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Predicting the risk of recurrence in women with stage III breast cancer
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Abstracts / The Breast 20 (2011) S12–S55
patients. In conclusion, lapatinib is not an option but an essential to manage HER2+MBC.
PO83 PREDICTING THE RISK OF RECURRENCE IN WOMEN WITH STAGE III BREAST CANCER Chia Hau Ng, Ern Yu Tan, Jc Chen, C. Teo, Myp Chan Tan Tock Seng Hospital, Singapore, Singapore Introduction: Despite the introduction of nationwide mammogram screening and an increasingly affluent and well-educated population, the incidence of advanced breast cancer remains higher in Singapore than in most Western countries. Although Stage III disease remains potentially curable, 5-year survival is less than 50%. Mortality almost exclusively results from metastatic disease, from which patients with Stage III disease are at particularly high risk of developing despite optimal treatment. In this study, we therefore aim to evaluate possible predictors of recurrence, in order to identify a subgroup of patients who are at high risk of disease recurrence. Materials and methods: Retrospective review was performed of 458 patients who were diagnosed with stage III breast cancer at our institution from 1st January 2001 to 31st December 2010. Recurrence (local or distant) was correlated with standard clinicopathological parameters. Results: Twenty-three percent (105 of 458) of patients had developed recurrence after a median follow-up period of 63 months. Compared with those with Stage I or II disease, patients with Stage III disease were 4 times more likely to develop recurrent disease (P <0.01, OR 3.55, 95% CI 2.66 to 4.75). Most patients were compliant to treatment recommendations. Recurrent disease was disseminated in the majority of patients (77%, 81 of 105). 16 patients (15%) presented with both local and distant recurrence, while 24 patients (23%) presented with local recurrence only. 71 patients died from breast cancer during the follow-up period; 6 died from noncancer related causes. Recurrence (local or distant) correlated significantly with more aggressive tumour features such as high tumour grade, the presence of lymphovascular invasion, hormone unresponsiveness (P < 0.05). In addition, the extent of nodal involvement (ratio of number of positive nodes to total number of nodes harvested) also correlated positively with the likelihood of recurrence (P < 0.01). Interestingly, we observed that those of Indian ethnicity were 5 times more likely to develop recurrence (P < 0.01, OR 4.74, 95% CI 2.14 to 10.48). This remained significant even on multivariate analysis. In addition, oestrogen receptor negativity and the ratio of number of positive nodes to total number of nodes harvested were also found to be independent predictors of recurrence (P < 0.05). Conclusion: The risk of recurrence remains significant in Stage III disease despite compliance to recommended treatments. Disease often recurred at distant sites and accounted for almost all the deaths seen during our study period. Indian ethnicity, ER status and the extent of nodal involvement were found to be independent predictors of recurrence. These findings highlight the importance of compliance to treatments and possibly also the need for more intensive surveillance in this subgroup.
PO84 ONE UK BREAST UNIT'S EXPERIENCE OF GP 2 WEEK WAIT REFERRALS TO BREAST CARE CLINIC - ARE THEY APPROPRIATE? Jennifer Yin, Jane V. Carter, Richard Hunt, Elizabeth Burd, Mohammed ElAbbar, Robert Price, Jasper Gill Breast Care Centre. Musgrove Park Hospital, Taunton and Somerset NHS Trust., Taunton, Somerset, UK Purpose of Audit: Around 80% of patients who go to breast clinics for investigation of possible or suspected breast cancer are referred by GPs. All patients with possible or suspected breast cancer should be referred to a breast clinic without delay. Referral guidelines have been published by
the Department of Health in the UK. NICE recommends that GPs should be given feedback on their use of these guidelines, as reflected in the appropriateness of their referrals to breast clinics. This audit compared the initial GP referral letter to the end outcome in one breast care unit to assess the appropriateness of GP referrals. Method: All referrals for women with new breast symptoms sent to the breast care unit over a 1 month period were collected and examined. These were compared to the end diagnosis once the patient had been seen in clinic. Results: A total of 148 GP referral letters were collected. Of these, no further information was available for 21 patients. Of the remaining 127 patients, 86 were referred to the clinic with a suspected cancer; 41 were referred as ‘for review but not suspected cancer'. In total 13 (10%) cancers were diagnosed of which 12 (92%) were correctly referred as suspected cancer. 38 (30%) patients were found to have normal breast tissue or mastalgia; and of these 18 (14%) had been referred with suspected cancer. 74 (86%) patients who were referrred with suspected cancer did not have a malignancy. Of the remaining patients, the most common diagnoses were confirmed benign breast lumps such as fibroadenomas - 26 patients (20%); and cystic disease - 13 patients (10%). Other diagnoses were fat necrosis or haematoma (6%), gynacomastia (3%), duct ectasia (2%), chostochondritis (<1%), benign breast discharge (<1%), and others (16%) which included dermatofibromas, benign skin changes, mastitis and breast abscesses. Only one patient did not attend (<1%). Conclusion: These results show that in the group examined, GP's were appropriately referring patients with cancer. A small but notable proportion of patients with normal breasts or mastalgia were referred to the breast cancer clinic as suspected cancer. The results show that GPs are picking up cancers when present - i.e. the referral process is very sensitive. However, the referral process is not specific - 86% of patients referred with a suspected cancer did not have a malignancy. This information will be fed back locally and nationally to help GPs maintain and improve the appropriateness of their referrals
PO85 BREAST CANCER METASTASIS IN THYROID GLAND - REPORT OF THREE CASES Inês Romero, Henrique Mora, Fernando Osório, Susy Costa, Cândida Cruz, Margarida Damasceno, Isabel Amendoeira, José-Luis Fougo Breast Center, S. João Hospital, Porto, Portugal Introduction: Secondary involvement of the thyroid gland is uncommon. Distinction between a primary thyroid tumor and metastasis is crucial. The incidence of metastasis in the thyroid gland at autopsy varies according series (1.25% to 24%), being the primitive tumours in lung, breast, iris, kidney, parotid gland and soft tissue sarcomas. The diagnosis can be obtained by fine needle aspiration cytology (FNA). The subsequent therapeutic decision depends on the stage of the primary tumor. Methods: Review of 3 clinical cases of thyroid gland metastasis identified in women with primary breast carcinoma. Case 1- 60 year-old woman with a breast carcinoma diagnosed in 1993, submitted to radical mastectomy (pT2N1, ER positive, HER2 negative). In 2005 bilateral cervical lymphnodes were detected and FNA cytology confirmed breast cancer metastasis. The remaining systemic staging was negative. By patient’s choice, hormonal therapy with tamoxifen was the only therapeutic measure. In 2006 symptomatic bone metastases were diagnosed and began bisphosphonates and exemestane. In 2010 a progression of bilateral cervical disease was observed as well as 27 mm nodule in thyroid gland. FNA showed metastatic breast carcinoma. A PET scan was performed suggesting local relapse and bilateral metastatic cervical lymph nodes. The multidisciplinary team (MCT) decision was chemotherapy with capcitabine, followed by bisphosphonates and anastrazole. Present overall survival was 18 years. Case 2- 60 year-old woman with a breast carcinoma diagnosed in 2006. Breast conservative surgery was performed (pT1cN2, ER positive, HER2 negative), followed by chemotherapy (4AC+4T), radiotherapy and anas-
Abstracts / The Breast 20 (2011) S12–S55
patients. In conclusion, lapatinib is not an option but an essential to manage HER2+MBC.
PO83 PREDICTING THE RISK OF RECURRENCE IN WOMEN WITH STAGE III BREAST CANCER Chia Hau Ng, Ern Yu Tan, Jc Chen, C. Teo, Myp Chan Tan Tock Seng Hospital, Singapore, Singapore Introduction: Despite the introduction of nationwide mammogram screening and an increasingly affluent and well-educated population, the incidence of advanced breast cancer remains higher in Singapore than in most Western countries. Although Stage III disease remains potentially curable, 5-year survival is less than 50%. Mortality almost exclusively results from metastatic disease, from which patients with Stage III disease are at particularly high risk of developing despite optimal treatment. In this study, we therefore aim to evaluate possible predictors of recurrence, in order to identify a subgroup of patients who are at high risk of disease recurrence. Materials and methods: Retrospective review was performed of 458 patients who were diagnosed with stage III breast cancer at our institution from 1st January 2001 to 31st December 2010. Recurrence (local or distant) was correlated with standard clinicopathological parameters. Results: Twenty-three percent (105 of 458) of patients had developed recurrence after a median follow-up period of 63 months. Compared with those with Stage I or II disease, patients with Stage III disease were 4 times more likely to develop recurrent disease (P <0.01, OR 3.55, 95% CI 2.66 to 4.75). Most patients were compliant to treatment recommendations. Recurrent disease was disseminated in the majority of patients (77%, 81 of 105). 16 patients (15%) presented with both local and distant recurrence, while 24 patients (23%) presented with local recurrence only. 71 patients died from breast cancer during the follow-up period; 6 died from noncancer related causes. Recurrence (local or distant) correlated significantly with more aggressive tumour features such as high tumour grade, the presence of lymphovascular invasion, hormone unresponsiveness (P < 0.05). In addition, the extent of nodal involvement (ratio of number of positive nodes to total number of nodes harvested) also correlated positively with the likelihood of recurrence (P < 0.01). Interestingly, we observed that those of Indian ethnicity were 5 times more likely to develop recurrence (P < 0.01, OR 4.74, 95% CI 2.14 to 10.48). This remained significant even on multivariate analysis. In addition, oestrogen receptor negativity and the ratio of number of positive nodes to total number of nodes harvested were also found to be independent predictors of recurrence (P < 0.05). Conclusion: The risk of recurrence remains significant in Stage III disease despite compliance to recommended treatments. Disease often recurred at distant sites and accounted for almost all the deaths seen during our study period. Indian ethnicity, ER status and the extent of nodal involvement were found to be independent predictors of recurrence. These findings highlight the importance of compliance to treatments and possibly also the need for more intensive surveillance in this subgroup.
PO84 ONE UK BREAST UNIT'S EXPERIENCE OF GP 2 WEEK WAIT REFERRALS TO BREAST CARE CLINIC - ARE THEY APPROPRIATE? Jennifer Yin, Jane V. Carter, Richard Hunt, Elizabeth Burd, Mohammed ElAbbar, Robert Price, Jasper Gill Breast Care Centre. Musgrove Park Hospital, Taunton and Somerset NHS Trust., Taunton, Somerset, UK Purpose of Audit: Around 80% of patients who go to breast clinics for investigation of possible or suspected breast cancer are referred by GPs. All patients with possible or suspected breast cancer should be referred to a breast clinic without delay. Referral guidelines have been published by
the Department of Health in the UK. NICE recommends that GPs should be given feedback on their use of these guidelines, as reflected in the appropriateness of their referrals to breast clinics. This audit compared the initial GP referral letter to the end outcome in one breast care unit to assess the appropriateness of GP referrals. Method: All referrals for women with new breast symptoms sent to the breast care unit over a 1 month period were collected and examined. These were compared to the end diagnosis once the patient had been seen in clinic. Results: A total of 148 GP referral letters were collected. Of these, no further information was available for 21 patients. Of the remaining 127 patients, 86 were referred to the clinic with a suspected cancer; 41 were referred as ‘for review but not suspected cancer'. In total 13 (10%) cancers were diagnosed of which 12 (92%) were correctly referred as suspected cancer. 38 (30%) patients were found to have normal breast tissue or mastalgia; and of these 18 (14%) had been referred with suspected cancer. 74 (86%) patients who were referrred with suspected cancer did not have a malignancy. Of the remaining patients, the most common diagnoses were confirmed benign breast lumps such as fibroadenomas - 26 patients (20%); and cystic disease - 13 patients (10%). Other diagnoses were fat necrosis or haematoma (6%), gynacomastia (3%), duct ectasia (2%), chostochondritis (<1%), benign breast discharge (<1%), and others (16%) which included dermatofibromas, benign skin changes, mastitis and breast abscesses. Only one patient did not attend (<1%). Conclusion: These results show that in the group examined, GP's were appropriately referring patients with cancer. A small but notable proportion of patients with normal breasts or mastalgia were referred to the breast cancer clinic as suspected cancer. The results show that GPs are picking up cancers when present - i.e. the referral process is very sensitive. However, the referral process is not specific - 86% of patients referred with a suspected cancer did not have a malignancy. This information will be fed back locally and nationally to help GPs maintain and improve the appropriateness of their referrals
PO85 BREAST CANCER METASTASIS IN THYROID GLAND - REPORT OF THREE CASES Inês Romero, Henrique Mora, Fernando Osório, Susy Costa, Cândida Cruz, Margarida Damasceno, Isabel Amendoeira, José-Luis Fougo Breast Center, S. João Hospital, Porto, Portugal Introduction: Secondary involvement of the thyroid gland is uncommon. Distinction between a primary thyroid tumor and metastasis is crucial. The incidence of metastasis in the thyroid gland at autopsy varies according series (1.25% to 24%), being the primitive tumours in lung, breast, iris, kidney, parotid gland and soft tissue sarcomas. The diagnosis can be obtained by fine needle aspiration cytology (FNA). The subsequent therapeutic decision depends on the stage of the primary tumor. Methods: Review of 3 clinical cases of thyroid gland metastasis identified in women with primary breast carcinoma. Case 1- 60 year-old woman with a breast carcinoma diagnosed in 1993, submitted to radical mastectomy (pT2N1, ER positive, HER2 negative). In 2005 bilateral cervical lymphnodes were detected and FNA cytology confirmed breast cancer metastasis. The remaining systemic staging was negative. By patient’s choice, hormonal therapy with tamoxifen was the only therapeutic measure. In 2006 symptomatic bone metastases were diagnosed and began bisphosphonates and exemestane. In 2010 a progression of bilateral cervical disease was observed as well as 27 mm nodule in thyroid gland. FNA showed metastatic breast carcinoma. A PET scan was performed suggesting local relapse and bilateral metastatic cervical lymph nodes. The multidisciplinary team (MCT) decision was chemotherapy with capcitabine, followed by bisphosphonates and anastrazole. Present overall survival was 18 years. Case 2- 60 year-old woman with a breast carcinoma diagnosed in 2006. Breast conservative surgery was performed (pT1cN2, ER positive, HER2 negative), followed by chemotherapy (4AC+4T), radiotherapy and anas-