Miscellaneous Publications

On this page you will find information about and links to miscellaneous publications

 

Summary

This pooled analysis of 2310 patients from four neoadjuvant clinical trials examined survival and treatment response in patients with HER2-low-positive (immunohistochemistry 1+ or 2+/in-situ hybridisation negative; n=1098) versus HER2-zero (immunohistochemistry0; n=1212) breast cancer. HER2-low-positive tumours had significantly lower pathological complete response (29.2% vs. 39%; p=0.0002). This was also seen in the hormone receptor positive subgroup (17.5% vs. 23.6%; p=0.024), but not in the hormone receptor negative subgroup (50.1% vs. 48%; p=0.21). Patients with HER2-low-positive tumours had significantly longer survival (3 year DFS 83.4% vs. 76.1%; p=0.0084). This was seen in hormone receptor negative tumours (3 year DFS 84.5% vs. 74.4%; p=0.0076), but not in hormone receptor positive tumours (3 year DFS 82.8% vs. 79.3%; p=0.39).  

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Summary

This meta-analysis, including 14 studies (n=19819), evaluates the safety of breast conserving surgery (BCS) in triple negative breast cancer. 9828 patients underwent BCS (49.6%) and 9991 patients (50.4%) underwent mastectomy. The pooled odds ratio (OR) for locoregional recurrence was 0.64 (0.48 to 0.85; p=0.002) indicating lower odds for LRR for women who had BCS as opposed to mastectomy.  The pooled OR for distant metastasis was 0.7 (0.53 to 0.94; p=0.02) indicating lower odds of distant metastasis for women who underwent BCS. This difference diminished with follow up time. Pooled hazard ratio of 0.78 (0.69 to 0.89; p<0.001) showed lower hazard ratio for all-cause mortality among women treated with BCS.

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Summary

This cohort study used prospectively collected national data and included women diagnosed with primary invasive T1-2 N0-2 breast cancer. Patients underwent breast surgery in Sweden (2008-2017; n=48986 with median follow up of 6.28 years). Patients received BCS and radiotherapy (n=29367; 59.9%), mastectomy without radiotherapy (n=12413; 25.3%), or mastectomy with radiotherapy (n=7206; 14.7%). 5 year OS was 91.1% and BCSS was 96.3%. OS and BCSS were significantly worse after mastectomy without radiotherapy (HR 1.79 and HR 1.66 respectively) and mastectomy with radiotherapy (HR 1.24 and HR 1.26 respectively) than after BCS and radiotherapy. 

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Summary

Poly(adenosine diphosphate–ribose) polymerase inhibitors target cancers with defects in homologous recombination. This study was a phase 3, double-blind, RCT involving patients with HER2–negative early breast cancer with BRCA1 or BRCA2 or likely pathogenic variants who had received local treatment and neoadjuvant or adjuvant chemotherapy. Patients were randomly assigned (in a 1:1 ratio) to 1 year of oral olaparib or placebo.

The primary end point was invasive disease–free survival. A total of 1836 patients underwent randomization.       The 3-year distant disease–free survival was 87.5% in the olaparib group and 80.4% in the placebo group (difference, 7.1 percentage points; 95% CI, 3.0 to 11.1; hazard ratio for distant disease or death, 0.57; 99.5% CI, 0.39 to 0.83; P<0.001). Olaparib was associated with fewer deaths than placebo (59 and 86, respectively) (hazard ratio, 0.68; 99% CI, 0.44 to 1.05; P=0.02); however, the between-group difference was not significant at an interim-analysis boundary of a P value of less than 0.01. Safety data were consistent with known side effects of olaparib, with no excess serious adverse events or adverse events of special interest.

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Summary

This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer (n=3416 with 56 UK breast units who participated). Adverse effects on quality-of-life outcomes were seen in the first few months after surgery, which largely resolved by 24 months.

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This manuscript was produced on behalf of the academic section of the Association of Breast Surgery and submitted to the Royal College of Surgeons working group on the ‘Future of Surgery’. The article summarises the impact of innovations in science and technology on the future management of breast cancer. The article focuses on genomic advances, de-escalation of surgery, optimisation of breast conserving surgery, neoadjuvant therapy, technologies to improve breast cancer staging, innovations in reconstructive breast surgery, patient follow up and survivorship, and breast cancer surgical research.

Summary

The B-Map-C investigated alterations to breast cancer management during the peak transmission period of the UK COVID-19 pandemic (March to May 2020). 64 UK breast units participated (n=3776) with 59% determined to have had ‘COVID-altered’ management. However, the majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer outcomes are unlikely to be negatively impacted.

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Roszkowski N, Lam SS, Copson E, Cutress RI, Oeppen R. Expanded criteria for pretreatment staging CT in breast cancer. BJS Open. 2021 Mar 5;5(2):zraa006. doi: 10.1093/bjsopen/zraa006. PMID: 33715004; PMCID: PMC7955978.

 

Summary

This study sought to identify factors predictive of distant metastatic disease at presentation to enable appropriate selection of patients for pretreatment CT. A total of 1377 patients with newly diagnosed breast cancer were identified, of whom 1025 had complete data; 323 staging CT examinations were performed. Distant metastases were identified at presentation in 47 (4.6 per cent).Some 30 of 47 patients with metastatic disease met established criteria for staging (T4, recurrence, symptoms of possible distant metastases), leaving 17 patients with metastatic disease potentially missed by use of these criteria alone. Multivariable analysis showed that tumour size at least 3 cm combined with sonographically abnormal axillary lymph nodes predicted a high probability of distant metastatic disease at pre- sentation (positive predictive value 18.8 per cent, odds ratio 4.83, P < 0.001).

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Summary

This study aimed to examine the planned long-term recurrence and survival outcomes from the ELIOT trial. Eligible women, aged 48-75 years with a clinical diagnosis of a unicentric breast carcinoma with an ultrasound diameter not exceeding 25 mm, clinically negative axillary lymph nodes, and who were suitable for breast-conserving surgery, were randomly assigned (1:1) via a web-based system, with a random permuted block design (block size of 16) and stratified by clinical tumour size, to receive post-operative whole breast irradiation (WBI) with conventional fractionation (50 Gy given as 25 fractions of 2 Gy, plus a 10 Gy boost), or 21 Gy intraoperative radiotherapy with electrons (ELIOT) in a single dose to the tumour bed during surgery. The trial was open label and no-one was masked to treatment group assignment. The primary endpoint was the occurrence of IBTR. After a median follow-up of 12·4 years (IQR 9·7-14·7), 86 (7%) patients developed IBTR, with 70 (11%) cases in the ELIOT group and 16 (2%) in the WBI group, corresponding to an absolute excess of 54 IBTRs in the ELIOT group (HR 4·62, 95% CI 2·68-7·95, p<0·0001). At final follow-up on March 11, 2019, 193 (15%) women had died from any cause, with no difference between the two groups (98 deaths in the ELIOT group vs 95 in the WBI group; HR 1·03, 95% CI 0·77-1·36, p=0·85.

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British Journal of Surgery: Feb 2020 

This study examines whether biological subtype in patients diagnosed with inflammatory breast cancer (IBC) influences their outcome using a national cancer database. Amongst 4068 patients diagnosed with IBC, 38.7% were ER+HER2-, 32.5% HER2+, and 28.8% were ER-HER2-. 84% were clinically node positive at presentation. Total pCR rates were 6.2% (ER+HER2-), 38.8% (HER2+), and 19.1% (ER-/HER2-). The 5 year overall survival was rates were 64.9% (ER+HER2-), 74% (HER2+), and 44% (ER-/HER2-). Multivariate analysis showed that ER-/HER2- subtype and the absence of pCR predicted for worse survival. The study findings support the concept that IBC is not a distinct biological entity with uniformly poor outcomes and highlights the recent improved outcomes in HER2+ IBC. However, future studies are needed to improve outcome for patients with ER-/HER2- IBC. 

Medication to Reduce Risk of Breast Cancer: USPS Task Force Recommendation

Journal: JAMA

Young patients with breast cancer and BRCA mutation have similar survival to sporadic breast cancer patients (POSH trial)

Journal: Lancet Oncol

TEAM study

Therapeutic mammaplasty is a safe and effective alternative to mastectomy or standard breast-conserving surgery

Journal: Brit J Surg

RCT Lymphoedema rates reduced with reverse mapping

Journal: Ann Surg Oncol

S-LYMPHA (simplified LYMPHA) may reduce rates of lymphoedema after axillary clearance

Journal: Annals of Surgery

BRASS  Jenny Banks

Breast Angiosarcoma Surveillance Study (BRASS) – A National Audit of Management and Outcomes of Angiosarcoma of the Breast and Chest Wall

The BRASS study is a collaborative project led by practising breast and plastic surgeons in the UK and ROI.