- Email: [email protected]
The prognostic influence of body mass index in premenopausal breast cancer patients
S 18
Poster Session 1. Epirlemology/Risk
guidelines Canada.
on survival of node-negative
factors
breast cancer patients in Quebec,
Methods: The study population includes women newly diagnosed with node-negative breast cancer between 1988 and 1994. Information on the patient, her disease, the source of care, treatment, recurrences and deaths was collected by chart rewew. Vital status was also updated by linkage with the mortality and other administrative databases, and by queries to the attending physicians. Guidelines from the 1992 St-Gallen conference were used as standard of care. Disease-free and overall survival were estimated by Kaplan-Meier and Cox proportional hazards analyses. Results: Median follow-up was 6.8 years. For the whole cohort, the crude seven-year survival was 82%. It varied between 90% among women at minimal risk (n= 521) to 85% in those at moderate risk (n=200) and 76% in those at high risk of recurrence (n=785). Virtually all women at minimal risk of recurrence were treated according to the consensus. As compared with them, the hazard ratios of death from any cause were 1.2 (95% confidence interval: 0.7,2.0) and 2.5 (1.4,4.4) among good-risk women treated according to the consensus (n=l41) or not (n=59). Among high-risk women, these hazard ratios were 2.4 (l&3.3) and 3.5 (2.5.4.8) (n=470 et 315, respectively). Both high-risk category (p-value I 0.0001) and compliance with guidelines (p-value = 0.002) were independent significant predictors of survival. Conclusion: Compliance with consensus recommendations improves survival of breast cancer patients in the population. Project funded by the Canadian Breast Cancer Research initiative.
clP5
Survival of breast cancer patients treated in Tripoli/Libya 1990-1999
Manal ECHabbash, Abokris Alwindi, Khalil Ekhabbash. Oncology Department, Tripoli Medical Centec Department of Medicine, Altiteh Univesi& Libya
Study Objective: To study survival of breast cancer patients in Tripoli over the past IO years, and to assess the effect of Tamoxifen in patients with unknown receptor status followed up in Tripoli over the past IO years. Design: Non-randomized retrospective study in patients with breast cancer confirmed by biopsy. Setting: Oncology clinic in central hospital, Tripoli Medical Center. Patients: Seven hyndred sixty four patients were included in theis study in the period between January 1990 and December 1999. All patients received adjuvant Tamoxifen 20 mg/day regardless the stage of the disease, and estrogen receptor status. Results: The age ranged between 20-70 years (mean = 45.8m12.6 SID.), median 45.7 years. The commonest stage, was stage III (39.9%) and stage II, IV, and I were 32.3%, 9.1%. 8.4%, respectively.Most patients were treated by mastectomy (84.7%). Chemotherapy alone, or chemotherapy with radiotherapy was given as adjuvant treatment. Tamoxifen was given to all patients regardless receptor status. Regarding overall recurrence and survival rate, 5 years survival rate of patients diagnosed between 1990-1999 was 45X%, and the overall recurrence rate was 63%. The response to therapy was assessed by recurrence rate and survival rate at 1, 2 and 5 years in node positive, and node negative disease. Response to Tamoxifen was assessed according to menopuse, age and type of chemotherapy received by the patients. Response to Tamoxifen was better in node negative postmenopausal women compared with node negative premenopausal women, where the overall 5 years recurrence rate were 21.4% versus 39.7%, ~10.05. and overall 5 years survival rate were 74% versus 68.3%. There were no significant difference in node positive premenopausal women and postmenopausal women, where overall 5 years recurrence rate were 62% versus 61%. ~10.05, and overall survival rate were 41% versus 41% In those patients received chemotherapy with Tamoxifen, response was better in those receiveing FA.C. than those receiving C.M.F., p=O.O5.
clP6
-I-
premenopausal
breast cancer patients
S. Taucher’, M. Gnant’. H. Hausmaninger’, E. Kubista’, P. Wagner3, Th. Payrits4, G. Steger’, Ch. Tausch5. R. Jakesz’. ’UniverStyof Vienna, Dept. of Surgery: Gynecology internal Medicine, Vienna, Austria; ’ Salzburg Hospital, Third Medical Dept., Salzbuig Austnti; 3 Unive@y of Gmz, Dept. of tnternat Med. Gmz, Austria: 4 WI: Neustadt Hospita( Dept.of Sqeq Wr Neustadt, Austria: 5BHS Linz, Dept. of Surge% Linz, Austria
Goals: The relation 01 body weight and breast cancer is complex. Higher body mass index (BMI) may be associated with higher incidence of breast cancer in the postmenopause and lower incidence in the premenopause. Little is known about the prognostic impact of current body weight in breast
Thrmday,
13 March 2003
cancer patients. We evaluated the correlation between BMI and outcome of radically resected premenopausal breast cancer patients. Methods: BMI was assessed in 417 premenopausal patients in a prospective randomized multicenter ABCSG trial 5 at time of diagnosis and at 3 years postoperatively. The two treatment arms consisted of 6 cycles of chemotherapy (CMF) versus endocrine therapy with goserelin 3.6mg monthly for 3 years and tamoxifen 20mg daily for 5 years. Multivariate cox analysis was performed in both treatment groups to evaluate the prognostic impact of body weight for overall prognosis of these patients. Changes in body weight were assessed in both therapy groups. Results: Patients with endocrine treatment as well as those patients receiving adjuvant chemotherapy did show weightgain at the end of adjuvant therapy. Median BMI increased from 24.3 to 25.9 in the endocrine treatment group and from 23.8 to 25.6 respectively, and did not differ significantly from each other. The relative risk was increased in patients with primarily very low BMI (ll8) and very high BMI (135). Multivariate cox analysis did show a statistical significant influence of squared BMI on overall survival (p=O.O003) and breast cancer related survival (p=O.O014). Impact of BMI on disease free survival was not statistically significant (p=O.O8). Conclusions: We could demonstrate for the first time that obese and very slender premenopausal breast cancer patients have a significantly poorer outcome. Moderate weight gain after adjuvant therapy was seen in all patients without correlation to the kind of treatment.
clP7
Mammographic density and obesity as risk factors for invasive breast cancer followina ductal carcinoma in situ (DCIS)
J. Dignam’,*. L. Habe13, S. Land*, T. Julian4, 8. Fishers, N. Wolmark4. ’Universi~ of Chicago, Departmenf of Health Studies, Chicagoz USA; 2 NSABP Biostatisticxf Centec Pittsburgh, USA: 3 Kaiser Research Foundation, Berkeley USA; 4 NSABP Operations Office, Pittsburgh, USA, 5 NSABP Scientific Director3 ORice, Pittsburgh, USA Background: In addition to clinical and pathologic features of the tumor, a number of other attributes may predispose women with previous DCIS to higher risk of subsequent invasive breast cancer, and thus may be important for long-term disease management. We examined two characteristics at diagnosis, mammographic density evident in the diagnostic film and obesity, in relation to breast cancer outcomes among women with previous DCIS. StudyCohort and Methods: The study involved a subset of women enrolled in National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-17, a randomized trial comparing excision alone to excision followed by radiotherapy for women with DCIS. Diagnostic films collected at trial entry were assessed by an expert (without knowledge of patient follow-up course) for percent of the breast occupied by radiologically dense tissue. Body mass index (weight (kg)/ (height (cm))2 (BMI) was classified according to standard definitions for normal weight, overweight, and obese. Statistical modeling was used to evaluate the prognostic effect of density and obesity on ipsilateral and contralateral breast tumors, controlling for potential confounders from among demographic, clinical, and pathologic characteristics. Results: High breast density was associated younger age, premenopausal status, and low body mass index. Only about 5% of patients had breasts categorized as being highly dense (175% dense of the breast occupied by dense tissue). Approximately 50% of patients were overweight or obese. After adjusting for treatment and other potential confounders, women highly dense breasts were at 3.1 times the risk (95% confidence interval (Cl) 1 .O-9.0) of an invasive breast cancer and had a similar approximate 3fold excess risk of any subsequent breast cancer (DCIS or invasive, either breast), compared to women with less than 25% of the breast occupied by dense tissue. Obese women (BMI I 30) had 2.6 times the risk of invasive breast cancer (95% Cl 1.2-5.5) and at 1.5-fold excess risk of any subsequent breast cancer compared to women with BMI I 25. Conclusions: Both mammographic density and obesity may be indicators of increased breast cancer risk among women with history of DCIS. Highly dense breasts were uncommon in this cohort but were associated with significantly increased invasive breast cancer risk after DCIS. Obesity, which was inversely correlated with density, was prevalent and associated with moderate excess risk.
Poster Session 1. Epirlemology/Risk
guidelines Canada.
on survival of node-negative
factors
breast cancer patients in Quebec,
Methods: The study population includes women newly diagnosed with node-negative breast cancer between 1988 and 1994. Information on the patient, her disease, the source of care, treatment, recurrences and deaths was collected by chart rewew. Vital status was also updated by linkage with the mortality and other administrative databases, and by queries to the attending physicians. Guidelines from the 1992 St-Gallen conference were used as standard of care. Disease-free and overall survival were estimated by Kaplan-Meier and Cox proportional hazards analyses. Results: Median follow-up was 6.8 years. For the whole cohort, the crude seven-year survival was 82%. It varied between 90% among women at minimal risk (n= 521) to 85% in those at moderate risk (n=200) and 76% in those at high risk of recurrence (n=785). Virtually all women at minimal risk of recurrence were treated according to the consensus. As compared with them, the hazard ratios of death from any cause were 1.2 (95% confidence interval: 0.7,2.0) and 2.5 (1.4,4.4) among good-risk women treated according to the consensus (n=l41) or not (n=59). Among high-risk women, these hazard ratios were 2.4 (l&3.3) and 3.5 (2.5.4.8) (n=470 et 315, respectively). Both high-risk category (p-value I 0.0001) and compliance with guidelines (p-value = 0.002) were independent significant predictors of survival. Conclusion: Compliance with consensus recommendations improves survival of breast cancer patients in the population. Project funded by the Canadian Breast Cancer Research initiative.
clP5
Survival of breast cancer patients treated in Tripoli/Libya 1990-1999
Manal ECHabbash, Abokris Alwindi, Khalil Ekhabbash. Oncology Department, Tripoli Medical Centec Department of Medicine, Altiteh Univesi& Libya
Study Objective: To study survival of breast cancer patients in Tripoli over the past IO years, and to assess the effect of Tamoxifen in patients with unknown receptor status followed up in Tripoli over the past IO years. Design: Non-randomized retrospective study in patients with breast cancer confirmed by biopsy. Setting: Oncology clinic in central hospital, Tripoli Medical Center. Patients: Seven hyndred sixty four patients were included in theis study in the period between January 1990 and December 1999. All patients received adjuvant Tamoxifen 20 mg/day regardless the stage of the disease, and estrogen receptor status. Results: The age ranged between 20-70 years (mean = 45.8m12.6 SID.), median 45.7 years. The commonest stage, was stage III (39.9%) and stage II, IV, and I were 32.3%, 9.1%. 8.4%, respectively.Most patients were treated by mastectomy (84.7%). Chemotherapy alone, or chemotherapy with radiotherapy was given as adjuvant treatment. Tamoxifen was given to all patients regardless receptor status. Regarding overall recurrence and survival rate, 5 years survival rate of patients diagnosed between 1990-1999 was 45X%, and the overall recurrence rate was 63%. The response to therapy was assessed by recurrence rate and survival rate at 1, 2 and 5 years in node positive, and node negative disease. Response to Tamoxifen was assessed according to menopuse, age and type of chemotherapy received by the patients. Response to Tamoxifen was better in node negative postmenopausal women compared with node negative premenopausal women, where the overall 5 years recurrence rate were 21.4% versus 39.7%, ~10.05. and overall 5 years survival rate were 74% versus 68.3%. There were no significant difference in node positive premenopausal women and postmenopausal women, where overall 5 years recurrence rate were 62% versus 61%. ~10.05, and overall survival rate were 41% versus 41% In those patients received chemotherapy with Tamoxifen, response was better in those receiveing FA.C. than those receiving C.M.F., p=O.O5.
clP6
-I-
premenopausal
breast cancer patients
S. Taucher’, M. Gnant’. H. Hausmaninger’, E. Kubista’, P. Wagner3, Th. Payrits4, G. Steger’, Ch. Tausch5. R. Jakesz’. ’UniverStyof Vienna, Dept. of Surgery: Gynecology internal Medicine, Vienna, Austria; ’ Salzburg Hospital, Third Medical Dept., Salzbuig Austnti; 3 Unive@y of Gmz, Dept. of tnternat Med. Gmz, Austria: 4 WI: Neustadt Hospita( Dept.of Sqeq Wr Neustadt, Austria: 5BHS Linz, Dept. of Surge% Linz, Austria
Goals: The relation 01 body weight and breast cancer is complex. Higher body mass index (BMI) may be associated with higher incidence of breast cancer in the postmenopause and lower incidence in the premenopause. Little is known about the prognostic impact of current body weight in breast
Thrmday,
13 March 2003
cancer patients. We evaluated the correlation between BMI and outcome of radically resected premenopausal breast cancer patients. Methods: BMI was assessed in 417 premenopausal patients in a prospective randomized multicenter ABCSG trial 5 at time of diagnosis and at 3 years postoperatively. The two treatment arms consisted of 6 cycles of chemotherapy (CMF) versus endocrine therapy with goserelin 3.6mg monthly for 3 years and tamoxifen 20mg daily for 5 years. Multivariate cox analysis was performed in both treatment groups to evaluate the prognostic impact of body weight for overall prognosis of these patients. Changes in body weight were assessed in both therapy groups. Results: Patients with endocrine treatment as well as those patients receiving adjuvant chemotherapy did show weightgain at the end of adjuvant therapy. Median BMI increased from 24.3 to 25.9 in the endocrine treatment group and from 23.8 to 25.6 respectively, and did not differ significantly from each other. The relative risk was increased in patients with primarily very low BMI (ll8) and very high BMI (135). Multivariate cox analysis did show a statistical significant influence of squared BMI on overall survival (p=O.O003) and breast cancer related survival (p=O.O014). Impact of BMI on disease free survival was not statistically significant (p=O.O8). Conclusions: We could demonstrate for the first time that obese and very slender premenopausal breast cancer patients have a significantly poorer outcome. Moderate weight gain after adjuvant therapy was seen in all patients without correlation to the kind of treatment.
clP7
Mammographic density and obesity as risk factors for invasive breast cancer followina ductal carcinoma in situ (DCIS)
J. Dignam’,*. L. Habe13, S. Land*, T. Julian4, 8. Fishers, N. Wolmark4. ’Universi~ of Chicago, Departmenf of Health Studies, Chicagoz USA; 2 NSABP Biostatisticxf Centec Pittsburgh, USA: 3 Kaiser Research Foundation, Berkeley USA; 4 NSABP Operations Office, Pittsburgh, USA, 5 NSABP Scientific Director3 ORice, Pittsburgh, USA Background: In addition to clinical and pathologic features of the tumor, a number of other attributes may predispose women with previous DCIS to higher risk of subsequent invasive breast cancer, and thus may be important for long-term disease management. We examined two characteristics at diagnosis, mammographic density evident in the diagnostic film and obesity, in relation to breast cancer outcomes among women with previous DCIS. StudyCohort and Methods: The study involved a subset of women enrolled in National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-17, a randomized trial comparing excision alone to excision followed by radiotherapy for women with DCIS. Diagnostic films collected at trial entry were assessed by an expert (without knowledge of patient follow-up course) for percent of the breast occupied by radiologically dense tissue. Body mass index (weight (kg)/ (height (cm))2 (BMI) was classified according to standard definitions for normal weight, overweight, and obese. Statistical modeling was used to evaluate the prognostic effect of density and obesity on ipsilateral and contralateral breast tumors, controlling for potential confounders from among demographic, clinical, and pathologic characteristics. Results: High breast density was associated younger age, premenopausal status, and low body mass index. Only about 5% of patients had breasts categorized as being highly dense (175% dense of the breast occupied by dense tissue). Approximately 50% of patients were overweight or obese. After adjusting for treatment and other potential confounders, women highly dense breasts were at 3.1 times the risk (95% confidence interval (Cl) 1 .O-9.0) of an invasive breast cancer and had a similar approximate 3fold excess risk of any subsequent breast cancer (DCIS or invasive, either breast), compared to women with less than 25% of the breast occupied by dense tissue. Obese women (BMI I 30) had 2.6 times the risk of invasive breast cancer (95% Cl 1.2-5.5) and at 1.5-fold excess risk of any subsequent breast cancer compared to women with BMI I 25. Conclusions: Both mammographic density and obesity may be indicators of increased breast cancer risk among women with history of DCIS. Highly dense breasts were uncommon in this cohort but were associated with significantly increased invasive breast cancer risk after DCIS. Obesity, which was inversely correlated with density, was prevalent and associated with moderate excess risk.