Patterns in detection of recurrence among patients treated for breast cancer

Saltbæk, Lena; Horsboel, Trine Allerslev; Offersen, Birgitte Vrou; Andersson, Michael; Friberg, Anne Sofie; Skriver, Signe Korsgaard; Bidstrup, Pernille Envold; Overgaard, Jens; Johansen, Christoffer; Dalton, Susanne Oksbjerg

doi:10.1007/s10549-020-05847-4

Cited by 9 publications

(8 citation statements)

References 25 publications

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“…The pain was most often caused by bone metastases. 33 In our patients with bone metastases, 63% reported pain. Our study confirms that a detailed history-taking remains the most important tool to discover distant metastases.…”

Section: Discussionmentioning

confidence: 65%

Detection of secondary metastatic breast cancer by measurement of plasma CA 15.3

et al. 2021

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Background: Most current guidelines do not recommend the serial analysis of tumour marker CA 15.3 in the follow-up of asymptomatic patients treated for early breast cancer (EBC). These guidelines are based on small-scale studies carried out in an era with more limited treatment options than today. In our large academic centre, serial measurements of CA 15.3 are used routinely in the follow-up of EBC, whereas imaging for distant metastases is only carried out on indication. Patients and methods: In this retrospective single-centre study, patients were included if they were treated for EBC between 1 January 2000 and 1 January 2018, diagnosed with secondary metastatic disease at least 6 months after initial surgery and had CA 15.3 available at the time of diagnosis of metastases. The primary objective was to evaluate the proportion of patients in whom metastatic disease was discovered by an increasing CA 15.3. Information on the method of metastases detection, CA 15.3 evolution and survival was collected after approval of the ethics committee. Results: At the moment of diagnosis of metastases, 451 of 730 included patients (62%) had CA 15.3 levels above the upper limit of normal (>30 kU/l). In 269 patients (37%), an increasing CA 15.3 was the first sign that led to the diagnosis of metastases. This was most frequent in luminal A-like tumours (48%) and in liver (45%) and bone (41%) localisation of metastases. By contrast, reported symptoms triggered the diagnosis of metastatic disease in 48% of the patients. Median overall survival was significantly longer when the relapse was discovered by CA 15.3 elevation versus those discovered by another trigger (abnormal clinical examination or history, abnormal laboratory tests or an incidental finding) (35 versus 22 months; P ¼ 0.0027). Conclusion: When CA 15.3 is systematically used in the follow-up of EBC patients, the diagnosis of metastatic disease is made in 37% by a CA 15.3 increase.

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Section: Discussionmentioning

confidence: 65%

Detection of secondary metastatic breast cancer by measurement of plasma CA 15.3

et al. 2021

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“…Since 2016, patients have been able to choose among patient-led, nurse-led, or fixed annual follow-up exams. All women are offered mammography, ultrasound screening, and open access to a breast cancer unit for 10 years after a breast cancer diagnosis [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Single-nucleotide polymorphisms and the effectiveness of taxane-based chemotherapy in premenopausal breast cancer: a population-based cohort study in Denmark

Hjorth

Damkier

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et al. 2022

Breast Cancer Res Treat

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Purpose Taxane-based chemotherapy is the primary treatment for premenopausal breast cancer. Although being inconsistent, research suggests that variant alleles alter pharmacokinetics through reduced function of OATP transporters (limiting hepatic uptake), CYP-450 enzymes (hampering drug metabolism), and ABC transporters (decreasing clearance). Reduced function of DNA repair enzymes may hamper effectiveness through dose-limiting toxicities. We investigated whether single-nucleotide polymorphisms (SNPs) were associated with breast cancer recurrence or mortality in premenopausal women diagnosed with breast cancer. Methods We conducted a population-based cohort study of premenopausal women diagnosed with non-distant metastatic breast cancer in Denmark during 2007‒2011, when guidelines recommended adjuvant combination chemotherapy (taxanes, anthracyclines, and cyclophosphamide). Using archived formalin-fixed paraffin-embedded primary tumor tissue, we genotyped 26 SNPs using TaqMan assays. Danish health registries provided data on breast cancer recurrence (through September 25, 2017) and death (through December 31, 2019). We fit Cox regression models to calculate crude hazard ratios (HRs) and 95% confidence intervals (CIs) for recurrence and mortality across genotypes. Results Among 2,262 women, 249 experienced recurrence (cumulative incidence: 13%) and 259 died (cumulative incidence: 16%) during follow-up (median 7.0 and 10.1 years, respectively). Mortality was increased in variant carriers of GSTP1 rs1138272 (HR: 1.30, 95% CI 0.95–1.78) and CYP3A rs10273424 (HR: 1.33, 95% CI 0.98–1.81). SLCO1B1 rs2306283 (encoding OATP1B1) variant carriers had decreased recurrence (HR: 0.82, 95% CI 0.64–1.07) and mortality (HR: 0.77, 95% CI 0.60–0.98). Conclusion Docetaxel effectiveness was influenced by SNPs in GSTP1, CYP3A, and SLCO1B1 in premenopausal women with non-distant metastatic breast cancer, likely related to altered docetaxel pharmacokinetics. These SNPs may help determine individual benefit from taxane-based chemotherapy.

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“…As items were developed based on clinical consensus, we cannot rule out the possibility that other symptoms relevant for the detection of breast cancer recurrence may have been overlooked. However, BreastCaRe items capture the most common symptoms presented at the time of recurrence detection, as reported in a recent cross-sectional study of 310 breast cancer patients [14]. The response rate of 66.4% means that we cannot exclude problems with the generalizability of the study population, although differences between the respondents and non-respondents were generally small.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Recurrence can occur as either locoregional recurrence (in the treated breast or lymph nodes), contralateral recurrence (opposite breast), or distant recurrence or metastasis (in other organs) [10,11]. Previous studies have shown that about 60% of breast cancer recurrences are symptomatic and about 30-40% of recurrences are detected by the woman herself [12][13][14], suggesting the potential of organizing breast cancer follow-up based on patient-reported symptoms for the detection of possible cancer recurrence.…”

Section: Introductionmentioning

confidence: 99%

“…Depending on the organ site, common symptoms often reported upon suspicion of breast cancer recurrence include lumps or any changes in the feel or appearance of the skin around the breast, pain, dyspnea, weight loss, fatigue, and swelling of lymph nodes [11,13,14] which can be operationalized as items in a patient-reported measurement instrument. COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) guidelines suggests that the extent to which a new instrument can provide meaningful data for analysis depends on its development and core measurement properties, such as content validity, structural validity and internal consistency [17,18].…”

Section: Introductionmentioning

confidence: 99%

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The development and initial validation of the Breast Cancer Recurrence instrument (BreastCaRe)—a patient-reported outcome measure for detecting symptoms of recurrence after breast cancer

et al. 2021

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Purpose Patient-reported outomes (PRO) may facilitate prompt treatment. We describe the development and psychometric properties of the first instrument to monitor for symptoms of breast cancer (BC) recurrence. Methods This study is nested in the MyHealth randomized trial of nurse-led follow-up based on electronically-collected PROs. We constructed items assessing symptoms of potential recurrence through expert interviews with six BC specialists in Denmark. Semi-structured cognitive interviews were carried out with a patient panel to assess acceptability and comprehensibility. Items were subsequently tested in a population of 1170 women 1-10 years after completing BC treatment. We carried out multiple-groups confirmatory factor analysis (CFA) and Rasch analysis to test dimensionality, local dependence (LD) and differential item functioning (DIF) according to sociodemographic and treatment-related factors. Clinical data was obtained from the Danish Breast Cancer Group registry. Results Twenty-two items were generated for the Breast Cancer Recurrence instrument (BreastCaRe). Cognitive testing resulted in clearer items. Seven subscales based on general, bone, liver, lung, brain, locoregional and contralateral recurrence symptoms were proposed. Both CFA and Rasch models confirmed the factor structure. No DIF was identified. Five item pairs showed LD but all items were retained to avoid loss of clinical information. Rasch models taking LD into account were used to generate a standardized scoring table for each subscale. Conclusions The BreastCaRe has good content and structural validity, patient acceptability and measurement invariance. We are preparing to examine the predictive validity of this new instrument.

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Patterns in detection of recurrence among patients treated for breast cancer

Cited by 9 publications

References 25 publications

Detection of secondary metastatic breast cancer by measurement of plasma CA 15.3

Detection of secondary metastatic breast cancer by measurement of plasma CA 15.3

Single-nucleotide polymorphisms and the effectiveness of taxane-based chemotherapy in premenopausal breast cancer: a population-based cohort study in Denmark

The development and initial validation of the Breast Cancer Recurrence instrument (BreastCaRe)—a patient-reported outcome measure for detecting symptoms of recurrence after breast cancer

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