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255 POSTER The relationship of use of hormone replacement therapy on the subsequent hormone receptor status of breast cancer in the Million Women Study
Poster session: Breast cancer are number and type of non-operative diagnostic procedures and operative therapeutic procedures. Results: The 738 postmenopausal women underwent a total of 831 nonoperative diagnostic procedures including 320 fine needle aspirations and 511 core biopsies. There was no difference in the number and type of nonoperative diagnostic procedure performed in the HRT users compared with non-users. The overall pre-operative diagnostic rate was similar in both groups (84% vs 83%). A total of 860 therapeutic operative procedures to the breast were performed in the 738 women. The overall breast conservation rate was 80% for HRT non-users and 81% for HRT users. Conclusion: The results of this study suggest that there are no significant differences in the number of non-operative diagnostic procedures and operative therapeutic procedures performed in postmenopausal women who use HRT and those who do not. 255
POSTER
The relationship of use of hormone replacement therapy on the subsequent hormone receptor status of breast cancer in the Million Women Study T. Gathani, J. Green, G. Reeves, V. Beral. University of Oxford, Cancer Epidemiology Unit, Oxford, United Kingdom Introduction: Recent evidence from observational studies and randomised trials suggest that current users of hormone replacement therapy are at increased an increased risk of developing breast cancer. It remains unclear as to whether tumours that arise in women who use HRT are more likely to be hormone receptor positive (oestrogen receptor or progesterone receptor positive) compared with women who do not use HRT. We examined the tumour hormone receptor status in a sample of Million Women Study participants for whom information on HRT use was available. Methods: A prospective study of 541 postmenopausal women who had all been screened and diagnosed with breast cancer either at screening or in the interval between screening, was carried out within the Million Women Study with information about HRT exposure collected at recruitment via selfreporting questionnaire. HRT users were defined as those women who were either currently using HRT or had stopped HRT use in the year previous to diagnosis. HRT non-users were defined as those women who had never used HRT or have used HRT more than one year previous to diagnosis. Information on oestrogen receptor status was collected prospectively from hospital pathology record data on 541 postmenopausal Million Women Study participants with invasive breast cancer. A multivariate conditional logistic regression equation was used to calculate the risk of a hormone receptive positive tumour in relation to HRT use. Results: Of the 541 women with known hormone receptor status, 278 women were current or recent users of HRT and 263 women were never or past users of HRT. The prevalence of hormone receptor positive tumours was 83% in the HRT user group compared with 86% in the non-user group (X2 = 0.98, p=0.3). Women who were users of HRT were not more likely to develop a hormone receptor positive tumour compared to women who did not use HRT (OR 1.04; 95% confidence interval 0.57-1.90). Conclusion: We do not find any evidence to suggest that current and recent users of HRT are more likely to develop hormone receptor positive tumours compared with women who do not use HRT. 256
POSTER
The impact of mdr1 and mrp1 gene induction on survival in locally advanced breast cancer C. Atalay 1 , U. Gunduz 2 . 1 Ankara Oncology Hospital, General Surgery, Ankara, Turkey; 2 Middle East Technical University, Biology, Ankara, Turkey Purpose: Drug resistance to chemotherapy in patients with locally advanced breast cancer leads to a decrease in treatment efficacy and probably patient survival. Multidrug resistance genes, mdr1 and mrp1, cause resistance to chemotherapy drugs used for breast cancer treatment. In this study, it is aimed to evaluate the influence of mdr1 and mrp1 gene induction in breast cancer patients. Patients and Methods: Patients with locally advanced breast cancer treated between 2001-2003 were prospectively included. Patients’ demographic
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and clinicopathologic properties and treatment modalities utilized were recorded. Breast tumor tissue samples were obtained before and after chemotherapy. mdr1 and mrp1 gene expression was evaluated, after RNA isolation from tissue samples, using RT-PCR. Presence of P-glycoprotein and MRP1 protein in tissues was detected using immunohistochemistry. Induction of both genes was compared to clinical response of patients. In addition, impact of mdr1 and mrp1 gene induction on survival was evaluated. Results: Twenty five female patients in stage IIIB were included. All patients were treated with anthracycline containing chemotherapy protocols. Modified radical mastectomy was performed in responsive patients and adjuvant chemo- and radiotherapy were added. Median follow-up time was 30 months and 11 patients (44%) had recurrence while 10 patients (40%) died during follow-up. Mean disease-free survival for patients with and without mdr1 gene induction was 13 and 45 months (p=0.0004), respectively whereas overall survival was 21 and 48 months (p=0.002), respectively. In contrast, mean disease-free survival for patients with and without mrp1 gene induction was 30 and 40 months (p=0.96), respectively, and overall survival was 32 and 42 months (p=0.5), respectively. Conclusion: mdr1 gene induction during chemotherapy decreases diseasefree and overall survival in patients with locally advanced breast cancer due to poorer response to chemotherapy drugs. Knowing mdr1 gene status of the patients before chemotherapy will help to choose the appropriate drugs and to increase the efficacy of drug treatment resulting in better survival. 257
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Breast cancer patients after surgery; How do they describe quality of care? M. de Kok 1 , H. Sixma 2 , R. Scholte 1 , K. Spijkers 2 , C. van de Velde 3 , J. Roukema 4 , F. van der Ent 5 , A. Bell 6 , M. von Meyenfeldt 1 . 1 Academic Hospital Maastricht, Department of Surgery, Maastricht, The Netherlands; 2 NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands; 3 Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands; 4 St. Elisabeth Hospital, Breast Unit, Tilburg, The Netherlands; 5 Orbis Medical Center, Department of Surgery, Sittard, The Netherlands; 6 Laurentius Hospital, Department of Surgery, Roermond, The Netherlands Introduction: The goal of this study was to explore how breast cancer patients define quality of care, as a first step towards a new questionnaire. Patients and Methods: After approval from the Medical Ethics Committees was obtained, 8 focus groups were organized in 5 different hospitals in the Netherlands. Seventy-five patients who had been operated on for breast cancer participated in the meetings. Each focus group lasted 2-2,5 hours. After the focus groups, 65 patients from the same 5 hospitals, participated in 6 concept mapping sessions. As part of this concept mapping procedure, the 81 items most frequently mentioned during the focus groups were rated on a 5-point Likert type scale ranging from 1 (relatively unimportant) to 5 (extremely important). The same 81 items were structured according to similarity. Results: The focus groups resulted in 221 aspects on quality of care mentioned by the respondents. Importance scores of the 81 aspects included in the concept mapping procedure ranged from 1.4 to 4.7. The 3 most important items that addressed clinicians were ‘caregivers should have all results available when I have an appointment with them for that reason’, ‘a check-up 6 months after surgery should be part of the protocol’ and ‘the results of the biopsy are told to me within a week after the test’. The 3 items with the lowest scores on importance level and involving clinicians were ‘caregivers should take into account my agenda when they schedule new appointments’, ‘caregivers should offer me information about filing a complaint’ and ‘my doctor should provide me with information on the availability of patient support groups’. Structuring according to similarity resulted in 6 general clusters of items: period of admission (6 items), focus on patient (9 items), respect for the patient (12 items), time schedule (10 items), continuity of care (10 items) and education (8 items). The remaining 26 items were labelled as miscellaneous. Conclusion: To assess quality of care from the perspective of breast cancer patients, focus groups and concept mapping were used as a first, important step towards a new quantitative questionnaire. Both qualitative methods resulted in items this specific patients group considers as reflecting quality of care. Moreover, they provide information on the relative importance of these quality aspects. A test version was developed based on the results of this study and sent to 614 patients after breast cancer surgery.
POSTER
The relationship of use of hormone replacement therapy on the subsequent hormone receptor status of breast cancer in the Million Women Study T. Gathani, J. Green, G. Reeves, V. Beral. University of Oxford, Cancer Epidemiology Unit, Oxford, United Kingdom Introduction: Recent evidence from observational studies and randomised trials suggest that current users of hormone replacement therapy are at increased an increased risk of developing breast cancer. It remains unclear as to whether tumours that arise in women who use HRT are more likely to be hormone receptor positive (oestrogen receptor or progesterone receptor positive) compared with women who do not use HRT. We examined the tumour hormone receptor status in a sample of Million Women Study participants for whom information on HRT use was available. Methods: A prospective study of 541 postmenopausal women who had all been screened and diagnosed with breast cancer either at screening or in the interval between screening, was carried out within the Million Women Study with information about HRT exposure collected at recruitment via selfreporting questionnaire. HRT users were defined as those women who were either currently using HRT or had stopped HRT use in the year previous to diagnosis. HRT non-users were defined as those women who had never used HRT or have used HRT more than one year previous to diagnosis. Information on oestrogen receptor status was collected prospectively from hospital pathology record data on 541 postmenopausal Million Women Study participants with invasive breast cancer. A multivariate conditional logistic regression equation was used to calculate the risk of a hormone receptive positive tumour in relation to HRT use. Results: Of the 541 women with known hormone receptor status, 278 women were current or recent users of HRT and 263 women were never or past users of HRT. The prevalence of hormone receptor positive tumours was 83% in the HRT user group compared with 86% in the non-user group (X2 = 0.98, p=0.3). Women who were users of HRT were not more likely to develop a hormone receptor positive tumour compared to women who did not use HRT (OR 1.04; 95% confidence interval 0.57-1.90). Conclusion: We do not find any evidence to suggest that current and recent users of HRT are more likely to develop hormone receptor positive tumours compared with women who do not use HRT. 256
POSTER
The impact of mdr1 and mrp1 gene induction on survival in locally advanced breast cancer C. Atalay 1 , U. Gunduz 2 . 1 Ankara Oncology Hospital, General Surgery, Ankara, Turkey; 2 Middle East Technical University, Biology, Ankara, Turkey Purpose: Drug resistance to chemotherapy in patients with locally advanced breast cancer leads to a decrease in treatment efficacy and probably patient survival. Multidrug resistance genes, mdr1 and mrp1, cause resistance to chemotherapy drugs used for breast cancer treatment. In this study, it is aimed to evaluate the influence of mdr1 and mrp1 gene induction in breast cancer patients. Patients and Methods: Patients with locally advanced breast cancer treated between 2001-2003 were prospectively included. Patients’ demographic
S77
and clinicopathologic properties and treatment modalities utilized were recorded. Breast tumor tissue samples were obtained before and after chemotherapy. mdr1 and mrp1 gene expression was evaluated, after RNA isolation from tissue samples, using RT-PCR. Presence of P-glycoprotein and MRP1 protein in tissues was detected using immunohistochemistry. Induction of both genes was compared to clinical response of patients. In addition, impact of mdr1 and mrp1 gene induction on survival was evaluated. Results: Twenty five female patients in stage IIIB were included. All patients were treated with anthracycline containing chemotherapy protocols. Modified radical mastectomy was performed in responsive patients and adjuvant chemo- and radiotherapy were added. Median follow-up time was 30 months and 11 patients (44%) had recurrence while 10 patients (40%) died during follow-up. Mean disease-free survival for patients with and without mdr1 gene induction was 13 and 45 months (p=0.0004), respectively whereas overall survival was 21 and 48 months (p=0.002), respectively. In contrast, mean disease-free survival for patients with and without mrp1 gene induction was 30 and 40 months (p=0.96), respectively, and overall survival was 32 and 42 months (p=0.5), respectively. Conclusion: mdr1 gene induction during chemotherapy decreases diseasefree and overall survival in patients with locally advanced breast cancer due to poorer response to chemotherapy drugs. Knowing mdr1 gene status of the patients before chemotherapy will help to choose the appropriate drugs and to increase the efficacy of drug treatment resulting in better survival. 257
POSTER
Breast cancer patients after surgery; How do they describe quality of care? M. de Kok 1 , H. Sixma 2 , R. Scholte 1 , K. Spijkers 2 , C. van de Velde 3 , J. Roukema 4 , F. van der Ent 5 , A. Bell 6 , M. von Meyenfeldt 1 . 1 Academic Hospital Maastricht, Department of Surgery, Maastricht, The Netherlands; 2 NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands; 3 Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands; 4 St. Elisabeth Hospital, Breast Unit, Tilburg, The Netherlands; 5 Orbis Medical Center, Department of Surgery, Sittard, The Netherlands; 6 Laurentius Hospital, Department of Surgery, Roermond, The Netherlands Introduction: The goal of this study was to explore how breast cancer patients define quality of care, as a first step towards a new questionnaire. Patients and Methods: After approval from the Medical Ethics Committees was obtained, 8 focus groups were organized in 5 different hospitals in the Netherlands. Seventy-five patients who had been operated on for breast cancer participated in the meetings. Each focus group lasted 2-2,5 hours. After the focus groups, 65 patients from the same 5 hospitals, participated in 6 concept mapping sessions. As part of this concept mapping procedure, the 81 items most frequently mentioned during the focus groups were rated on a 5-point Likert type scale ranging from 1 (relatively unimportant) to 5 (extremely important). The same 81 items were structured according to similarity. Results: The focus groups resulted in 221 aspects on quality of care mentioned by the respondents. Importance scores of the 81 aspects included in the concept mapping procedure ranged from 1.4 to 4.7. The 3 most important items that addressed clinicians were ‘caregivers should have all results available when I have an appointment with them for that reason’, ‘a check-up 6 months after surgery should be part of the protocol’ and ‘the results of the biopsy are told to me within a week after the test’. The 3 items with the lowest scores on importance level and involving clinicians were ‘caregivers should take into account my agenda when they schedule new appointments’, ‘caregivers should offer me information about filing a complaint’ and ‘my doctor should provide me with information on the availability of patient support groups’. Structuring according to similarity resulted in 6 general clusters of items: period of admission (6 items), focus on patient (9 items), respect for the patient (12 items), time schedule (10 items), continuity of care (10 items) and education (8 items). The remaining 26 items were labelled as miscellaneous. Conclusion: To assess quality of care from the perspective of breast cancer patients, focus groups and concept mapping were used as a first, important step towards a new quantitative questionnaire. Both qualitative methods resulted in items this specific patients group considers as reflecting quality of care. Moreover, they provide information on the relative importance of these quality aspects. A test version was developed based on the results of this study and sent to 614 patients after breast cancer surgery.