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Number of deliveries as a prognostic factor in different breast cancer subtypes
abstracts
Annals of Oncology
230P
Breast cancer incidence and survival in renal transplant patients: 35-year experience
M. Kontos1, E. Riza1, T. Tsiampalis2, G. Kirkilesis1, I. Bokos3, D. Moris4, M. Darema3, A. Andriopoulos3, A. Varletzidou3, S. Vernadakis3, C. Nikolaidis3, S. Lionaki3, X. Sarantzi3, C. Anagnostopoulou3, I. Boletis3, G. Zavos3 1 National and Kapodistrian University of Athens, Athens, Greece, 2Institute of Preventive Medicine, Environmental & Occupational Health, Marousi, Greece, 3Laiko General Hospital, Athens, Greece, 4Duke University Medical Center, Durham, NC, USA Background: Renal transplantation is known to be associated with increased risk of malignancy. Concurrent presence of malignant diseases and transplantation may influence overall survival. This study summarizes our 35-year experience in breast cancer (BC) in renal transplant patients focusing on the incidence of BC and its impact on survival of this population. Methods: Prospectively collected data of female patients treated with renal transplantation for chronic renal failure from 1973 to 2017 were analysed. Patients diagnosed with BC were identified. Age at transplantation, age at BC diagnosis, date and causes of death were recorded for all patients. BC incidence and overall survival were calculated. Kaplan-Meier and Cox proportional hazards models were used to determine the difference in survival and hazard between the two patient groups. Results: Out of 821 transplant patients, 7 developed BC. The mean age in the total population of kidney transplant patients was 42.7 years (SD ¼ 13.8), while the mean age of women diagnosed with BC was 48.3 years (SD ¼ 10.2) and 53.0 years (SD ¼ 12.3), at transplantation and BC diagnosis respectively. In total 7 women (1.0%) were diagnosed with BC of which 4 died from BC and 1 from a different cause. The median survival for women diagnosed with BC was 193 months (16.1 years) compared to 299 months (24.9 years) from transplantation for women not diagnosed with BC (p < 0.001). The transplanted women with BC have 4.3 times higher hazard of dying (p ¼ 0.002) compared to those without. After adjusting for age, this difference decreases to 2.4 (p ¼ 0.059). The median overall survival of the BC transplant patients was 35 months from cancer diagnosis. Regarding the incidence of BC in the total sample, there are approximately 13 new cases per 100,000 person-months. In the age groups 45, 46-60 and 61 years 2, 23 and 18 new BC cases per 100,000 person-months were recorded. Conclusions: BC incidence appears increased in this population. BC diagnosis may adversely affect survival of renal transplant recipients. Further study of predisposing BC risk factors may reveal additional associations. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
231P
The changing landscape of breast cancer incidence after treatment for Hodgkin’s disease 1
1
1
233P
Number of deliveries as a prognostic factor in different breast cancer subtypes
A. J€a€askel€ainen1, N. Roininen1, A. Jukkola2, P. Karihtala1 Department of Oncology and Radiotherapy, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland, 2Department of Oncology and Radiotherapy, Tampere University Hospital and University of Tampere, Tampere, Finland
1
Background: Some registry-based and population-based studies have suggested that high parity could be an adverse prognostic factor in luminal breast cancer, although the definition of breast cancer subtypes has been varied and prospective studies are lacking. Methods: We report long-term follow-up (median 8.5 years) from prospectively collected single-institution material of early breast cancers. The patients (n ¼ 612) were treated with modern treatment modalities in a Finnish university hospital clinic and clinicopathological surrogates of intrinsic subtypes were updated to match with the ESMO 2015 Early Breast Cancer Clinical Practice Guidelines. Long-term outcomes were recorded and special emphasis was given to exact reproductive factor anamnesis as a potential prognostic factor. Results: Ten-year breast cancer-specific survival (BCSS) in this real-life prospective population was 91.4% in the whole cohort. The longest ten-year BCSS was observed in luminal A-like cancers (97.6%) and the worst in luminal B-like (HER2-positive) subgroup (80.6%). Having five or more deliveries associated with dismal BCSS (univariate p ¼ 0.0015). When subtypes were assessed separately in multivariate analysis, this association remained significant only in luminal B-like (HER2-negative) cancers (HR 2.64; 95% CI 1.05-6.65; p ¼ 0.04) when tumor size and nodal status were also included to the analysis. Having 5 or more deliveries also associated with node positivity in the whole cohort (p ¼ 0.0016), but not with different subtypes. Conclusions: This is the first prospectively collected study with the modern definition of breast cancer subtypes and contemporary treatments to assess parity as a breast cancer prognostic factor. Our results suggest that high parity is an adverse prognostic factor, but only in luminal B-like (HER2-negative) subtype. The biological effects of parity seem extend to later breast cancer and its metastasis in estrogen dependent, rapidly proliferating breast cancers. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
234P
Effects of supervised and adapted exercise program in the quality of life and strength of breast cancer survivors: MAMA MOVE Gaia trial
2
A.J. Benjamin , S. Cleator , P.T.R. Thiruchelvam , D.M. Gujral Oncology, Imperial College Healthcare NHS Trust, London, UK, 2Oncology, Imperial College Healthcare NHS Trust - Charing Cross Hospital, London, UK
1
Background: Breast cancer (BC) incidence increases after treatment for Hodgkin’s disease (HD). Over time, radiation techniques (RT) have reduced in dose and irradiated volume, and fewer alkylating (and gonadotoxic) chemotherapy (CT) agents used. We investigated BC incidence in the context of treatment changes over almost 4 decades and known risk factors. Methods: PubMed abstracts were identified using search terms ‘Hodgkin disease’, ‘Breast neoplasm’ and ‘risk’. Articles in English between 01/01/1990-31/12/2018 reporting on risk of BC in HD survivors were included. Outcomes included relative risk (RR), standardized incidence ratio (SIR), absolute excess risk (AER), cumulative incidence (CI), hazard ratio (HR) and odds ratio (OR) of BC in HD survivors. Results: 30/245 articles were included. 6 report BC incidence alone (n ¼ 7573). Other factors were RT dose and volume, CT, age at HD and its proximity to menarche and menopause. 10 studies looked at 2 factors (n ¼ 34637), 7 at 3 factors (n ¼ 15253), 4 at 4 factors (n ¼ 5763), and 2 at 5 factors (n ¼ 6110). 1 study was on radiation volume only (n ¼ 734). SIR of BC ranged from 2.4-75.3; AER from 9.2-83.6/10,000 years; RR was 1.9-10.6. Variation is due to differences in cohort characteristics, and incomplete
Volume 30 | Supplement 5 | October 2019
follow-up. BC incidence peaks 11-35 years post HD. Risk remains high at age 50-59 (SIR 3.8), when women are no longer annually screened. BC risk increases if RT is given within 6 months menarche (OR 5.52 (1.97–15.46). Earlier menopause reduces BC risk. BC risk increases linearly with increasing radiation dose. The OR can increase 11-fold with breast doses >40Gy compared to 0Gy. Mantle vs. mediastinal RT doubles HR. CT reduces the BC risk compared with RT alone. Newer RTs reduce BC risk; as a result, some studies demonstrate lower BC incidence in more recent treatment periods (SIR 3.2 in 1970s vs. 1.3 1990-2007). Other studies show no temporal change in incidence. Conclusions: Reduction in BC risk from lower doses and volumes of RT may be offset by reduced CT gonadotoxicity from newer regimens and, therefore, the impact of treatment changes over 4 decades on BC incidence requires further investigation. Current guidelines on screening HD survivors need to be adapted to reflect the changes in treatment regimens. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
A. Joaquim1, P. Antunes2, C. Garcia3, V. Afreixo4, A. Amarelo1, B. Duarte5, M. Vieira6, R. Lopes7, I. Le~ao1, A. Baptista Capela1, L. Helguero8, A. Alves9 1 Medical Oncology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E)Unidade 1, Vila Nova De Gaia, Portugal, 2Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Beira Interior, Covilh~ a, Portugal, 3Institute of Biomedicine (IBiMED), Aveiro University, Maia, Portugal, 4 5 Department of Mathematics, Aveiro University, Aveiro, Portugal, Physical exercise Department, Associac¸~ ao de Investigac¸~ ao e Cuidados de Suporte em Oncologia, Vila ao, SC Fitness, S.A. e Pump, Vila Nova De Gaia, Nova De Gaia, Portugal, 6Solinca Drag~ 7 Portugal, Physical Education and Sports Sciences Department, University Intitute of 8 Maia, Maia, Portugal, Hormones & Cancer Lab of Institute of Biomedicine (IBiMED), Aveiro University, Aveiro, Portugal, 9Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University Institute of Maia, Portugal, Maia, Portugal Background: Treatments for early breast cancer have side effects that affect quality of life (QoL) and cause deconditioning. Physical exercise might have a supportive and coadjuvant role in the rehabilitation of breast cancer survivors. We aimed to analyse the preliminary results of a community-based supervised exercise training program on QoL and muscle strength in breast cancer survivors.
doi:10.1093/annonc/mdz240 | v77
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.057/5578366 by guest on 25 October 2019
132 suspected participants were referred for mammographic evaluation at medical centers and malignancies were detected in 76 participants, which indicates high impact of such training programs in rural India. Conclusions: Conclusion: cancer awareness and education programs should be an integral part of health camps to improve women’s health and BSE Is easy to teach and have positive impact for early detection of cancer (the detection rate of 1.5% was quite high especially in the rural areas where medical facilities are poor). If implemented in structured manner BSE is the best and cheapest option for screening women of all ages in Indian population. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology
230P
Breast cancer incidence and survival in renal transplant patients: 35-year experience
M. Kontos1, E. Riza1, T. Tsiampalis2, G. Kirkilesis1, I. Bokos3, D. Moris4, M. Darema3, A. Andriopoulos3, A. Varletzidou3, S. Vernadakis3, C. Nikolaidis3, S. Lionaki3, X. Sarantzi3, C. Anagnostopoulou3, I. Boletis3, G. Zavos3 1 National and Kapodistrian University of Athens, Athens, Greece, 2Institute of Preventive Medicine, Environmental & Occupational Health, Marousi, Greece, 3Laiko General Hospital, Athens, Greece, 4Duke University Medical Center, Durham, NC, USA Background: Renal transplantation is known to be associated with increased risk of malignancy. Concurrent presence of malignant diseases and transplantation may influence overall survival. This study summarizes our 35-year experience in breast cancer (BC) in renal transplant patients focusing on the incidence of BC and its impact on survival of this population. Methods: Prospectively collected data of female patients treated with renal transplantation for chronic renal failure from 1973 to 2017 were analysed. Patients diagnosed with BC were identified. Age at transplantation, age at BC diagnosis, date and causes of death were recorded for all patients. BC incidence and overall survival were calculated. Kaplan-Meier and Cox proportional hazards models were used to determine the difference in survival and hazard between the two patient groups. Results: Out of 821 transplant patients, 7 developed BC. The mean age in the total population of kidney transplant patients was 42.7 years (SD ¼ 13.8), while the mean age of women diagnosed with BC was 48.3 years (SD ¼ 10.2) and 53.0 years (SD ¼ 12.3), at transplantation and BC diagnosis respectively. In total 7 women (1.0%) were diagnosed with BC of which 4 died from BC and 1 from a different cause. The median survival for women diagnosed with BC was 193 months (16.1 years) compared to 299 months (24.9 years) from transplantation for women not diagnosed with BC (p < 0.001). The transplanted women with BC have 4.3 times higher hazard of dying (p ¼ 0.002) compared to those without. After adjusting for age, this difference decreases to 2.4 (p ¼ 0.059). The median overall survival of the BC transplant patients was 35 months from cancer diagnosis. Regarding the incidence of BC in the total sample, there are approximately 13 new cases per 100,000 person-months. In the age groups 45, 46-60 and 61 years 2, 23 and 18 new BC cases per 100,000 person-months were recorded. Conclusions: BC incidence appears increased in this population. BC diagnosis may adversely affect survival of renal transplant recipients. Further study of predisposing BC risk factors may reveal additional associations. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
231P
The changing landscape of breast cancer incidence after treatment for Hodgkin’s disease 1
1
1
233P
Number of deliveries as a prognostic factor in different breast cancer subtypes
A. J€a€askel€ainen1, N. Roininen1, A. Jukkola2, P. Karihtala1 Department of Oncology and Radiotherapy, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland, 2Department of Oncology and Radiotherapy, Tampere University Hospital and University of Tampere, Tampere, Finland
1
Background: Some registry-based and population-based studies have suggested that high parity could be an adverse prognostic factor in luminal breast cancer, although the definition of breast cancer subtypes has been varied and prospective studies are lacking. Methods: We report long-term follow-up (median 8.5 years) from prospectively collected single-institution material of early breast cancers. The patients (n ¼ 612) were treated with modern treatment modalities in a Finnish university hospital clinic and clinicopathological surrogates of intrinsic subtypes were updated to match with the ESMO 2015 Early Breast Cancer Clinical Practice Guidelines. Long-term outcomes were recorded and special emphasis was given to exact reproductive factor anamnesis as a potential prognostic factor. Results: Ten-year breast cancer-specific survival (BCSS) in this real-life prospective population was 91.4% in the whole cohort. The longest ten-year BCSS was observed in luminal A-like cancers (97.6%) and the worst in luminal B-like (HER2-positive) subgroup (80.6%). Having five or more deliveries associated with dismal BCSS (univariate p ¼ 0.0015). When subtypes were assessed separately in multivariate analysis, this association remained significant only in luminal B-like (HER2-negative) cancers (HR 2.64; 95% CI 1.05-6.65; p ¼ 0.04) when tumor size and nodal status were also included to the analysis. Having 5 or more deliveries also associated with node positivity in the whole cohort (p ¼ 0.0016), but not with different subtypes. Conclusions: This is the first prospectively collected study with the modern definition of breast cancer subtypes and contemporary treatments to assess parity as a breast cancer prognostic factor. Our results suggest that high parity is an adverse prognostic factor, but only in luminal B-like (HER2-negative) subtype. The biological effects of parity seem extend to later breast cancer and its metastasis in estrogen dependent, rapidly proliferating breast cancers. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
234P
Effects of supervised and adapted exercise program in the quality of life and strength of breast cancer survivors: MAMA MOVE Gaia trial
2
A.J. Benjamin , S. Cleator , P.T.R. Thiruchelvam , D.M. Gujral Oncology, Imperial College Healthcare NHS Trust, London, UK, 2Oncology, Imperial College Healthcare NHS Trust - Charing Cross Hospital, London, UK
1
Background: Breast cancer (BC) incidence increases after treatment for Hodgkin’s disease (HD). Over time, radiation techniques (RT) have reduced in dose and irradiated volume, and fewer alkylating (and gonadotoxic) chemotherapy (CT) agents used. We investigated BC incidence in the context of treatment changes over almost 4 decades and known risk factors. Methods: PubMed abstracts were identified using search terms ‘Hodgkin disease’, ‘Breast neoplasm’ and ‘risk’. Articles in English between 01/01/1990-31/12/2018 reporting on risk of BC in HD survivors were included. Outcomes included relative risk (RR), standardized incidence ratio (SIR), absolute excess risk (AER), cumulative incidence (CI), hazard ratio (HR) and odds ratio (OR) of BC in HD survivors. Results: 30/245 articles were included. 6 report BC incidence alone (n ¼ 7573). Other factors were RT dose and volume, CT, age at HD and its proximity to menarche and menopause. 10 studies looked at 2 factors (n ¼ 34637), 7 at 3 factors (n ¼ 15253), 4 at 4 factors (n ¼ 5763), and 2 at 5 factors (n ¼ 6110). 1 study was on radiation volume only (n ¼ 734). SIR of BC ranged from 2.4-75.3; AER from 9.2-83.6/10,000 years; RR was 1.9-10.6. Variation is due to differences in cohort characteristics, and incomplete
Volume 30 | Supplement 5 | October 2019
follow-up. BC incidence peaks 11-35 years post HD. Risk remains high at age 50-59 (SIR 3.8), when women are no longer annually screened. BC risk increases if RT is given within 6 months menarche (OR 5.52 (1.97–15.46). Earlier menopause reduces BC risk. BC risk increases linearly with increasing radiation dose. The OR can increase 11-fold with breast doses >40Gy compared to 0Gy. Mantle vs. mediastinal RT doubles HR. CT reduces the BC risk compared with RT alone. Newer RTs reduce BC risk; as a result, some studies demonstrate lower BC incidence in more recent treatment periods (SIR 3.2 in 1970s vs. 1.3 1990-2007). Other studies show no temporal change in incidence. Conclusions: Reduction in BC risk from lower doses and volumes of RT may be offset by reduced CT gonadotoxicity from newer regimens and, therefore, the impact of treatment changes over 4 decades on BC incidence requires further investigation. Current guidelines on screening HD survivors need to be adapted to reflect the changes in treatment regimens. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
A. Joaquim1, P. Antunes2, C. Garcia3, V. Afreixo4, A. Amarelo1, B. Duarte5, M. Vieira6, R. Lopes7, I. Le~ao1, A. Baptista Capela1, L. Helguero8, A. Alves9 1 Medical Oncology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E)Unidade 1, Vila Nova De Gaia, Portugal, 2Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Beira Interior, Covilh~ a, Portugal, 3Institute of Biomedicine (IBiMED), Aveiro University, Maia, Portugal, 4 5 Department of Mathematics, Aveiro University, Aveiro, Portugal, Physical exercise Department, Associac¸~ ao de Investigac¸~ ao e Cuidados de Suporte em Oncologia, Vila ao, SC Fitness, S.A. e Pump, Vila Nova De Gaia, Nova De Gaia, Portugal, 6Solinca Drag~ 7 Portugal, Physical Education and Sports Sciences Department, University Intitute of 8 Maia, Maia, Portugal, Hormones & Cancer Lab of Institute of Biomedicine (IBiMED), Aveiro University, Aveiro, Portugal, 9Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University Institute of Maia, Portugal, Maia, Portugal Background: Treatments for early breast cancer have side effects that affect quality of life (QoL) and cause deconditioning. Physical exercise might have a supportive and coadjuvant role in the rehabilitation of breast cancer survivors. We aimed to analyse the preliminary results of a community-based supervised exercise training program on QoL and muscle strength in breast cancer survivors.
doi:10.1093/annonc/mdz240 | v77
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.057/5578366 by guest on 25 October 2019
132 suspected participants were referred for mammographic evaluation at medical centers and malignancies were detected in 76 participants, which indicates high impact of such training programs in rural India. Conclusions: Conclusion: cancer awareness and education programs should be an integral part of health camps to improve women’s health and BSE Is easy to teach and have positive impact for early detection of cancer (the detection rate of 1.5% was quite high especially in the rural areas where medical facilities are poor). If implemented in structured manner BSE is the best and cheapest option for screening women of all ages in Indian population. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.