Spectrum of very early breast cancer in a setting without organised screening

Bhoo-Pathy, Nirmala; Subramaniam, Shridevi; Taib, Nur Aishah Mohd; Hartman, Mikael; Alias, Z.; Gh, Tan; Ibrahim, Rose Irnawaty; Ch, Yip; Verkooijen, H.

doi:10.1038/bjc.2014.183

Cited by 15 publications

(14 citation statements)

References 36 publications

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“…Although young women with breast cancer have conventionally been more likely to undergo breast‐conserving surgery (BCS; lumpectomy with adjuvant radiotherapy), concerns regarding recurrence and reduced survival may influence patients to opt for mastectomy . A number of studies investigating trends in surgical management of breast cancer in the USA and Europe have highlighted that younger patients are increasingly being treated by mastectomy .…”

Section: Introductionmentioning

confidence: 99%

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Breast-conserving surgeryversusmastectomy in young women with breast cancer in Asian settings

et al. 2018

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BackgroundMastectomy rates among women with early breast cancer in Asia have traditionally been high. This study assessed trends in the surgical management of young women with early‐stage breast cancer in Asian settings. Survival in women treated with breast‐conserving surgery (BCS; lumpectomy with adjuvant radiotherapy) and those undergoing mastectomy was compared.MethodsYoung women (aged less than 50 years) newly diagnosed with stage I or II (T1–2 N0–1 M0) breast cancer in four hospitals in Malaysia, Singapore and Hong Kong in 1990–2012 were included. Overall survival (OS) was compared for patients treated by BCS and those who had a mastectomy. Propensity score analysis was used to account for differences in demographic, tumour and treatment characteristics between the groups.ResultsSome 63·5 per cent of 3536 women underwent mastectomy. Over a 15‐year period, only a modest increase in rates of BCS was observed. Although BCS was significantly associated with favourable prognostic features, OS was not significantly different for BCS and mastectomy; the 5‐year OS rate was 94·9 (95 per cent c.i. 93·5 to 96·3) and 92·9 (91·7 to 94·1) per cent respectively. Inferences remained unchanged following propensity score analysis (hazard ratio for BCS versus mastectomy: 0·81, 95 per cent c.i. 0·64 to 1·03).ConclusionThe prevalence of young women with breast cancer treated by mastectomy remains high in Asian countries. Patients treated with BCS appear to survive as well as those undergoing mastectomy.

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Section: Introductionmentioning

confidence: 99%

“…Compared with Europe and the USA , rates of BCS have traditionally been very low in Asian settings. The high use of mastectomy in Asia has been highlighted in a number of studies . A Malaysian study showed that approximately one in two patients with stage I breast cancer opted for mastectomy.…”

Section: Introductionmentioning

confidence: 99%

Breast-conserving surgeryversusmastectomy in young women with breast cancer in Asian settings

et al. 2018

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“…In a recent single institutional study from Malaysia, TNBCs comprised almost one‐third of all newly diagnosed cases, and the age‐standardized incidence was higher in certain ethnic groups such as in Malays and the indigenous populations . Furthermore, Asian breast cancer patients have a preponderance to opt for mastectomy, even when presenting with small tumors . Hence, if radiotherapy truly confers a survival benefit in TNBC, the question of whether adjuvant radiotherapy should be discussed as a standard option following mastectomy is pertinent …”

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confidence: 99%

“…13 Furthermore, Asian breast cancer patients have a preponderance to opt for mastectomy, even when presenting with small tumors. [14][15][16] Hence, if radiotherapy truly confers a survival benefit in TNBC, the question of whether adjuvant radiotherapy should be discussed as a standard option following mastectomy is pertinent. 3 Within a large multiethnic cohort of Asian TNBC patients, we determined the association between adjuvant radiotherapy and survival following the diagnosis of breast cancer.…”

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confidence: 99%

Prognostic role of adjuvant radiotherapy in triple‐negative breast cancer: A historical cohort study

Bhoo‐Pathy

Verkooijen

Wong

et al. 2015

Intl Journal of Cancer

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The value of adjuvant radiotherapy in triple-negative breast cancer (TNBC) is currently debated. We assessed the association between adjuvant radiotherapy and survival in a large cohort of Asian women with TNBC. Women diagnosed with TNBC from 2006 to 2011 in five Asian centers (N 5 1,138) were included. Survival between patients receiving mastectomy only, breastconserving therapy (BCT, lumpectomy and adjuvant radiotherapy) and mastectomy with radiotherapy were compared, and adjusted for demography, tumor characteristics and chemotherapy types. Median age at diagnosis was 53 years (range: 23-96 years). Median tumor size at diagnosis was 2.5 cm and most patients had lymph node-negative disease. The majority of patients received adjuvant chemotherapy (n 5 861, 76%) comprising predominantly anthracycline-based regimes. In 775 women with T1-2, N0-1, M0 TNBCs, 5-year relative survival ratio (RSR) was highest in patients undergoing mastectomy only (94.7%, 95% CI: 88.8-98.8%), followed by BCT (90.8%, 95% CI: 85.0-94.7%), and mastectomy with radiotherapy (82.3%, 95% CI: 73.4-88.1%). The adjusted risks of mortality between the three groups were not significantly different. In 363 patients with T3-4, N2-3, M0 TNBCs, BCT was associated with highest 5-year RSR (94.1%, 95% CI: 81.3-99.4%), followed by mastectomy with radiotherapy (62.7%, 95% CI: 54.3-70.1%), and mastectomy only (58.6%, 95% CI: 43.5-71.6%). Following multivariable adjustment, BCT and mastectomy with radiotherapy remained significantly associated with lower mortality risk compared to mastectomy only. Overall, adjuvant radiotherapy was associated with higher survival in women aged <40 years, but not in older women. Adjuvant radiotherapy appears to be independently associated with a survival gain in locally advanced as well as in very young TNBC.

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“…However, majority of women undergo mastectomy for breast cancer in Asia, where published data indicate that only 20–40% of women undergo BCT . Even for what has been termed as very early breast cancer (Stage I disease), BCT rates are 45%, which is below the requisite NAPBC standard. It has been thought that the smaller breast tissue volume in Asian women serves as a relative contraindication to BCT, especially for tumours in excess of 2 cm .…”

Section: Introductionmentioning

confidence: 99%

Are breast conservation treatment rates optimized for Asian women with symptomatic malignancies?

Tan¹,

Sitoh

2019

ANZ Journal of Surgery

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Background:Published data indicate that 20-40% of patients undergo breast conservation treatment (BCT) in Asia, which is below an indicative benchmark of 50%. With an increasing body of evidence suggesting that BCT might be associated with improved survival outcomes, it is exigent to increase BCT utilization. This study was therefore undertaken to evaluate BCT rates for women presenting with symptomatic breast cancer and potential for de-escalation of surgical treatment. Methods: All patients who presented with symptomatic tumours and underwent surgical treatment at the authors' healthcare facility between January 2009 and December 2011 were included in this retrospective study. Standard wide excision was performed to achieve clear margins and reasonable cosmetic outcomes for BCT-eligible patients. Oncoplastic techniques such as therapeutic mammoplasty or volume replacement with flaps were not employed. Results: A total of 116 women presented with symptomatic breast cancer. The majority (92.2%) were Asian. Mean age at diagnosis was 48.3 years and mean tumour size was 23.4 mm. Ninety-five patients (81.9%) underwent BCT. Of the 22 patients, 13 (59%) who underwent neoadjuvant chemotherapy had sufficient tumour size downstaging to successfully undergo BCT instead of mastectomy. Conclusion: It is possible for more than 80% of Asian women with symptomatic breast malignancies to undergo BCT, with the appropriate use of neoadjuvant medical therapy and surgical techniques. As increasing data indicate improved survival with BCT, this should be offered as the treatment of choice.

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Spectrum of very early breast cancer in a setting without organised screening

Cited by 15 publications

References 36 publications

Breast-conserving surgeryversusmastectomy in young women with breast cancer in Asian settings

Breast-conserving surgeryversusmastectomy in young women with breast cancer in Asian settings

Prognostic role of adjuvant radiotherapy in triple‐negative breast cancer: A historical cohort study

Are breast conservation treatment rates optimized for Asian women with symptomatic malignancies?

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