Does the presence of symptoms at the regular breast cancer screening appointment affect the likelihood of detecting breast cancer between two screening appointments? Is lymphonodectomy always necessary in women with aggressive tumor types after a good response to neoadjuvant chemotherapy? Studies at the European Breast Cancer Conference provided answers.
The earlier breast cancer is detected, the better the chances of treatment and cure. To ensure this for all women as far as possible, there is a mammography screening program in Switzerland in the cantons of Basel-Stadt, Bern, Fribourg, Geneva, Grisons, Jura, Neuchâtel, St. Gallen, Ticino, Thurgau, Vaud and Valais [1]. Women aged 50 and older are systematically invited for mammography. If there are no abnormal findings at this screening appointment, the next screening appointment will take place again in two years. However, a specific group of patients should be looked at more closely between screenings, a Finnish study now warns.
Women who participated in the Finish National Breast Cancer Screening Program between 1992 and 2012 were studied [2]. Under this program, women between the ages of 50 and 69 are invited for mammography every two years (with the exception of some communities that invite up to age 74). 51,332 women presented with a lump in the breast tissue at their inital screening appointment, 40,917 women presented with retracted nipple, and 9083 women presented with nipple discharge. These subjects were matched with women from a reference group who reported no symptoms at their initial screening appointment. It was found that while symptomatic women were more likely to be seen again after their mammogram, they were also more likely to be diagnosed with breast cancer between now and their next scheduled or screening appointment. The presence of a lump at initial presentation increased the risk of a diagnosis of breast cancer at the screening interval by more than threefold, nipple secretions by twofold, and a retracted nipple by 1.5-fold. Following the results of this study, consideration should be given to how best to monitor this patient population or whether these women would benefit from shorter screening intervals.
Lymph node surgery for aggressive tumor types
Lymph node surgery for breast carcinoma has significantly decreased in radicality over time. Depending on the findings, sometimes only the sentinel lymph node needs to be removed. Reduction of the surgical area is generally associated with a lower risk of surgery-related complications, although this is not zero. Two studies from Spain and the Netherlands now investigated women with triple-negative or HER2-positive breast cancer who received neoadjuvant chemotherapy with respect to pre- and posttherapeutic tumor involvement of the breast efferent lymph nodes, leading to consideration of the need for lymphonodectomy after a good therapeutic response in the above cases.
The research group led by Dr. Christian Siso included 90 patients with the above tumor types in their study [3]. All participants underwent lymph node ultrasound and confirmatory testing via pathologic examination. In 60% of patients, no evidence of lymph node metastases was found pretherapeutically. After chemotherapy, 96.3% of these patients remained tumor-free with respect to their lymph nodes, and in 42.5% no tumor cells could be detected in the mamma or adjacent lymph nodes posttherapeutically. Of the 40% who had shown evidence of affected lymph nodes pretherapeutically, 47.2% showed tumor-free breast tissue after chemotherapy. Of these 47.2%, 76.5% also had no tumor cells found in the lymph nodes. The results lead to consideration of whether surgical therapy may not be necessary in women with triple-negative or HER2-positive breast cancer, no evidence of lymph node metastases before therapy, and a good breast tissue response to neoadjuvant chemotherapy, the authors said.
In the Netherlands, Dr. Marieke van der Noordaa and her team studied 294 women with triple-negative or HER2-positive breast cancer, all of whom had unremarkable ultrasound, PET/CT, or cytologic findings of the lymph nodes before starting therapy [4]. After chemotherapy, all patients with HER2-positive breast cancer showed tumor-free lymph nodes. In contrast, tumor cells were detected in the lymph nodes of 1% of women with triple-negative breast cancer. Of the women who were found to be tumor-free in the breast tissue after chemotherapy, none showed cancer in the lymph nodes. Follow up with the ASICS trial to investigate whether forgoing lymphonodectomy after neoadjuvant chemotherapy for aggressive tumor types is safe with respect to the risk of recurrence in the lymph nodes. Overall survival and quality of life are also assessed. If the study delivers positive results, this would be a further step towards individualized medicine.
Source:11th European Breast Cancer Conference, March 21-23, 2018, Barcelona.
Literature:
- Cancer League: Mammography Screening. www.krebsliga.ch/krebs-vorbeugen/krebs-frueh-erkennen-und-vorbeugen/brustkrebs/mammografie-screening (as of 03/22/18)
- EBCC 11 Press releases: Abstract no: 11, “Breast symptoms and risk of interval breast cancers in mammography-screening programme”, presented at the11th European Breast Cancer Conference in Barcelona
- EBCC 11 Press releases: Abstract no: 104, “Her2 positive and triple negative breast cancer patients with clinically negative nodes at diagnosis and breast pathologic complete response may spare axillary surgery after neoadjuvant treatment”, presented at the 11th European Breast Cancer Conference in Barcelona
- EBCC 11 Press releases: Abstract no: 20, “Omitting sentinel lymph node biopsy after neoadjuvant systemic tgerapy in selected breast cancer patients with clinical node-negative disease”, presented at the11th European Breast Cancer Conference in Barcelona.
InFo ONCOLOGY & HEMATOLOGY 2018; 6(2): 33-34.
