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Breast Articles From 2023: Informing Practice Across the Continuum of Care

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

With new investigations and clinical trials in breast oncology reported every year, it is critical that surgeons be aware of advances and insights into the evolving care paradigms and treatments available to their patients. This article highlights five publications found to be particularly impactful this past year. These articles report on efforts to select the minimal effective dose of tamoxifen for prevention, to challenge the existing age-based screening guidelines as they relate to race and ethnicity, to refine axillary management treatment standards, to optimize systemic therapy in multidisciplinary care settings, and to reduce the burden of breast cancer-related lymphedema after treatment. Taken together, these efforts have an impact on all facets of the continuum of care from prevention and screening through treatment and survivorship.

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References

  1. Cuzick J, Sestak I, Bonanni B, et al. Selective oestrogen receptor modulators in prevention of breast cancer: an updated meta-analysis of individual participant data. Lancet. 2013;381:1827–34. https://doi.org/10.1016/S0140-6736(13)60140-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Visvanathan K, Fabian CJ, Bantug E, et al. Use of endocrine therapy for breast cancer risk reduction: ASCO clinical practice guideline update. J Clin Oncol. 2019;37:3152–65. https://doi.org/10.1200/JCO.19.01472.

    Article  CAS  PubMed  Google Scholar 

  3. Waters EA, McNeel TS, Stevens WM, Freedman AN. Use of tamoxifen and raloxifene for breast cancer chemoprevention in 2010. Breast Cancer Res Treat. 2012;134:875–80. https://doi.org/10.1007/s10549-012-2089-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Noonan S, Pasa A, Fontana V, et al. A survey among breast cancer specialists on the low uptake of therapeutic prevention with tamoxifen or raloxifene. Cancer Prev Res Philadelphia. 2018;11:38–43. https://doi.org/10.1158/1940-6207.CAPR-17-0162.

    Article  CAS  Google Scholar 

  5. Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103:478–88. https://doi.org/10.1093/jnci/djr027.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the national surgical adjuvant breast and bowel project P-1 study. J Natl Cancer Inst. 1998;90:1371–88.

    Article  CAS  PubMed  Google Scholar 

  7. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: current status of the national surgical adjuvant breast and bowel project P-1 study. J Natl Cancer Inst. 2005;97:1652–62. https://doi.org/10.1093/jnci/dji372.

    Article  CAS  PubMed  Google Scholar 

  8. Bychkovsky B, Laws A, Katlin F, et al. Initiation and tolerance of chemoprevention among women with high-risk breast lesions: the potential of low-dose tamoxifen. Breast Cancer Res Treat. 2022;193:417–27. https://doi.org/10.1007/s10549-022-06577-5.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Land SR, Walcott FL, Liu Q, et al. Symptoms and QOL as predictors of chemoprevention adherence in NRG Oncology/NSABP Trial P-1. J Natl Cancer Inst. 2016;108:365. https://doi.org/10.1093/jnci/djv365.

    Article  Google Scholar 

  10. Smith SG, Sestak I, Howell A, Forbes J, Cuzick J. Participant-reported symptoms and their effect on long-term adherence in the International Breast Cancer Intervention Study I (IBIS I). J Clin Oncol. 2017;35:2666–73. https://doi.org/10.1200/JCO.2016.71.7439.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Decensi A, Robertson C, Viale G, et al. A randomized trial of low-dose tamoxifen on breast cancer proliferation and blood estrogenic biomarkers. J Natl Cancer Inst. 2003;95:779–90. https://doi.org/10.1093/jnci/95.11.779.

    Article  CAS  PubMed  Google Scholar 

  12. Decensi A, Robertson C, Guerrieri-Gonzaga A, et al. Randomized double-blind 2 × 2 trial of low-dose tamoxifen and fenretinide for breast cancer prevention in high-risk premenopausal women. J Clin Oncol. 2009;27:3749–56. https://doi.org/10.1200/JCO.2008.19.3797.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Guerrieri-Gonzaga A, Sestak I, Lazzeroni M, et al. Benefit of low-dose tamoxifen in a large observational cohort of high-risk ER-positive breast DCIS. Int J Cancer. 2016;139:2127–34. https://doi.org/10.1002/ijc.30254.

    Article  CAS  PubMed  Google Scholar 

  14. DeCensi A, Puntoni M, Guerrieri-Gonzaga A, et al. Randomized placebo controlled trial of low-dose tamoxifen to prevent local and contralateral recurrence in breast intraepithelial neoplasia. J Clin Oncol. 2019;37:1629–37. https://doi.org/10.1200/JCO.18.01779.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. DeCensi A, Puntoni M, Johansson H, et al. Effect modifiers of low-dose tamoxifen in a randomized trial in breast noninvasive disease. Clin Cancer Res. 2021;27:3576–83. https://doi.org/10.1158/1078-0432.CCR-20-4213.

    Article  CAS  PubMed  Google Scholar 

  16. Lazzeroni M, Puntoni M, Guerrieri-Gonzaga A, et al. Randomized placebo controlled trial of low-dose tamoxifen to prevent recurrence in breast noninvasive neoplasia: a 10-year follow-up of TAM-01 study. J Clin Oncol. 2023;41:3116–21. https://doi.org/10.1200/JCO.22.02900.

    Article  CAS  PubMed  Google Scholar 

  17. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Version 1.2024. Retrieved 22 February 2024 at National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.

  18. Clinicaltrials.gov. Finding the Best Tamoxifen Dose for Breast Cancer Risk Reduction in Premenopausal Women, RENAISSANCE Trial. Retrieved 9 April 2024 at https://classic.clinicaltrials.gov/ct2/show/NCT06184750.

  19. Smith RA, Andrews KS, Brooks D, et al. Cancer screening in the United States, 2019: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2019;69:184–210. https://doi.org/10.3322/caac.21557.

    Article  PubMed  Google Scholar 

  20. Jhangiani N, Philip M, Jatoi I. Breast cancer screening guidelines: discrepancies raise concerns about validity. Breast Cancer. 2023;30:869–71. https://doi.org/10.1007/s12282-023-01493-y.

    Article  PubMed  Google Scholar 

  21. Siu AL, Force USPST. Screening for breast cancer: US preventive services task force recommendation statement. Ann Intern Med. 2016;164:279–96. https://doi.org/10.7326/M15-2886.

  22. Koh B, Tan DJH, Ng CH, et al. Patterns in cancer incidence among people younger than 50 years in the US 2010 to 2019. JAMA Netw Open. 2023;6:e2328171. https://doi.org/10.1001/jamanetworkopen.2023.28171.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Chen T, Kharazmi E, Fallah M. Race and ethnicity-adjusted age recommendation for initiating breast cancer screening. JAMA Netw Open. 2023;6:e238893. https://doi.org/10.1001/jamanetworkopen.2023.8893.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Centers for Disease Control and Prevention. National Center for Health Statistics. Retrieved 22 February 2024 at https://www.cdc.gov/nchs/.

  25. Allman R, Dite GS, Hopper JL, et al. SNPs and breast cancer risk prediction for African American and Hispanic women. Breast Cancer Res Treat. 2015;154:583–9. https://doi.org/10.1007/s10549-015-3641-7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gail MH, Costantino JP, Pee D, et al. Projecting individualized absolute invasive breast cancer risk in African American women. J Natl Cancer Inst. 2007;99:1782–92. https://doi.org/10.1093/jnci/djm223.

    Article  PubMed  Google Scholar 

  27. Fayanju OM, Edmonds CE, Reyes SA, et al. The landmark series: addressing disparities in breast cancer screening: new recommendations for black women. Ann Surg Oncol. 2023;30:58–67. https://doi.org/10.1245/s10434-022-12535-8.

    Article  PubMed  Google Scholar 

  28. Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32. https://doi.org/10.1097/SLA.0b013e3181f08f32.

    Article  PubMed  Google Scholar 

  29. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15:1303–10. https://doi.org/10.1016/S1470-2045(14)70460-7.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569–75. https://doi.org/10.1001/jama.2011.90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Gentilini OD, Botteri E, Sangalli C, et al. Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: the SOUND randomized clinical trial. JAMA Oncol. 2023;9:1557–64. https://doi.org/10.1001/jamaoncol.2023.3759.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kalinsky K, Barlow WE, Gralow JR, et al. 21-Gene assay to inform chemotherapy benefit in node-positive breast cancer. N Engl J Med. 2021;385:2336–47. https://doi.org/10.1056/NEJMoa2108873.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Shaitelman SF, Anderson BM, Arthur DW, et al. Partial breast irradiation for patients with early-stage invasive breast cancer or ductal carcinoma in situ: an ASTRO clinical practice guideline. Pract Radiat Oncol. 2024;14:112. https://doi.org/10.1016/j.prro.2023.11.001.

    Article  PubMed  Google Scholar 

  34. Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31:2382–7. https://doi.org/10.1200/JCO.2012.45.2615.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Tolaney SM, Barry WT, Dang CT, et al. Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer. N Engl J Med. 2015;372:134–41. https://doi.org/10.1056/NEJMoa1406281.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Tolaney SM, Guo H, Pernas S, et al. Seven-year follow-up analysis of adjuvant paclitaxel and trastuzumab trial for node-negative, human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol. 2019;37:1868–75. https://doi.org/10.1200/JCO.19.00066.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Tolaney SM, Tarantino P, Graham N, et al. Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer: final 10-year analysis of the open-label, single-arm, phase 2 APT trial. Lancet Oncol. 2023;24:273–85. https://doi.org/10.1016/S1470-2045(23)00051-7.

    Article  CAS  PubMed  Google Scholar 

  38. Weiss A, Martinez-Saez O, Waks AG, et al. Nodal positivity and systemic therapy among patients with clinical T1–T2N0 human epidermal growth factor receptor-positive breast cancer: results from two international cohorts. Cancer. 2023;129:1836–45. https://doi.org/10.1002/cncr.34750.

    Article  CAS  PubMed  Google Scholar 

  39. von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med. 2019;380:617–28. https://doi.org/10.1056/NEJMoa1814017.

    Article  Google Scholar 

  40. Loibl S MM, Untch M, et al. Phase III study of adjuvant ado-trastuzumab emtansine vs trastuzumab for residual invasive HER2-positive early breast cancer after neoadjuvant chemotherapy and HER2-targeted therapy: KATHERINE final IDFS and updated OS analysis. Presented at the 2023 San Antonio Breast Cancer Symposium, 5–9 December 2023, San Antonio, TX. Abstract GS03-12.

  41. Bellon JR, Guo H, Barry WT, et al. Local-regional recurrence in women with small node-negative, HER2-positive breast cancer: results from a prospective multi-institutional study (the APT trial). Breast Cancer Res Treat. 2019;176:303–10. https://doi.org/10.1007/s10549-019-05238-4.

    Article  PubMed  Google Scholar 

  42. Clinicaltrials.gov. Testing radiation and HER2-targeted therapy versus HER2-targeted therapy alone for low-risk HER2-positive breast cancer (HERO). Retrieved 4 February 2024 at https://clinicaltrials.gov/study/NCT05705401?cond=Breast%20Cancer&term=HERO&rank=1.

  43. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14:500–15. https://doi.org/10.1016/S1470-2045(13)70076-7.

    Article  PubMed  Google Scholar 

  44. Montagna G, Zhang J, Sevilimedu V, et al. Risk factors and racial and ethnic disparities in patients with breast cancer-related lymphedema. JAMA Oncol. 2022;8:1195–200. https://doi.org/10.1001/jamaoncol.2022.1628.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Boccardo F, Casabona F, De Cian F, et al. Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy. Ann Surg Oncol. 2009;16:703–8. https://doi.org/10.1245/s10434-008-0270-y.

    Article  PubMed  Google Scholar 

  46. Boccardo F, Casabona F, De Cian F, et al. Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: over 4 years follow-up. Microsurgery. 2014;34:421–4. https://doi.org/10.1002/micr.22254.

    Article  PubMed  Google Scholar 

  47. Feldman S, Bansil H, Ascherman J, et al. Single-institution experience with lymphatic microsurgical preventive healing approach (LYMPHA) for the primary prevention of lymphedema. Ann Surg Oncol. 2015;22:3296–301. https://doi.org/10.1245/s10434-015-4721-y.

    Article  PubMed  Google Scholar 

  48. Levy AS, Murphy AI, Ishtihar S, et al. Lymphatic microsurgical preventive healing approach for the primary prevention of lymphedema: a 4-year follow-up. Plast Reconstr Surg. 2023;151:413–20. https://doi.org/10.1097/PRS.0000000000009857.

    Article  CAS  PubMed  Google Scholar 

  49. Coriddi M, Dayan J, Bloomfield E, et al. Efficacy of immediate lymphatic reconstruction to decrease incidence of breast cancer-related lymphedema: preliminary results of randomized controlled trial. Ann Surg. 2023;278:630–7. https://doi.org/10.1097/SLA.0000000000005952.

    Article  PubMed  Google Scholar 

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Acknowledgment

Elizabeth A. Mittendorf acknowledges support as the Rob and Karen Hale Distinguished Chair in Surgical Oncology. The authors also thank Kate Bifolck for her editorial assistance with manuscript preparation and submission.

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Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Tari A. King MD & Elizabeth A. Mittendorf MD, PhD, MHCM

  2. Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA

    Tari A. King MD & Elizabeth A. Mittendorf MD, PhD, MHCM

  3. Harvard Medical School, Boston, MA, USA

    Tari A. King MD & Elizabeth A. Mittendorf MD, PhD, MHCM

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Correspondence to Tari A. King MD.

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Tari A. King reports spearker’s honoraria and compensated service on the scientific advisory board of Exact Sciences (formerly Genomic Health) and compensated service as faculty, PrecisCa cancer information service. Elizabeth A. Mittendorf reports compensated service on scientific advisory boards for Astra Zeneca, BioNTech, Merck and Moderna; uncompensated service on steering committees for Bristol Myers Squibb and Roche/Genentech; speaker’s honoraria and travel support from Merck Sharp & Dohme; and institutional research support from Roche/Genentech (via SU2C grant) and Gilead. She also reports research funding from Susan Komen for the Cure, for which she serves as a Scientific Advisor, and uncompensated participation as a member of the American Society of Clinical Oncology Board of Directors.

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King, T.A., Mittendorf, E.A. Breast Articles From 2023: Informing Practice Across the Continuum of Care. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15387-6

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