Participation in a high-risk program is associated with a diagnosis of earlier-stage disease among women at increased risk for breast cancer development Journal Article
| Authors: | Pilewskie, M.; Eroglu, I.; Sevilimedu, V.; Le, T.; Mangino, D.; Morrow, M. |
| Article Title: | Participation in a high-risk program is associated with a diagnosis of earlier-stage disease among women at increased risk for breast cancer development |
| Abstract: | Background: High-risk programs provide recommendations for surveillance/risk reduction for women at elevated risk for breast cancer development. This study evaluated the impact of high-risk surveillance program participation on clinicopathologic breast cancer features at the time of diagnosis. Methods: Women followed in the authors’ high-risk program (high-risk cohort [HRC]) with a diagnosis of breast cancer from January 2015 to June 2021 were identified and compared with the general population of women undergoing breast cancer surgery at Memorial Sloan Kettering Cancer Center (MSK; general cohort [GC]) during the same period. Patient and tumor factors were collected. Clinicopathologic features were compared between the two cohorts and in a subset of women with a family history of known BRCA mutation. Results: The study compared 255 women in the HRC with 9342 women in the GC. The HRC patients were slightly older and more likely to be white and have family history than the GC patients. The HRC patients also were more likely to present with DCIS (41 % vs 23 %; p < 0.001), to have smaller invasive tumors (pT1: 100 % vs 77 %; p < 0.001), and to be pN0 (95 % vs 81 %; p < 0.001). The HRC patients had more invasive triple-negative tumors (p = 0.01) and underwent less axillary surgery (p < 0.001), systemic therapy (p < 0.001), and radiotherapy (p = 0.002). Among those with a known BRCA mutation, significantly more women in the HRC underwent screening mammography (75 % vs 40 %; p < 0.001) or magnetic resonance imaging (MRI: 82 % vs 9.9 %; p < 0.001) in the 12 months before diagnosis. Conclusions: Women followed in a high-risk screening program have disease diagnosed at an earlier stage and therefore require less-intensive breast cancer treatment than women presenting to a cancer center at the time of diagnosis. Identification of high-risk women and implementation of increased surveillance protocols are vital to improving outcomes. © Society of Surgical Oncology 2024. |
| Keywords: | adult; cancer chemotherapy; controlled study; aged; middle aged; cancer surgery; gene mutation; major clinical study; mutation; clinical feature; disease course; cancer risk; systemic therapy; comparative study; cancer staging; nuclear magnetic resonance imaging; follow up; follow-up studies; antineoplastic agent; cancer diagnosis; neoplasm staging; neoplasm; breast cancer; mastectomy; cohort analysis; risk factors; cancer screening; pathology; breast neoplasms; brca1 protein; brca2 protein; retrospective study; risk factor; risk assessment; patient participation; cancer center; statistical significance; mammography; early cancer; early diagnosis; family history; breast tumor; diagnosis; imaging; cancer epidemiology; high risk population; neoadjuvant chemotherapy; epidemiology; chi square test; fisher exact test; breast surgery; early detection of cancer; carcinoma, intraductal, noninfiltrating; rank sum test; caucasian; health education; lumpectomy; carcinoma, ductal, breast; high-risk; breast cancer risk; triple negative breast cancer; tumor invasion; invasive ductal carcinoma; estrogen receptor positive breast cancer; humans; prognosis; mri screening; human; female; article; early cancer diagnosis; breast ductal carcinoma; progesterone receptor positive breast cancer; hormone receptor-positive, her2-negative breast cancer; ductal breast carcinoma in situ; invasive lobular breast carcinoma; early-stage diagnosis; high-risk screening program; increased surveillance protocols; well differentiated breast cancer |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 31 |
| Issue: | 10 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2024-10-01 |
| Start Page: | 6764 |
| End Page: | 6773 |
| Language: | English |
| DOI: | 10.1245/s10434-024-15633-x |
| PUBMED: | 38949720 |
| PROVIDER: | scopus |
| PMCID: | PMC11605954 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Melissa Pilewskie -- Source: Scopus |
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