This slide show includes some of the highlights from the 2014 ASCO Breast Cancer Symposium, including an increase in BRCA testing, the Angelina Jolie effect, how to boost screening rates, a link between BRCA mutations and triple-negative disease, and more.
References:
1. Raphael J, Verma S, Hewitt P, Eisen A. The impact of Angelina Jolie’s (AJ) story on genetic referral and testing at an academic cancer centre. 2014 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium. Abstract 44.
2. Chan EK, Wilson C, Tyldesley S, et al. Improving screening mammography return rates in overdue women: A randomized study of signed reminder letters from family physicians. 2014 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium. Abstract 1.
3. Mamounas EP, Cortazar P, Zhang L, et al. Locoregional recurrence (LRR) after neoadjuvant chemotherapy (NAC): Pooled-analysis results from the collaborative trials in neoadjuvant breast cancer (CTNeoBC). 2014 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium. Abstract 61.
4. Silva AK, Lapin B, Yao K, et al. A NSQIP analysis of 30-day complications after bilateral versus unilateral mastectomy with immediate reconstruction. 2014 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium. Abstract 62.
5. Chun J, Schnabel FR, Schwartz S, et al. Prevalence of BRCA2 mutations and other clinical characteristics in women with triple-negative breast cancer. 2014 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium. Abstract 160.
6. Schneble EJ, Perez SA, Murray JL, et al. Primary analysis of the prospective, randomized, phase II trial of GP2+GM-CSF vaccine versus GM-CSF alone administered in the adjuvant setting to high-risk breast cancer patients. 2014 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium. Abstract 134.
Slide 1: Angelina Jolie May Have Been Driving Factor in Rising BRCA Testing Rates:
Referrals for genetic testing increased by almost 90% in the 6 months after Angelina Jolie, who is a BRCA1 carrier, announced her bilateral mastectomy in May 2013. Researchers retrospectively analyzed records at the Sunnybrook Odette Cancer Center in Toronto, Canada, finding that a total of 916 women sought genetic testing between May 2013 and November 2013 compared to 487 in the 6 months prior. The quality of referrals did not decrease, as the proportion of high-risk women who were actually referred increased. Prior to May 2013, a total of 213 women qualified for genetic testing; in the 6 months after, 437 qualified for genetic testing, an increase of 105%.[1] Image source: Jacques Raphael, MD, Sunnybrook Odette Cancer Center, Toronto, Canada.
Slide 2: Reminders With Personal Touch Boosted Breast Cancer Screening Rates:
A reminder letter signed by a patient’s physician improved screening rates in women who were 30 to 48 months overdue for a mammography screening test by 70%. The study included women between the ages of 52 and 74 in British Columbia, Canada. A total of 2,689 women were sent postcard reminders and 2,696 women were sent both a postcard and the physician letter. Within 6 months, more women who were sent the personalized letter returned for their overdue screening (33.2% compared with 22.3%).[2] Image source: Elisa Chan, MD, BC Cancer Agency, Vancouver, Canada.
Slide 3: Predictors of Locoregional Recurrence-Tumor Subtype, Neoadjuvant Chemo Response:
An early breast tumor’s pathologic response to neoadjuvant chemotherapy and the patient’s tumor subtype are the two major predictors of breast cancer recurrence (both local or regional), according to the results of pooled analysis of 11,995 women involved in 12 clinical trials. These two factors may be more predictive than tumor stage at diagnosis, which is currently used to predict recurrence. Women with residual disease had a risk of recurrence 1.6 times greater than those who achieved a pathologic complete response. Patients with cancer in the axillary lymph nodes had a 2.8 times greater risk of recurrence. Patients with hormone receptor (HR)-positive, HER2-negative grade 1/2 tumors had a lower risk of recurrence compared to other subtypes.[3] Image source: Eleftherios Mamounas, MD, MPH, Comprehensive Breast Program, UF Health Cancer Center, Orlando, Florida.
Slide 4: Surgical Complications Linked to Double Mastectomy:
Even though surgical complications are relatively rare, women who opt for a double mastectomy may have a higher rate of certain surgical complications within 30 days of surgery, according to the results of a study that analyzed data from the American College of Surgeons National Surgical Quality Improvement Program. The study included 18,229 women who received a mastectomy for their breast cancer, 35.7% of the whom opted for bilateral breast surgery. The types of complications that were more prevalent among those who received a double vs a single mastectomy included implant loss, need for re-operation postimplant, and bleeding requiring a transfusion.[4] Image source: Mark Sisco, MD, University of Chicago Pritzker School of Medicine, Chicago, Illinois
Slide 5: Triple-Negative Breast Cancer Patients Have Higher Rate of BRCA2 Mutations:
Out of a cohort of 1,332 women with different breast cancer subtypes, the 125 (9%) women with triple-negative breast cancer (TNBC) on the study were more likely to have tumors that harbored a
BRCA2
mutation. Within the group of TNBC patients, 29% (12 patients) harbored a
BRCA1,2
mutation vs 8% (23 patients) from the non-TNBC group. A
BRCA2
mutation was significantly associated with TNBC (
P
BRCA1 mutation was not (
P
= .40). According to the researchers, TNBC is a risk for all age groups, and older age should not prevent women from receiving genetic testing.[5] Image source: Jennifer Chun, MD, New York University Cancer Institute, Langone Medical Center, New York, New York.
Slide 6: Vaccine Shows Potential for Recurrence Prevention for HER2-Overexpressed Breast Cancers:
Patients with HER2-overexpressed breast cancer may experience a greater benefit from a GP2 immunogenic peptide, derived from the transmembrane portion of the HER2 protein, compared with other breast cancer patients. The GP2+GM-CSF was well-tolerated among the 180 patients in this phase II trial. One grade 3 local, systemic toxicity was reported. The trial tested whether the vaccine was effective in preventing breast cancer recurrence after initial therapy. Excluding three patients who had a recurrence during the primary vaccination, no HER2-positive patient who completed the vaccination series had recurred after a median 34-month follow-up.[6] Image source: Erika J. Schneble, MD, San Antonio Military Medical Center, San Antonio, Texas.
