Introduction: Fertility-related decisions among young women with breast cancer may be influenced by reproductive concerns, access to counseling, family circumstances, and cultural values. Methods: This cross-sectional study examined fertility intention and reproductive concerns among women aged 18-40 years with breast cancer at Shanxi Bethune Hospital, northern China, from January 2021 to April 2022. Data were collected using a self-designed questionnaire and the Chinese version of the Reproductive Concerns After Cancer (RCAC) scale. Propensity score matching and multivariable logistic regression were used to identify factors associated with fertility intention. Results: Among 178 participants, 91 (51.1%) reported fertility intention, 113 (63.5%) had at least one son, and only 56 (31.5%) had received fertility-related consultation. The mean RCAC score was 49.57 ± 7.92. After propensity score matching, having at least one son was associated with a lower likelihood of fertility intention, whereas receiving fertility-related consultation was associated with a higher likelihood of fertility intention. Conclusion: Family composition and access to professional consultation are associated with fertility intention among young breast cancer patients in northern China. Fertility counseling should therefore be incorporated into routine care and tailored to patients’ reproductive goals, family circumstances, and cultural backgrounds.
Background: The role of ^18F-FDG PET/CT in the initial staging of early-stage breast cancer remains controversial, as current guidelines discourage its routine use due to the low prevalence of distant metastases. This study aimed to evaluate the diagnostic yield and clinical impact of baseline PET/CT in a large multicenter cohort. Methods: In this retrospective multicenter study, 997 patients with clinical stage I–II breast cancer who underwent baseline PET/CT prior to treatment planning were included. The primary outcome was the detection of distant metastases, and the secondary outcome was the impact of PET/CT findings on treatment decisions. Clinicopathological factors associated with PET/CT positivity were also analyzed. Results: PET/CT identified abnormal findings in 29 patients (2.9%), including distant metastases in 21 patients (2.1%). Treatment strategy was altered in 21 patients (2.1%), primarily due to upstaging to metastatic disease. PET/CT positivity increased with tumor stage (0.4% in stage I vs. 3.7% in stage IIB, p < 0.001). In multivariable analysis, HER2 positivity, clinical nodal positivity (cN1), and higher tumor stage (cT2–3 vs cT1) were independently associated with PET/CT positivity. Conclusion: In this real-world PET/CT-referred cohort of patients with clinically stage I–II breast cancer, clinically relevant additional findings were identified in only 2.9% of patients, indicating a low overall diagnostic yield. These findings support current recommendations against routine systemic FDG PET/CT staging in clinically early-stage disease. When PET/CT is contemplated, higher-risk clinical and biological features may support selective, patient-specific use rather than routine application.
Introduction: Elacestrant is an oral selective estrogen receptor degrader (SERD) approved for the treatment of hormone receptor-positive (HR-positive), human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) following progression on endocrine therapy and CDK4/6 inhibitors. While randomized trial data from the EMERALD study demonstrated its clinical benefit, real-world evidence remains limited. Methods: We conducted a retrospective chart review of patients with HR-positive/HER2-negative MBC treated with elacestrant at two large cancer centers in Vienna, Austria. Clinical outcomes and safety were evaluated in routine clinical practice by experienced oncologists. Results: Elacestrant demonstrated clinically meaningful efficacy in a heavily pretreated patient population of 30 patients with estrogen receptor 1 (ESR1) mutations. Median age was 65 years and the cohort was predominantly postmenopausal (86.7%). Before initiation of elacestrant, patients had received a median of two lines of endocrine therapy and one line of chemotherapy. Co-mutations of ESR1/PIK3CA were present in 33.3% of patients. Median progression-free survival (PFS) was 3.6 months (95% CI 2.96–4.24) and median overall survival was 20.2 months (95% CI 5.04–35.36). In univariate analyses, de novo metastatic disease and the presence of a single ESR1-mutated exon were associated with longer PFS, whereas the ESR1 E380Q mutation was associated with shorter PFS. Adverse events of any grade occured in 46.7% of patients. Within our cohort, a low rate of dose reductions (3.3%) was found. Subsequent therapies after elacestrant mainly consisted of antibody-drug conjugates (36.7% of patients) and chemotherapy (26.7%). Conclusion: In this real-world cohort, elacestrant showed effectiveness and tolerability similar to data observed in the EMERALD trial. Larger prospective real-world analyses are warranted to further validate these findings and define optimal patient selection.
Introduction: Prehabilitation exercise interventions aim to enhance physical performance preoperatively, potentially improving recovery and reducing hospital stays. Despite evidence of positive effects in other cancers, it remains underexplored in breast cancer, highlighting the need for randomized controlled studies to assess their impact on various outcomes. Methods: The PräMaCa study was a monocentric randomised controlled trial comparing hypertrophy strength and vibration training (RES, n=35) with group-based stretching and relaxation exercises (FLEX, n=32). Both exercise interventions were scheduled for a 12-week program prior to the surgery date. The primary outcome was post-operative recovery, assessed through hospital stay length and complication rate. Secondary outcomes included handgrip strength, body composition, and patient-reported outcomes (PRO) like quality of life, fatigue, anxiety and additional activity levels. Results: Comparison of the RES- and FLEX group showed no significant differences towards the primary endpoint duration of hospital stay (RES: 6.54; FLEX: 6.00, p=0.396) and towards the post-surgical complication rates. Participants in the RES group showed a non-significant increase in activity levels (41.61 to 50.73 MET·h/week, p = 0.122), while FLEX group showed a significant rise (38.36 to 61.08 MET·h/week, p = 0.001). Both groups significantly increased lean body mass (RES: 47.5 to 49.0 kg; FLEX: 47.7 to 49.1 kg; p = 0.001). In the RES group, fatigue decreased (12.6 to 11.26, p = 0.013) as did depression scores (5.59 to 4.31, p = 0.005). Conclusion: This study provides evidence for the efficacy of exercise interventions. The overall incidence of complications was low. Improvements were observed in fatigue, cognitive function, social functioning, and depressive symptoms. Notably, even participants with high baseline physical activity levels demonstrated further increases through the exercise intervention.
Introduction: Treatment of HR+/HER2− metastatic breast cancer (MBC) increasingly relies on biomarker-guided strategies and response to prior endocrine based therapy. The use of extensive biomarker testing prior to consecutive therapy lines is recommended by almost all oncology societies. However, the extent of real-world implementation of biomarker testing remains unclear. Methods: Data were derived from the AGO QS-Mamma registry 2024, collecting a nationwide, representative sample of real-world breast cancer care in Germany. Patients with HR+/HER2− MBC receiving systemic therapy were included in the analysis. Associations between clinical variables and biomarker testing were assessed using chi-square tests, Cochran–Mantel–Haenszel analysis, and multivariable logistic regression. Results: A total of 805 patients with HR+/HER2− MBC were analyzed. ESR1 testing was performed in 53% of patients in second-line or later. Testing rates increased with prior endocrine therapy exposure (57% after ≥12 months CDK4/6 inhibitor therapy vs. 14% with endocrine therapy alone; p < 0.001). In multivariable analysis, prior endocrine therapy was strongly associated with ESR1 testing (OR 6.20, 95% CI 2.85–13.46 for ≥12 months exposure), whereas treatment line was not. PI3K testing was performed in 15% of patients. Although higher testing rates were observed in endocrine-resistant patients, this association was not significant after adjustment (p = 0.248), while treatment line was strongly associated with testing (p < 0.001). BRCA testing was performed in 27% of patients and was significantly associated with treatment line (p < 0.001), peaking in second line. Conclusion: Biomarker testing in HR+/HER2− MBC reveals heterogeneous implementation in real-world practice. ESR1 testing is primarily driven by prior endocrine therapy exposure, whereas PI3K and BRCA testing are more strongly influenced by treatment line. These findings highlight gaps in the consistent application of biomarker-guided strategies and underscore the need for improved implementation of testing recommendations – especially given the advancement in available treatment options.
