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PO35 What do women want? Fertility preservation preferences of young Israeli breast cancer patients
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Clinical Research / The Breast 23S1 (2014) S12–S23
receptor status showed a TN phenotype; ER+/HER2− had 94/58%, ER+/HER2+ 28/17% and ER−/HER2+ 19/12%. Conclusion: YBCps treated at the IORS are often diagnosed with more advanced stage. Further research to elucidate differences in BC biology and efficacy of therapy within tumor types by age is ongoing. PO35 What do women want? Fertility preservation preferences of young Israeli breast cancer patients E. Dagan, S. Gatengo-Modiano, D. i Birenbaum-Carmel. University of Haifa, Department of Nursing, Haifa, Israel About 300 women under the age 40 are diagnosed with breastcancer (BC) in Israel every year. Issues of long term quality of life, including future fertility and parenthood thus become more pressing. We probe the preferences of young BC patients towards fertility preservation (FP) as compared to the women’s reports of the physicians’ recommendations. We conducted qualitative semistructured interviews with 16 Jewish Israeli young BC patients who had undergone chemotherapy and FP. Participants were diagnosed one to three years prior to the interview, when they were 25 to 38 years of age. Nine had no children at diagnosis and seven were married with at least one child. Interviews were subscribed and analysed thematically. From the women’s accounts, FP counselling emerged as ‘normative’ rather than clinical. In most cases, the doctor’s decision to refer the woman to a fertility expert was based primarily on her sociodemographic status rather than her clinical condition (e.g., tumor characteristics, prognosis or infertility risk). Married women with children were therefore hardly informed about FP options whereas single women with no children were referred to FP irrespective of their clinical condition. The accounts revealed that most women wanted to preserve their fertility as a “security measure”, “just in case”. We suggest that many young BC patients construct FP as a sphere of negotiation in which they can voice particular, personal preferences. Whereas most women tend to accept the chemotherapy protocol as given and unnegotiable, they viewed FP procedures as optional and as such, allowing them to seek and articulate a personal-subjective presence within the clinical world. On the basis of the women’s perspectives, we call for clinicians’ attention to women’s individual subjective needs and wishes, as well as their hope to be heard and treated beyond protocol based principles. Being asked what you would like to do regarding FP, may make a difference. PO36 Clinicopathologic characteristics of breast cancer in young women: Croatian single institution experience ´ c´ 1 , M. Kralik2 , N. Dedic´ Plavetic´ 1 , P. Podolski1 , T. Badovinac Crnjevi J. Jakic-Razumovi ´ c´ 3 , D. Vrbanec1 . 1 University Hospital Center Zagreb, Department of Medical Oncology, Zagreb, Croatia, 2 University Hospital Center Zagreb, Department of Radiology, Zagreb, Croatia, 3 University Hospital Center Zagreb, Department of Pathology, Zagreb, Croatia Introduction: According to the data provided by Croatian National Cancer Registry for 2011, there were 2094 new cases of breast cancer in Croatia. That number represents 22% of all newly diagnosed cases making it most common cancer site in Croatian women. Aim: The aim of this study was to analyse clinicopathologic prognostic factors of breast cancer in patients younger than 40 in the cohort of single institution Croatian breast cancer patients. Materials and Methods: Breast cancer paraffin-embedded tissue specimens were obtained from a consecutive retrospective series of 215 female patients with primary invasive tumors referred to the University Hospital Center Zagreb, Croatia. Median of follow up is 9.38 years (min 8 months, max 10.4 years). 135 pts were menopausal at diagnosis. Surrogate biological subtypes were defined according
to primary tumour IHC analyses according to St Gallen Consensus Conference recommendations. Results: Among 215 patients, thirteen of them (6.04%) were younger than 40 in the time of diagnosis (breast cancer in young or BCY subgroup). In the premenopausal subgroup they had share of 16.3%, and 6.04% share in whole cohort of breast cancer patients. More than a third of the tumours were classified as luminal B like surrogate subtype (5 tumours or 38.5%), 3 of 13, or 23.1% were luminal A like, and, finally, more than one third were triple negative like (5 of 13, or 38.5%). Compared with whole cohort, triple-negative like subtype was more often in BCY subgroup (24.2% vs 38.5%). In the almost 10-years follow-up 53.8% of patients in BCY subgroup have relapsed, compared with 30.2% patients with locoregional and/or distant relapse in whole cohort. Similarly, 30.8% of patients in BCY subgroup have died compared with 20.6% died in whole cohort. Conclusions: BCY subgroup represents those who tend to have a triple negative subtype, they are more prone to locoregional and/or distant relapse, and death from breast cancer. PO37 HPR: a randomized chemoprevention trial in high risk women I. Feroce1 , C. Varricchio1 , M. Cazzaniga1 , V. Aristarco1 , N. Rotmensz2 , B. Bonanni1 . 1 European Institute of Oncology, Department of Cancer Prevention and Genetics, Milano, Italy, 2 European Institute of Oncology, Department of Epidemiology and Biostatistics, Milano, Italy Fenretinide (4-hydroxyphenylretinamide or HPR) is the most studied retinoid in clinical trials of breast cancer (BC) prevention for its selective accumulation in the breast tissue and its low toxicity. It is effective in inhibiting the growth of BRCA-1 mutated BC cell lines. A previous randomized phase III trial of HPR showed a 17%, durable reduction of second BC incidence. When stratified by menopausal status, the analysis showed a 38%, statistically significant reduction of second BC in premenopausal women which persisted for up to 15 years, i.e. 10 years after treatment cessation. Importantly, the younger the women (≤40 years), the greater the trend of benefit. Considering the protective activity of HPR on second BC and a similar trend on ovarian cancer (OC), it appears that young women at high risk such as carriers of germline BRCA-1 and BRCA-2 mutations or those with a high family risk may be ideal candidates for a trial with HPR. The European Institute of Oncology has promoted a multicentric (6 centers) phase III placebo-controlled study with HPR in 20–46 years old women at increased BC risk (BRCA 1/2 mutation or mutation probability ≥20%). These subjects are randomized to HPR 200 mg/day versus placebo for 5 years followed by a 10 years follow up period. The aim is to assess the efficacy of HPR in reducing the incidence of invasive BC and ductal intraepithelial neoplasia (DIN). Secondary endpoints are the incidence of OC, other cancers and the modulation of various risk biomarkers. So far we have screened 243 subjects and 63 have been randomized. Median age is 36 years, median treatment duration 23.3 months. Clinical visit, blood tests, breast and transvaginal ultrasound every 6 months, mammography and breast MRI every 12 months. The treatment is very well tolerated, only 3 subjects have spontaneously decided to stop the treatment due to mucosal dryness. The follow-up is ongoing. PO38 An analysis of breast cancer incidence in young women: a single site study T. Makharadze1 , D. Kintsurashvili2 . 1 LTD “Medulla – Chemotherapy and Immunotherapy Clinic”, Department of Oncology, Tbilisi, Georgia, 2 LTD “Medulla – Chemotherapy and Immunotherapy Clinic”, Department of Histo-Pathological Laboratory, Tbilisi, Georgia Background: Breast cancer cases in women are on the rise. It is estimated to raise breast cancer cases in young women. There are no
Clinical Research / The Breast 23S1 (2014) S12–S23
receptor status showed a TN phenotype; ER+/HER2− had 94/58%, ER+/HER2+ 28/17% and ER−/HER2+ 19/12%. Conclusion: YBCps treated at the IORS are often diagnosed with more advanced stage. Further research to elucidate differences in BC biology and efficacy of therapy within tumor types by age is ongoing. PO35 What do women want? Fertility preservation preferences of young Israeli breast cancer patients E. Dagan, S. Gatengo-Modiano, D. i Birenbaum-Carmel. University of Haifa, Department of Nursing, Haifa, Israel About 300 women under the age 40 are diagnosed with breastcancer (BC) in Israel every year. Issues of long term quality of life, including future fertility and parenthood thus become more pressing. We probe the preferences of young BC patients towards fertility preservation (FP) as compared to the women’s reports of the physicians’ recommendations. We conducted qualitative semistructured interviews with 16 Jewish Israeli young BC patients who had undergone chemotherapy and FP. Participants were diagnosed one to three years prior to the interview, when they were 25 to 38 years of age. Nine had no children at diagnosis and seven were married with at least one child. Interviews were subscribed and analysed thematically. From the women’s accounts, FP counselling emerged as ‘normative’ rather than clinical. In most cases, the doctor’s decision to refer the woman to a fertility expert was based primarily on her sociodemographic status rather than her clinical condition (e.g., tumor characteristics, prognosis or infertility risk). Married women with children were therefore hardly informed about FP options whereas single women with no children were referred to FP irrespective of their clinical condition. The accounts revealed that most women wanted to preserve their fertility as a “security measure”, “just in case”. We suggest that many young BC patients construct FP as a sphere of negotiation in which they can voice particular, personal preferences. Whereas most women tend to accept the chemotherapy protocol as given and unnegotiable, they viewed FP procedures as optional and as such, allowing them to seek and articulate a personal-subjective presence within the clinical world. On the basis of the women’s perspectives, we call for clinicians’ attention to women’s individual subjective needs and wishes, as well as their hope to be heard and treated beyond protocol based principles. Being asked what you would like to do regarding FP, may make a difference. PO36 Clinicopathologic characteristics of breast cancer in young women: Croatian single institution experience ´ c´ 1 , M. Kralik2 , N. Dedic´ Plavetic´ 1 , P. Podolski1 , T. Badovinac Crnjevi J. Jakic-Razumovi ´ c´ 3 , D. Vrbanec1 . 1 University Hospital Center Zagreb, Department of Medical Oncology, Zagreb, Croatia, 2 University Hospital Center Zagreb, Department of Radiology, Zagreb, Croatia, 3 University Hospital Center Zagreb, Department of Pathology, Zagreb, Croatia Introduction: According to the data provided by Croatian National Cancer Registry for 2011, there were 2094 new cases of breast cancer in Croatia. That number represents 22% of all newly diagnosed cases making it most common cancer site in Croatian women. Aim: The aim of this study was to analyse clinicopathologic prognostic factors of breast cancer in patients younger than 40 in the cohort of single institution Croatian breast cancer patients. Materials and Methods: Breast cancer paraffin-embedded tissue specimens were obtained from a consecutive retrospective series of 215 female patients with primary invasive tumors referred to the University Hospital Center Zagreb, Croatia. Median of follow up is 9.38 years (min 8 months, max 10.4 years). 135 pts were menopausal at diagnosis. Surrogate biological subtypes were defined according
to primary tumour IHC analyses according to St Gallen Consensus Conference recommendations. Results: Among 215 patients, thirteen of them (6.04%) were younger than 40 in the time of diagnosis (breast cancer in young or BCY subgroup). In the premenopausal subgroup they had share of 16.3%, and 6.04% share in whole cohort of breast cancer patients. More than a third of the tumours were classified as luminal B like surrogate subtype (5 tumours or 38.5%), 3 of 13, or 23.1% were luminal A like, and, finally, more than one third were triple negative like (5 of 13, or 38.5%). Compared with whole cohort, triple-negative like subtype was more often in BCY subgroup (24.2% vs 38.5%). In the almost 10-years follow-up 53.8% of patients in BCY subgroup have relapsed, compared with 30.2% patients with locoregional and/or distant relapse in whole cohort. Similarly, 30.8% of patients in BCY subgroup have died compared with 20.6% died in whole cohort. Conclusions: BCY subgroup represents those who tend to have a triple negative subtype, they are more prone to locoregional and/or distant relapse, and death from breast cancer. PO37 HPR: a randomized chemoprevention trial in high risk women I. Feroce1 , C. Varricchio1 , M. Cazzaniga1 , V. Aristarco1 , N. Rotmensz2 , B. Bonanni1 . 1 European Institute of Oncology, Department of Cancer Prevention and Genetics, Milano, Italy, 2 European Institute of Oncology, Department of Epidemiology and Biostatistics, Milano, Italy Fenretinide (4-hydroxyphenylretinamide or HPR) is the most studied retinoid in clinical trials of breast cancer (BC) prevention for its selective accumulation in the breast tissue and its low toxicity. It is effective in inhibiting the growth of BRCA-1 mutated BC cell lines. A previous randomized phase III trial of HPR showed a 17%, durable reduction of second BC incidence. When stratified by menopausal status, the analysis showed a 38%, statistically significant reduction of second BC in premenopausal women which persisted for up to 15 years, i.e. 10 years after treatment cessation. Importantly, the younger the women (≤40 years), the greater the trend of benefit. Considering the protective activity of HPR on second BC and a similar trend on ovarian cancer (OC), it appears that young women at high risk such as carriers of germline BRCA-1 and BRCA-2 mutations or those with a high family risk may be ideal candidates for a trial with HPR. The European Institute of Oncology has promoted a multicentric (6 centers) phase III placebo-controlled study with HPR in 20–46 years old women at increased BC risk (BRCA 1/2 mutation or mutation probability ≥20%). These subjects are randomized to HPR 200 mg/day versus placebo for 5 years followed by a 10 years follow up period. The aim is to assess the efficacy of HPR in reducing the incidence of invasive BC and ductal intraepithelial neoplasia (DIN). Secondary endpoints are the incidence of OC, other cancers and the modulation of various risk biomarkers. So far we have screened 243 subjects and 63 have been randomized. Median age is 36 years, median treatment duration 23.3 months. Clinical visit, blood tests, breast and transvaginal ultrasound every 6 months, mammography and breast MRI every 12 months. The treatment is very well tolerated, only 3 subjects have spontaneously decided to stop the treatment due to mucosal dryness. The follow-up is ongoing. PO38 An analysis of breast cancer incidence in young women: a single site study T. Makharadze1 , D. Kintsurashvili2 . 1 LTD “Medulla – Chemotherapy and Immunotherapy Clinic”, Department of Oncology, Tbilisi, Georgia, 2 LTD “Medulla – Chemotherapy and Immunotherapy Clinic”, Department of Histo-Pathological Laboratory, Tbilisi, Georgia Background: Breast cancer cases in women are on the rise. It is estimated to raise breast cancer cases in young women. There are no