Use of adjuvant endocrine therapy (ET) for ductal carcinoma in situ (DCIS) varies widely in clinical practice. We investigated oestrogen receptor (ER) testing, the initiation of ET, and the effect of ET on outcomes for DCIS in New Zealand. Women with DCIS (2000–2022) were identified from the New Zealand Breast Cancer Foundation National Register and linked to the national pharmaceutical data. Logistic regression identified factors associated with ER testing, and cumulative incidence of breast cancer events was estimated with death as a competing risk. Among 5813 women with DCIS, 894 patients (15.4
Post-surgical bleeding is a clinically relevant complication after mastectomy. Although high body mass index (BMI) is associated with the risk of this complication, the impact of regional skeletal muscle mass adjacent to the operative field remains unclear. This study aims to evaluate the association between pectoralis major muscle mass and post-surgical bleeding after mastectomy in patients with breast cancer. We retrospectively analyzed 669 patients who underwent mastectomy between 2015 and 2022, involving a total of 709 breasts. The pectoralis major muscle area was measured using preoperative computed tomography (CT) at the Th2 level, and the pectoralis major muscle index (PMI) was then calculated as the muscle area divided by height squared. We analyzed the association between BMI and PMI, and the incidence of post-surgical bleeding. Post-surgical bleeding occurred in 42 cases (5.9
Neighborhood environments appear to influence breast cancer biology and outcomes. This study evaluated somatic, treatment, and outcome differences by Area Deprivation Index in patients with metastatic breast cancer. Retrospective, population-based cohort study using clinical and genomic data gathered between 2015 and 2024 at four academic institutions in the United States. The outcomes were differences in circulating tumor DNA mutation profiles, PI3K inhibitor use, and survival between patients with metastatic breast cancer living in high deprivation (Area Deprivation Index ≥ 60 by national rank) and low deprivation (< 60) neighborhoods. Among 1127 patients with metastatic breast cancer, 335 (29.7
Neoadjuvant chemotherapy, a cornerstone of early-stage triple-negative breast cancer (TNBC) treatment, has limited efficacy and is often accompanied by substantial toxicity. As a promising chemotherapy-free alternative, the combination of immune checkpoint inhibitors and anti-angiogenic agents provides the potential to enhance antitumor efficacy by remodeling the tumor microenvironment while reducing treatment-related adverse events (TRAEs). This study aimed to assess the clinical value and feasibility of neoadjuvant camrelizumab plus apatinib in patients with early-stage TNBC. This study enrolled stage II-III TNBC patients with baseline tumor-infiltrating lymphocytes (TILs) > 10
Obesity is an established risk factor for breast cancer and is associated with alterations in gut microbial composition. We evaluated associations among body mass index (BMI), breast density, gut microbial diversity and composition and microbial functional pathways in women undergoing surgery for benign, high-risk/non-invasive, and invasive breast disease. Preoperative stool samples were collected from 131 women (median age 59) with benign (n = 23), high-risk/non-invasive (n = 47), or malignant (n = 61) disease. Shallow shotgun metagenomic sequencing was performed. Taxonomic profiling used Sourmash 4.2.4 (GTDBv207 reference database); functional profiling employed HUMAnN 3.6 with gene families mapped to MetaCyc pathways. α-diversity differed across diagnosis groups and inversely correlated with increasing BMI (Inverse Simpson p = 0.025). β-diversity differed by diagnosis group and BMI. No significant differences in diversity were observed based on age, menopausal status or mammographic breast density. BMI was also associated with enrichment of Dorea, Blautia, and Streptococcus species. Functional pathway profiling showed greater relative abundance of genes involved in NAD biosynthesis, folate metabolism, and aromatic amino acid metabolism pathways with higher BMI. Cross-referencing the most significant taxonomic and functional pathway findings suggested enrichment of Blautia species, via tryptophan metabolism, might link to NAD biosynthesis. In this study of women with benign, high-risk/non-invasive, and invasive breast disease, BMI was associated with distinct differences in gut microbial taxonomy and functional pathway profiles. These hypothesis-generating findings provide a rationale for future study to determine how the obesity-associated microbiome contributes to breast cancer development. Not applicable.
Accurate preoperative radiological assessment is essential in breast-conserving surgery (BCS) to achieve clear margins while minimizing unnecessary healthy tissue excision. Discrepancies between radiological and pathological tumor size may contribute to re-excision. This study evaluated factors associated with radiology–pathology discordance and their impact on re-excision. This post hoc analysis of the MagTotal randomized trial included patients with non-palpable breast cancer undergoing BCS with lesion localization and sentinel lymph node dissection. The Pathology-to-Radiology Ratio (PRR) quantified discordance between size on preoperative imaging and specimen pathology. Primary outcomes were predictors of PRR and re-excision. A multivariable model was used to construct a nomogram for predicting PRR. Among 414 patients (median age 65 years; median tumor size 10.3 mm), MRI was performed in 24.4
The role of contrast-based imaging (CBI) at diagnosis in early breast cancer remains debated. More sensitive baseline staging may identify synchronous disease that would otherwise present as early ipsilateral or contralateral events. We examined whether CBI at diagnosis is associated with differences in early locoregional outcomes. A retrospective cohort study of women with early invasive breast cancer or ductal carcinoma in situ (DCIS). Patients were grouped according to whether they underwent CBI (CEM or MRI) at diagnosis. All underwent mammographic surveillance including contrast-enhanced mammography (CEM). Locoregional events from diagnosis to 30 June 2025 were identified and evaluated. Cox proportional hazards models to assess associations between CBI use and subsequent locoregional events were adjusted for age, calendar period, mammographic density (MD), and stage. Among 1,106 women (594 CBI, 512 non-CBI) diagnosed between April 2015 and June 2022, there were 60 locoregional events (39 invasive, 21 DCIS). Patients who underwent CBI had fewer subsequent locoregional events. After adjustment, CBI use at diagnosis was associated with significantly lower 5-year event rates among women with invasive cancer (adjusted HR 0.50, 95
Adjuvant cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) improve outcomes in hormone receptor–positive (HR+), HER2-negative early breast cancer, though trial results have been heterogeneous. Menopausal status and endocrine therapy backbone may contribute to variability in treatment effect. We performed a meta-analysis evaluating whether menopausal status influences the efficacy of adjuvant CDK 4/6 inhibition. A systematic review of phase III randomized trials evaluating adjuvant CDK4/6i in HR+/HER2- early-stage breast cancer was conducted. Trial-level hazard ratios (HRs) and 95
Clinical benefit from adjuvant capecitabine in patients with early-stage triple-negative breast cancer (eTNBC) and deleterious BRCA1/BRCA2 mutation (BRCAm) is not well characterized. This retrospective, observational study explored the real-world effectiveness of adjuvant capecitabine in patients with eTNBC by BRCAm status. Data from adults diagnosed with eTNBC from 2016 to 2024 were captured from electronic health records in the US Flatiron Health database. Patients who initiated adjuvant capecitabine within 6 months after primary surgery and had documented BRCA status (by germline/tumor testing) were included. Of 882 patients who received adjuvant capecitabine, 53 (6
Programmed cell death protein-1 (PD-1) inhibitors have transformed cancer therapy, but evidence suggests PD-1 signaling modulates µ-opioid receptor activity, potentially attenuating opioid analgesia. This study evaluated the effect of PD-1–based neoadjuvant chemotherapy (NAC) on perioperative opioid use and pain outcomes following mastectomy with immediate reconstruction. We retrospectively reviewed consecutive mastectomies with immediate reconstruction following NAC between 2020 and 2024. Patients were grouped by PD-1-based NAC (NAC + PD-1) versus NAC without PD-1 inhibitors (NAC). Patient and procedural characteristics, perioperative opioid use, pain scores, and post-discharge opioid refills were analyzed. Multivariable analysis identified predictors of post-anesthesia care unit (PACU) opioid use per hour, postoperative pain, and post-discharge refills. Among 277 patients, 54 received NAC + PD-1 and 223 received NAC. BRCA1/2 mutations (38.9
This study aimed to identify factors associated with breast skin ulceration (BSU) and to describe its timing and patterns of occurrence in de novo metastatic breast cancer (MBC). We conducted a retrospective cohort study including women diagnosed with de novo MBC between 2008 and 2019 at Institut Curie. Clinical, pathological, and treatment-related data were extracted from the ESME database, a large, nationwide French real-world database dedicated to metastatic breast cancer. The primary endpoint was the presence or development of BSU. Secondary endpoints included progression-free survival (PFS) and overall survival (OS). Among 669 patients with de novo MBC, 53 (7.9
Patient-reported outcomes (PROs) inform benefit-risk tradeoffs in breast cancer treatment, yet reporting quality across registration trials remains incompletely characterized. We conducted a scoping review of PRO reporting in randomized trials supporting FDA breast cancer drug approvals (January 2011–December 2024), identified via the FDA Oncology Approval Notifications database. Associated manuscripts were retrieved through systematic PubMed and EBSCO searches using trial-specific NCT identifiers. We assessed PRO endpoint prespecification status, instruments used, PRO publication delay (defined as the interval in months between the primary trial manuscript and corresponding PRO-dedicated manuscript publication date), and missing data reporting across eligible primary trial, PRO-dedicated, and subpopulation-specific PRO manuscripts. We identified 34 FDA breast cancer drug approvals supported by 36 unique randomized trials, yielding 45 eligible manuscripts. No trial designated PROs as a primary or co-primary endpoint; nine (25
Interstitial lung disease (ILD) is a serious side effect of certain mBC treatments, but our understanding of its prevalence outside of clinical trials and treatment-specific studies is limited. We sought to characterize the incidence of ILD among a large, population-based cohort of adults with mBC in the United States. We included females and males aged 66 + years who were diagnosed with Stage IV breast cancer (as their first cancer) between January 1, 2002-December 31, 2017, using the SEER-Medicare linked. Our primary outcome was an incident ILD diagnosis after their mBC diagnosis, which was operationalized as a binary outcome. We examined demographic and clinical factors associated with incident ILD using logistic regression models. Among the 14,343 patients with mBC and no evidence of ILD at baseline, the median age at diagnosis was 76 (IQR 70, 82) years and 98
Tumor-associated nerves have recently emerged as an understudied key regulator of cancer biology. However, its quantification using histological or transcriptomic approaches is challenging because their small diameters hinder reliable detection and their cell bodies that hold most mRNA reside outside the tumor. This study evaluated a Schwann cell (SC)-related transcriptomic score as a surrogate for tumor-associated nerves in tumors from triple-negative breast cancer (TNBC) patients. Transcriptomic and clinical data from three independent TNBC cohorts, TCGA (n = 170), METABRIC (n = 335), and SCAN-B (n = 174) were analyzed. An SC score was calculated from SC-related gene signatures, and spatial transcriptomics was used to validate SC localization. In addition, seven independent neoadjuvant chemotherapy (NAC) cohorts were analyzed to evaluate the association between SC score and treatment response. Associations between the SC score and clinical features, genomic features, proliferation, treatment response, and the tumor microenvironment (TME) were evaluated. SC signature genes spatially localized to intratumoral nerve regions, confirming that the SC score reflects their presence within tumors. SC-high tumors were associated with lower mutation burden and with less cell proliferation in the TCGA, METABRIC, and SCAN-B cohorts. SC-high tumors were also associated with low immune activity and fewer infiltrating immune cells, along with enrichment of epithelial–mesenchymal transition (EMT), TGF-beta signaling and stromal remodeling pathways. The SC score-high TNBC is associated with lower cell proliferation, enhanced stromal remodeling and EMT and suppressed immune activity, suggesting a role of neural-associated TME features in shaping TNBC biology.
Despite advancements in breast cancer adjuvant therapies, some patients with indications may not receive treatment. We examined the association of self-reported racial/ethnic discrimination in patient-provider interactions and the receipt of clinically indicated therapies. The Pathways Study is a prospective cohort of women diagnosed with invasive breast cancer from 2005 to 2013 at Kaiser Permanente Northern California. Racial/ethnic discrimination in patient-provider interactions was assessed from the Interpersonal Processes of Care survey at baseline, 6 months, and 24 months post-diagnosis. Logistic regression compared women who did not initiate clinically-indicated adjuvant therapy with those who did overall, and by race and ethnicity. Covariates included race and ethnicity, age at diagnosis, country of birth, education level, income, marital status, and American Joint Committee on Cancer staging. Overall, 3,610 women had indication for hormonal therapy, 2,450 for chemotherapy, and 3,258 for radiation therapy. In multivariable analyses, women reporting discrimination were at increased odds of not initiating hormonal therapy (adjusted odds ratio [aOR] = 1.43, 95
Invasive lobular carcinoma (ILC) of the breast typically affects older women. As a result, there is limited research on prognosis and prognostic factors in young women with ILC. Here we set out to determine the long-term outcome and prognostic factors of women under 40 years of age with lymph node-negative (N0), hormone-receptor positive (HR+)/human epidermal growth-factor receptor 2 negative (HER2-) ILC who did not receive adjuvant systemic treatment (chemo- and/or endocrine therapy). Through the Netherlands Cancer Registry we selected all systemically untreated patients younger than 40 years with HR+/HER2-, N0, early breast cancer diagnosed in the Netherlands from 1989-2000. At the time, node-negativity was considered a favorable prognostic marker and guidelines recommended no adjuvant systemic therapy for this subgroup. Distant recurrence-free survival (DRFS), recurrence-free survival (RFS) and overall survival (OS) were assessed according to the STEEP criteria. Uni- and multivariable Cox proportional hazard models were used to assess prognosis, calculating hazard ratios (HR) with confidence interval (CI). Of the n = 1138 selected patients, n = 95 were histologically classified as ILC and n = 805 as invasive breast cancer of no special type (BC-NST), n = 238 were classified as other breast cancer subtype. In ILC, tumor grade was not associated with DRFS/RFS or OS (HR for DRFS 1.40, 95
To identify screening intervals and BI-RADS–specific management pathways that balance cancer detection yield against recall burden in ultrasound-based breast cancer screening in China. We analysed 1,694,838 ultrasound examinations reported with BI-RADS (2018–2023). For BI-RADS 1/2, inter-screen intervals were evaluated by recall rate, cancer detection rate (CDR), positive predictive value (PPV), and early-stage proportion. For BI-RADS 0/3/4/5, we assessed associations between biopsy waiting time and PPV/early-stage proportion, and examined imaging follow-up outcomes for BI-RADS 4A. Among 337,497 screening intervals following BI-RADS 1/2, longer intervals were associated with higher CDR (0.13–0.54 per 1,000) but higher recall (17.4
Life expectancy is increasing and the number of patients age ≥ 85 with breast cancer (BC) may be on the rise. We report descriptive statistics regarding surgical management and outcomes in this cohort. Patients ≥ 85 years surgically treated for a primary or in-breast tumor recurrence (IBTR) were identified through Oncoshare, a database that links Stanford Healthcare and Sutter Health electronic medical records with the California Cancer Registry. From 2010 to 2019, 91 patients, 65 (71
Contemporary real-world data on treatment patterns and clinical outcomes in patients with programmed death ligand 1 (PD-L1)-negative locally recurrent inoperable or metastatic triple-negative breast cancer (lr/mTNBC) are sparse. We describe first-line (1L) systemic therapies and real-world survival outcomes in this population in the United States (US). Adults with PD-L1-negative lr/mTNBC initiating 1L systemic treatment in the US were identified using the Komodo Research Data (KRD+; 1/1/2016-12/31/2023). Treatment patterns, including treatment durations and sequences from 1L through three lines of therapy, real-world overall survival (rwOS) and progression-free survival (rwPFS) from 1L, were analyzed. rwOS and rwPFS were summarized using Kaplan-Meier methods in subgroups of patients with ≥ 18 months and ≥ 6 months of potential follow-up, respectively. Overall, 929 patients were included (median age 59.0 years, 60.1
