Trends in Breast Cancer Mortality, Incidence, and Survival, and Mammographic screening in Tuscany, Italy

Objective: The study describes breast cancer mortality trends in Tuscany (period 1970–97), comparing Florence with the rest of Tuscany (Florence excluded), and, for Florence, incidence (period 1985–94) and survival (1985–86 versus 1991–92) trends, taking into account the diffusion of screening. Methods: Mortality and incidence rates, age-adjusted on the European population, and 95% confidence intervals (95% CI). Five-year relative survival rates and estimates of risk of dying provided by the Cox model. Results: Mammographic screening, started at the beginning of the 1970s in some municipalities, largely involved the Florence area after 1990 (mammograms/years: from 8000–9000 to 28,000–29,000, respectively, before and after 1990). In the same period no population-based screenings were ongoing in the rest of Tuscany. A significant mortality drop was observed in Tuscany (–3.7%/year), starting at the beginning of the 1990s and observed for ages 74 (especially ages 40–49: –11.2%/year). The drop was similar in Florence and in the rest of Tuscany. In ages 50–69, incidence, increasing between 1985–87 and 1988–90 (+6.5%), rose sharply in 1991–94 (+17.0%); it was stable in other ages. Local disease increased more markedly in ages 50–69 (globally: +88.3%), but also in other ages (+20–30%). Regional and metastatic cancers decreased. A significantly better 5-year survival was observed among cases diagnosed in 1991–92, persisting after adjustment by extent of disease. Conclusion: Even if the causes of breast cancer mortality trends are not easy to clarify in an observational study, our data suggest that the drop in mortality observed in Tuscany at the beginning of the 1990s could be largely explained by both earlier detection, outside of an organized screening program, and by better treatments. The increase in incidence and the shift in stage distribution that occurred before the enlargement of the screening area and in age groups not involved in the program, supports the role of a `spontaneous' widespread earlier detection. The better survival of the period 1991–92, only partly explained by the shift in stage at diagnosis, indirectly supports the role of improvement in therapy.     

A pooled analysis of post‐diagnosis lifestyle factors in association with late estrogen‐receptor–positive breast cancer prognosis

Lifestyle factors have been well studied in relation to breast cancer prognosis overall; however, associations of lifestyle and late outcomes (>5 years after diagnosis) have been much less studied, and no studies have focused on estrogen receptor‐positive (ER+) breast cancer survivors, who may have high risk of late recurrence and mortality. We utilized a large prospective pooling study to evaluate the associations of lifestyle factors with late recurrence and all‐cause mortality among 6,295 5‐year ER+ Stage I–III breast cancer survivors. Pooled and harmonized data were available on clinical factors and lifestyle factors (pre‐ to post‐diagnosis weight change, body mass index (BMI) (kg/m²), recreational physical activity, alcohol intake and smoking history), measured on average 2.1 years after diagnosis. Updated information for weight only was available. Study heterogeneity was evaluated by the Q‐statistic. Multivariable Cox regression models were stratified by study. Adjusting for clinical factors and potential confounders, ≥10% weight gain and obesity (BMI, 30–34.99 and ≥35) were associated with increased risk of late recurrence (hazard ratios (95% confidence intervals): 1.24 (1.00–1.53), 1.40 (1.05–1.86) and 1.41 (1.02–1.93), respectively). Daily alcohol intake was associated with late recurrence, 1.28 (1.01–1.62). Physical activity was inversely associated with late all‐cause mortality (0.81 (0.71–0.93) and 0.71 (0.61–0.82) for 4.9 to <17.4 and ≥17.4 metabolic equivalent‐hr/week). A U‐shaped association was observed for late all‐cause mortality and BMI using updated weight (1.42 (1.15–1.74) and 1.40 (1.09–1.81), <21.5 and ≥35, respectively). Smoking was associated with increased risk of late outcomes. In this large prospective pooling project, modifiable lifestyle factors were associated with late outcomes among long‐term ER+ breast cancer survivors.     

Crisis,Social Support,and the Family Response: Exploring the Narratives of Young Breast Cancer Survivors

This article explores how 70 younger women diagnosed with breast cancer draw on social support resources. The authors found that most respondents’ core support networks were their families, and social support came in several forms including emotional, tangible, and informational. However, the authors also found that many respondents relied on a distinct form of social support, experiential support, which has not been identified in current research. Experiential support is defined as a relationship with someone who has gone through a similar illness and can help provide firsthand information, insight, and even hope. The authors conclude that experiential support is an important area for future research on social support and health outcomes.     

Female Breast Cancer Incidence and Mortality in Mexico, 2000-2010

The objective of this study was to investigate the recent incidence and mortality trends for breast cancer inMexican females. Data between 2000 and 2010 from the Department of Epidemiology of the Ministry of Health,and International Agency for Research on Cancer (IARC) were analyzed. Age-standardized rates (ASRs) andannual percent changes (APCs) were calculated. The absolute incidence and mortality rates of breast cancerincreased: 3,726 and 4,615 in 2000 to 8,545 and 4,966 in 2010, respectively. Incidence increased over time in allage groups tested, the 60-64 age group had the highest ASR (57.4 per 100,000 women in 2010), while the 20-44age group had the lowest ASR (12.3 in 2010). The results show that incidence of breast cancer has increased inMexico during last one decade, especially among older women, while the downturn observed in mortality mainlyreflects improved survival as a result of earlier diagnosis and better cancer treatment.     

Depression Burden,Self-Help Interventions,and Social Support in Women Receiving Treatment for Breast Cancer

Abstract

The purpose of this article is to describe the interaction effects of depression burden (depressive symptoms experienced as a burdensome side effect) with a set of oncology support interventions on social support for women receiving treatment for breast cancer. A repeated measures design was used with measurement occurring at three points in time: T1 (baseline after adjuvant medical treatment was initiated), T2 (six to eight weeks after T1) and T3 (three months after T2). Two hundred forty-seven women were randomly assigned to treatment (n = 194) or control (n = 53). The treatment group consisted of women participating in three different, but complimentary self-help interventions. Depression burden, even at low levels, influenced the critical dimensions of social support structure, function, and nature.     

Breast conserving therapy and mastectomy revisited: Breast cancer‐specific survival and the influence of prognostic factors in 129,692 patients

This large population‐based study compared breast‐conserving surgery with radiation therapy (BCT) with mastectomy on (long‐term) breast cancer‐specific (BCSS) and overall survival (OS), and investigated the influence of several prognostic factors. Patients with primary T1‐2N0‐2M0 breast cancer, diagnosed between 1999 and 2012, were selected from the Netherlands Cancer Registry. We investigated the 1999–2005 (long‐term outcome) and the 2006–2012 cohort (contemporary adjuvant systemic therapy). Cause of death was derived from the Statistics Netherlands (CBS). Multivariable analyses, per time cohort, were performed in T1‐2N0‐2, and separately in T1‐2N0‐1 and T1‐2N2 stages. The T1‐2N0‐1 stages were further stratified for age, hormonal receptor and HER2 status, adjuvant systemic therapy and comorbidity. In total, 129,692 patients were included. In the 1999–2005 cohort, better BCSS and OS for BCT than mastectomy was seen in all subgroups, except in patients < 40 years with T1‐2N0‐1 stage. In the 2006–2012 cohort, superior BCSS and OS were found for T1‐2N0‐1, but not for T1‐2N2. Subgroup analyses for T1‐2N0‐1 showed superior BCSS and OS for BCT in patients >50 years, not treated with chemotherapy and with comorbidity. Both treatments led to similar BCSS in patients <50 years, without comorbidity and those treated with chemotherapy. Although confounding by severity and residual confounding cannot be excluded, this study showed better long‐term BCSS for BCT than mastectomy. Even with more contemporary diagnostics and therapies we identified several subgroups that may benefit from BCT. Our results support the hypothesis that BCT might be preferred in most breast cancer patients when both treatments are suitable.     

Effectiveness of Trastuzumab in First‐Line HER2+ Metastatic Breast Cancer After Failure in Adjuvant Setting: A Controlled Cohort Study

Background.

The evidence supporting the use of trastuzumab (T) in a metastatic setting comes from studies that included (almost) only patients who never received prior T. We investigated the effectiveness of T as first-line therapy for metastatic breast cancer (mBC) in women previously treated with T in the adjuvant setting.

Materials and Methods.

By using record linkage of five administrative health care databases of Lombardy, Italy, we identified 2,046 women treated with T for early breast cancer (eBC) in 2006–2009, 96 of whom developed a metastasis and were retreated with T in first-line treatment for mBC (treatment group). We compared the overall survival (OS) of these women with that of 197 women treated with T in first-line treatment for mBC, who were treated with therapies other than T for early disease (control group). We computed Kaplan-Meier 2-year OS and used a proportional hazard model to estimate the multivariate hazard ratio (HR) of death in the intervention group compared with the control group, adjusted by age, use of endocrine therapy, and site of metastasis.

Results.

Two-year OS was 60.0% in the treatment group and 59.5% in the control group. The adjusted HR of death in the treatment group compared with the control group was 0.79 (95% confidence interval, 0.50–1.26).

Conclusion.

Our data provide convincing evidence that the outcome of women receiving first-line T treatment for mBC after T failure in the adjuvant setting is comparable to that of women not receiving T for eBC. These data are of specific interest, given the unavailability of data from randomized clinical trials.     

Menopausal hormone therapy use and long-term all-cause and cause-specific mortality in the Long Island Breast Cancer Study Project

Previous studies have observed a reduced mortality risk associated with menopausal hormone therapy (MHT) use among breast cancer survivors. We sought to clarify whether such association could be explained by tumor heterogeneity, specific causes of death, confounding from comorbidities or health behaviors, and a comparison group of women without breast cancer. We interviewed 1508 women newly diagnosed with first primary breast cancer in 1996 to 1997 (~3 months after diagnosis), and 1556 age-matched women without breast cancer, about MHT use history. The National Death Index was used to ascertain vital status after a median of 17.6 years of follow-up (N = 597 deaths for breast cancer subjects). Multivariable-adjusted Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality, and cause-specific HR (cHR) for breast cancer and cardiovascular disease (CVD). The Fine-Gray model was used to account for competing causes of death. Among women with breast cancer, ever vs never MHT use was inversely associated with all-cause (HR = 0.77, 95%CI = 0.62-0.95), breast cancer-specific (cHR = 0.69, 95%CI = 0.48-0.98), and CVD-specific mortality (cHR = 0.57, 95%CI = 0.38-0.85). Difference of the association was observed in breast cancer-specific mortality according to hormone receptor status (negative tumors: cHR = 0.44, 95%CI = 0.19-1.01; positive tumors: cHR = 0.96, 95%CI = 0.60-1.53). Among the comparison group, we observed similar, but more modest inverse associations for all-cause and CVD-specific mortality. MHT use was inversely associated with mortality after breast cancer, even after accounting for competing causes of death and multiple confounders, and was evident among women without breast cancer. Potential heterogeneity by hormone receptor status requires more study.     

Postdiagnosis supplement use and breast cancer prognosis in the After Breast Cancer Pooling Project

Vitamin supplement use after breast cancer diagnosis is common, but little is known about long-term effects on recurrence and survival. We examined postdiagnosis supplement use and risk of death or recurrence in the After Breast Cancer Pooling Project, a consortium of four cohorts of 12,019 breast cancer survivors from the United States and China. Post-treatment supplement use (vitamins A, B, C, D, E, and multivitamins) was assessed 1–5 years postdiagnosis. Associations with risk of recurrence, breast cancer-specific mortality, or total mortality were analyzed in Cox proportional hazards models separately by cohort. Individual cohort results were combined using random effects meta-analysis. Interactions with smoking, treatment, and hormonal status were examined. In multivariate models, vitamin E was associated with a decreased risk of recurrence (RR: 0.88; 95 % CI 0.79–0.99), and vitamin C with decreased risk of death (RR: 0.81; 95 % CI 0.72–0.92). However, when supplements were mutually adjusted, all associations were attenuated. There were no statistically significant associations with breast cancer mortality. The use of antioxidant supplements (multivitamins, vitamin C, or E) was not associated with recurrence, but was associated with a 16 % decreased risk of death (95 % CI 0.72–0.99). In addition, vitamin D was associated with decreased risk of recurrence among ER positive, but not ER negative tumors (p-interaction = 0.01). In this large consortium of breast cancer survivors, post-treatment use of vitamin supplements was not associated with increased risk of recurrence or death. Post-treatment use of antioxidant supplements was associated with improved survival, but the associations with individual supplement were difficult to determine. Stratification by ER status and considering antioxidants as a group may be more clinically relevant when evaluating associations with cancer risk and mortality.     

Differences in Incidence,Mortality and Survival of Breast Cancer by Regions and Countries in Asia and Contributing Factors

Although the incidence of breast cancer in Asia remains lower than in North America, Western Europe,and Oceania, rates have been increasing rapidly during the past few decades, and Asian countries now accountfor 40% of breast cancer cases diagnosed worldwide. Breast cancer mortality has also increased among Asianwomen, in contrast to decreased mortality in Northern America, Western Europe, and Oceania. These increasedrates are associated with higher prevalence of breast cancer risk factors (e.g., reduced parity, delayed childbirth,increased obesity) that have accompanied economic development throughout the region. However, Asian regions(western, south-central, south-eastern, and eastern) and countries differ in the types and magnitude of changesin breast cancer risk factors, and cannot be viewed as a single homogeneous group. The objective of this paperwas to contrast the heterogeneous epidemiology of breast cancer by Asian regions and countries, and to suggestpotential avenues for future research.     

Suddenly,a Carriage Appears: Social Support Needs of Latina Breast Cancer Survivors

Through focus groups and individual interviews, data were gathered on the emotional, informational, and instrumental support needs of 22 immigrant Latina women. A thematic analysis revealed that participants who perceived to receive social support reported less psychological distress and better adjustment to breast cancer than those who did not perceive this support. Types and sources of support varied across survivorship stages. Many needs were related to financial, linguistic, and cultural barriers participants encountered in the course of the disease. Based on the findings, we conclude with several clinical recommendations to improve the quality of life in this medically underserved population.     

Mammography Screening and Breast Cancer Mortality in New South Wales, Australia

OBJECTIVE: To investigate the relationship between utilisation of service mammography screening and breast cancer mortality in New South Wales (NSW) women. Setting : Population-based biennial mammography screening was progressively introduced in NSW from 1988, with active recruitment and re-invitation for women aged 50-69 years, and reached full geographic coverage by 1996. Biennial mammography screening participation has varied widely over time and by municipality. METHODS: Breast cancer mortality by age, period and municipality was obtained from the NSW Central Cancer Registry. Biennial mammography screening rates for the same strata were obtained from the BreastScreen NSW database. Temporal changes in breast cancer mortality for NSW were summarised as annual average declines using Poisson regression. Breast cancer mortality for 1997-2001 was examined in relation to lagged biennial screening rates by municipality, adjusted for age, area socio-economic and geographic indicators, and breast cancer incidence, also using Poisson regression. RESULTS: For the 50-69 year age group, the mean annual breast cancer mortality decline was 0.8% (not significant) for 1988-1994, and 4.4% (p < 0.0001) for 1995-2001. Statistically significant negative associations between breast cancer mortality in 1997-2001 and lagged biennial screening rates were found with the highest significance at a four-year lag for women aged 50-69 years ( p = 0.0003) and also for women aged 50-79 years (p c = 0.0002). From the regression coefficient, a 70% biennial screening rate is associated with 32% lower breast cancer mortality (compared to zero screening). CONCLUSIONS: The effect of population-based mammography screening on breast cancer mortality in NSW inferred using this method is consistent with results of trials and other service studies. This suggests that population-based mammography screening programs can achieve significant reductions in breast cancer mortality with adequate participation.     

Sexual Desire and Satisfaction in Sexual Life Affecting Factors in Breast Cancer Survivors After Mastectomy

The purpose of this study was to examine impact of treatment and personality characteristics, and support need for femininity and body image on sexual desire and sexual satisfaction of women with breast cancer. The sample consisted of 123 married women who previously underwent mastectomy and applied to medical oncology clinics of a university hospital. Sexual desire of the women in this study was low, and they were slightly satisfied with sexual life. Consequently, the women required supporting needs of femininity and body image. The result of this study could be utilized to determine sexual desire and satisfaction related to sexual life of women with breast cancer.