RT. At a median follow-up of 40 months, there was 1 axillary nodal recurrence synchronous with local recurrence in a patient who refused RT. Among patients who received RT (n = 205), there were no nodal recurrences. Conclusions and Relevance This cohort study found that in patients with cN1 disease rendered cN0 with NAC, with 3 or more negative SLNs with SLNB alone, nodal recurrence rates were low, without routine nodal clipping. These findings potentially support omitting ALND in such patients.

Supernumerary breast components occur predominantly between the breast and umbilicus.(1) Carcinoma of this ectopic, or accessory breast tissue (ABT), is exceedingly rare, accounting for

Neoadjuvant chemotherapy (NAC) for breast cancer increases breast-conserving surgery (BCS) rates, but many women opt for mastectomy with contralateral prophylactic mastectomy (CPM). Here we evaluate factors associated with CPM use in women undergoing mastectomy post-NAC. A retrospective institutional NAC database review identified women with clinical stage I-III, unilateral invasive breast cancer undergoing unilateral mastectomy (UM) or CPM mastectomy from 9/2013 to 12/2017. Clinical/pathologic characteristics, imaging, and presence of contraindications to BCS post-NAC were compared, with subset analysis of BCS candidates. The multivariable analysis was adjusted for potential confounders. Five hundred sixty-nine women underwent mastectomy after NAC, 297 (52%) UM and 272 (48%) CPM. On univariable analysis, younger age, BRCA+, lower pre-NAC clinical stage, pathologic complete response, and axillary surgery extent were associated with CPM (all p

Women with dense breasts may have less-accurate preoperative evaluation of extent of disease, potentially affecting the achievement of negative margins. The goal of this study is to examine the association between breast density and re-excision rates in women having breast-conserving surgery for invasive breast cancer. Women with stage I/II invasive breast cancer treated with breast-conserving surgery between 1/1/2014 and 10/31/2014 were included. Breast density was assessed by two radiologists. The association between breast density and re-excision was examined using logistic regression. Seven hundred and one women were included. Overall, 106 (15.1%) women had at least one re-excision. Younger age at diagnosis was associated with increased breast density (p

BACKGROUND. Low incidence of breast cancer in men (BCM) (65 years). Kaplan-Meier methods were used to compare overall survival (OS) and breast cancer-specific survival (BCSS). Competing-risk methods analyzed time to second primary cancers (SPCs), with any-cause death treated as a competing risk. RESULTS. The study identified 152 BCM patients with a median age of 64 years (range, 19–96 years). The median body mass index (BMI) was 28 kg/m(2). Men age 65 years or younger (n = 78, 51 %) were more overweight/obese than men older than 65 years (n = 74, 49 %) (89 % vs 74 %, respectively; P = 0.008). Both groups had similar nodal metastases rates (P = 0.4), estrogen receptor positivity (P = 1), and human epidermal growth factor receptor 2 (HER2)neu overexpression (P = 0.6). Men 65 years of age or younger were more likely to receive chemotherapy (P = 0.002). The median follow-up period was 5.8 years (range, 0.1–14.4 years). The 5-year OS was 86 % (95 % confidence interval [CI], 80–93 %), whereas the 5-year BCSS was 95 % (95 % CI, 91–99 %). The BCM patients 65 years of age and younger had better OS (P = 0.003) but not BCSS (P = 0.8). The 5-year cumulative incidence of SPC was 8.4 % (95 % CI, 3.4–13.4 %). The prior SPC rate was higher for men older than 65 years (n = 20, 31 %) than for those age 65 years or younger (n = 7, 11 %) (P = 0.008). This did not account for differences in life years at risk. No difference was observed in SPC cumulative incidence stratified by age (P = 0.3). CONCLUSIONS. Men 65 years of age or younger received more chemotherapy and had improved OS, but not BCSS compared with men older than 65 years. For all BCM, SPC is a risk, and appropriate screening may be warranted.

Background Early-stage breast cancer is often treated with breast-conserving therapy (BCT), including lumpectomy with radiation therapy. Patients’ expectations of BCT remain largely unknown. Expectations affect perceptions of treatment-related experiences and health-related quality of life (HR-QOL) outcomes. Our primary aim was to describe expectations of BCT among patients with early breast cancer through qualitative methods. Our secondary aim was to inform preoperative patient education and improve the patient experience through knowledge. Methods We used a grounded-theory approach to investigate a convenience sample of 22 women with stage I and II breast cancer who were treated with BCT at a single hospital in New York City between May and August 2016. Semi-structured interviews were conducted in person and by telephone. Open-ended questions covered participants’ expectations of treatment experiences and outcomes. Data was analyzed in a line-by-line approach to identify emergent themes related to patient expectations. Interviews continued until no new themes emerged. Results Analysis of data identified the following themes related to patient expectations of BCT: experience of cancer care, recovery, appearance, and HR-QOL. Despite preoperative informed consent and teaching, participants expressed few expectations preoperatively, owing to a lack of knowledge about the process of care. Lack of expectations preoperatively was compensated with available care and resources postoperatively. Conclusions Patients in our sample had a surprisingly limited understanding of what to expect during treatment with BCT. Despite available information and preoperative teaching, patients have a clear knowledge gap regarding BCT. These findings suggest patients often undergo cancer treatment with trust rather than complete understanding of the process. This data may be used to enhance preoperative discussions aimed at preparing patients for surgery and treatment.

Background: There is evidence that many cancer survivors live with sexual dysfunction that impacts their quality of life. It is essential to identify factors that influence the development of sexual symptoms and understand their trajectory over time in order to guide potential interventions to treat sexual dysfunction. Most studies to date have been cross-sectional and longitudinal studies are needed to understand the change of sexual function over time. This study aims to investigate and describe the factors that impact sexual health and dysfunction in breast cancer patients during and after their cancer treatment. Methods: A longitudinal prospective trial is being conducted in premenopausal women 18-50 years of age with breast cancer being treated at MSKCC. Validated questionnaires on sexual health and function were administered to patients after they were diagnosed with breast cancer, but before they initiated cancer treatment and at one-year follow-up after initiation of primary breast cancer therapy. Demographic and treatment information was also collected. The female sexual function index (FSFI) total and individual domain scores were calculated. Baseline and 12-month scores were compared using paired t-tests. Multivariable linear regression was used to assess individual variable associations with 12-month FSFI total scores controlling for baseline scores. Results: 127 women were eligible for analysis at the time of this abstract and had a median age of 41. Eighty-nine percent of tumors were estrogen receptor positive and 24.4% were HER-2 overexpressing. Eighty-nine percent of patients received chemotherapy, 61.4% received Tamoxifen and 23% received a LHRH agonist in combination with an aromatase inhibitor. Mean FSFI total score was 20.4 at baseline and 21.2 at 12-months post diagnosis. More than half of women met FSFI criteria for sexual dysfunction (FSFI score Conclusions: Mean FSFI scores in our patients with breast cancer before and after treatment are consistent with scores from other studies looking at cancer patients and are lower than those of healthy women. In the peri-diagnosis period patients had worse sexual function that showed signs of small improvements 12 months after initiation of treatment, especially in the desire domain. Patients are being followed to see if sexual function continues to improve over time, to better understand the factors causing sexual dysfunction in these patients and to determine the best time to intervene in order to improve symptoms. Citation Format: Goldfarb SB, Kamer S, Baser R, Quistorff J, Gemignani ML, Dickler M. Improvement in sexual function over time in premenopausal women with breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-12.

Background The definition of an adequate surgical margin for breast cancer has been a hotly debated topic for over 20 years, with “no ink on tumor” now widely recognized as an adequate pathological margin for invasive carcinoma. Patients with dense breasts pose unique challenges in terms of accurate pre-operative evaluation of extent of disease and achieving adequate margins at initial surgery. The aim of this study therefore is to analyze re-excision rates and correlate with breast density and other clinical and pathological factors before and after the decision to accept 'no tumor at the inked margin” as an adequate margin. Methods Patients with stage I or II invasive breast cancer treated with breast conserving surgery between the 1st of June 2013 and the 31st of October 2014 were included. Patients who had surgery prior to January 1, 2014 comprise the pre-guideline group whereas those who had surgery on or after January 1, 2014 comprise the post-guideline group. Breast density was assessed by 2 independent radiologists. Inter-reader agreement was assessed using data on all study subjects and intra-reader agreement was assessed on a random sample of 121 study subjects; agreement was assessed using the kappa statistic with bootstrap confidence intervals. Logistic regression was used to model the association between breast density and re-excision, using the minimum value of breast density according to the two independent readers, within the 2 time periods. Multivariable logistic regression adjusted for patient and disease characteristics associated with re-excision on univariable analysis. Results The inter-reader agreement was 0.633 (95% confidence interval (CI): 0.604, 0.663) whereas the intra-reader agreement was 0.755 (95% CI: 0.663, 0.834). A total of 1205 patients were included, of whom 504 (41.8%) had surgery before the guideline change and 701 (58.2%) after. Overall 214 (17.8%) had at least one re-excision. The re-excision rate was significantly lower in the time period after the guideline change (15.1% verus 21.4%, p=0.006). There was no significant difference in tumor characteristics between the time periods. Younger age at diagnosis was the only clinicopathological factor that was significantly associated with increased breast density (p Conclusions Women who are of younger age at diagnosis are more likely to have increased breast density. Although, younger age was associated with higher rate of re-excision, we did not find breast density to be associated with a higher rate of re-excision on multivariable analysis. Citation Format: Walsh SM, Brennan SB, Zabor E, Rosenberger LH, Stempel M, Lebron-Zapata L, Gemignani ML. Does breast density increase the risk of re-excision for women with breast cancer having breast conservation therapy? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-12-10.

Neo-adjuvant chemotherapy (NAC) is administered in breast cancer treatment for downstaging of disease. Here, we determined the impact of response to NAC on breast reconstruction uptake. A prospective NAC and mastectomy database with or without reconstruction were reviewed with IRB approval. Univariable analyses were conducted using Kruskal-Wallis or Fisher's exact tests. Multivariable logistic regression was used to adjust for potential confounders. We identified 271 patients with unilateral breast cancer receiving NAC and either unilateral or bilateral mastectomy from 9/2013 to 5/2016. Seventy patients (25.8%) had a pCR to NAC. One hundred and seventy-five patients (64.6%) had immediate reconstruction (IR), and 96 had no IR. On univariable analysis, younger age (P < .001), lower T-stage at presentation (P < .001), bilateral versus unilateral mastectomy (P

Background: Four prospective multi-institutional trials have demonstrated that clinically node-positive patients (cN1) who receive neoadjuvant therapy (NAC) and convert to cN0 can be reliably staged with sentinel lymph node biopsy (SLNB) with false-negative rates (FNRs) of < 10%, when ≥ 3 SLNs are retrieved. Since study patients all had axillary lymph node dissection (ALND), the rate of axillary recurrence after SLNB alone is unknown. Of concern is the possibility that residual chemotherapy-resistant axillary disease could lead to higher recurrence rates than seen in the primary surgery setting for cN0 patients where SLN FNRs of 5-10% result in axillary recurrence in < 1% of cases. Here we report regional recurrence rates in a prospectively defined cohort of cN1 patients receiving NAC, followed by a negative SLNB using a standardized technique, and no further axillary surgery. Methods: From 06/2014 to 02/2019, patients with cT1-3 biopsy-proven cN1 breast cancer who received NAC and converted to cN0 by physical exam were prospectively managed with SLNB with dual tracer mapping and omission of ALND if ≥ 3 SLNs were pathologically negative. Nodes were not routinely clipped, and retrieval of clipped metastatic nodes was not required. Pathologically negative SLNs were defined as the absence of any metastases including isolated tumor cells. Results: Of 610 cN1 patients treated with NAC, 555 (91%) converted to cN0 and had SLNB; 234 (42%) had ≥ 3 negative SLNs and were treated with SLNB alone. Median patient age was 49 years and median tumor size at presentation was 3 cm; 61% were HER2+ and 18% triple negative. Most (91%) received doxorubicin-based NAC and 88% received adjuvant radiotherapy (RT), with 80% (n = 164) of RT patients receiving nodal RT (Table). At a median follow-up of 35 months, there was only 1 (0.4%) axillary recurrence for the entire cohort, synchronous with a breast recurrence, in a patient who refused RT. Among patients who received RT (n = 205), there were no axillary recurrences. The 4-year rate of distant recurrence for all patients was 6.1% (95% CI, 3.4-10.7%) and 4-year overall survival was 93.9% (95% CI, 87.6-97.1%). Conclusion: In cN1 patients treated with NAC, rates of axillary recurrence in patients with ≥ 3 pathologically negative SLNs treated with SLNB alone were low, without routine nodal clipping. Although further follow-up is needed, multiple studies have shown that nodal recurrence is an early event, particularly in HER2+ and triple negative patients, who comprised the majority of the population. Our findings support omitting ALND in cN1 patients after NAC when the SLNs are negative using an optimal SLNB technique. Table. Patient PopulationOverall cohort (n = 234)Age, years (median, IQR)49 (40, 58)Tumor size at presentation, cm (median, IQR)3.0 (2.2, 5.0)Number SLNs retrieved (median, IQR)4 (3, 5)Palpable nodes at presentation (n, %)179 (76%)HistologyDuctal211 (90%)Lobular and mixed7 (3%)Micropapillary and mixed10 (4%)Other3 (1%)Occult3 (1%)DifferentiationWell1 (0.5%)Moderate36 (15%)Poor196 (84%)Unknown1 (0.5%)Receptor StatusHR+/HER2-47 (20%)HR+/HER2+80 (34%)HR-/HER2+64 (27%)HR-/HER2-43 (18%)Breast SurgeryBCS118 (50%)Mastectomy116 (50%)Breast pCR¥Yes161 (70%)No70 (30%)NAC regimenAC-T197 (84%)AC-T + carbo15 (6.4%)TC8 (3.4%)Other14 (6%)Neoadjuvant anti-HER2 treatmentHP (dual-therapy)144 (100%)Adjuvant RTYes205 (88%)No*29 (12%)¥3 patients had occult primary breast cancer and were not included in breast pCR calculation; *6/29 patients who did not receive RT enrolled in NSABP B-51 Citation Format: Andrea V Barrio, Giacomo Montagna, Anita Mamtani, Varadan Sevilimedu, Hiram S Cody, III, Mahmoud El-Tamer, Mary L Gemignani, Alexandra S Heerdt, Tracy-Ann Moo, Melissa Pilewskie, George Plitas, Lisa Sclafani, Kimberly J Van Zee, Monica Morrow. Axillary recurrence is a rare event in node-positive patients. treated with sentinel node biopsy alone after neoadjuvant chemotherapy: Results of a prospective study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD4-05.

•Consider exemestane plus ovarian function suppression for premenopausal HR+ women•Premenopausal HR+ breast cancer patients should be treated with tamoxifen (10yrs).•Premenopausal HR+ breast cancer pts may benefit from endocrine therapy and ovarian function suppression.

The consequences of patient identification errors due to specimen mislabeling can be deleterious. We describe two near-miss events involving mislabeled breast specimens from two patients who sought treatment at our institution. In both cases, microscopic review of the slides identified inconsistencies between the histologic findings and patient age, unveiling specimen identification errors. By correlating the clinical information with the microscopic findings, we identified mistakes that had occurred at the time of specimen accessioning at the original laboratories. In both cases, thanks to a timely reassignment of the specimens, the patients suffered no harm. These cases highlight the importance of routine clinical and pathologic correlation as a critical component of quality assurance and patient safety. A review of possible specimen identification errors in the anatomic pathology setting is presented.

Cancer occurs in 0.05% to 0.1% of all pregnancies. Despite literature reporting good oncologic and fetal outcomes in women treated for cancer during pregnancy, as many as 44% of gynecologists would offer termination, and 37% would not administer chemotherapy or radiotherapy in pregnancy.The aims of this study were to summarize current recommendations for the treatment of cervical and ovarian cancers in pregnancy and to review updates on existing knowledge regarding the safety of surgical and chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes.A detailed literature review was performed on PubMed.The treatment of gynecologic malignancies during pregnancy mirrors that outside pregnancy, with a balance between maternal versus fetal health. Fertility-sparing surgery can be offered to stage IA2 and low-risk IB1 cervical, stage I epithelial ovarian, germ cell ovarian, or sex-cord stromal ovarian tumors. Delayed treatment can be offered for stage IB1 cervical cancer. Neoadjuvant and/or adjuvant chemotherapy can be given for advanced gynecologic cancers with good disease-free survival without significant adverse neonatal outcomes.A multidisciplinary approach and improved education of providers regarding the surgical and chemotherapeutic treatments in pregnancy are needed in order to fully inform patients regarding treatment options. Further research in women who are pregnant is needed to determine the safety of diagnostic and therapeutic procedures used in the nonpregnant woman.This article reviews and supports treatment of gynecologic cancer during pregnancy, calls for additional study and long-term follow-up, and justifies improved education of patients and providers regarding treatment options.Obstetricians and gynecologists, family physicians.After completing this activity, the learner should be better able to (1) review general principles in the management and treatment of gynecologic cancers in pregnancy, (2) review the diagnosis and treatment of cervical cancer in pregnancy, and (3) review the diagnosis and treatment of ovarian cancer in pregnancy.