JAMA Oncology最新文献

{"title":"Longer Interval Between First Colonoscopy With Negative Findings for Colorectal Cancer and Repeat Colonoscopy","authors":"Qunfeng Liang, Trasias Mukama, Kristina Sundquist, Jan Sundquist, Hermann Brenner, Elham Kharazmi, Mahdi Fallah","doi":"10.1001/jamaoncol.2024.0827","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0827","url":null,"abstract":"ImportanceFor individuals without a family history of colorectal cancer (CRC), colonoscopy screening every 10 years is recommended to reduce CRC incidence and mortality. However, debate exists about whether and for how long this 10-year interval could be safely expanded.ObjectiveTo assess how many years after a first colonoscopy with findings negative for CRC a second colonoscopy can be performed.Design, Setting, and ParticipantsThis cohort study leveraged Swedish nationwide register-based data to examine CRC diagnoses and CRC-specific mortality among individuals without a family history of CRC. The exposed group included individuals who had a first colonoscopy with findings negative for CRC at age 45 to 69 years between 1990 and 2016. The control group included individuals matched by sex, birth year, and baseline age (ie, the age of their matched exposed individual when the exposed individual’s first colonoscopy with findings negative for CRC was performed). Individuals in the control group either did not have a colonoscopy during the follow-up or underwent colonoscopy that resulted in a CRC diagnosis. Up to 18 controls were matched with each exposed individual. Individuals were followed up from 1990 to 2018, and data were analyzed from November 2022 to November 2023.ExposureA first colonoscopy with findings negative for CRC, defined as a first colonoscopy without a diagnosis of colorectal polyp, adenoma, carcinoma in situ, or CRC before or within 6 months after screening.Main Outcomes and MeasuresThe primary outcomes were CRC diagnosis and CRC-specific death. The 10-year standardized incidence ratio and standardized mortality ratio were calculated to compare risks of CRC and CRC-specific death in the exposed and control groups based on different follow-up screening intervals.ResultsThe sample included 110 074 individuals (65 147 females [59.2%]) in the exposed group and 1 981 332 (1 172 646 females [59.2%]) in the control group. The median (IQR) age for individuals in both groups was 59 (52-64) years. During up to 29 years of follow-up of individuals with a first colonoscopy with findings negative for CRC, 484 incident CRCs and 112 CRC-specific deaths occurred. After a first colonoscopy with findings negative for CRC, the risks of CRC and CRC-specific death in the exposed group were significantly lower than those in their matched controls for 15 years. At 15 years after a first colonoscopy with findings negative for CRC, the 10-year standardized incidence ratio was 0.72 (95% CI, 0.54-0.94) and the 10-year standardized mortality ratio was 0.55 (95% CI, 0.29-0.94). In other words, the 10-year cumulative risk of CRC in year 15 in the exposed group was 72% that of the 10-year cumulative risk of CRC in the control group. Extending the colonoscopy screening interval from 10 to 15 years in individuals with a first colonoscopy with findings negative for CRC could miss the early detection of only 2 CRC cases and the prevention of 1 CRC-specific death pe","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"62 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140821040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Omission of Axillary Dissection Following Nodal Downstaging With Neoadjuvant Chemotherapy","authors":"Giacomo Montagna, Mary M. Mrdutt, Susie X. Sun, Callie Hlavin, Emilia J. Diego, Stephanie M. Wong, Andrea V. Barrio, Astrid Botty van den Bruele, Neslihan Cabioglu, Varadan Sevilimedu, Laura H. Rosenberger, E. Shelley Hwang, Abigail Ingham, Bärbel Papassotiropoulos, Bich Doan Nguyen-Sträuli, Christian Kurzeder, Danilo Díaz Aybar, Denise Vorburger, Dieter Michael Matlac, Edvin Ostapenko, Fabian Riedel, Florian Fitzal, Francesco Meani, Franziska Fick, Jacqueline Sagasser, Jörg Heil, Hasan Karanlık, Konstantin J. Dedes, Laszlo Romics, Maggie Banys-Paluchowski, Mahmut Muslumanoglu, Maria Del Rosario Cueva Perez, Marcelo Chávez Díaz, Martin Heidinger, Mathias K. Fehr, Mattea Reinisch, Mustafa Tukenmez, Nadia Maggi, Nicola Rocco, Nina Ditsch, Oreste Davide Gentilini, Regis R. Paulinelli, Sebastián Solé Zarhi, Sherko Kuemmel, Simona Bruzas, Simona di Lascio, Tamara K. Parissenti, Tanya L. Hoskin, Uwe Güth, Valentina Ovalle, Christoph Tausch, Henry M. Kuerer, Abigail S. Caudle, Jean-Francois Boileau, Judy C. Boughey, Thorsten Kühn, Monica Morrow, Walter P. Weber","doi":"10.1001/jamaoncol.2024.0578","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0578","url":null,"abstract":"ImportanceData on oncological outcomes after omission of axillary lymph node dissection (ALND) in patients with breast cancer that downstages from node positive to negative with neoadjuvant chemotherapy are sparse. Additionally, the best axillary surgical staging technique in this scenario is unknown.ObjectiveTo investigate oncological outcomes after sentinel lymph node biopsy (SLNB) with dual-tracer mapping or targeted axillary dissection (TAD), which combines SLNB with localization and retrieval of the clipped lymph node.Design, Setting, and ParticipantsIn this multicenter retrospective cohort study that was conducted at 25 centers in 11 countries, 1144 patients with consecutive stage II to III biopsy-proven node-positive breast cancer were included between April 2013 and December 2020. The cumulative incidence rates of axillary, locoregional, and any invasive (locoregional or distant) recurrence were determined by competing risk analysis.ExposureOmission of ALND after SLNB or TAD.Main Outcomes and MeasuresThe primary end points were the 3-year and 5-year rates of any axillary recurrence. Secondary end points included locoregional recurrence, any invasive (locoregional and distant) recurrence, and the number of lymph nodes removed.ResultsA total of 1144 patients (median [IQR] age, 50 [41-59] years; 78 [6.8%] Asian, 105 [9.2%] Black, 102 [8.9%] Hispanic, and 816 [71.0%] White individuals; 666 SLNB [58.2%] and 478 TAD [41.8%]) were included. A total of 1060 patients (93%) had N1 disease, 619 (54%) had <jats:italic>ERBB2</jats:italic> (formerly <jats:italic>HER2</jats:italic>)–positive illness, and 758 (66%) had a breast pathologic complete response. TAD patients were more likely to receive nodal radiation therapy (85% vs 78%; <jats:italic>P</jats:italic> = .01). The clipped node was successfully retrieved in 97% of TAD cases and 86% of SLNB cases (without localization). The mean (SD) number of sentinel lymph nodes retrieved was 3 (2) vs 4 (2) (<jats:italic>P</jats:italic> &amp;amp;lt; .001), and the mean (SD) number of total lymph nodes removed was 3.95 (1.97) vs 4.44 (2.04) (<jats:italic>P</jats:italic> &amp;amp;lt; .001) in the TAD and SLNB groups, respectively. The 5-year rates of any axillary, locoregional, and any invasive recurrence in the entire cohort were 1.0% (95% CI, 0.49%-2.0%), 2.7% (95% CI, 1.6%-4.1%), and 10% (95% CI, 8.3%-13%), respectively. The 3-year cumulative incidence of axillary recurrence did not differ between TAD and SLNB (0.5% vs 0.8%; <jats:italic>P</jats:italic> = .55).Conclusions and RelevanceThe results of this cohort study showed that axillary recurrence was rare in this setting and was not significantly lower after TAD vs SLNB. These results support omission of ALND in this population.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"53 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140648973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Hypofractionated Intensity-Modulated Radiotherapy With Concurrent Chemotherapy in Cervical Cancer","authors":"Won Kyung Cho, Won Park, Sang-Won Kim, Kang Kyu Lee, Ki Jung Ahn, Jin Hwa Choi","doi":"10.1001/jamaoncol.2024.0565","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0565","url":null,"abstract":"ImportanceProspective data assessing the safety of hypofractionated (40 Gy in 16 fractions) radiotherapy (RT) among patients who receive postoperative concurrent chemoradiotherapy for cervical cancer are lacking.ObjectiveTo evaluate the acute toxic effects of hypofractionated pelvic intensity-modulated radiotherapy (IMRT) with concurrent chemotherapy among women with cervical cancer who underwent radical hysterectomy.Design, Setting, and ParticipantsThe POHIM-CCRT (Postoperative Hypofractionated Intensity-Modulated Radiation Therapy With Concurrent Chemotherapy in Cervical Cancer) study was designed as a multicenter, phase 2 nonrandomized controlled trial that accrued and followed up patients from June 1, 2017, to February 28, 2023. In total, 84 patients were enrolled from 5 institutions affiliated with the Korean Radiation Oncology Group. Eligible patients experienced lymph node metastasis, parametrial invasion, or positive resection margins after radical hysterectomy for treatment of confirmed cervical cancer.InterventionPostoperative pelvic radiation using hypofractionated IMRT with 40 Gy in 16 fractions to the whole pelvis combined with concurrent chemotherapy.Main Outcomes and MeasuresThe primary end point was incidence of acute grade 3 or higher gastrointestinal tract, genitourinary, and hematologic toxic effects (based on the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0) in the evaluable population during RT or within 3 months after RT completion.ResultsOf 84 patients enrolled, 5 dropped out prior to RT, and data from 79 patients were analyzed. The patients’ median (IQR) age was 48 (42-58) years, and the median (IQR) tumor size was 3.7 (2.7-4.5) cm. Of these patients, 31 (39.7%) had lymph node metastasis, 4 (5.1%) had positive resection margins, and 43 (54.4%) had parametrial invasion. Grade 3 or higher acute toxic effects occurred in 2 patients (2.5% [90% CI, 0%-4.8%]). After a median (IQR) follow-up of 43.0 (21.1-59.0) months, the 3-year disease-free survival rate was 79.3%, and the overall survival rate was 98.0%.ConclusionsFindings from this nonrandomized control trial indicated that postoperative pelvic irradiation combined with concurrent chemotherapy using hypofractionated IMRT with 40 Gy in 16 fractions was safe and well-tolerated in women with cervical cancer. Studies assessing long-term toxic effects and oncological outcomes with longer follow-up periods are needed.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://classic.clinicaltrials.gov/ct2/show/NCT03239613\">NCT03239613</jats:ext-link>","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"23 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140649095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gefitinib vs Gefitinib Plus Pemetrexed and Carboplatin Chemotherapy in EGFR-Variant Lung Cancer—Long-Term Results of a Randomized Clinical Trial","authors":"Vanita Noronha, Vijay Patil, Nandini Menon, Minit Shah, Anuradha Chougule, Zoya Peelay, Kumar Prabhash","doi":"10.1001/jamaoncol.2024.0584","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0584","url":null,"abstract":"This randomized clinical trial examines whether adding chemotherapy with pemetrexed and carboplatin to gefitinib improves survival among patients with epidermal growth factor receptor (<jats:italic>EGFR</jats:italic>)–variant non–small cell lung cancer.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"51 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140649107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allogeneic CD19/CD22 CAR T-Cell Therapy for B-Cell Acute Lymphoblastic Leukemia","authors":"Laurent Phely, Luca Hensen, Christoph Faul, Christer Alexander Ruff, Dina Schneider, Wolfgang Andreas Bethge, Claudia Lengerke","doi":"10.1001/jamaoncol.2024.0473","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0473","url":null,"abstract":"This case series reports durable remissions in 2 patients with relapsed/refractory B-cell acute lymphoblastic leukemia treated with allogeneic bispecific CD19/CD22-targeting chimeric antigen receptor T cells.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"89 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"T-Cell Malignant Neoplasms After Chimeric Antigen Receptor T-Cell Therapy","authors":"Ryan Storgard, Kai Rejeski, Miguel-Angel Perales, Adam Goldman, Roni Shouval","doi":"10.1001/jamaoncol.2024.0662","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0662","url":null,"abstract":"This cohort study assesses the increase in second primary malignant neoplasms and T-cell malignant neoplasm cases associated with chimeric antigen receptor–T cells.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"30 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy Priorities in Cancer Care for Transgender People","authors":"Alicia C. Smart, Michael J. Yunes, Karen M. Winkfield","doi":"10.1001/jamaoncol.2024.0451","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0451","url":null,"abstract":"This Viewpoint calls for health care systems, oncologists, and staff to prioritize and adopt policies that are inclusive and respectful of transgender patients with cancer.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"20 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to American Cancer Society Nutrition and Physical Activity Guidelines Among Cancer Survivors","authors":"Carter Baughman, Kathryn Norman, Kenneth Mukamal","doi":"10.1001/jamaoncol.2024.0470","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0470","url":null,"abstract":"ImportanceThe American Cancer Society’s (ACS’s) nutrition and physical activity guidelines are intended to reduce morbidity and mortality among cancer survivors, but to our knowledge, adherence to these guidelines has not been systematically quantified.ObjectiveTo evaluate adherence to and factors associated with adherence to lifestyle modification guidelines among cancer survivors.Design, Setting, and ParticipantsThis cross-sectional study used data from the Behavioral Risk Factor Surveillance System using survey administration years 2017 (surveys completed between January 2017 and March 2018), 2019 (surveys completed between January 2019 and December 2019), and 2021 (surveys completed between January 2021 and February 2022). The study included people who had completed cancer treatment at any point prior to the given survey administration year. Data were analyzed from September 19, 2022, to December 12, 2022.Main Outcomes and MeasuresThe primary outcome was adherence to current ACS guidelines for physical activity, body mass index, alcohol use, and fruit and vegetable intake. Factors associated with adherence rates to the guidelines, including age, sex, race and ethnicity, location, and educational level, were evaluated using linear regression. Complex survey weights were used.ResultsA total of 10 020 respondents (57% female; mean [SE] age, 64.2 [0.3] years) reported completion of cancer treatment, representing 2.7 million US individuals over 3 years. Of these respondents, 9121 completed questionnaires for all 4 metrics measured. A total of 72% (95% CI, 71%-74%) of cancer survivors met criteria for adequate physical activity, 68% (95% CI, 66%-69%) did not have obesity, 12% (95% CI, 11%-13%) ate adequate fruits and vegetables, and 50% (95% CI, 49%-52%) did not drink alcohol. In total, 4% (95% CI, 3%-4%) of cancer survivors adhered to all 4 guidelines, with the mean number of guidelines met being 2.0 (95% CI, 2.0-2.1). Factors associated with greater adherence included female sex, older age, Black race, higher educational level, and residence in Western US states.Conclusions and RelevanceIn this cross-sectional study, 4% of cancer survivors fully adhered to current ACS recommendations. Improved understanding of guideline adherence and its determinants may guide oncologists and general internists in providing recommendations for their patients who have completed cancer treatments.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"100 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcomes as a Recruitment Strategy for Clinical Trial Enrollment","authors":"Nicholas P. Verdini, Karolina L. Bryl, Raymond E. Baser, Kaitlyn Lapen, Jun J. Mao, Erin F. Gillespie","doi":"10.1001/jamaoncol.2024.0280","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0280","url":null,"abstract":"ImportanceClinical trials are critical for progress in oncology; however, only 5% of the adult cancer population participates. Harnessing data that are routinely collected (ie, electronic patient-reported outcomes [ePROs]) may serve as a method to promote trial enrollment.ObjectiveTo evaluate if an ePRO-prompted recruitment strategy is associated with increased clinical trial enrollment.Design, Setting, and ParticipantsA randomized substudy was conducted from September 2022 to March 2023 at a multisite tertiary cancer center as part of an ongoing clinical trial that was testing a symptom-intervention for cancer-related fatigue. Patients with breast cancer who were undergoing radiotherapy who completed at least 1 ePRO questionnaire during the study period were included. Physician-level cluster randomization assigned fatigue-eligible patients to either receive a portal message invitation to a symptom-intervention trial or standard of care (SOC; physician-based referral).ExposureePRO questionnaires distributed in routine practice were queried weekly and screened for moderate or greater fatigue, the principle inclusion criterion for the primary trial. To assess the association of the portal message source with response and enrollment, every other patient received a message from the primary radiation oncology team or the referral service.Main Outcomes and MeasuresClinical trial response/referral and enrollment.ResultsA total of 1041 patients completed ePRO questionnaires, of whom 394 (38%; 53 Asian [13.6%], 43 Black [11.0%], 29 Hispanic [7.4%], and 262 White individuals [66.5%]; median [IQR] age, 55 [47-65] years) endorsed moderate or greater fatigue while receiving treatment. A total of 210 patients (53.3%) were assigned to receive a portal message and 184 (46.7%) patients, SOC. In the portal message group, 73 patients (35%) responded and 41 (20%) enrolled compared with 1 patient (0.5%) referred and 0 enrolled in the SOC group (<jats:italic>P</jats:italic> &amp;amp;lt; .001). The response rate to portal messages favored the referral service vs the primary radiation oncology service (44% vs 26%; <jats:italic>P</jats:italic> = .01), but there was no significant difference in enrollments.Conclusions and RelevanceThe study results suggest that use of routine care ePROs was associated with greater enrollment in a symptom-intervention trial compared with physician-based referral. Messaging directly from the referral service may support enrollment and help reduce oncology physician-level barriers to trial enrollment for studies testing symptom interventions.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"33 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140547696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second Primary Breast Cancer in Young Breast Cancer Survivors","authors":"Kristen D. Brantley, Shoshana M. Rosenberg, Laura C. Collins, Kathryn J. Ruddy, Rulla M. Tamimi, Lidia Schapira, Virginia F. Borges, Ellen Warner, Steven E. Come, Yue Zheng, Gregory J. Kirkner, Craig Snow, Eric P. Winer, Ann H. Partridge","doi":"10.1001/jamaoncol.2024.0286","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0286","url":null,"abstract":"ImportanceAmong women diagnosed with primary breast cancer (BC) at or younger than age 40 years, prior data suggest that their risk of a second primary BC (SPBC) is higher than that of women who are older when they develop a first primary BC.ObjectiveTo estimate cumulative incidence and characterize risk factors of SPBC among young patients with BC.Design, Setting, and ParticipantsParticipants were enrolled in the Young Women’s Breast Cancer Study, a prospective study of 1297 women aged 40 years or younger who were diagnosed with stage 0 to III BC from August 2006 to June 2015. Demographic, genetic testing, treatment, and outcome data were collected by patient surveys and medical record review. A time-to-event analysis was used to account for competing risks when determining cumulative incidence of SPBC, and Fine-Gray subdistribution hazard models were used to evaluate associations between clinical factors and SPBC risk. Data were analyzed from January to May 2023.Main Outcomes and MeasuresThe 5- and 10- year cumulative incidence of SPBC.ResultsIn all, 685 women with stage 0 to III BC (mean [SD] age at primary BC diagnosis, 36 [4] years) who underwent unilateral mastectomy or lumpectomy as the primary surgery for BC were included in the analysis. Over a median (IQR) follow-up of 10.0 (7.4-12.1) years, 17 patients (2.5%) developed an SPBC; 2 of these patients had cancer in the ipsilateral breast after lumpectomy. The median (IQR) time from primary BC diagnosis to SPBC was 4.2 (3.3-5.6) years. Among 577 women who underwent genetic testing, the 10-year risk of SPBC was 2.2% for women who did not carry a pathogenic variant (12 of 544) and 8.9% for carriers of a pathogenic variant (3 of 33). In multivariate analyses, the risk of SPBC was higher among PV carriers vs noncarriers (subdistribution hazard ratio [sHR], 5.27; 95% CI, 1.43-19.43) and women with primary in situ BC vs invasive BC (sHR, 5.61; 95% CI, 1.52-20.70).ConclusionsFindings of this cohort study suggest that young BC survivors without a germline pathogenic variant have a low risk of developing a SPBC in the first 10 years after diagnosis. Findings from germline genetic testing may inform treatment decision-making and follow-up care considerations in this population.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"108 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140547616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}