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General breast cancer research

March 2016

Factors affecting preferences of women with high risk breast cancer for immediate, delayed or no breast reconstruction

Australian researchers have conducted a small study exploring what factors most influence the decisions of women diagnosed with locally advanced breast cancer to have an immediate, delayed or no breast reconstruction.

The study included 51 women who had attended a breast surgery practice in Sydney between July 2013 and December 2014, who needed a mastectomy and who were likely to need radiotherapy following their mastectomy. In the study, women were offered all options (i.e. to have an immediate, delayed or no breast reconstruction). Women who participated had already made their decision about whether or not to have a breast reconstruction before taking part in the study. As part of their participation, women were asked to complete questionnaires to indicate what reasons most impacted their decisions about whether to have an immediate, delayed or no breast reconstruction.

In total, 32 women chose to have an immediate breast reconstruction, seven women had a delayed breast reconstruction and 12 women chose to have no breast reconstruction. The researchers found that the women who had chosen to have an immediate reconstruction and those who had decided to have a delayed reconstruction both selected reasons relating to a desire to feel ‘normal’ or feel ‘good’. In contrast, women who decided not to have a breast reconstruction were more likely to indicate they did not consider breast reconstruction necessary to their wellbeing or for reasons related to ‘being practical’.

The researchers also found that, even though women understood that radiotherapy following their mastectomy might affect the look of their breast reconstruction, 32 of the 51 women (63%) still choose to have an immediate breast reconstruction.

Source: Flitcroft, K. et al. (2016). ‘An evaluation of factors affecting preference for immediate, delayed or no breast reconstruction in women with high-risk breast cancer,’ Psycho-Oncology, doi: 10.1002/pon.4087.

November 2015

Genetic test may identify which women with early breast cancer could avoid chemotherapy

Researchers conducting the international clinical trial TAILORx examined whether the Oncotype DX test, a test which analyses 21 genes within a breast cancer tumour, can accurately predict whether women affected by hormone-receptor positive breast cancer are likely to experience a recurrence of breast cancer and whether or not they may safely avoid chemotherapy.

A total of 10,253 women participated in the trial. All women received the Oncotype DX test and were given a score of 0 to 100. The lower the score, the less likely it is that a woman will experience a recurrence of breast cancer and so may be able to avoid chemotherapy and receive hormone therapy only. In the trial, women with a score of 0 to 10 were treated with hormone therapy, those with a score of 26 or higher received both hormone therapy and chemotherapy, and women with a score of 11 to 25 were randomly assigned to receive either hormone therapy alone or hormone therapy and chemotherapy.

In total, 1626 women received a score of 0 to 10, 6897 received a score of 11 to 25 and 1730 received a score of 26 or higher.

Of the 1,626 women who received a score of 0 to 10 (low risk), the researchers found that 98.7% had not had a recurrence after five years of hormone therapy only. This was found to be the case regardless of women’s age when diagnosed, or the size or grade of the tumour.

Analysis of the results is ongoing and researchers will examine whether women with scores in the middle ranges may be able to avoid chemotherapy safely.

Source: J Sparano, ‘Prospective Validation of a 21-Gene Expression Assay in Breast Cancer,’ The New England Journal of Medicine, vol. 373, 2015, pp. 2005-2014.

April 2015

Hormone therapy

Australian researchers have explored the factors that most impact whether women continue to take their prescribed hormone therapy (e.g. tamoxifen, Femara, Arimidex, Aromasin) for the full course of treatment or stop taking it earlier than recommended.

Hormone therapies are drugs which are used to treat hormone positive breast cancer. It is usually recommended that hormone therapies be taken for at least five years.

The study included 1,531 Australian women diagnosed with breast cancer who were prescribed Tamoxifen, Arimidex or Femara between July 2003 and December 2008. The researchers looked at whether factors such as health issues women experienced before and after starting hormone therapy affected the length of time they continued to take hormone therapy. Some of the factors they examined included anxiety, depression, sexual difficulties, joint pain, hot flushes and osteoporosis. The researchers also explored demographic factors, such as whether women lived in metropolitan or rural areas, their marital status, income and country of birth.

The researchers found that only 42 per cent of the women in the study continued taking hormone therapy for five years. Of these, only 19 per cent used the hormone therapy they were first prescribed for the full five years. The remainder switched between different hormone therapies. The researchers found that women were most likely to switch to another hormone therapy if they were first prescribed tamoxifen, were being newly treated for anxiety or had arthritis which existed before they began hormone therapy.

The researchers also found that women who did not have a mastectomy or chemotherapy were most likely to stop taking hormone therapy before five years. Women who experienced hot flushes after beginning hormone therapy were also more likely to stop hormone therapy early.  

Neoadjuvant chemotherapy

American researchers have investigated the impact of neoadjuvant chemotherapy on the type of surgery women later have to remove their breast cancer.

Neoadjuvant chemotherapy is chemotherapy that is given before surgery. Women are sometimes offered chemotherapy before surgery if they have locally advanced breast cancer or a large tumour. Giving chemotherapy before surgery can help to shrink the size of a tumour which may then give women more options in terms of the type of surgery they have.  

In this study, researchers used the U.S. National Cancer Database to identify women who were diagnosed with breast cancer between 2006 and 2011, who had breast surgery and who received chemotherapy either before or after their surgery. In total, 354,204 women met these criteria.

The researchers found that a total of 59,063 women (16.7 per cent) were given neoadjuvant chemotherapy (i.e. chemotherapy before their surgery).

When the researchers looked at the cases of women who had a tumour that was larger than 3 centimetres, they found that women who received neoadjuvant chemotherapy were 70 per cent more likely to have a lumpectomy than mastectomy, when compared with women who received chemotherapy after their surgery.

The researchers also found that the proportion of women receiving neoadjuvant chemotherapy increased between 2006 and 2011. While 13.9 per cent of women were given neoadjuvant chemotherapy in 2006, 20.5 per cent of women received neoadjuvant chemotherapy in 2011.