nach oben

Annals of Surgical Oncology

Erschienen in:

26.11.2021 | Breast Oncology

Young Women with Breast Cancer: Chemotherapy or Surgery First? An Evaluation of Time to Treatment for Invasive Breast Cancer

verfasst von: Evelyne Guay, BSc, Erin Cordeiro, MD, MSc, FRCSC, Amanda Roberts, MD, MPH, FRCSC

Erschienen in: Annals of Surgical Oncology | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Background

Breast cancer in young women (ages 18–40 years) is rare, yet remains a leading cause of cancer-related death. Time to treatment (TTT) is an increasingly important factor in breast cancer outcomes, specifically time to systemic therapy. Our objective was to review patterns of care for young women presenting with invasive breast cancer and compare TTT for surgery first versus neoadjuvant chemotherapy (NAC).

Patients and Methods

A retrospective chart review of young women with non-metastatic, non-inflammatory invasive breast cancer between 2012 and 2018 at a single institution was completed. The primary outcome was time to first treatment (surgery or NAC).

Results

One hundred forty-two young women were treated for invasive breast cancer during the study period. The majority of patients underwent surgery first (57.7%) compared with NAC (42.3%). Women who underwent NAC were more likely to have abnormal lymph nodes on imaging (p = 0.002) and clinical exam (p < 0.0001) and were also more likely to have larger tumor sizes (p < 0.05). The majority of triple negative patients underwent NAC first (88% [14/16]). Median TTT was significantly longer for surgery (27 [range 7–70] days) versus (20.5 [3–50] days) chemotherapy (p = 0.004). Median number of additional hospital visits prior to surgery was 4 (range 1–8) versus 5 (0–11) for NAC (p < 0.001).

Conclusions

Young women with breast cancer who undergo NAC have a shorter TTT and clinically similar median number of hospital visits compared with women undergoing surgery first. These results support the use of NAC in young women, when indicated, as additional workup and consultations prior to NAC do not delay care.

Bleyer A, Barr R, Hayes-Lattin B, et al. The distinctive biology of cancer in adolescents and young adults. Nat Rev Cancer. 2008;8(4):288–98. https://doi.org/10.1038/nrc2349.CrossRefPubMed

Plichta JK, Thomas SM, Vernon R, et al. Breast cancer tumor histopathology, stage at presentation, and treatment in the extremes of age. Breast Cancer Res Treat. 2020;180:227–35. https://doi.org/10.1007/s10549-020-05542-4.CrossRefPubMedPubMedCentral

Anders CK, Johnson R, Litton J, Phillips M, Bleyer A, Author SO. Breast cancer before age 40 years NIH public access author manuscript. Semin Oncol. 2009;36(3):237–49. https://doi.org/10.1053/j.seminoncol.2009.03.001.CrossRefPubMedPubMedCentral

Anderson WF, Bingshu AE, Chen E, Ae LAB, Devesa SS. Qualitative age interactions (or effect modification) suggest different cancer pathways for early-onset and late-onset breast cancers. Cancer Causes Control. 2007. https://doi.org/10.1007/s10552-007-9057-x.CrossRefPubMed

Tichy JR, Lim E, Anders CK. Breast cancer in adolescents and young adults: a review with a focus on biology. J Natl Compr Cancer Netw. 2013;11(9):1060–9. https://doi.org/10.6004/jnccn.2013.0128.CrossRef

Cleator S, Heller W, Coombes RC. Triple-negative breast cancer: therapeutic options. Lancet Oncol. 2007;8(3):235–44. https://doi.org/10.1016/S1470-2045(07)70074-8.CrossRefPubMed

Assi HA, Khoury KE, Dbouk H, Khalil LE, Mouhieddine TH, El Saghir NS. Epidemiology and prognosis of breast cancer in young women. J Thorac Dis. 2013;5 Suppl 1(Suppl 1):S2-8. https://doi.org/10.3978/j.issn.2072-1439.2013.05.24.CrossRefPubMed

Foxcroft LM, Evans EB, Porter AJ. The diagnosis of breast cancer in women younger than 40. Breast. 2004;13(4):297–306. https://doi.org/10.1016/j.breast.2004.02.012.CrossRefPubMed

Bharat A, Aft RL, Gao F, Margenthaler JA. Patient and tumor characteristics associated with increased mortality in young women (≤ 40 years) with breast cancer. J Surg Oncol. 2009;100(3):248–51. https://doi.org/10.1002/jso.21268.CrossRefPubMed

10.

Gnerlich JL, Deshpande AD, Jeffe DB, Sweet A, White N, Margenthaler JA. Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg. 2009;208(3):341–7. https://doi.org/10.1016/j.jamcollsurg.2008.12.001.CrossRefPubMedPubMedCentral

11.

De Bock GH, Van Der Hage JA, Putter H, Bonnema J, Bartelink H, Van De Velde CJ. Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: long-term results of European Organisation for Research and Treatment of Cancer studies. Eur J Cancer. 2006;42(3):351–6. https://doi.org/10.1016/j.ejca.2005.10.006.CrossRefPubMed

12.

Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five national surgical adjuvant breast and bowel project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24(13):2028–37. https://doi.org/10.1200/JCO.2005.04.3273.CrossRefPubMed

13.

Reyna C, Lee MC. Breast cancer in young women: special considerations in multidisciplinary care. J Multidiscip Healthc. 2014. https://doi.org/10.2147/JMDH.S49994.CrossRefPubMedPubMedCentral

14.

Loibl S, Jackisch C, Lederer B, et al. Outcome after neoadjuvant chemotherapy in young breast cancer patients: a pooled analysis of individual patient data from eight prospectively randomized controlled trials. Breast Cancer Res Treat. 2015;152(2):377–87. https://doi.org/10.1007/s10549-015-3479-z.CrossRefPubMed

15.

Suter MB, Pagani O. Should age impact breast cancer management in young women? Fine tuning of treatment guidelines. Ther Adv Med Oncol. 2018;10:1758835918776923. https://doi.org/10.1177/1758835918776923.CrossRefPubMedPubMedCentral

16.

Raza S, Welch S, Younus J. Relative dose intensity delivered to patients with early breast cancer: Canadian experience. Curr Oncol. 2009;16(6):8–12. https://doi.org/10.3747/CO.V16I6.311.CrossRefPubMedPubMedCentral

17.

Shayne M, Crawford J, Dale DC, Culakova E, Lyman GH. Predictors of reduced dose intensity in patients with early-stage breast cancer receiving adjuvant chemotherapy. Breast Cancer Res Treat. 2006;100(3):255–62. https://doi.org/10.1007/S10549-006-9254-4.CrossRefPubMed

18.

Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to surgery and breast cancer survival in the United States. JAMA Oncol. 2016;2(3):330–9. https://doi.org/10.1001/jamaoncol.2015.4508.CrossRefPubMedPubMedCentral

19.

Eaglehouse YL, Georg MW, Shriver CD, Zhu K. Time-to-surgery and overall survival after breast cancer diagnosis in a universal health system. Breast Cancer Res Treat. 2019;178:441–50. https://doi.org/10.1007/s10549-019-05404-8.CrossRefPubMed

20.

Suleman K, Almalik O, Haque E, et al. Does the timing of surgery after neoadjuvant therapy in breast cancer patients affect the outcome? Oncology. 2020;98(3):168–73. https://doi.org/10.1159/000504964.CrossRefPubMed

21.

Omarini C, Guaitoli G, Noventa S, et al. Impact of time to surgery after neoadjuvant chemotherapy in operable breast cancer patients. Eur J Surg Oncol. 2017;43(4):613–8. https://doi.org/10.1016/j.ejso.2016.09.020.CrossRefPubMed

22.

Riba LA, Gruner RA, Fleishman A, James TA. Surgical risk factors for the delayed initiation of adjuvant chemotherapy in breast cancer. Ann Surg Oncol. 2018;25(7):1904–11. https://doi.org/10.1245/s10434-018-6351-7.CrossRefPubMed

23.

Yu K-D, Fan L, Qiu L-X, Ling H, Jiang Y-Z, Shao Z-M. Influence of delayed initiation of adjuvant chemotherapy on breast cancer survival is subtype-dependent. Oncotarget. 2017;8(28):46549–56. https://doi.org/10.18632/oncotarget.10551.CrossRefPubMed

24.

Raphael MJ, Biagi JJ, Kong W, Mates M, Booth CM, Mackillop WJ. The relationship between time to initiation of adjuvant chemotherapy and survival in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2016;160(1):17–28. https://doi.org/10.1007/s10549-016-3960-3.CrossRefPubMed

25.

Abdel-Rahman O. Impact of timeliness of adjuvant chemotherapy and radiotherapy on the outcomes of breast cancer; a pooled analysis of three clinical trials. Breast. 2018;38:175–80. https://doi.org/10.1016/j.breast.2018.01.010.CrossRefPubMed

26.

Kaufmann M, Von Minckwitz G, Mamounas EP, et al. Recommendations from an international consensus conference on the current status and future of neoadjuvant systemic therapy in primary breast cancer. Ann Surg Oncol. 2012;19(5):1508–16. https://doi.org/10.1245/s10434-011-2108-2.CrossRefPubMed

27.

Akhtar Z, Stearns V, Cartwright P, et al. The effect of 1-day multidisciplinary clinic on breast cancer treatment. Breast Cancer Res Treat. 2020;182(3):623–9. https://doi.org/10.1007/s10549-020-05721-3.CrossRefPubMed

28.

Graham PJ, Brar MS, Foster T, et al. Neoadjuvant chemotherapy for breast cancer, is practice changing? A population-based review of current surgical trends. Ann Surg Oncol. 2015;22(10):3376–82. https://doi.org/10.1245/s10434-015-4714-x.CrossRefPubMed

29.

Ang E, Wewala N, Carroll R, et al. Neoadjuvant chemotherapy in non-metastatic breast cancer: a study on practice trends in a regional cancer treatment service. Intern Med J. 2020;50(3):315–21. https://doi.org/10.1111/imj.14326.CrossRefPubMed

30.

Eisen A, Hey A, Arnout A, Pinchuk B, Muradali D. Breast cancer pathway map | Cancer Care Ontario. Accessed 29 Jan 2021. https://www.cancercareontario.ca/en/pathwaymap/breast-cancer-pathway-map.

31.

NCCN. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Breast Cancer. Version 12014. 2014.

32.

Chia S, Swain SM, Byrd DR, Mankoff DA. Locally advanced and inflammatory breast cancer. J Clin Oncol. 2008;26(5):786–90. https://doi.org/10.1200/JCO.2008.15.0243.CrossRefPubMed

33.

Mamtani A, Barrio AV, King TA, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? results of a prospective study. Ann Surg Oncol. 2016;23(11):3467–74. https://doi.org/10.1245/s10434-016-5246-8.CrossRefPubMedPubMedCentral

34.

Rosenberg SM, Dominici LS, Gelber S, et al. Association of breast cancer surgery with quality of life and psychosocial well-being in young breast cancer survivors Supplemental content. JAMA Surg. 2020;155(11):1035–42. https://doi.org/10.1001/jamasurg.2020.3325.CrossRefPubMed

35.

Sheng JY, Santa-Maria CA, Mangini N, et al. Management of breast cancer during the COVID-19 pandemic: a stage- and subtype-specific approach. JCO Oncol Pract. 2020. https://doi.org/10.1200/op.20.00364.CrossRefPubMedPubMedCentral

36.

Fedewa SA, Edge SB, Stewart AK, Halpern MT, Marlow NM, Ward EM. Race and ethnicity are associated with delays in breast cancer treatment (2003–2006). J Health Care Poor Underserved. 2011;22(1):128–41. https://doi.org/10.1353/HPU.2011.0006.CrossRefPubMed

37.

Crown A, Muhsen S, Zabor EC, et al. Does use of neoadjuvant chemotherapy affect the decision to pursue fertility preservation options in young women with breast cancer? Oncology. 2020;27:4740–9. https://doi.org/10.1245/s10434-020-08883-y.CrossRef

38.

Wright F, De Vito C, Langer B. Multidisciplinary Cancer Conference Standards. Cancer Care Ontario. 2006. Accessed 30 Jan 2021. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/286.

39.

Simmons CE, Hogeveen S, Leonard R, et al. A Canadian national expert consensus on neoadjuvant therapy for breast cancer: linking practice to evidence and beyond. Curr Oncol. 2015;22:2328. https://doi.org/10.3747/co.22.2328.CrossRef

Titel: Young Women with Breast Cancer: Chemotherapy or Surgery First? An Evaluation of Time to Treatment for Invasive Breast Cancer
verfasst von: Evelyne Guay, BSc
Erin Cordeiro, MD, MSc, FRCSC
Amanda Roberts, MD, MPH, FRCSC
Publikationsdatum: 26.11.2021
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 4/2022
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-11102-x

Comprehensive Analysis of Somatic Mutations in Driver Genes of Resected Pancreatic Ductal Adenocarcinoma Reveals KRAS G12D and Mutant TP53 Combination as an Independent Predictor of Clinical Outcome

Translational Research

Cachexia Versus Sarcopenia in Clinical Characteristics and Prognostic Value After Radical Gastrectomy for Gastric Cancer: A Large-Scale Prospective Study

Gastrointestinal Oncology

ASO Visual Abstract: Utility of Neoadjuvant Chemotherapy for Peritoneal Carcinomatosis Secondary to High-Grade Appendiceal Neoplasms for Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

ASO Visual Abstract

ASO Author Reflections: Minimally Invasive Secondary Cytoreductive Surgery for Ovarian Cancer Lymph Node Recurrence: Shaping Treatment with All Arrows in our Quiver

ASO Author Reflections

ASO Visual Abstract: The Effect of Hospital Versus Surgeon Volume on Short-Term Patient Outcomes after Pancreaticoduodenectomy: A SEER-Medicare Analysis

ASO Visual Abstract

The Effect of Hospital Versus Surgeon Volume on Short-Term Patient Outcomes After Pancreaticoduodenectomy: a SEER–Medicare Analysis

Pancreatic Tumors

Neu im Fachgebiet Chirurgie

Verbände und Cremes gegen Dekubitus: „Wir wissen nicht, was sie bringen!“

17.01.2025
Dekubitus
Nachrichten

Die Datenlage zur Wirksamkeit von Verbänden oder topischen Mitteln zur Prävention von Druckgeschwüren sei schlecht, so die Verfasser einer aktuellen Cochrane-Studie. Letztlich bleibe es unsicher, ob solche Maßnahmen den Betroffenen nutzen oder schaden.

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

15.01.2025
Nackenschmerzen
Nachrichten

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

US-Team empfiehlt Gastropexie nach Hiatushernien-Op.

14.01.2025
Zwerchfellhernie
Nachrichten

Zur Vermeidung von Rezidiven nach Reparatur einer paraösophagealen Hiatushernie sollte einem US-Team zufolge der Magen bei der Op. routinemäßig an der Bauchwand fixiert werden. Das Ergebnis einer randomisierten Studie scheint dafür zu sprechen.

Mit Lidocain kommt der Darm nicht schneller in Schwung

13.01.2025
Kolektomie
Nachrichten

Verzögertes Wiederanspringen der Darmfunktion ist ein Hauptfaktor dafür, wenn Patientinnen und Patienten nach einer Kolonresektion länger als geplant im Krankenhaus bleiben müssen. Ob man diesem Problem mit Lidocain vorbeugen kann, war Thema einer Studie.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Young Women with Breast Cancer: Chemotherapy or Surgery First? An Evaluation of Time to Treatment for Invasive Breast Cancer