Breast Cancer

Two hormone-modulating breast cancer therapies (HMTs), tamoxifen and steroidal aromatase inhibitors, were associated with a decrease in the number of women who received a diagnosis of a neurodegenerative disease, according to a study published in JAMA Network Open. Specifically, the 2 HMTs were associated with significant decreases in diagnoses of Alzheimer disease and dementia.

Patients who undergo neoadjuvant chemotherapy tend to be younger, with larger tumors and greater nodal involvement. But differences in their 30- and 90-day mortality rates compared with those of patients treated adjuvantly are clinically insignificant.

Investigators tracked time to treatment for 3 types of cancer in states that expanded Medicaid coverage on January 1, 2014, comparing rates before and after the expansion. Patients with new diagnoses of invasive breast, colon, or lung cancers aged 40 to 64 years were included in the analysis.

Thirty-seven percent of women prefer to receive their lifetime risk of breast cancer through numbers and words, while 73% prefer a combination of lifetime and 10-year age-related risk.

Of the women in the 2017 study over age 75, 63% had a mammogram.

Screening mammography is important for reducing race- and ethnicity-associated triple-negative breast cancer (TNBC) disparities among African American and white American patients. At present, there is a 40% higher mortality rate among African American women compared with white American women.

Recommendations abound for when women at average risk for breast cancer should begin yearly mammography screening, ranging from age 40 to 50. Questions remain, however, on the optimal age at which to stop. However, with over 50% of women older than age 75 still undergoing mammography, is there a truly safe age at which to stop what has been shown to be a life-saving practice if it does not decrease their mortality from breast cancer?

When time to first treatment ranged from 31 to 90 days for patients with breast cancer, doctors had more time for extensive diagnostic workups without compromising survival rates.

The 5-year survival rate for triple-negative breast cancer (TNBC) is about 77%. The recurrence rate is highest in the first 3 years after treatment, but falls off at the 5-year mark—although the survival rate at this time point tends to be lower. Because TNBC cells lack the hormone receptors for estrogen and progesterone and do not overexpress the human epidermal growth factor receptor 2 gene, treatment often involves chemotherapy, radiation, and surgery. Targeted treatments are not used with TNBC.

CMS said it is expanding coverage of next generation sequencing (NGS) for use as a diagnostic for patients with germline breast and ovarian cancer, paving the way for Medicare beneficiaries to receive more personalized medicine. However, an advocate said the wording of CMS' decision could actually limit testing access for some women with breast or ovarian cancer.

Two abstracts on liquid biopsy tests revealed the potential of analyzing circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs) in promoting heightened decision-making by clinicians for patients with early-stage and metastatic breast cancer.

In phase 3 trial results presented at the San Antonio Breast Cancer Symposium in San Antonio, Texas, oral paclitaxel with encequidar, the first orally administered paclitaxel, was shown to exhibit superior confirmed response and survival with less neuropathy for patients with metastatic breast cancer compared with intravenous (IV) paclitaxel.

Ensuring that prognostic or predictive tests to help make decisions regarding radiation therapy are accurate and clinically validated remains a challenge, said Corey Speers, MD, PhD, assistant professor, radiation oncology, University of Michigan.

Data from the MINDACT trial revealed that among women with luminal breast cancers (hormone receptor–positive, HER2-negative by local pathology) with a high clinical risk and low genomic risk, those aged 40 to 50 years had a greater, but insignificant, benefit from chemotherapy than patients older than 50.

The bar for who should get genetic testing for breast cancer keeps getting lowered, and oncologists have to keep informed about which results should trigger a referral for germline testing, said Nadine Tung, MD, director, Cancer Risk and Prevention Program, Beth Israel Deaconess Medical Center, and associate professor, medicine, Harvard Medical School.

Using biomarker tests can help personalize care for women with ductal carcinoma in situ and determine the risks of using or not using radiation, said Eileen Rakovitch, MD, MSc, FRCPC, professor, department of radiation oncology, University of Toronto.

In 3 abstracts presented at the San Antonio Breast Cancer Symposium in San Antonio, Texas, patient-reported outcomes (PROs) and quality of life were measured for different therapeutic interventions aiming to either heighten tumor detection or ease chemotherapy-induced effects.

Results from the phase 2 DESTINY-Breast01 clinical trial show the novel efficacy of trastuzumab deruxtecan in providing durable benefit to heavily pretreated patients having undergone other HER2-targeted treatments.

Overall survival was shown to be greater but insignificant in patients administered pertuzumab compared with placebo, while subgroups of lymph node–positive and hormone receptor–negative patients were distinguished as major beneficiaries, according to the results of the second interim analysis of APHINITY presented at the San Antonio Breast Cancer Symposium in San Antonio, Texas.

With the ACA putting emphasis on preventive care, there has been an immediate increase in breast and coloreactal cancer screenings. A recent study found that incidence rates of early-stage breast and colorectal cancer increased in 2014, but did not vary for late-stage breast and colorectal cancer.

The FDA has approved the first 2D digital mammography system that lets patients adjust the level of compression applied to their breast during the imaging procedure.

Breast cancer screening may not improve in early medical home implementation.

Data released by the CDC today indicate that while breast cancer deaths are on the decline, black women still have worse outcomes than white women. The report also noted disparate trends in breast cancer incidence among different races and age groups.

What we’re reading, October 13, 2016: researchers, Alzheimer’s patients, and their families anxiously await the results of a clinical trial that could help slow the disease’s progress; many breast cancers detected by mammograms are overtreated even though they likely would not be fatal on their own; stock prices fall for Humana and Cigna as CMS says a minority of their patients are in plans rated 4 stars or higher.

The authors describe a quality improvement intervention that focuses on directly scheduling mammogram appointments for women who lack adherence despite written outreach letters.