Locally Advanced Breast Cancer in Jamaica: Prevalence, Disease Characteristics and Response to Preoperative Therapy

Chin, Stephanie; Green, Cheryl May Antoinette; Gordon‐Strachan, Georgiana; Wharfe, Gilian

doi:10.7314/apjcp.2014.15.7.3323

Cited by 9 publications

(15 citation statements)

References 21 publications

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“…Of those included, more than 95% of the patients had symptomatic disease at presentation, with more than half of the patients having masses greater than 5 cm and staged as locally advanced disease. The rate of advanced disease at presentation in the Haitian population appears higher than rates from other published studies on Caribbean populations [10,12,29,33–35]. However, in a recent systematic review of studies from low‐resource settings in sub‐Saharan Africa, some countries had even higher rates of advanced disease, with some exceeding 90% [36].…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Fadelu

Damuse²,

Lormil³

et al. 2020

The Oncologist

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Background There are few studies on breast cancer outcomes in the Caribbean region. This study identified a retrospective cohort of female patients with nonmetastatic breast cancer in Haiti and conducted survival analyses to identify prognostic factors that may affect patient outcomes. Methods The cohort included 341 patients presenting between June 2012 and December 2016. The primary endpoint was event‐free survival (EFS), defined as time to disease progression, recurrence, or death. Descriptive summaries of patient characteristics and treatments were reported. Survival curves were plotted using Kaplan‐Meier estimation. Multivariate survival analyses were performed using Cox proportional hazards regression. Results Median age at diagnosis was 49 years, with 64.2% being premenopausal. Most patients (55.1%) were staged as locally advanced. One hundred and sixty patients received neoadjuvant therapy: 33.3% of patients with early stage disease and 61.2% of those with locally advanced stage disease. Curative‐intent surgery was performed in 278 (81.5%) patients, and 225 patients received adjuvant therapy. Adjuvant endocrine therapy was used in 82.0% of patients with estrogen receptor–positive disease. During the follow‐up period, 28 patients died, 77 had disease recurrence, and 10 had progressive disease. EFS rates at 2 years and 3 years were 80.9% and 63.4%, respectively. After controlling for multiple confounders, the locally advanced stage group had a statistically significant adjusted hazard ratio for EFS of 3.27 compared with early stage. Conclusion Patients with nonmetastatic breast cancer in Haiti have more advanced disease, poorer prognostic factors, and worse outcomes compared with patients in high‐income countries. Despite several limitations, curative treatment is possible in Haiti. Implications for Practice Patients with breast cancer in Haiti have poor outcomes. Prior studies show that most Haitian patients are diagnosed at later stages. However, there are no rigorous studies describing how late‐stage diagnosis and other prognostic factors affect outcomes in this population. This study presents a detailed analysis of survival outcomes and assessment of prognostic factors in patients with nonmetastatic breast cancer treated in Haiti. In addition to late‐stage diagnosis, other unfavorable prognostic factors identified were young age and estrogen receptor‐negative disease. The study also highlights that the availability of basic breast cancer treatment in Haiti can lead to promising early patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Fadelu

Damuse²,

Lormil³

et al. 2020

The Oncologist

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“…In our study the mean age of patients at diagnosis was 50.58 yrs with a standard deviation of 10.94. In a study conducted by Saxena et al the mean age of presentation of breast cancer in the Indian population was 47.8 yrs [ 15 ] and as per the study conducted by Chin et al the mean age at presentation was 52 yrs [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…A pCR of 19–31% has been found in large prospective studies conducted by Smith et al [ 19 ] and Baer et al [ 20 ]; however the study conducted by Chin et al found a lower rate of pCR of 10% [ 16 ]. Studies of Fayanju et al showed a pCR of 40% [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Pathological Response of Breast Carcinoma in Modified Radical Mastectomy Specimens after Neoadjuvant Chemotherapy

Vasudevan

Jayalakshmy

Kumar

et al. 2015

International Journal of Breast Cancer

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Aim. Paclitaxel based neoadjuvant chemotherapy regimen (NAT) in the setting of locally advanced breast cancer (LABC) can render inoperable tumor (T4, N2/N3) resectable. The aim of this study was to assess the status of carcinoma in the breast and lymph nodes after paclitaxel based NAT in order to find out the patient and the tumor characteristics that correspond to the pathological responses which could be used as a surrogate biomarker to assess the treatment response. Materials and Methods. Clinical and tumor characteristics of patients with breast carcinoma (n = 48) were assessed preoperatively. These patients were subjected to modified radical mastectomy after 3 courses of paclitaxel based NAT regimen. The pathological responses of the tumor in the breast and the lymph nodes were studied by using Chevallier's system which graded the responses into pathological complete response (pCR), pathological partial response (pPR), and pathological no response (pNR). Results. Our studies showed a pCR of 27.1% and a pPR of 70.9% . Clinically small sized tumors (2–5 cms) and Bloom Richardson's grade 1 tumors showed a pCR. Mean age at presentation was 50.58 yrs. 79.2% of cases were invasive ductal carcinoma NOS; only 2.1% were invasive lobular carcinoma, their response to NAT being the same. There was no downgrading of the tumor grades after NAT. Ductal carcinoma in situ and lymphovascular invasion were found to be resistant to chemotherapy. The histopathological changes noted in the lymph nodes were similar to that found in the tumor bed. Discussion and Conclusion. From our study we conclude that histopathological examination of the tumor bed is the gold standard for assessing the chemotherapeutic tumor response. As previous studies have shown pCR can be used as a surrogate biomarker to assess the tumor response.

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“…In a study by Vasudevan (12), pCRwas observed in 27.1% and pPR in 70.9% cases. Smith et al (21) and Baer et al (22) reported pCR in 19-31% cases, 10% cases by Chin et al (23) and 40% was reported by Fayanju et al (24). In another study conducted by Shintia et al (18) reported rate of pNR, pPR and pCR was 35.71%, 59.53% and 4.76%, respectively.…”

Section: Discussionmentioning

confidence: 90%

Assessment of pathological response to neoadjuvant chemotherapy in patients with breast carcinoma using Sataloff system

et al. 2019

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Background: Neoadjuvant chemotherapy is frequently administered to patients with breast carcinoma. Response to chemotherapeutic regime can be assessed clinically as well as by pathological examination of the breast tissue. It is essential to accurately categorize the patients with residual disease according to the standard guidelines for pathological evaluation of breast specimens after neoadjuvant chemotherapy. The present study was undertaken to assess the histomorphological changes in mastectomy specimens and axillary lymphatic nodes of patients receiving neoadjuvant chemotherapy, grade the pathological response using Sataloff system and to compare the clinical and pathological response after neoadjuvant chemotherapy. Methods: Present prospective study included a total of 31 patients with locally advanced breast carcinoma, diagnosed with infiltrating ductal carcinoma, not otherwise specified on biopsy specimen and subsequently treated with 2 to 6 cycles of neoadjuvant chemotherapy. Pathological response to neoadjuvant chemotherapy was assessed in breast and axillary lymphatic nodes according to Sataloff criteria. Results: Clinical response observed was complete (cCR) in four cases (12.9%), partial response (cPR) in 24 cases (77.4%), and no response (cNR) in three cases (9.7%). Based on tumor response, breast and lymph nodes were graded as pathological complete response (pCR), pathological partial response (pPR), and pathological no response (pNR) in five (16.1%), 18 (58.1%) and eight (25.8%) cases respectively using Sataloff criteria. Ductal carcinoma in situ and lymphovascular invasion were seen in 11 (35.4%) and 16 cases (51.6%), respectively. Conclusion: The pathological assessment of tumor response remains the gold standard, as neither the clinical nor the radiological responses are sensitive predictors of tumor response after treatment. However pathological examination is quite challenging and demands sufficient experience along with detailed clinical and radiological data of pre- and postoperative neoadjuvant chemotherapy for precise response evaluation.

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Locally Advanced Breast Cancer in Jamaica: Prevalence, Disease Characteristics and Response to Preoperative Therapy

Cited by 9 publications

References 21 publications

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Assessment of Pathological Response of Breast Carcinoma in Modified Radical Mastectomy Specimens after Neoadjuvant Chemotherapy

Assessment of pathological response to neoadjuvant chemotherapy in patients with breast carcinoma using Sataloff system

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