NEWS & PERSPECTIVE
Early mammography screening substantially decreases the risk of advanced and fatal breast cancers
Breast cancer is a prevalent invasive cancer in women, and one of the leading causes of death worldwide.1 However, there is a significant global variation in breast cancer survival rates. The CONCORD study demonstrated the highest survival rates of 80% in North America, Sweden, and Japan, followed by an estimated 60% in middle-income countries and below 40% in low-income countries.2 Employing early-stage cancer detection strategy has been suggested to account for the higher survival rates in breast cancer patients. Furthermore, according to the World Health Organization (WHO), the five-year survival rate for early localized breast cancer is ≤80% for women who had early breast cancer detection. To date, mammography screening has proven to be the most effective screening method for breast cancer.3 A recent 10-year breast cancer mortality study involving 549,091 women reported that early mammography screening contributed to the reduction of breast cancer deaths by 41%.4
Breast cancer is currently the leading cancer for women worldwide, with a higher frequency of women diagnosed with late-stage breast cancer.2 Lower survival rates, ranging from 10-40%, were observed in the majority of breast cancer patients diagnosed only at the advanced stage of the diseases.1 While WHO promotes the implementation of early breast cancer screening programs for breast cancer control.1 With the recent establishments of adjuvant breast cancer therapies, there is a growing doubt on the relevance of early breast cancer screening strategies towards reducing breast cancer mortality.5
A new study published by Dr. Stephen Duffy, from the Queen Mary University of London Center for Cancer Prevention and Dr. László Tabár, from the mammography department in the Falun Central Hospital in Sweden, highlighted the benefits of early breast cancer screening despite current improvements in breast cancer treatment. As such, researches led by Dr. Duffy and Dr. Tabár aimed to evaluate the effectiveness of mammography screening as a strategy to reduce the 10-year risk of death in breast cancer patients residing in 9 Swedish counties.4
Both the Swedish Cancer Registry and Swedish National Board of Health and Welfare provided patient data on breast cancer diagnoses and dates of deaths and causes, respectively. The study consisted of 549,091 women, which included 30% of the Swedish screening-eligible population. Breast cancer screening utilizing 2‐view mammography defined individuals with advanced breast cancer as an invasive disease involving tumors measuring >20mm, and ≥4 metastatic axillary lymph nodes.4
Classification of individuals receiving mammography screening involved meeting the requirements of completing majority screening sessions as per protocol. Women aged 40 to 54 years had to attend mammography screening every 18 months and every 24 months for women aged 55 to 69 years every 24 months. The average range of observation was 13 (range 7-16) years for patients with a fatal disease and 22 (range 16-25) years for patients with advanced disease. The total number of fatal diseases were 2,473 (0.45%) cases and 9,737 (1.8%) cases for advanced-stage breast cancer.4
Both a decline by 41% in the risk from dying of breast cancer (RR=0.59; 95% CI: 0.51-0.68; p<0.001) and a reduction of 25% in advanced breast cancers (RR=0.75; 95% CI: 0.66-0.84; p<0.001) was observed within 10 years of diagnosis for women who participated in the mammography screening. The conservative estimate adjusted for potential lead time and self‐selection biases was still significant at 34% (RR=0.66; 95% CI: 0.55-0.79; p<0.001). Despite the large patient population, statistical precision and long-term follow-up, there was an absence of data about the mammography screenings from private facilities.4
Dr. Duffy commented, “This study showed that participation in breast cancer screening substantially reduced the risk of having fatal breast cancer. Besides, because the comparison of participating with non-participating persons was contemporaneous with mammography screening and breast cancer treatment belonging to the same time, it was not affected by potential changes in the treatment of breast cancer over time.”
The study demonstrated substantial positive treatment outcomes associated with early-stage breast cancer detection through mammography screening and the feasibility of collecting critical screening data on a national basis. To conclude, early mammography screening still plays a vital role in improving the mortality rate for women with breast cancer in a period in which modern adjuvant therapies are available.
- WHO Position Paper on Mammography Screening. Geneva: World Health Organization; 2014.
- Coleman M et al. Cancer survival in five continents: a worldwide population-based study (CONCORD). The Lancet Oncology.2008;9(8):730-756.
- Tabar L et al. The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer. 2019; 125:515‐523.
- Duffy S et al. Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women. Cancer.2020.
- Giordano S et al. Systemic Therapy for Patients with advanced human epidermal growth factor receptor 2–positive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology. 2014;32(19):2078-2099.
Results of DESTINY-Breast04: Trastuzumab deruxtecan vs. TPC for HER2-low unresectable and/or mBC
Glossary: BICR: Blinded independent central review; CI: Confidence interval; ECOG: Eastern Cooperation Oncology Group; HER2-: Human epidermal growth factor receptor 2-negative; HR: Hazard ratio; HR+: Hormone receptor-positive; HR-: Hormone receptor-negative; IHC: Immunohistochemistry; ISH: In situ
MAINTAIN: ET with or without ribociclibafter progression on AET + CDK4/6i in patients with unresectable or HR+, HER2- mBC
Glossary: AEs: Adverse events; AI: Aromatase inhibitor; CBR: Clinical benefit rate; CDK4/6i: Cyclin-dependent kinase 4/6 inhibitor; CI: Confidence interval; CR: Complete response; ECOG: Eastern Cooperation Oncology Group; ER+: Estrogen receptor-positive; ET: Endocrine therapy; GnRH: Gonadotropin-r
MONALEESA-2: Impact of ribociclib dose modifications on OS in HR+/HER2- ABC patients
Glossary: 1L: First-line; ABC: Advanced breast cancer; AE: Adverse event; CBR: Clinical benefit rate; CI: Confidence interval; CKD4/6i: Cyclin-dependent kinase 4/6 inhibotor; HER2-: Human epidermal growth factor receptor 2-negative; HR: Hazard ratio; HR+: Hormone receptor-positive; NR: Not reached
Ribociclib plus fulvestratnt has the longest mOS OF over 67 months in postmenopausal breast cancer patients
Cancer is a leading cause of death globally, claiming almost 10 million deaths in 2020.1 Breast cancer is one of the most common cancers in women, with nearly 2.3 million new breast cancer diagnoses in 2020 worldwide.1 Gene-expression profiling has identified distinct subtypes of cancer, among which there are subpopulations expressing specific markers.2 According to the National Institutes of Health (NIH), hormone receptor-positive/human epidermal growth factor 2-negative (HR+/HER2-) is the most prevalent breast cancer.3 Cyclin-dependent kinase 4 and 6 (CDK4/6) are good drug targets for cancer, owing to their role in cell cycle progression.4 Ribociclib is one of the 3 inhibitors of CDK4/6 approved in combination with fulvestrant for treating HR+/HER2- advanced breast cancers in adults, based on a series of phase 3 clinical trials called MONALEESA, which tested ribociclib along with different drug partners in HR+/HER2- cancer patients.4-7 The MONALEESA-2 study showed that progression-free survival (PFS) was significantly longer with first-line ribociclib + letrozole than with placebo + letrozole.7 The MONALEESA-7 trial also showed significantly longer median overall survival (mOS) in ribociclib in combination with the endocrine therapy (ET) vs. the placebo arm in postmenopausal HR+/HER2- cancer patients.6 Similarly, the primary MONALEESA-3 trial and its subsequent analysis Demonstrated that ribociclib + fulvestrant had significant OS benefit as compared with placebo in HR+/HER2- patients advanced breast cancer patients.5,6 In a recently held European Society of Medical Oncology (ESMO) Breast Cancer Congress, Neven, et al. presented an updated exploratory mOS analysis result with the longest follow-up of the MONALEESA 3 study to date.8
Optimal breast cancer screening approaches for women with ATM, CHEK2, and PALB2 PVs
Recently, a group of non-BRCA1/2, moderate- to high-risk breast cancer susceptibility genes, have been observed. Among them, the most prevalent ones are ATM, CHEK2 and PALB2.1-3 These pathogenic variants (PVs) can increase the risk of breast cancer by at least 2-fold, thus indicating an obvious and urgent need for screening them.1,3 However, optimal strategies for screening in women carrying these PVs have yet to be well established.1 In a recent study published in the Journal of the American Medical Association (JAMA), Lowry K P and his colleagues conducted a comparative simulation modeling analysis to determine whether screening using mammography and magnetic resonance imaging (MRI) could benefit breast cancer patients with ATM, CHEK2 and PALB2 PVs at various age intervals, which may increase the survival rate in these female patients.1
Poorer survival outcomes in breast cancer patients with chronic stress
The allostatic load, which results from lifelong exposure to social and environmental stressors such as discrimination and poverty, provides with us a way to evaluate the eftects of chronic stress on a patient's physiology.1 Chronic stress has been shown to be associated with various health problems, including hypertension, kidney disease, inflammation, and other conditions.1 According to a recent ECOG-ACRIN E5103 phase 3 clinical trial, Dr. Samilia Obeng-Gysai, a surgical oncologist at The Ohio State University Comprehensive Cancer Center, analyzed the data from the trial on the relationship between allostatic load and clinical outcomes in breast cancer patients, the elevated allostatic load was found to be linked with a lover likelihood of chemotherapy completion and a higher risk of death among breast cancer patients.1
Overcoming the clinical challenges of breast cancer management: From identifying prognostic factors to achieving personalized treatment
Breast cancer is the most common cancer among females in Hong Kong and accounted for 27.2% and 12.4% of all cancer incidences and deaths in 2018, respectively.1 Over the past decade, the incidence and death rate of breast cancer continued to increase while the challenges of managing the disease rema
Clinical challenges and considerations in managing HR+/HER2- advanced breast cancer in the post-CDK inhibitor setting
Demonstrating efficacy with a nearly doubled progression-free survival (PFS) rate, cyclin-dependent kinase inhibitor (CDKi) plus endocrine therapy (ET) have now become the new standard-of-care (SOC) in the first-line treatment setting of hormone receptor positive (HR+), human epidermal growth factor
Protective effects of surgery plus radiotherapy in DCIS wear off with time
At the 12th European Breast Cancer Conference, the results of a major study conducted on women diagnosed with ductal carcinoma in situ (DCIS) were presented and revealed that patients treated with breast conserving surgery (BCS) plus radiotherapy (RT) received a better protection from developing sub