Breast Cancer Research and Treatment最新文献

{"title":"Natural language processing for local, regional, and distant breast cancer relapse identification in pathology reports.","authors":"Jaimie J Lee, William Jettinghoff, Gregory Arbour, Andres Zepeda, Kathryn V Isaac, Raymond T Ng, Alan M Nichol","doi":"10.1007/s10549-025-07801-8","DOIUrl":"10.1007/s10549-025-07801-8","url":null,"abstract":"<p><strong>Purpose: </strong>Cancer registries rarely track breast cancer relapse due to the resource-intensive nature of manual chart review. To address this gap, we developed natural language processing (NLP) models to automate the identification of breast cancer relapse in pathology reports.</p><p><strong>Methods: </strong>We collected pathology reports from patients diagnosed with breast cancer between January 1, 2005, and December 31, 2014, in British Columbia, Canada, and manually annotated each for the presence or absence of local, regional, distant, and any breast cancer relapses. With these reports, we fine-tuned large language models to classify pathology reports.</p><p><strong>Results: </strong>The corpus contained 1,888 pathology reports from a cohort of 993 breast cancer patients. Of these reports, 673 (35.6%) described local, 296 (15.7%) regional, and 654 (34.6%) distant relapses. In addition, 1,510 (80.0%) described at least one of any relapse type. The median time from diagnosis to first relapse was 7.3 years (range 0.2-18.2). All models demonstrated excellent performance. The local-relapse model performed particularly well, with > 93% accuracy, sensitivity, specificity, and 0.98 area under the receiver operating characteristic curve (AUC) score.</p><p><strong>Conclusion: </strong>We developed NLP models to detect breast cancer relapses from pathology reports with excellent accuracy, sensitivity, specificity, and AUC. NLP may facilitate more efficient and accurate collection of breast cancer outcomes data from clinical reports.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"149-158"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do regularly scheduled visits result in earlier detection of curable breast cancer recurrences?","authors":"Ana-Alicia Beltran-Bless, Igor de Lima Machada, Lucas Clemons, Gregory R Pond, Michelle Bradbury, Kelly-Anne Baines, Gail Larocque, Lisa Vandermeer, Marie-France Savard, John Hilton, Andréanne Leblanc, Mark Clemons","doi":"10.1007/s10549-025-07793-5","DOIUrl":"10.1007/s10549-025-07793-5","url":null,"abstract":"<p><strong>Purpose: </strong>An important goal of routinely scheduled physical examination in the post-treatment surveillance of patients with early breast cancer (EBC) is to allow for earlier detection of potentially curable recurrences. We present an updated analysis of recurrence detection, and its potential for curative management, at a single-centre survivorship program that follows ASCO recommendations.</p><p><strong>Methods: </strong>Patients with EBC referred to the Wellness Beyond Cancer Program who had breast cancer recurrence between February 2013 and June 2023 were reviewed. Descriptive analyses were used to present patient and disease characteristics stratified by type of recurrence and mode of cancer detection.</p><p><strong>Results: </strong>Of 389 first recurrences, 250 were distant (64.3%), 75 local (19.3%), and 64 (16.5%) contralateral new breast primaries. Distant recurrences were primarily detected via patient-reported symptoms (220/250, 88.0%). 42.7% (32/75) of ipsilateral breast recurrences were detected by patients and 53.3% (40/75) by routine imaging. Contralateral breast primaries were primarily detected by routine imaging 71.9% (46/64) and patient-reported symptoms 25.0% (16/64). 2.1% (8/389) recurrences were detected by healthcare providers, 3 were coincidental intraoperative findings and 1.3% (5/389) were detected by healthcare providers at routinely scheduled follow-up visits. Of the 5 recurrences detected at routinely scheduled follow-up visits, only 0.3% (1/389) was potentially curable.</p><p><strong>Conclusion: </strong>Despite following ASCO guidelines, potentially curable recurrences are rarely detected by healthcare providers at routinely scheduled follow-up appointments. Our data suggests that approximately 87,670 follow-up visits were required for healthcare providers to detect one curable recurrence. Updated evidence-based guidelines are required to optimise the post-treatment surveillance procedures.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"59-68"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-level factors drive use of sentinel lymph node biopsy in older women with early-stage breast cancer.","authors":"Madeline B Thomas, Sumaya Abdul Ghaffar, Haaris Kadri, Christopher M Quinn, Laura D Leonard, Nicole M Mott, Salvador Rodriguez Franco, Lia R Assumpção, Gretchen Ahrendt, Sarah E A Tevis, Nicole Christian, Jodi Widner, Alicia A Heelan, Ana L Gleisner","doi":"10.1007/s10549-025-07789-1","DOIUrl":"10.1007/s10549-025-07789-1","url":null,"abstract":"<p><strong>Purpose: </strong>In 2016, the Society of Surgical Oncology and Choosing Wisely Campaign recommended against sentinel lymph node biopsy (SLNB) in women > 70 years with early-stage, hormone receptor-positive (ER/PR +) breast cancer, citing limited clinical benefit. Despite earlier evidence supporting de-implementation, SLNB rates remained high. We aimed to evaluate patient, tumor, facility, and unmeasured contextual factors associated with SLNB de-implementation using a national cohort.</p><p><strong>Methods: </strong>We queried the National Cancer Database (NCDB) for women > 70 years diagnosed with early-stage ER/PR + and HER2-negative breast cancer between 2012 and 2019. A mixed effects logistic regression model assessed associations between SLNB non-utilization and patient, tumor, and facility-level characteristics. Interaction terms between year and facility breast surgery volume quartiles were included to examine trends over time. Reference Effect Measures (REM) were used to estimate the contribution of unmeasured contextual effects relative to measured covariates.</p><p><strong>Results: </strong>Among eligible patients, SLNB use declined from 86.7% in 2012 to 81.0% in 2019. SLNB use was significantly associated with age, insurance, urbanization, distance to facility, education, income, tumor size, lymphovascular invasion, treatment type, facility region, program type, and surgical volume. Academic programs had the highest adjusted odds of SLNB non-utilization (AOR 1.62; 95%CI: 1.29-2.02), while facilities in the South had the lowest (AOR 0.53; 95%CI: 0.45-0.63). High-volume centers de-implemented more rapidly post-2016, with 24% higher odds of SLNB non-utilization per year. REM analysis identified patient age and unmeasured contextual effects as the predominant drivers of de-implementation.</p><p><strong>Conclusion: </strong>SLNB use in older women is influenced by multi-level factors, with patient age and unmeasured contextual effects driving de-implementation-though progress remain slow and limited in the United States.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"37-48"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological interventions for anthracycline-induced cardiotoxicity in breast cancer: a systematic review and meta-analysis of randomized controlled trials.","authors":"Pinyadapat Vacharanukrauh, Kyle J Miller, Sheikh M Alif, Fergal Grace, Muhammad Aziz Rahman","doi":"10.1007/s10549-025-07791-7","DOIUrl":"10.1007/s10549-025-07791-7","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to systematically assess the efficacy of cardioprotective agents in preventing anthracycline-induced cardiotoxicity in patients with breast cancer using a comprehensive network meta-analysis (NMA).</p><p><strong>Methods: </strong>This study included patients with breast cancer undergoing anthracycline-based chemotherapy. Randomized controlled trials (RCTs) published before March 2020 were identified through systematic searches in MEDLINE, Cochrane CENTRAL, Web of Science, and CINAHL. The primary outcome was left ventricular ejection fraction (LVEF), assessed using cardiac magnetic resonance imaging, multigated radionuclide angiography, or echocardiography. The NMA integrated direct and indirect comparisons to estimate the relative effectiveness of pharmacological interventions.</p><p><strong>Results: </strong>The systematic review included 31 RCTs with 3,228 participants, whereas the NMA synthesized 25 effect sizes from 15 RCTs. Mineralocorticoid receptor antagonists (MRAs) [standardized mean difference (SMD): -1.78, 95% confidence interval (CI): -2.81 to -0.75] and trimetazidine (SMD: -1.12, 95%CI: -2.32 to -0.09) exhibited the most substantial cardioprotective effects. Dexrazoxane (SMD: -0.53, 95%CI: -1.90 to -0.02) and β-blockers (SMD: -0.34, 95%CI: -0.70 to 0.02) showed potential benefits, albeit with greater uncertainty. Direct comparisons showed that dexrazoxane was more effective than β-blockers (SMD: -1.25, 95%CI: -2.22 to -0.48), with mineralocorticoid receptor antagonists (MRAs) outperforming both. Despite heterogeneity and potential publication bias, mineralocorticoid receptor antagonists (MRAs) and trimetazidine consistently ranked as the most effective interventions. LVEF findings confirmed the cardioprotective benefits of β-blockers, ARBs, ACE inhibitors, and dexrazoxane.</p><p><strong>Conclusions: </strong>RCT evidence suggested that cardioprotective drugs effectively mitigate anthracycline-induced LVEF decline. However, the lack of direct head-to-head trials limits definitive conclusions on comparative efficacy, warranting trials in patients with lower baseline LVEF to optimize cardioprotective strategies.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"1-23"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast biopsies and breast cancer risk in Israeli BRCA germline pathogenic variant carriers.","authors":"Dana Madorsky Feldman, Miri Sklair-Levy, Yael Laitman, Renata Faermann, Noam Nissan, Osnat Halshtok Neiman, David Samoocha, Yael Yagil, Eitan Friedman","doi":"10.1007/s10549-025-07787-3","DOIUrl":"10.1007/s10549-025-07787-3","url":null,"abstract":"<p><strong>Purpose: </strong>Benign breast disease (BBD), particularly with proliferative changes, is a risk factor for breast cancer (BC) development in average risk women. There is a paucity of data on high-risk, BRCA1 and BRCA2 pathogenic variants (PVs) carriers.</p><p><strong>Methods: </strong>Female BRCA1 and BRCA2 PV carriers treated at the Meirav Clinic, Sheba Medical Center between May 2011 and December 2024 were eligible. Data on in-hospital breast biopsies were retrieved following an ethically approved protocol. Statistical analyses included χ² test (categorical variables) Mann-Whitney U test (continuous variables) and logistic regression for multivariate analysis.</p><p><strong>Results: </strong>Overall, 1466 women (849 BRCA1 PV carriers) were monitored over 10,113 women/years. A total of 1453 biopsies were carried out in 454 participants (range 1-8 biopsies), with the majority (76.3%) benign and 242 (16.6%) malignant. Rates of BC in women undergoing at least two benign biopsies were correlated with the number of biopsies, being an older BRCA1 PV carrier, whereas having been diagnosed with fibroadenoma-seems not to increase BC risk.</p><p><strong>Conclusions: </strong>In Israeli BRCA PV carriers, the number of biopsies, BRCA1 PV carriership were associated with an increased risk for developing BC, whereas fibroadenoma does not increase that risk. It is imperative to validate these preliminary observations.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"377-384"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Axillary dissection is avoidable in most cT1N0 triple-negative & HER2+ breast cancers treated with upfront surgery.","authors":"Anita Mamtani, Varadan Sevilimedu, Andrea V Barrio, Monica Morrow","doi":"10.1007/s10549-025-07785-5","DOIUrl":"10.1007/s10549-025-07785-5","url":null,"abstract":"<p><strong>Purpose: </strong>The use of neoadjuvant chemotherapy (NAC) in cT1N0 patients with triple-negative (TN) or HER2-positive (HER2+) breast cancer has been controversial. It is unclear whether NAC or upfront surgery minimizes axillary dissection (ALND) risk in the contemporary cT1N0 TN/HER2+ patient population.</p><p><strong>Methods: </strong>Consecutive cT1N0 TN/HER2+ patients who received NAC or underwent upfront surgery at our institution between 01/2020-12/2022 were examined. ALND was indicated for any positive sentinel nodes (+SLNs) after NAC, ≥ 3 positive SLNs after upfront surgery, or 1-2 positive SLNs after upfront mastectomy not requiring radiotherapy (RT). Clinicopathologic features, nodal burden, and ALND rates were compared between NAC versus upfront surgery cohorts.</p><p><strong>Results: </strong>Among 506 patients, 43% (N = 218) were TN and 57% (N = 288) were HER2+; 9% (N = 47) received NAC before surgery; 68%( N = 343) underwent upfront breast-conserving surgery (BCS); 23% (N = 116) underwent upfront mastectomy. Axillary ultrasound was performed in 23% of patients who received NAC versus 26% of patients who underwent upfront BCS versus 33% of patients who underwent upfront mastectomy. ALND was performed in 6.4% (N = 3) of patients with any positive SLN after NAC, 1.7% (N = 6) who underwent upfront BCS, and 1.7% (N = 2) who underwent upfront mastectomy with ≥ 3 positive SLNs or 1-2 positive SLNs not meeting RT criteria (p = 0.13). No factors were associated with ALND, including T stage, upfront versus NAC approach, or tumor subtype.</p><p><strong>Conclusion: </strong>Nodal disease burden is low among cT1N0 TN/HER2+ patients even in the absence of routine axillary ultrasound. ALND was performed in < 2% of patients with cT1N0 TN/HER2+ disease who had upfront surgery, and adjuvant systemic therapy was de-escalated among many pathologically node-negative patients following surgery.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"355-363"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive effects of aromatase inhibitors in early breast cancer patients: a prospective study.","authors":"Guido Maria Giuffrè, Luisa Carbognin, Giovanna Masone Iacobucci, Maria Gistro, Antonio Tanzilli, Valentina Morganti, Paola Fuso, Mimma Raffaele, Valentina Rossi, Ida Paris, Antonella Palazzo, Domenico Cristiano Corsi, Veronica Villani, Federica Moffa, Maria Cecilia Cercato, Maria Perrone, Gioia Massimiani, Carmen Gerace, Diana Giannarelli, Camillo Marra, Alessandra Fabi","doi":"10.1007/s10549-025-07788-2","DOIUrl":"10.1007/s10549-025-07788-2","url":null,"abstract":"<p><strong>Purpose: </strong>Several patients undergoing aromatase inhibitors (AIs) for breast cancer (BC) report cognitive difficulties, although studies on the cognitive effects have yielded mixed findings. This prospective study aimed to investigate the impact on cognitive function of adjuvant AIs and the changes over time.</p><p><strong>Methods: </strong>Patients with diagnosis of early-stage BC, eligible for adjuvant AIs endocrine therapy, underwent comprehensive neuropsychological assessments for the evaluation of several cognitive domains before and after 12 months of therapy. Participants were stratified according to menopausal status, type of surgery, and prior chemotherapy.</p><p><strong>Results: </strong>Eighty-three subjects were enrolled and, among these, 77 patients underwent neuropsychological assessments. At baseline, post-menopausal subjects (71%) performed significantly worse than pre-menopausal subjects in tests assessing executive functions. Subjects who received chemotherapy were younger, but showed poorer episodic memory performance compared to those chemotherapy-naïve. After 12 months, although most patients (66.1%) reported cognitive difficulties, the neuropsychological performance did not show significant deterioration. Notably, differences in verbal episodic memory between subjects treated with or without chemotherapy persisted over time.</p><p><strong>Conclusion: </strong>This study suggests that the cognitive difficulties reported by BC patients who underwent AIs may be more influenced by prior chemotherapy rather than from the direct cognitive effects of AIs, highlighting the persistent cognitive consequences of chemotherapy. These findings emphasize the need for further research to better understand the interplay between chemotherapy, AIs, and cognitive function and the relevance of cognitive assessments.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"385-395"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The feasibility and safety of fasting-mimicking diet in breast cancer patients with chemotherapy in China.","authors":"Meiqin Xue, Nan Zhang, Xiaojing Dong, Qiuju Tian, Kunwei Shen, Beiwen Wu","doi":"10.1007/s10549-025-07756-w","DOIUrl":"10.1007/s10549-025-07756-w","url":null,"abstract":"<p><strong>Purpose: </strong>The Fasting-Mimicking Diet (FMD) has emerged as a promising approach for mitigating the side effects and enhancing the efficacy of chemotherapy in cancer patients, while it is still challenging to implement FMD in clinical setting due the concern of nutritional supplements. This study is aimed to evaluate the feasibility of a recipe-based FMD among breast cancer (BC) patients, and assessing its effects on metabolic health and body composition.</p><p><strong>Methods: </strong>This is a single-arm, pilot clinical trial involving BC patients undergoing chemotherapy. Participants were required to adhere to the FMD recipes for four days prior to and on the day of each chemotherapy cycle, which provided 34-54% of the normal caloric intake, with a total of three cycles needed for the study. FMD-related adverse events, body composition, and serum samples were monitored.</p><p><strong>Results: </strong>A total of 30 participants were enrolled, and 27 of them completed 3 cycles of the FMD. The incidence of grade III or worse FMD-related adverse effects was 5.95% (5/84). A decline in IGF-1 compared to baseline was observed to be statistically significant at the end of the first FMD (B =  - 23.29, p = 0.001) and second FMD (B =  - 16.20, p = 0.023), but no statistical difference at the end of the third FMD (B =  - 8.372, p = 0.327). After 3 FMD cycles and a 21-day washout, BC patients experienced a statistically significant reduction in body mass (- 2.04kg, 95% CI - 2.86, - 1.21 kg; p < 0.001), fat mass (- 1.88kg, 95% CI - 2.72, - 1.05 kg, p < 0.001), visceral fat area (- 14.78%, 95% CI - 21.13, - 8.43%, p < 0.001) and waist circumference (- 4.01,95% CI - 6.18, - 1.83, p < 0.001), while muscle mass remained stable (- 0.05 kg, 95% CI - 0.36, 0.27 kg; p = 0.270).</p><p><strong>Conclusion: </strong>The recipe-based FMD program is well-tolerated by BC patients. It is proved to be safe, with few or no fasting-related adverse effects and an acceptable magnitude of weight loss. Additionally, it is effective in reducing IGF1, indirectly correlating to insulin resistance and inflammation that could enhance efficacy of anticancer therapies.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"313-323"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Omission of anthracyclines from neoadjuvant chemotherapy for breast cancer: a population-based analysis.","authors":"Danilo Giffoni M M Mata, Rinku Sutradhar, Matthew Castelo, Ezra Hahn, Lena Nguyen, Danielle Rodin, Omolara Fatiregun, Sabina Trebinjac, Lawrence Paszat, Andrea Eisen, Katarzyna J Jerzak, Eileen Rakovitch","doi":"10.1007/s10549-025-07778-4","DOIUrl":"10.1007/s10549-025-07778-4","url":null,"abstract":"<p><strong>Background: </strong>Most individuals diagnosed with high-risk breast cancer are treated with anthracycline-containing neoadjuvant chemotherapy (NAC). There is interest to identify individuals for whom anthracyclines can be avoided. A paucity of data exists on the extent to which anthracyclines are omitted in the neoadjuvant setting and its associated effectiveness.</p><p><strong>Objective: </strong>To investigate the extent to which anthracycline-free NAC is used in the treatment of breast cancer and the impact of its omission on risks of mortality.</p><p><strong>Methods: </strong>Population-based analysis of individuals diagnosed with stage I-III invasive breast cancer between 2012 and 2021 treated with NAC and surgery in Ontario, Canada. Baseline characteristics of patients who did and did not receive an anthracycline were compared. Five-year cumulative risks of breast cancer and all-cause mortality were calculated. Cause-specific hazard ratios (HRs) and 95% CIs were calculated using adjusted multivariable proportional hazards models for the whole cohort and subsets stratified by stage and receptor subtype.</p><p><strong>Results: </strong>The cohort includes 6672 patients; 6126 received an anthracycline, 546 received an anthracycline-free regimen. Median follow-up was 3.9 years. The 5-year cumulative incidence of breast cancer mortality was 12.3% for individuals treated with an anthracycline-free regimen and 14.5% for those who received an anthracycline (p = 0.10). On multivariable analysis, individuals treated with non-anthracycline NAC did not experience an increased risk of breast cancer mortality (HR = 0.88; 95% CI: 0.65,1.18, p = 0.38) or all-cause mortality (HR 0.86; 95% CI 0.67, 1.10, p = 0.23). For patients with stage I or II HER2+ disease, treatment with non-anthracycline NAC was associated with excellent survival.</p><p><strong>Conclusions: </strong>Most individuals treated with NAC received an anthracycline but its omission for selected patients with early HER2+ breast cancer was associated with excellent outcomes.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"335-346"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BRCA testing utilization among commercially insured women with breast or ovarian cancer.","authors":"Lu Shi, Katherine Kolor, Zhuo Chen, Ramal Moonesinghe, Juan Rodriguez, Muin J Khoury, Scott D Grosse","doi":"10.1007/s10549-025-07618-5","DOIUrl":"10.1007/s10549-025-07618-5","url":null,"abstract":"<p><strong>Purpose: </strong>This report examines utilization of germline BRCA genetic testing among women with breast or ovarian cancer in the context of current clinical guidelines for testing.</p><p><strong>Methods: </strong>Linked IQVIA commercial claims and electronic medical record data were used to analyze BRCA test utilization among women aged 18-64 years with newly diagnosed breast cancer or ovarian cancer during 2016-2021, excluding 2018. Log-binomial regression models were used to estimate prevalence ratios (PRs) comparing utilization of testing by cancer type, age group, race, and year.</p><p><strong>Results: </strong>Among commercially insured women with newly diagnosed breast cancer (n = 19,139) or epithelial ovarian cancer (n = 1639), 50 and 47%, respectively, received germline BRCA testing during the study years. BRCA testing rates were higher among women with breast cancer aged 18-50 years (69%) compared to those aged 51-64 years (39%). Overall utilization among women with breast or ovarian cancer was slightly lower in 2021 compared to 2019 and 2020. Compared with White women with breast cancer, Asian women were less likely (PR, 0.83 [95% CI, 0.74-0.92]) to receive testing.</p><p><strong>Conclusion: </strong>Nearly one-third of women who had breast cancer at age 50 or younger and a majority of women with ovarian cancer had no germline BRCA testing recorded within 1 year of diagnosis. Under current (2024) guidelines, these women and their family members are eligible for genetic counseling and testing to guide preventive interventions for future cancers. Healthcare providers have an important role in offering genetic services to women and their families, ensuring that eligible women receive recommended care.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":"213 3","pages":"291-298"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}