Objectives To explore effects of adjuvant endocrine therapy (ET) among women with early-stage hormone receptor positive breast cancer aged 70+ years, with comorbidities or experiencing polypharmacy. Methods Women diagnosed with breast cancer in 2006-2022 were identified from the Te Rēhita Mate Ūtaetae – Breast Cancer Foundation National Register in New Zealand. Patients with pathological stage I-III, hormone receptor positive disease, and had surgery within 1 year after diagnosis were included. All-cause survival, breast cancer-specific survival and disease-free survival were explored between women with adjuvant ET and women without using Kaplan-Meier methods, after propensity score matching on key factors. Results Only half patients completed 5 years of adjuvant ET, and the rate declined with cancer stage. Women with stage I cancer aged 70+ years, with comorbidities or experiencing polypharmacy had excellent relapse-free survival and breast-cancer specific survival but poor all-cause survival. The 10-year all-cause mortality rate (26.1%-37.2%) were more than 10 times the breast cancer-specific mortality rate (0.7%-3.2%) and more than three times the cancer relapse rate (6.0%-10.3%). Among these women, no significant difference was found in all-cause survival, breast cancer-specific survival or disease-free survival between those receiving and not receiving adjuvant ET. Conclusions Women with stage I hormone receptor-positive breast cancer who were older, had comorbidities or polypharmacy showed excellent breast cancer-specific and disease-free survival but poorer all-cause survival. These patients with stage I cancer may derive limited benefit from adjuvant ET with high competing mortality. Further research should be performed to verify these findings.
Background Radiotherapy (RT) increases the risk of capsular contracture after mastectomy with implant-based breast reconstruction (IBBR). The present study assessed the association between the use of polyurethane coated versus non-polyurethane coated implants and the likelihood of surgical revision due to capsular contracture after RT. Methods The international multicenter retrospective PRExRT cohort study included patients with breast cancer treated at 26 sites in 15 countries between January 2016 and December 2024. Eligible patients underwent prepectoral IBBR with either polyurethane coated or non-polyurethane coated implants and received RT.Primary endpoint was surgical revision due to capsular contracture and was analyzed using Cox regression models. Results Among 1455 patients, 475 (32.6%) received polyurethane coated implants and 980 (67.3%) non-polyurethane coated implants.The use of polyurethane coated implants was associated with less frequent use of synthetic or biologic mesh (1.6% vs. 42.8%, p < 0.001), and less frequent two-stage IBBR (8.4% vs. 21.5%, p < 0.001).Compared to IBBR with non-polyurethane coated implants, use of polyurethane coated implants was independently associated with a lower rate of surgical revision due to capsular contracture (9.3% vs. 25.7%; HR 0.2, 95%CI 0.1-0.5, p < 0.001).The risk of major infection (OR 0.3, 95%CI 0.2-0.6, p < 0.001), implant loss (OR 0.2, 95%CI 0.09-0.4, p < 0.001), reoperation (OR 0.3, 95%CI 0.2-0.6, p = 0.001) and implant rotation (OR 0.05, 95%CI 0.004-0.7, p = 0.02) was also lower in the polyurethane group. Conclusions In the setting of RT, the use of prepectoral polyurethane coated implants was associated with a lower likelihood of surgical revision due to capsular contracture compared to non-polyurethane coated implants. Trial registration ClinicalTrials.gov identifier: NCT06747065.
Background Breast cancer remains a major public health concern worldwide and is the most common malignancy among women. Although it predominantly affects women over 50 years, a growing number of cases occur in adolescents and young adults (AYA; aged 15–39 years). In low- and middle-Human Development Index (HDI) countries, particularly in sub-Saharan Africa, this group faces disproportionately high mortality rates. Methods Number of new cases, deaths, and age-standardized rates (ASR) per 100,000 women aged 15–39 years in 2022 were extracted from the Global Cancer Observatory (GLOBOCAN) database. Data were analyzed for 185 countries and aggregated by the six United Nations regions. Projections to 2040 were estimated by applying 2022 age-specific rates to UN national population forecasts, assuming stable cancer risk and mortality patterns over time. Results In 2022, an estimated 245,827 new cases of breast cancer occurred among AYA women, representing 10.7% of all breast cancer cases. Asia accounted for the largest number of incident cases (49% of the global total), while Africa showed the highest mortality rates (6.2 per 100,000 AYA). At the national level, the proportion of AYA cases ranged from 43.6% in The Gambia to 3.3% in Finland. By 2040, the number of breast cancer cases among AYA women is projected to increase by 7.6% globally, with Africa showing an approximately 57% increase in the numbers of incident cases and deaths. Conclusion The rising burden of breast cancer among AYA women highlights a critical need to strengthen health systems in low- and middle-HDI countries. Our findings may help inform health system planning in regions where the burden of breast cancer among AYA women is projected to increase. They support consideration of context-appropriate strategies to improve early diagnosis, expand access to multidisciplinary cancer care, and strengthen surgical capacity, including oncoplastic and reconstructive surgery, where appropriate.
