Improvement of best practice in early breast cancer: actionable surgeon and hospital factors

Gort, Marjan; Broekhuis, Manda; Otter, Renée; Klazinga, Niek

doi:10.1007/s10549-006-9327-4

Cited by 24 publications

(15 citation statements)

References 24 publications

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“…The reasons for regional variations are unclear, but mastectomy rates tend to be higher in rural areas and this association is not confined to the United Kingdom (Craft et al, 1997;Gort et al, 2007). The data for 2002 -2004 indicate that patients with lymph node-negative disease had a large number of nodes removed even when the surgical procedure was conservative (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome data for symptomatic breast cancer: the breast cancer clinical outcome measures (BCCOM) project

et al. 2009

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BACKGROUND: Data collection for screen-detected breast cancer in the United Kingdom is fully funded, which has led to improvements in clinical practice. However, data on symptomatic cancer are deficient, and the aim of this project was to monitor the current practice. METHODS: A data set was designed together with surrogate outcome measures to reflect best practice. Data from cancer registries initially required the consent of clinicians, but in the third year anonymised data were available. RESULTS: The quality of data improved, but this varied by region and only a third of the cases were validated by clinicians. Regional variations in mastectomy rates were identified, and one-third of patients who underwent conservative surgery for the treatment invasive breast cancer were not recorded as receiving radiotherapy. CONCLUSION: National data are essential to ensure that all patients receive appropriate treatment for breast cancer, but variations still exist in the United Kingdom and further improvement in data capture is required.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome data for symptomatic breast cancer: the breast cancer clinical outcome measures (BCCOM) project

et al. 2009

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“…For each chromosome and compartment for which the LOH/AI frequency (y-axis) was found to be related to a clinicopathological feature (x-axis), the summary statistics of LOH/AI frequency for each level of the clinicopathological features (tumor grade [1][2][3], progesterone receptor [(ϩ) equals Ͼ10% of nuclei, (±) equals Ͼ0% but Ͻ10% of nuclei, and (−) equals 0% of nuclei immunoreactive], and regional lymph node metastasis status [pN: 0, 1, Ն2]) are shown in a box plot. The characteristics depicted include the mean (line in the middle of each box), the interquartile range (height of the box), and outlying observations (error bars above and below each box).…”

Section: Tumor Grade Progesterone Receptormentioning

confidence: 99%

Genomic Instability Within Tumor Stroma and Clinicopathological Characteristics of Sporadic Primary Invasive Breast Carcinoma

Fukino¹,

Shen²,

Patócs³

et al. 2007

JAMA

102

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A HIGH DEGREE OF VARIABILITY IS observed in both biological behavior and clinical outcome in sporadic breast cancer, and this interpatient diversity in breast cancer biology and behavior may confound clinical management based on averages. Breast conserving surgery has become the standard of care for early stage breast cancer. In a recently published study, 2929 patients with early stage breast cancer were examined for the relative impact of the patient, the surgeon, hospital factors, or all 3 on surgical treatment outcome variation in patients with breast cancer. The study by Gort et al 1 showed that 91.2% of the total variance was attributable to the patient level (there was large interpatient variability). These data suggested that interpatient variation accounts for the high degree of clinical variability. Indeed, the demand for personalized medicine illustrates the medical community's and public's recognition of interpatient variability. It has been recognized for decades that identical chemotherapeutic regimens for similar stage and grade in patients with, for example, breast cancer (or virtually any malignancy) respond differently. Context That genomic alterations occur in both the epithelium and stroma of sporadic breast cancers has been documented by several groups. However, whether these microenvironmental alterations relate to clinicopathological features is unknown.Objective To analyze the relationship between stromal genomic alterations and presenting clinicopathological features in sporadic breast cancer. Main Outcome Measures Association of the loss of heterozygosity/allelic imbalance, in both the stroma and epithelium, with presenting clinicopathological features, such as tumor grade, expression status of estrogen receptor and progesterone receptor, human epidermal growth factor receptor 2, clinical stage, and regional lymph node metastasis status. Associations were assessed in regression models and tested with Fisher exact test. Bonferroni correction was applied to P values, with significance set at PϽ.0022. Design, Setting, and Participants

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“…Although breast cancer treatment regimens are based largely on tumor characteristics such as tumor size and grade, ER, PR and HER2 status, traditional pathological evaluation is imperfect in predicting outcome [4]. Molecular characteristics may be more accurate prognostic tools than histological evaluation alone.…”

Section: Discussionmentioning

confidence: 99%

“…At the molecular level, breast tumors have additional levels of variability, with at least five breast subtypes based on patterns of differential gene expression [2], [3]. This pathological and molecular heterogeneity influences prognosis and treatment: in a study of 2,929 breast cancer patients, despite use of identical treatment modalities for patients with similar pathological characteristics, clinical outcomes were highly variable [4].…”

Section: Introductionmentioning

confidence: 99%

Molecular Alterations Associated with Breast Cancer Mortality

et al. 2012

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BackgroundBreast cancer is a heterogeneous disease and patients with similar pathologies and treatments may have different clinical outcomes. Identification of molecular alterations associated with disease outcome may improve risk assessment and treatments for aggressive breast cancer.MethodsAllelic imbalance (AI) data was generated for 122 invasive breast tumors with known clinical outcome. Levels and patterns of AI were compared between patients who died of disease (DOD) and those with ≥5 years disease-free survival (DFS) using Student t-test and chi-square analysis with a significance value of P<0.05.ResultsLevels of AI were significantly higher in tumors from the 31 DOD patients (28.6%) compared to the 91 DFS patients (20.1%). AI at chromosomes 7q31, 8p22, 13q14, 17p13.3, 17p13.1 and 22q12.3 was associated with DOD while AI at 16q22–q24 was associated with DFS. After multivariate analysis, AI at chromosome 8p22 remained an independent predictor of breast cancer mortality. The frequency of AI at chromosome 13q14 was significantly higher in patients who died ≥5 years compared to those who died <5 years from diagnosis.ConclusionTumors from DOD compared to DFS patients are marked by increased genomic instability and AI at chromosome 8p22 is significantly associated with breast cancer morality, independent of other clinicopathological factors. AI at chromosome 13q14 was associated with late (>5-years post-diagnosis) mortality but not with death from disease within five years, suggesting that patients with short- and long-term mortality may have distinct genetic diseases.

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Improvement of best practice in early breast cancer: actionable surgeon and hospital factors

Cited by 24 publications

References 24 publications

Clinical outcome data for symptomatic breast cancer: the breast cancer clinical outcome measures (BCCOM) project

Clinical outcome data for symptomatic breast cancer: the breast cancer clinical outcome measures (BCCOM) project

Genomic Instability Within Tumor Stroma and Clinicopathological Characteristics of Sporadic Primary Invasive Breast Carcinoma

Molecular Alterations Associated with Breast Cancer Mortality

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