Key clinical point: Continued breast cancer (BC) screening leads to the detection of a higher number of BC cases which may increase the risk of BC overdiagnosis in women age ≥ 70 years.

Major finding: The cumulative incidence of BC was 6.1 vs 4.2 cases per 100 screened vs unscreened women age 70-74 years, and the rate of BC overdiagnosis was estimated to be 31%. The estimated rates of BC overdiagnosis increased to 47% and 54% in women age 75-84 years and ≥85 years, respectively, and screening did not improve BC-specific mortality in any of these age groups.

Study details: This retrospective cohort study evaluated 54,635 women from the Surveillance, Epidemiology, and End Results-Medicare (SEER) registry who were age ≥ 70 years and underwent screening.

Disclosures: This study was funded by the US National Cancer Institute. Some authors declared receiving grants, salary support, or research funding from various sources, including the National Cancer Institute.

Source: Richman IB et al. Estimating breast cancer overdiagnosis after screening mammography among older women in the United States. Ann Intern Med. 2023 (Aug 8). doi: 10.7326/M23-0133

Key clinical point: Continued breast cancer (BC) screening leads to the detection of a higher number of BC cases which may increase the risk of BC overdiagnosis in women age ≥ 70 years.

Major finding: The cumulative incidence of BC was 6.1 vs 4.2 cases per 100 screened vs unscreened women age 70-74 years, and the rate of BC overdiagnosis was estimated to be 31%. The estimated rates of BC overdiagnosis increased to 47% and 54% in women age 75-84 years and ≥85 years, respectively, and screening did not improve BC-specific mortality in any of these age groups.

Study details: This retrospective cohort study evaluated 54,635 women from the Surveillance, Epidemiology, and End Results-Medicare (SEER) registry who were age ≥ 70 years and underwent screening.

Disclosures: This study was funded by the US National Cancer Institute. Some authors declared receiving grants, salary support, or research funding from various sources, including the National Cancer Institute.

Source: Richman IB et al. Estimating breast cancer overdiagnosis after screening mammography among older women in the United States. Ann Intern Med. 2023 (Aug 8). doi: 10.7326/M23-0133

Key clinical point: Continued breast cancer (BC) screening leads to the detection of a higher number of BC cases which may increase the risk of BC overdiagnosis in women age ≥ 70 years.

Major finding: The cumulative incidence of BC was 6.1 vs 4.2 cases per 100 screened vs unscreened women age 70-74 years, and the rate of BC overdiagnosis was estimated to be 31%. The estimated rates of BC overdiagnosis increased to 47% and 54% in women age 75-84 years and ≥85 years, respectively, and screening did not improve BC-specific mortality in any of these age groups.

Study details: This retrospective cohort study evaluated 54,635 women from the Surveillance, Epidemiology, and End Results-Medicare (SEER) registry who were age ≥ 70 years and underwent screening.

Disclosures: This study was funded by the US National Cancer Institute. Some authors declared receiving grants, salary support, or research funding from various sources, including the National Cancer Institute.

Source: Richman IB et al. Estimating breast cancer overdiagnosis after screening mammography among older women in the United States. Ann Intern Med. 2023 (Aug 8). doi: 10.7326/M23-0133

Key clinical point: A higher body mass index (BMI) was associated with a lower frequency of hematologic toxicities and, consequently, with a lower rate of treatment discontinuation in women with early-stage hormone receptor-positive (HR+) breast cancer (BC) who received palbociclib + endocrine therapy (ET).

Major finding: In women who received palbociclib, higher BMI was associated with a significantly lower rate of neutropenia (odds ratio for a 1-unit change in BMI 0.93; 95% CI 0.92-0.95) and hence, with a lower rate of treatment discontinuation (adjusted hazard ratio for a 10-unit change in BMI 0.75; 95% CI 0.67-0.83).

Study details: Findings are from an analysis of the PALLAS trial including 5698 patients with early-stage II-III, HR+/human epidermal growth factor receptor 2-negative BC who were randomly assigned to receive adjuvant ET for ≥ 5 years with or without palbociclib for 2 years.

Disclosures: This study was supported by Pfizer and other sources. Two authors declared being employees and stockholders of Pfizer. The other authors reported ties with several sources, including Pfizer.

Source: Pfeiler G et al on behalf of the PALLAS Groups and Investigators. Impact of BMI in patients with early hormone receptor-positive breast cancer receiving endocrine therapy with or without palbociclib in the PALLAS trial. J Clin Oncol. 2023 (Aug 9). doi: 10.1200/JCO.23.00126

Key clinical point: A higher body mass index (BMI) was associated with a lower frequency of hematologic toxicities and, consequently, with a lower rate of treatment discontinuation in women with early-stage hormone receptor-positive (HR+) breast cancer (BC) who received palbociclib + endocrine therapy (ET).

Major finding: In women who received palbociclib, higher BMI was associated with a significantly lower rate of neutropenia (odds ratio for a 1-unit change in BMI 0.93; 95% CI 0.92-0.95) and hence, with a lower rate of treatment discontinuation (adjusted hazard ratio for a 10-unit change in BMI 0.75; 95% CI 0.67-0.83).

Study details: Findings are from an analysis of the PALLAS trial including 5698 patients with early-stage II-III, HR+/human epidermal growth factor receptor 2-negative BC who were randomly assigned to receive adjuvant ET for ≥ 5 years with or without palbociclib for 2 years.

Disclosures: This study was supported by Pfizer and other sources. Two authors declared being employees and stockholders of Pfizer. The other authors reported ties with several sources, including Pfizer.

Source: Pfeiler G et al on behalf of the PALLAS Groups and Investigators. Impact of BMI in patients with early hormone receptor-positive breast cancer receiving endocrine therapy with or without palbociclib in the PALLAS trial. J Clin Oncol. 2023 (Aug 9). doi: 10.1200/JCO.23.00126

Key clinical point: A higher body mass index (BMI) was associated with a lower frequency of hematologic toxicities and, consequently, with a lower rate of treatment discontinuation in women with early-stage hormone receptor-positive (HR+) breast cancer (BC) who received palbociclib + endocrine therapy (ET).

Major finding: In women who received palbociclib, higher BMI was associated with a significantly lower rate of neutropenia (odds ratio for a 1-unit change in BMI 0.93; 95% CI 0.92-0.95) and hence, with a lower rate of treatment discontinuation (adjusted hazard ratio for a 10-unit change in BMI 0.75; 95% CI 0.67-0.83).

Study details: Findings are from an analysis of the PALLAS trial including 5698 patients with early-stage II-III, HR+/human epidermal growth factor receptor 2-negative BC who were randomly assigned to receive adjuvant ET for ≥ 5 years with or without palbociclib for 2 years.

Disclosures: This study was supported by Pfizer and other sources. Two authors declared being employees and stockholders of Pfizer. The other authors reported ties with several sources, including Pfizer.

Source: Pfeiler G et al on behalf of the PALLAS Groups and Investigators. Impact of BMI in patients with early hormone receptor-positive breast cancer receiving endocrine therapy with or without palbociclib in the PALLAS trial. J Clin Oncol. 2023 (Aug 9). doi: 10.1200/JCO.23.00126

Key clinical point: Trastuzumab deruxtecan can be considered a safe treatment option in patients with metastatic breast cancer (BC) given the low incidence of interstitial lung disease (ILD) and cardiotoxicity events and the fact that a 5.4 mg/kg dosing is significantly safer than a 6.4 mg/kg dosing.

Major finding: The incidence rate of ILD was 11.7%, with ILD being reported in a significantly higher proportion of patients receiving 6.4 mg/kg vs 5.4 mg/kg (22.7% vs 10.2%; P < .01) of trastuzumab deruxtecan. The majority (80.2%) of ILD cases were of grade 1 or 2 and mostly manageable. Cardiotoxicity measured by decreased left ventricular ejection fraction was reported in 1.95% patients.

Study details: Findings are from a meta-analysis of 15 studies including 1970 patients with metastatic BC who received ≥ 1 dose of trastuzumab deruxtecan.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Soares LR et al. Incidence of interstitial lung disease and cardiotoxicity with trastuzumab deruxtecan in breast cancer patients: A systematic review and single-arm meta-analysis. ESMO Open. 2023;8(4):101613 (Jul 21). doi: 10.1016/j.esmoop.2023.101613

Key clinical point: Trastuzumab deruxtecan can be considered a safe treatment option in patients with metastatic breast cancer (BC) given the low incidence of interstitial lung disease (ILD) and cardiotoxicity events and the fact that a 5.4 mg/kg dosing is significantly safer than a 6.4 mg/kg dosing.

Major finding: The incidence rate of ILD was 11.7%, with ILD being reported in a significantly higher proportion of patients receiving 6.4 mg/kg vs 5.4 mg/kg (22.7% vs 10.2%; P < .01) of trastuzumab deruxtecan. The majority (80.2%) of ILD cases were of grade 1 or 2 and mostly manageable. Cardiotoxicity measured by decreased left ventricular ejection fraction was reported in 1.95% patients.

Study details: Findings are from a meta-analysis of 15 studies including 1970 patients with metastatic BC who received ≥ 1 dose of trastuzumab deruxtecan.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Soares LR et al. Incidence of interstitial lung disease and cardiotoxicity with trastuzumab deruxtecan in breast cancer patients: A systematic review and single-arm meta-analysis. ESMO Open. 2023;8(4):101613 (Jul 21). doi: 10.1016/j.esmoop.2023.101613

Key clinical point: Trastuzumab deruxtecan can be considered a safe treatment option in patients with metastatic breast cancer (BC) given the low incidence of interstitial lung disease (ILD) and cardiotoxicity events and the fact that a 5.4 mg/kg dosing is significantly safer than a 6.4 mg/kg dosing.

Major finding: The incidence rate of ILD was 11.7%, with ILD being reported in a significantly higher proportion of patients receiving 6.4 mg/kg vs 5.4 mg/kg (22.7% vs 10.2%; P < .01) of trastuzumab deruxtecan. The majority (80.2%) of ILD cases were of grade 1 or 2 and mostly manageable. Cardiotoxicity measured by decreased left ventricular ejection fraction was reported in 1.95% patients.

Study details: Findings are from a meta-analysis of 15 studies including 1970 patients with metastatic BC who received ≥ 1 dose of trastuzumab deruxtecan.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Soares LR et al. Incidence of interstitial lung disease and cardiotoxicity with trastuzumab deruxtecan in breast cancer patients: A systematic review and single-arm meta-analysis. ESMO Open. 2023;8(4):101613 (Jul 21). doi: 10.1016/j.esmoop.2023.101613

Key clinical point: Pyrotinib showed promising anti-tumor activity in first-, second-, and third- or later-line treatment settings along with a manageable safety profile in patients with human epidermal growth factor receptor 2-positive (HER2+) advanced breast cancer (BC).

Major finding: Median real-world progression-free survival (rwPFS) was 14.3 months (95% CI 13.3-15.2) for the total population. Median rwPFS was 17.8 months (95% CI 15.2-24.9) in the first-line treatment setting, 14.4 months (95% CI 12.9-15.3) in the second-line setting, and 9.3 months (95% CI 8.4-11.8) in the third- or later-line settings. Diarrhea (any grade) was the most common adverse event (73.4%).

Study details: This prospective observational study included 1129 patients with HER2+ advanced BC who received pyrotinib-based therapy in first- (n = 437), second- (n = 476), and third- or later-line (n = 216) settings.

Disclosures: This study was supported by Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences and Jiangsu Hengrui Pharmaceuticals Co., Ltd. The authors declared no conflicts of interest.

Source: Li Y et al. Real-world treatment patterns and outcomes of pyrotinib-based therapy in patients with HER2-positive advanced breast cancer (PRETTY): A nationwide, prospective, observational study. Int J Cancer. 2023 (Aug 6). doi: 10.1002/ijc.34676

Key clinical point: Pyrotinib showed promising anti-tumor activity in first-, second-, and third- or later-line treatment settings along with a manageable safety profile in patients with human epidermal growth factor receptor 2-positive (HER2+) advanced breast cancer (BC).

Major finding: Median real-world progression-free survival (rwPFS) was 14.3 months (95% CI 13.3-15.2) for the total population. Median rwPFS was 17.8 months (95% CI 15.2-24.9) in the first-line treatment setting, 14.4 months (95% CI 12.9-15.3) in the second-line setting, and 9.3 months (95% CI 8.4-11.8) in the third- or later-line settings. Diarrhea (any grade) was the most common adverse event (73.4%).

Study details: This prospective observational study included 1129 patients with HER2+ advanced BC who received pyrotinib-based therapy in first- (n = 437), second- (n = 476), and third- or later-line (n = 216) settings.

Disclosures: This study was supported by Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences and Jiangsu Hengrui Pharmaceuticals Co., Ltd. The authors declared no conflicts of interest.

Source: Li Y et al. Real-world treatment patterns and outcomes of pyrotinib-based therapy in patients with HER2-positive advanced breast cancer (PRETTY): A nationwide, prospective, observational study. Int J Cancer. 2023 (Aug 6). doi: 10.1002/ijc.34676

Key clinical point: Pyrotinib showed promising anti-tumor activity in first-, second-, and third- or later-line treatment settings along with a manageable safety profile in patients with human epidermal growth factor receptor 2-positive (HER2+) advanced breast cancer (BC).

Major finding: Median real-world progression-free survival (rwPFS) was 14.3 months (95% CI 13.3-15.2) for the total population. Median rwPFS was 17.8 months (95% CI 15.2-24.9) in the first-line treatment setting, 14.4 months (95% CI 12.9-15.3) in the second-line setting, and 9.3 months (95% CI 8.4-11.8) in the third- or later-line settings. Diarrhea (any grade) was the most common adverse event (73.4%).

Study details: This prospective observational study included 1129 patients with HER2+ advanced BC who received pyrotinib-based therapy in first- (n = 437), second- (n = 476), and third- or later-line (n = 216) settings.

Disclosures: This study was supported by Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences and Jiangsu Hengrui Pharmaceuticals Co., Ltd. The authors declared no conflicts of interest.

Source: Li Y et al. Real-world treatment patterns and outcomes of pyrotinib-based therapy in patients with HER2-positive advanced breast cancer (PRETTY): A nationwide, prospective, observational study. Int J Cancer. 2023 (Aug 6). doi: 10.1002/ijc.34676

Key clinical point: Surgery followed by adjuvant chemotherapy (ACT) did not demonstrate inferior survival outcomes compared with neoadjuvant chemotherapy (NACT) followed by surgery in patients with clinical stage T1 node-negative (T1N0) triple negative breast cancer (TNBC), whereas NACT was more effective than ACT in clinical stage T1c BC.

Major finding: Patients with T1N0 TNBC who received NACT vs ACT had worse overall survival (OS) outcomes (hazard ratio 1.42; P < .001); however, OS was better in patients with clinical stage T1c TNBC who achieved pathological complete response with NACT vs those with unchanged stages who underwent surgery and received ACT (94.4% vs 91.9%; P = .025).

Study details: This retrospective analysis included 35,521 patients with T1N0 TNBC from the US National Cancer Database who received either adjuvant chemotherapy after upfront surgery (n = 32,066) or neoadjuvant chemotherapy before surgery (n = 3455).

Disclosures: This study did not declare any funding source or conflicts of interest.

Source: Huang K et al. Overall survival following neoadjuvant chemotherapy versus adjuvant chemotherapy in clinically node negative T1 triple negative breast cancer. Ann Surg Oncol. 2023 (Jul 25). doi: 10.1245/s10434-023-13977-4

Key clinical point: Surgery followed by adjuvant chemotherapy (ACT) did not demonstrate inferior survival outcomes compared with neoadjuvant chemotherapy (NACT) followed by surgery in patients with clinical stage T1 node-negative (T1N0) triple negative breast cancer (TNBC), whereas NACT was more effective than ACT in clinical stage T1c BC.

Major finding: Patients with T1N0 TNBC who received NACT vs ACT had worse overall survival (OS) outcomes (hazard ratio 1.42; P < .001); however, OS was better in patients with clinical stage T1c TNBC who achieved pathological complete response with NACT vs those with unchanged stages who underwent surgery and received ACT (94.4% vs 91.9%; P = .025).

Study details: This retrospective analysis included 35,521 patients with T1N0 TNBC from the US National Cancer Database who received either adjuvant chemotherapy after upfront surgery (n = 32,066) or neoadjuvant chemotherapy before surgery (n = 3455).

Disclosures: This study did not declare any funding source or conflicts of interest.

Source: Huang K et al. Overall survival following neoadjuvant chemotherapy versus adjuvant chemotherapy in clinically node negative T1 triple negative breast cancer. Ann Surg Oncol. 2023 (Jul 25). doi: 10.1245/s10434-023-13977-4

Key clinical point: Surgery followed by adjuvant chemotherapy (ACT) did not demonstrate inferior survival outcomes compared with neoadjuvant chemotherapy (NACT) followed by surgery in patients with clinical stage T1 node-negative (T1N0) triple negative breast cancer (TNBC), whereas NACT was more effective than ACT in clinical stage T1c BC.

Major finding: Patients with T1N0 TNBC who received NACT vs ACT had worse overall survival (OS) outcomes (hazard ratio 1.42; P < .001); however, OS was better in patients with clinical stage T1c TNBC who achieved pathological complete response with NACT vs those with unchanged stages who underwent surgery and received ACT (94.4% vs 91.9%; P = .025).

Study details: This retrospective analysis included 35,521 patients with T1N0 TNBC from the US National Cancer Database who received either adjuvant chemotherapy after upfront surgery (n = 32,066) or neoadjuvant chemotherapy before surgery (n = 3455).

Disclosures: This study did not declare any funding source or conflicts of interest.

Source: Huang K et al. Overall survival following neoadjuvant chemotherapy versus adjuvant chemotherapy in clinically node negative T1 triple negative breast cancer. Ann Surg Oncol. 2023 (Jul 25). doi: 10.1245/s10434-023-13977-4

Key clinical point: In patients with cT1-2 N0 breast cancer (BC) who underwent mastectomy and had 1-2 positive nodes on sentinel lymph node biopsy (SLNB), the rate of local-regional recurrence (LRR) was extremely low regardless of completion axillary node dissection (CLND) or radiation therapy.

Major finding: The 5-year cumulative incidence rate of overall LRR was comparable between patients who underwent vs did not undergo CLND (1.8% vs 1.3%; P = .93), with the receipt of post-mastectomy radiation therapy not affecting the LRR rate in both categories of patients who underwent SLNB alone and SLNB with CLND (P = .1638 for both).

Study details: Findings are from the analysis of a prospective institutional database including 548 patients with cT1-2 N0 BC who underwent mastectomy and had 1-2 positive lymph nodes on SLNB, and 77% of these patients underwent CLND.

Disclosures: This study was supported by the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research and other sources. The authors declared no conflicts of interest.

Source: Zaveri S et al. Extremely low incidence of local-regional recurrences observed among T1-2 N1 (1 or 2 positive SLNs) breast cancer patients receiving upfront mastectomy without completion axillary node dissection. Ann Surg Oncol. 2023 (Jul 17). doi: 10.1245/s10434-023-13942-1

Key clinical point: In patients with cT1-2 N0 breast cancer (BC) who underwent mastectomy and had 1-2 positive nodes on sentinel lymph node biopsy (SLNB), the rate of local-regional recurrence (LRR) was extremely low regardless of completion axillary node dissection (CLND) or radiation therapy.

Major finding: The 5-year cumulative incidence rate of overall LRR was comparable between patients who underwent vs did not undergo CLND (1.8% vs 1.3%; P = .93), with the receipt of post-mastectomy radiation therapy not affecting the LRR rate in both categories of patients who underwent SLNB alone and SLNB with CLND (P = .1638 for both).

Study details: Findings are from the analysis of a prospective institutional database including 548 patients with cT1-2 N0 BC who underwent mastectomy and had 1-2 positive lymph nodes on SLNB, and 77% of these patients underwent CLND.

Disclosures: This study was supported by the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research and other sources. The authors declared no conflicts of interest.

Source: Zaveri S et al. Extremely low incidence of local-regional recurrences observed among T1-2 N1 (1 or 2 positive SLNs) breast cancer patients receiving upfront mastectomy without completion axillary node dissection. Ann Surg Oncol. 2023 (Jul 17). doi: 10.1245/s10434-023-13942-1

Key clinical point: In patients with cT1-2 N0 breast cancer (BC) who underwent mastectomy and had 1-2 positive nodes on sentinel lymph node biopsy (SLNB), the rate of local-regional recurrence (LRR) was extremely low regardless of completion axillary node dissection (CLND) or radiation therapy.

Major finding: The 5-year cumulative incidence rate of overall LRR was comparable between patients who underwent vs did not undergo CLND (1.8% vs 1.3%; P = .93), with the receipt of post-mastectomy radiation therapy not affecting the LRR rate in both categories of patients who underwent SLNB alone and SLNB with CLND (P = .1638 for both).

Study details: Findings are from the analysis of a prospective institutional database including 548 patients with cT1-2 N0 BC who underwent mastectomy and had 1-2 positive lymph nodes on SLNB, and 77% of these patients underwent CLND.

Disclosures: This study was supported by the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research and other sources. The authors declared no conflicts of interest.

Source: Zaveri S et al. Extremely low incidence of local-regional recurrences observed among T1-2 N1 (1 or 2 positive SLNs) breast cancer patients receiving upfront mastectomy without completion axillary node dissection. Ann Surg Oncol. 2023 (Jul 17). doi: 10.1245/s10434-023-13942-1

Key clinical point: Patients with advanced or metastatic breast cancer (BC) who received concomitant proton pump inhibitors (PPI) plus palbociclib experienced less favorable survival outcomes compared with those who received palbociclib only.

Major finding: Patients who received concomitant PPI + palbociclib vs only palbociclib had significantly shorter progression-free survival (hazard ratio [HR] 1.76; 95% CI 1.46-2.13) and overall survival (HR 2.72; 95% CI 2.07-3.53) rates.

Study details: This retrospective cohort study included 1310 patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative advanced or metastatic BC, of which 344 and 966 patients received concomitant PPI + palbociclib and palbociclib only, respectively.

Disclosures: This study was funded by Sungkyunkwan University (South Korea), the Korean Ministry of Education, and the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Lee J-E et al. Concomitant use of proton pump inhibitors and palbociclib among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2324852 (Jul 21). doi: 10.1001/jamanetworkopen.2023.24852

Key clinical point: Patients with advanced or metastatic breast cancer (BC) who received concomitant proton pump inhibitors (PPI) plus palbociclib experienced less favorable survival outcomes compared with those who received palbociclib only.

Major finding: Patients who received concomitant PPI + palbociclib vs only palbociclib had significantly shorter progression-free survival (hazard ratio [HR] 1.76; 95% CI 1.46-2.13) and overall survival (HR 2.72; 95% CI 2.07-3.53) rates.

Study details: This retrospective cohort study included 1310 patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative advanced or metastatic BC, of which 344 and 966 patients received concomitant PPI + palbociclib and palbociclib only, respectively.

Disclosures: This study was funded by Sungkyunkwan University (South Korea), the Korean Ministry of Education, and the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Lee J-E et al. Concomitant use of proton pump inhibitors and palbociclib among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2324852 (Jul 21). doi: 10.1001/jamanetworkopen.2023.24852

Key clinical point: Patients with advanced or metastatic breast cancer (BC) who received concomitant proton pump inhibitors (PPI) plus palbociclib experienced less favorable survival outcomes compared with those who received palbociclib only.

Major finding: Patients who received concomitant PPI + palbociclib vs only palbociclib had significantly shorter progression-free survival (hazard ratio [HR] 1.76; 95% CI 1.46-2.13) and overall survival (HR 2.72; 95% CI 2.07-3.53) rates.

Study details: This retrospective cohort study included 1310 patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative advanced or metastatic BC, of which 344 and 966 patients received concomitant PPI + palbociclib and palbociclib only, respectively.

Disclosures: This study was funded by Sungkyunkwan University (South Korea), the Korean Ministry of Education, and the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Lee J-E et al. Concomitant use of proton pump inhibitors and palbociclib among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2324852 (Jul 21). doi: 10.1001/jamanetworkopen.2023.24852

Should we be exercising in the morning or afternoon? Before a meal or after a meal?

Popular media outlets, researchers, and clinicians seem to love these debates. I hate them. For me, it’s a false dichotomy. A false dichotomy is when people argue two sides as if only one option exists. A winner must be crowned, and a loser exists. But in reality, a gray zone exists, and/or a number of options are available. For me, exercise at any point of the day is a win.

Some but not all research suggests that morning fasted exercise may be the best time of day and condition to work out for weight control and training adaptations. Morning exercise may be a bit better for logistical reasons if you like to get up early. Some of us are indeed early chronotypes who rise early, get as much done as we can, including all our fitness and work-related activities, and then head to bed early (for me that is about 10 PM). Getting an early morning workout seems to fit with our schedules as morning larks.

But if you are a late-day chronotype, early exercise may not be in sync with your low morning energy levels or your preference for leisure-time activities later in the day. And lots of people with diabetes prefer to eat and then exercise. Late chronotypes are less physically active in general, compared with early chronotypes, and those who train in the morning tend to have better training adherence and expend more energy overall throughout the day. According to Dr. Normand Boulé from the University of Alberta, Edmonton, who presented on the topic of exercise time of day at the recent scientific sessions of the American Diabetes Association in San Diego, morning exercise in the fasted state tends to be associated with higher rates of fat oxidation, better weight control, and better skeletal muscle adaptations over time, compared with exercise performed later in the day. Dr Boulé also proposed that fasted exercise might be superior for training adaptations and long-term glycemia if you have type 2 diabetes.

But the argument for morning-only exercise falls short when we look specifically at postmeal glycemia, according to Dr. Jenna Gillen from the University of Toronto, who faced off against Dr. Boulé at a debate at the meeting and also publishes on the topic. She pointed out that mild to moderate intensity exercising done soon after meals typically results in fewer glucose spikes after meals in people with diabetes, and her argument is supported by at least one recent meta-analysis where postmeal walking was best for improving glycemia in those with prediabetes and type 2 diabetes.

The notion that postmeal or afternoon exercise is best for people with type 2 diabetes is also supported by a recent reexamination of the original Look AHEAD Trial of over 2,400 adults with type 2 diabetes, wherein the role of lifestyle intervention on cardiovascular outcomes was the original goal. In this recent secondary analysis of the Look AHEAD Trial, those most active in the afternoon (between 1:43 p.m. and 5:00 p.m.) had the greatest improvements in their overall glucose control after 1 year of the intensive lifestyle intervention, compared with exercise at other times of day. Afternoon exercisers were also more likely to have complete “remission” of their diabetes, as defined by no longer needing any glucose-lowering agents to control their glucose levels. But this was not a study that was designed for determining whether exercise time of day matters for glycemia because the participants were not randomly assigned to a set time of day for their activity, and glycemic control was not the primary endpoint (cardiovascular events were).

But hold on a minute. I said this was a false-dichotomy argument. It is. Just because it may or may not be “better” for your glucose to exercise in the morning vs. afternoon, if you have diabetes, it doesn’t mean you have to choose one or the other. You could choose neither (okay, that’s bad), both, or you could alternate between the two. For me this argument is like saying; “There only one time of day to save money”; “to tell a joke”; “to eat a meal” (okay, that’s another useless debate); or “do my laundry” (my mother once told me it’s technically cheaper after 6 p.m.!).

I live with diabetes, and I take insulin. I like how morning exercise in the form of a run with my dog wakes me up, sets me up for the day with positive thoughts, helps generate lots of creative ideas, and perhaps more importantly for me, it tends not to result in hypoglycemia because my insulin on board is lowest then.

Exercise later in the day is tricky when taking insulin because it tends to result in a higher insulin “potency effect” with prandial insulins. However, I still like midday activity and late-day exercise. For example, taking an activity break after lunch blunts the rise in my glucose and breaks up my prolonged sitting time in the office. After-dinner exercise allows me to spend a little more time with my wife, dog, or friends outdoors as the hot summer day begins to cool off. On Monday nights, I play basketball because that’s the only time we can book the gymnasium and that may not end until 9:45 p.m. (15 minutes before I want to go to bed; if you remember, I am a lark). That can result in two frustrating things related to my diabetes: It can cause an immediate rise in my glucose because of a competitive stress response and then a drop in my glucose overnight when I’m sleeping. But I still do it. I know that the training I’m doing at any point of the day will benefit me in lots of little ways, and I think we all need to take as many opportunities to be physically active as we possibly can. My kids and I coin this our daily “fitness opportunities,” and it does not matter to me if its morning, noon, or night!

It’s time to make the headlines and arguments stop. There is no wrong time of day to exercise. At least not in my opinion.
 

Dr. Riddle is a full professor in the school of kinesiology and health science at York University and senior scientist at LMC Diabetes & Endocrinology, both in Toronto. He has disclosed financial relationships with Dexcom, Eli Lilly, Indigo Diabetes, Insulet, Novo Nordisk, Sanofi, Supersapiens, and Zucara Therapeutics.

A version of this article first appeared on Medscape.com.

Should we be exercising in the morning or afternoon? Before a meal or after a meal?

Popular media outlets, researchers, and clinicians seem to love these debates. I hate them. For me, it’s a false dichotomy. A false dichotomy is when people argue two sides as if only one option exists. A winner must be crowned, and a loser exists. But in reality, a gray zone exists, and/or a number of options are available. For me, exercise at any point of the day is a win.

Some but not all research suggests that morning fasted exercise may be the best time of day and condition to work out for weight control and training adaptations. Morning exercise may be a bit better for logistical reasons if you like to get up early. Some of us are indeed early chronotypes who rise early, get as much done as we can, including all our fitness and work-related activities, and then head to bed early (for me that is about 10 PM). Getting an early morning workout seems to fit with our schedules as morning larks.

But if you are a late-day chronotype, early exercise may not be in sync with your low morning energy levels or your preference for leisure-time activities later in the day. And lots of people with diabetes prefer to eat and then exercise. Late chronotypes are less physically active in general, compared with early chronotypes, and those who train in the morning tend to have better training adherence and expend more energy overall throughout the day. According to Dr. Normand Boulé from the University of Alberta, Edmonton, who presented on the topic of exercise time of day at the recent scientific sessions of the American Diabetes Association in San Diego, morning exercise in the fasted state tends to be associated with higher rates of fat oxidation, better weight control, and better skeletal muscle adaptations over time, compared with exercise performed later in the day. Dr Boulé also proposed that fasted exercise might be superior for training adaptations and long-term glycemia if you have type 2 diabetes.

But the argument for morning-only exercise falls short when we look specifically at postmeal glycemia, according to Dr. Jenna Gillen from the University of Toronto, who faced off against Dr. Boulé at a debate at the meeting and also publishes on the topic. She pointed out that mild to moderate intensity exercising done soon after meals typically results in fewer glucose spikes after meals in people with diabetes, and her argument is supported by at least one recent meta-analysis where postmeal walking was best for improving glycemia in those with prediabetes and type 2 diabetes.

The notion that postmeal or afternoon exercise is best for people with type 2 diabetes is also supported by a recent reexamination of the original Look AHEAD Trial of over 2,400 adults with type 2 diabetes, wherein the role of lifestyle intervention on cardiovascular outcomes was the original goal. In this recent secondary analysis of the Look AHEAD Trial, those most active in the afternoon (between 1:43 p.m. and 5:00 p.m.) had the greatest improvements in their overall glucose control after 1 year of the intensive lifestyle intervention, compared with exercise at other times of day. Afternoon exercisers were also more likely to have complete “remission” of their diabetes, as defined by no longer needing any glucose-lowering agents to control their glucose levels. But this was not a study that was designed for determining whether exercise time of day matters for glycemia because the participants were not randomly assigned to a set time of day for their activity, and glycemic control was not the primary endpoint (cardiovascular events were).

But hold on a minute. I said this was a false-dichotomy argument. It is. Just because it may or may not be “better” for your glucose to exercise in the morning vs. afternoon, if you have diabetes, it doesn’t mean you have to choose one or the other. You could choose neither (okay, that’s bad), both, or you could alternate between the two. For me this argument is like saying; “There only one time of day to save money”; “to tell a joke”; “to eat a meal” (okay, that’s another useless debate); or “do my laundry” (my mother once told me it’s technically cheaper after 6 p.m.!).

I live with diabetes, and I take insulin. I like how morning exercise in the form of a run with my dog wakes me up, sets me up for the day with positive thoughts, helps generate lots of creative ideas, and perhaps more importantly for me, it tends not to result in hypoglycemia because my insulin on board is lowest then.

Exercise later in the day is tricky when taking insulin because it tends to result in a higher insulin “potency effect” with prandial insulins. However, I still like midday activity and late-day exercise. For example, taking an activity break after lunch blunts the rise in my glucose and breaks up my prolonged sitting time in the office. After-dinner exercise allows me to spend a little more time with my wife, dog, or friends outdoors as the hot summer day begins to cool off. On Monday nights, I play basketball because that’s the only time we can book the gymnasium and that may not end until 9:45 p.m. (15 minutes before I want to go to bed; if you remember, I am a lark). That can result in two frustrating things related to my diabetes: It can cause an immediate rise in my glucose because of a competitive stress response and then a drop in my glucose overnight when I’m sleeping. But I still do it. I know that the training I’m doing at any point of the day will benefit me in lots of little ways, and I think we all need to take as many opportunities to be physically active as we possibly can. My kids and I coin this our daily “fitness opportunities,” and it does not matter to me if its morning, noon, or night!

It’s time to make the headlines and arguments stop. There is no wrong time of day to exercise. At least not in my opinion.
 

Dr. Riddle is a full professor in the school of kinesiology and health science at York University and senior scientist at LMC Diabetes & Endocrinology, both in Toronto. He has disclosed financial relationships with Dexcom, Eli Lilly, Indigo Diabetes, Insulet, Novo Nordisk, Sanofi, Supersapiens, and Zucara Therapeutics.

A version of this article first appeared on Medscape.com.

Should we be exercising in the morning or afternoon? Before a meal or after a meal?

Popular media outlets, researchers, and clinicians seem to love these debates. I hate them. For me, it’s a false dichotomy. A false dichotomy is when people argue two sides as if only one option exists. A winner must be crowned, and a loser exists. But in reality, a gray zone exists, and/or a number of options are available. For me, exercise at any point of the day is a win.

Some but not all research suggests that morning fasted exercise may be the best time of day and condition to work out for weight control and training adaptations. Morning exercise may be a bit better for logistical reasons if you like to get up early. Some of us are indeed early chronotypes who rise early, get as much done as we can, including all our fitness and work-related activities, and then head to bed early (for me that is about 10 PM). Getting an early morning workout seems to fit with our schedules as morning larks.

But if you are a late-day chronotype, early exercise may not be in sync with your low morning energy levels or your preference for leisure-time activities later in the day. And lots of people with diabetes prefer to eat and then exercise. Late chronotypes are less physically active in general, compared with early chronotypes, and those who train in the morning tend to have better training adherence and expend more energy overall throughout the day. According to Dr. Normand Boulé from the University of Alberta, Edmonton, who presented on the topic of exercise time of day at the recent scientific sessions of the American Diabetes Association in San Diego, morning exercise in the fasted state tends to be associated with higher rates of fat oxidation, better weight control, and better skeletal muscle adaptations over time, compared with exercise performed later in the day. Dr Boulé also proposed that fasted exercise might be superior for training adaptations and long-term glycemia if you have type 2 diabetes.

But the argument for morning-only exercise falls short when we look specifically at postmeal glycemia, according to Dr. Jenna Gillen from the University of Toronto, who faced off against Dr. Boulé at a debate at the meeting and also publishes on the topic. She pointed out that mild to moderate intensity exercising done soon after meals typically results in fewer glucose spikes after meals in people with diabetes, and her argument is supported by at least one recent meta-analysis where postmeal walking was best for improving glycemia in those with prediabetes and type 2 diabetes.

The notion that postmeal or afternoon exercise is best for people with type 2 diabetes is also supported by a recent reexamination of the original Look AHEAD Trial of over 2,400 adults with type 2 diabetes, wherein the role of lifestyle intervention on cardiovascular outcomes was the original goal. In this recent secondary analysis of the Look AHEAD Trial, those most active in the afternoon (between 1:43 p.m. and 5:00 p.m.) had the greatest improvements in their overall glucose control after 1 year of the intensive lifestyle intervention, compared with exercise at other times of day. Afternoon exercisers were also more likely to have complete “remission” of their diabetes, as defined by no longer needing any glucose-lowering agents to control their glucose levels. But this was not a study that was designed for determining whether exercise time of day matters for glycemia because the participants were not randomly assigned to a set time of day for their activity, and glycemic control was not the primary endpoint (cardiovascular events were).

But hold on a minute. I said this was a false-dichotomy argument. It is. Just because it may or may not be “better” for your glucose to exercise in the morning vs. afternoon, if you have diabetes, it doesn’t mean you have to choose one or the other. You could choose neither (okay, that’s bad), both, or you could alternate between the two. For me this argument is like saying; “There only one time of day to save money”; “to tell a joke”; “to eat a meal” (okay, that’s another useless debate); or “do my laundry” (my mother once told me it’s technically cheaper after 6 p.m.!).

I live with diabetes, and I take insulin. I like how morning exercise in the form of a run with my dog wakes me up, sets me up for the day with positive thoughts, helps generate lots of creative ideas, and perhaps more importantly for me, it tends not to result in hypoglycemia because my insulin on board is lowest then.

Exercise later in the day is tricky when taking insulin because it tends to result in a higher insulin “potency effect” with prandial insulins. However, I still like midday activity and late-day exercise. For example, taking an activity break after lunch blunts the rise in my glucose and breaks up my prolonged sitting time in the office. After-dinner exercise allows me to spend a little more time with my wife, dog, or friends outdoors as the hot summer day begins to cool off. On Monday nights, I play basketball because that’s the only time we can book the gymnasium and that may not end until 9:45 p.m. (15 minutes before I want to go to bed; if you remember, I am a lark). That can result in two frustrating things related to my diabetes: It can cause an immediate rise in my glucose because of a competitive stress response and then a drop in my glucose overnight when I’m sleeping. But I still do it. I know that the training I’m doing at any point of the day will benefit me in lots of little ways, and I think we all need to take as many opportunities to be physically active as we possibly can. My kids and I coin this our daily “fitness opportunities,” and it does not matter to me if its morning, noon, or night!

It’s time to make the headlines and arguments stop. There is no wrong time of day to exercise. At least not in my opinion.
 

Dr. Riddle is a full professor in the school of kinesiology and health science at York University and senior scientist at LMC Diabetes & Endocrinology, both in Toronto. He has disclosed financial relationships with Dexcom, Eli Lilly, Indigo Diabetes, Insulet, Novo Nordisk, Sanofi, Supersapiens, and Zucara Therapeutics.

A version of this article first appeared on Medscape.com.

Key clinical point: Discontinuing adjuvant hormone therapy (HT) was associated with a higher likelihood of discontinuing cardiovascular therapy and an increased risk for mortality due to cardiovascular diseases in patients with estrogen receptor-positive breast cancer (ER+ BC).

Major finding: Compared with patients who continued adjuvant HT, the rate of discontinuing cardiovascular therapy was higher among patients who discontinued HT within a period of 3 months before (incidence rate ratio [IRR] 1.83; 95% CI 1.41-2.37) and after (IRR 2.31; 95% CI 1.74-3.05) adjuvant HT discontinuation. Discontinuation of adjuvant HT was also associated with a higher risk for death due to cardiovascular diseases (hazard ratio 1.79; 95% CI 1.15-2.81).

Study details: Findings are from a population-based cohort study including 5493 patients with nonmetastatic ER+ BC who initiated adjuvant HT and concomitantly used cardiovascular therapy.

Disclosures: This study was supported by grants from the Swedish Research Council and other sources. The authors declared no conflicts of interest.

Source: He W et al. Concomitant discontinuation of cardiovascular therapy and adjuvant hormone therapy among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2323752 (Jul 17). doi: 10.1001/jamanetworkopen.2023.23752

Key clinical point: Discontinuing adjuvant hormone therapy (HT) was associated with a higher likelihood of discontinuing cardiovascular therapy and an increased risk for mortality due to cardiovascular diseases in patients with estrogen receptor-positive breast cancer (ER+ BC).

Major finding: Compared with patients who continued adjuvant HT, the rate of discontinuing cardiovascular therapy was higher among patients who discontinued HT within a period of 3 months before (incidence rate ratio [IRR] 1.83; 95% CI 1.41-2.37) and after (IRR 2.31; 95% CI 1.74-3.05) adjuvant HT discontinuation. Discontinuation of adjuvant HT was also associated with a higher risk for death due to cardiovascular diseases (hazard ratio 1.79; 95% CI 1.15-2.81).

Study details: Findings are from a population-based cohort study including 5493 patients with nonmetastatic ER+ BC who initiated adjuvant HT and concomitantly used cardiovascular therapy.

Disclosures: This study was supported by grants from the Swedish Research Council and other sources. The authors declared no conflicts of interest.

Source: He W et al. Concomitant discontinuation of cardiovascular therapy and adjuvant hormone therapy among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2323752 (Jul 17). doi: 10.1001/jamanetworkopen.2023.23752

Key clinical point: Discontinuing adjuvant hormone therapy (HT) was associated with a higher likelihood of discontinuing cardiovascular therapy and an increased risk for mortality due to cardiovascular diseases in patients with estrogen receptor-positive breast cancer (ER+ BC).

Major finding: Compared with patients who continued adjuvant HT, the rate of discontinuing cardiovascular therapy was higher among patients who discontinued HT within a period of 3 months before (incidence rate ratio [IRR] 1.83; 95% CI 1.41-2.37) and after (IRR 2.31; 95% CI 1.74-3.05) adjuvant HT discontinuation. Discontinuation of adjuvant HT was also associated with a higher risk for death due to cardiovascular diseases (hazard ratio 1.79; 95% CI 1.15-2.81).

Study details: Findings are from a population-based cohort study including 5493 patients with nonmetastatic ER+ BC who initiated adjuvant HT and concomitantly used cardiovascular therapy.

Disclosures: This study was supported by grants from the Swedish Research Council and other sources. The authors declared no conflicts of interest.

Source: He W et al. Concomitant discontinuation of cardiovascular therapy and adjuvant hormone therapy among patients with breast cancer. JAMA Netw Open. 2023;6(7):e2323752 (Jul 17). doi: 10.1001/jamanetworkopen.2023.23752

Key clinical point: A diagnosis of breast cancer (BC) within the first 5 years of childbirth was associated with aggressive clinicopathological characteristics and unfavorable survival outcomes.

Major finding: Women diagnosed with post-partum BC (PPBC) within 5 years of childbirth showed more aggressive disease characteristics than nulliparous women with BC and women diagnosed with PPBC ≥ 5 years after childbirth (clinical stage T3: 5.9% vs 3.3% and 3.9%, respectively, or higher lymph node metastases: 40.6% vs 27.8% and 34.7%, respectively) and had the worst survival rates (hazard ratio 1.55; P = .004).

Study details: This study retrospectively reviewed 32,628 premenopausal women aged 20-50 years who underwent BC surgery, of which 508 women were nulliparous and 2406 women were diagnosed with BC within 5 years of childbirth.

Disclosures: This study was supported by the Korean Breast Cancer Society. The authors declared no conflicts of interest.

Source: Paik PS et al for the Korean Breast Cancer Society. Clinical characteristics and prognosis of postpartum breast cancer. Breast Cancer Res Treat. 2023 (Aug 5). doi: 10.1007/s10549-023-07069-w

Key clinical point: A diagnosis of breast cancer (BC) within the first 5 years of childbirth was associated with aggressive clinicopathological characteristics and unfavorable survival outcomes.

Major finding: Women diagnosed with post-partum BC (PPBC) within 5 years of childbirth showed more aggressive disease characteristics than nulliparous women with BC and women diagnosed with PPBC ≥ 5 years after childbirth (clinical stage T3: 5.9% vs 3.3% and 3.9%, respectively, or higher lymph node metastases: 40.6% vs 27.8% and 34.7%, respectively) and had the worst survival rates (hazard ratio 1.55; P = .004).

Study details: This study retrospectively reviewed 32,628 premenopausal women aged 20-50 years who underwent BC surgery, of which 508 women were nulliparous and 2406 women were diagnosed with BC within 5 years of childbirth.

Disclosures: This study was supported by the Korean Breast Cancer Society. The authors declared no conflicts of interest.

Source: Paik PS et al for the Korean Breast Cancer Society. Clinical characteristics and prognosis of postpartum breast cancer. Breast Cancer Res Treat. 2023 (Aug 5). doi: 10.1007/s10549-023-07069-w

Key clinical point: A diagnosis of breast cancer (BC) within the first 5 years of childbirth was associated with aggressive clinicopathological characteristics and unfavorable survival outcomes.

Major finding: Women diagnosed with post-partum BC (PPBC) within 5 years of childbirth showed more aggressive disease characteristics than nulliparous women with BC and women diagnosed with PPBC ≥ 5 years after childbirth (clinical stage T3: 5.9% vs 3.3% and 3.9%, respectively, or higher lymph node metastases: 40.6% vs 27.8% and 34.7%, respectively) and had the worst survival rates (hazard ratio 1.55; P = .004).

Study details: This study retrospectively reviewed 32,628 premenopausal women aged 20-50 years who underwent BC surgery, of which 508 women were nulliparous and 2406 women were diagnosed with BC within 5 years of childbirth.

Disclosures: This study was supported by the Korean Breast Cancer Society. The authors declared no conflicts of interest.

Source: Paik PS et al for the Korean Breast Cancer Society. Clinical characteristics and prognosis of postpartum breast cancer. Breast Cancer Res Treat. 2023 (Aug 5). doi: 10.1007/s10549-023-07069-w