Routine and interval detection of locoregional breast cancer recurrences and risk of subsequent distant metastasis

Eijkelboom, Anouk H; Munck, Linda de; Vries, Maaike de; Francken, Anne Brecht; Hendriks, Mathijs P.; Strobbe, Luc J. A.; Witteveen, Annemieke; Maaren, Marissa C. van; Siesling, Sabine

doi:10.1007/s10549-022-06757-3

Cited by 7 publications

(11 citation statements)

References 30 publications

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“…One study reported no significant relationship between the way of detection (i.e. routine visits or symptomatic discovery) of the LRR and the grade and stage of the LRR or the risk of DM, further underlining the de-escalation of follow-up [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, several studies have previously evaluated guideline adherence and mainly reported a higher than recommended intensity of follow-up related to the application of radiotherapy, patient preferences, financial incentives and inadequate intervals, irrespective of patients’ individual risk of recurrence [ 11 – 13 ]. Additionally, nearly half of all recurrences are found by patients themselves between routine visits and are of similar severity as recurrences detected at routine visits [ 7 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk

Voets,

Hassink,

Veltman

et al. 2024

Breast Cancer Res Treat

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Purpose Follow-up guidelines barely diverge from a one-size-fits-all approach, even though the risk of recurrence differs per patient. However, the personalization of breast cancer care improves outcomes for patients. This study explores the variation in follow-up pathways in the Netherlands using real-world data to determine guideline adherence and the gap between daily practice and risk-based surveillance, to demonstrate the benefits of personalized risk-based surveillance compared with usual care. Methods Patients with stage I–III invasive breast cancer who received surgical treatment in a general hospital between 2005 and 2020 were selected from the Netherlands Cancer Registry and included all imaging activities during follow-up from hospital-based electronic health records. Process analysis techniques were used to map patients and activities to investigate the real-world utilisation of resources and identify the opportunities for improvement. The INFLUENCE 2.0 nomogram was used for risk prediction of recurrence. Results In the period between 2005 and 2020, 3478 patients were included with a mean follow-up of 4.9 years. In the first 12 months following treatment, patients visited the hospital between 1 and 5 times (mean 1.3, IQR 1–1) and received between 1 and 9 imaging activities (mean 1.7, IQR 1–2). Mammogram was the prevailing imaging modality, accounting for 70% of imaging activities. Patients with a low predicted risk of recurrence visited the hospital more often. Conclusions Deviations from the guideline were not in line with the risk of recurrence and revealed a large gap, indicating that it is hard for clinicians to accurately estimate this risk and therefore objective risk predictions could bridge this gap.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk

Voets,

Hassink,

Veltman

et al. 2024

Breast Cancer Res Treat

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“…On the other hand, MECs without any of the aforementioned characteristics, breast‐conserving surgery with clear margins would suffice to avoid overtreatment 64–66 . In both scenarios, it is wise to adopt tailored follow‐up procedures 67–69 . Similarly, the de‐escalation of adjuvant medical treatment, including chemotherapy, immunotherapy, targeted therapies, and radiotherapy requires a multidisciplinary approach 70–72 .…”

Section: Discussionmentioning

confidence: 99%

“… 64 , 65 , 66 In both scenarios, it is wise to adopt tailored follow‐up procedures. 67 , 68 , 69 Similarly, the de‐escalation of adjuvant medical treatment, including chemotherapy, immunotherapy, targeted therapies, and radiotherapy requires a multidisciplinary approach. 70 , 71 , 72 Hence, the paucity of comprehensive molecular information on large cohorts of patients prevents any specific recommendation and thus, our results should be validated and discussed in the context of multi‐institutional studies and dedicated cancer registries.…”

Section: Discussionmentioning

confidence: 99%

The molecular landscape of breast mucoepidermoid carcinoma

et al. 2023

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Mucoepidermoid carcinoma (MEC) of the breast is an extremely rare salivary gland‐type tumor characterized by epidermoid, basaloid, intermediate, and/or mucinous cells arranged in solid and cystic patterns. Despite their triple‐negative phenotype, breast MECs are generally considered low‐risk malignancies but their biology is largely unexplored; therefore, guidelines for clinical management are lacking. Here, we sought to characterize the molecular landscape of breast MECs. Thirteen cases were histologically reviewed, characterized for tumor‐infiltrating lymphocytes (TILs), and were subjected to immunohistochemistry for programmed death‐ligand 1 (PD‐L1, clone 22C3), EGFR, and amphiregulin (AREG). Rearrangements in MAML2 and EWSR1 were investigated by fluorescent in situ hybridization. Targeted next‐generation sequencing of 161 genes was performed on eight cases. Most MECs had low histological grade (n = 10, 77%), with the presence of TILs (n = 9/12; 75%) and PD‐L1 combined positive score ranging from 10 to 20 (n = 4/6; 67%). All cases showed EGFR and AREG overexpression and were fusion negative. Enrichment of genetic alterations was observed in PI3K/AKT/mTOR and cell cycle regulation pathways, while only one case harbored TP53 mutations. This is the first study providing extensive molecular data on breast MECs and the largest collection of cases available to date in the literature. Breast MECs lack TP53 mutations found in high‐grade forms of triple‐negative breast cancers and MAML2 or EWSR1 rearrangements pathognomonic of salivary MECs. Triple‐negativity and PD‐L1 positivity suggest a window of opportunity for immunotherapy in these patients. The EGFR/AREG axis activation, coupled with the mutational patterns in PI3K/AKT/mTOR and cell cycle pathways warrants caution in considering MECs as low‐risk neoplasms.

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“…In the Netherlands, one in seven women is diagnosed with breast cancer at some point in their lives (Eijkelboom et al, 2020). Early diagnosis, for example by the national screening programme, and improved treatment have increased the survival rates over the years (Netherlands Cancer Registry, 2021).…”

Section: Introductionmentioning

confidence: 99%

Patient preference attributes in eHealth interventions for cancer‐related fatigue: A scoping review

Beenhakker

Witteveen

Wijlens

et al. 2022

European J Cancer Care

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Introduction: Cancer-related fatigue (CRF) is one of the most reported long-term effects breast cancer patients experience after diagnosis. Many interventions for CRF are effective, however, not for every individual. Therefore, intervention advice should be adjusted to patients' preferences and characteristics. Our aim was to develop an overview of eHealth interventions and their (preference sensitive) attributes. Methods: eHealth interventions were identified using a scoping review approach. Eligible studies included breast cancer patients and assessed CRF as outcome. Interventions were categorised as physical activity, mind-body, psychological, 'other' or 'combination'. Information was extracted on various (preference sensitive) attributes, like duration, intensity, peer support and costs. Results: Thirty-five interventions were included and divided over the intervention categories. (Preference sensitive) attributes varied both within and between these categories. Duration varied from 4 weeks to 6 months, intensity from daily to own pace. Peer support was present in seven interventions and costs were known for six. Conclusion: eHealth interventions exist in various categories, additionally, there is much variation in (preference sensitive) attributes. This provides opportunities to implement our overview for personalised treatment recommendations for breast cancer patients struggling with CRF. Taking into account patients' preferences and characteristics suits the complexity of CRF and heterogeneity of patients.

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Routine and interval detection of locoregional breast cancer recurrences and risk of subsequent distant metastasis

Cited by 7 publications

References 30 publications

Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk

Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk

The molecular landscape of breast mucoepidermoid carcinoma

Patient preference attributes in eHealth interventions for cancer‐related fatigue: A scoping review

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