Breast Cancer

Key clinical point: Findings from this real-world study supported the previous evidence for improved clinical outcomes on adding pertuzumab to trastuzumab plus neoadjuvant chemotherapy (TCT) in patients with human epidermal growth factor receptor 2-positive (HER2+) early-stage breast cancer (BC).

Major finding: The pathological complete response (odds ratio 1.74; P = .032) and 5-year event-free survival (hazard ratio, 2.22; P = .041) rates were significantly worsened in patients receiving TCT vs pertuzumab+TCT. The incidence of serious adverse events did not differ significantly between both groups.

Study details: Findings are from a retrospective, observational study including 271 patients with HER2+ stage II-III BC who received TCT with (n = 137) or without pertuzumab (n = 134).

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

Source: Fabbri A et al. Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: The Neopearl nationwide collaborative study. Front Oncol. 2023;13:1177681 (Jun 27). Doi: 10.3389/fonc.2023.1177681

Key clinical point: Findings from this real-world study supported the previous evidence for improved clinical outcomes on adding pertuzumab to trastuzumab plus neoadjuvant chemotherapy (TCT) in patients with human epidermal growth factor receptor 2-positive (HER2+) early-stage breast cancer (BC).

Major finding: The pathological complete response (odds ratio 1.74; P = .032) and 5-year event-free survival (hazard ratio, 2.22; P = .041) rates were significantly worsened in patients receiving TCT vs pertuzumab+TCT. The incidence of serious adverse events did not differ significantly between both groups.

Study details: Findings are from a retrospective, observational study including 271 patients with HER2+ stage II-III BC who received TCT with (n = 137) or without pertuzumab (n = 134).

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

Source: Fabbri A et al. Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: The Neopearl nationwide collaborative study. Front Oncol. 2023;13:1177681 (Jun 27). Doi: 10.3389/fonc.2023.1177681

Key clinical point: Findings from this real-world study supported the previous evidence for improved clinical outcomes on adding pertuzumab to trastuzumab plus neoadjuvant chemotherapy (TCT) in patients with human epidermal growth factor receptor 2-positive (HER2+) early-stage breast cancer (BC).

Major finding: The pathological complete response (odds ratio 1.74; P = .032) and 5-year event-free survival (hazard ratio, 2.22; P = .041) rates were significantly worsened in patients receiving TCT vs pertuzumab+TCT. The incidence of serious adverse events did not differ significantly between both groups.

Study details: Findings are from a retrospective, observational study including 271 patients with HER2+ stage II-III BC who received TCT with (n = 137) or without pertuzumab (n = 134).

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

Source: Fabbri A et al. Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: The Neopearl nationwide collaborative study. Front Oncol. 2023;13:1177681 (Jun 27). Doi: 10.3389/fonc.2023.1177681

Key clinical point: According to an analysis of two large prospective US-based cohorts, the consumption of olive oil was not associated with an increased risk for breast cancer (BC) among women.

Major finding: Compared with women who never or rarely consumed olive oil, those with the highest consumption of olive oil (>1/2 tablespoon/day or >7 g/day) did not report an increased risk of developing BC (hazard ratio 1.01;  95% CI 0.93-1.09).

Study details: Findings are from an analysis of two large prospective cohorts of women who were free of cancer at baseline, the Nurses’ Health Study (n = 71,330) and Nurses’ Health Study II (n = 93,295), of whom 9638 women developed invasive BC after 3,744,068 person-years of follow-up.

Disclosures: This study was supported by the US National Institutes of Health and other sources. The authors declared no conflicts of interest.

Source: Romanos-Nanclares A et al. Consumption of olive oil and risk of breast cancer in U.S. women: Results from the Nurses' Health Studies. Br J Cancer. 2023 (Jun 13). Doi: 10.1038/s41416-023-02306-x

Key clinical point: According to an analysis of two large prospective US-based cohorts, the consumption of olive oil was not associated with an increased risk for breast cancer (BC) among women.

Major finding: Compared with women who never or rarely consumed olive oil, those with the highest consumption of olive oil (>1/2 tablespoon/day or >7 g/day) did not report an increased risk of developing BC (hazard ratio 1.01;  95% CI 0.93-1.09).

Study details: Findings are from an analysis of two large prospective cohorts of women who were free of cancer at baseline, the Nurses’ Health Study (n = 71,330) and Nurses’ Health Study II (n = 93,295), of whom 9638 women developed invasive BC after 3,744,068 person-years of follow-up.

Disclosures: This study was supported by the US National Institutes of Health and other sources. The authors declared no conflicts of interest.

Source: Romanos-Nanclares A et al. Consumption of olive oil and risk of breast cancer in U.S. women: Results from the Nurses' Health Studies. Br J Cancer. 2023 (Jun 13). Doi: 10.1038/s41416-023-02306-x

Key clinical point: According to an analysis of two large prospective US-based cohorts, the consumption of olive oil was not associated with an increased risk for breast cancer (BC) among women.

Major finding: Compared with women who never or rarely consumed olive oil, those with the highest consumption of olive oil (>1/2 tablespoon/day or >7 g/day) did not report an increased risk of developing BC (hazard ratio 1.01;  95% CI 0.93-1.09).

Study details: Findings are from an analysis of two large prospective cohorts of women who were free of cancer at baseline, the Nurses’ Health Study (n = 71,330) and Nurses’ Health Study II (n = 93,295), of whom 9638 women developed invasive BC after 3,744,068 person-years of follow-up.

Disclosures: This study was supported by the US National Institutes of Health and other sources. The authors declared no conflicts of interest.

Source: Romanos-Nanclares A et al. Consumption of olive oil and risk of breast cancer in U.S. women: Results from the Nurses' Health Studies. Br J Cancer. 2023 (Jun 13). Doi: 10.1038/s41416-023-02306-x

Key clinical point: Breast-conserving therapy (BCT) vs mastectomy resulted in higher improvement in survival without increasing the risk for locoregional recurrence (LRR) in patients with breast cancer (BC), regardless of their clinical nodal status.

Major finding: BCT vs mastectomy improved overall survival (hazard ratio [HR] 1.37; P < .001, and HR 1.46; P < .001, respectively) and BC-specific survival (HR 1.32; P < .001, and HR 1.44; P = .008, respectively) without increasing the risk for LRR (P = .14 and P = .70, respectively) in patients with clinical node-negative and node-positive BC.

Study details: Findings are from an analysis including 13,914 women with T1-3N0-3 BC (clinically node-negative BC n = 12,537 and clinically node-positive BC n = 1,377) from a prospectively maintained database, the majority of whom received systemic therapy.

Disclosures: This study did not declare the source of funding. The authors did not report any conflicts of interest.

Source: Vasilyeva E et al. Breast-conserving therapy is associated with improved survival without an increased risk of locoregional recurrence compared with mastectomy in both clinically node-positive and node-negative breast cancer patients. Ann Surg Oncol. 2023 (Jun 26). Doi: 10.1245/s10434-023-13784-x

Key clinical point: Breast-conserving therapy (BCT) vs mastectomy resulted in higher improvement in survival without increasing the risk for locoregional recurrence (LRR) in patients with breast cancer (BC), regardless of their clinical nodal status.

Major finding: BCT vs mastectomy improved overall survival (hazard ratio [HR] 1.37; P < .001, and HR 1.46; P < .001, respectively) and BC-specific survival (HR 1.32; P < .001, and HR 1.44; P = .008, respectively) without increasing the risk for LRR (P = .14 and P = .70, respectively) in patients with clinical node-negative and node-positive BC.

Study details: Findings are from an analysis including 13,914 women with T1-3N0-3 BC (clinically node-negative BC n = 12,537 and clinically node-positive BC n = 1,377) from a prospectively maintained database, the majority of whom received systemic therapy.

Disclosures: This study did not declare the source of funding. The authors did not report any conflicts of interest.

Source: Vasilyeva E et al. Breast-conserving therapy is associated with improved survival without an increased risk of locoregional recurrence compared with mastectomy in both clinically node-positive and node-negative breast cancer patients. Ann Surg Oncol. 2023 (Jun 26). Doi: 10.1245/s10434-023-13784-x

Key clinical point: Breast-conserving therapy (BCT) vs mastectomy resulted in higher improvement in survival without increasing the risk for locoregional recurrence (LRR) in patients with breast cancer (BC), regardless of their clinical nodal status.

Major finding: BCT vs mastectomy improved overall survival (hazard ratio [HR] 1.37; P < .001, and HR 1.46; P < .001, respectively) and BC-specific survival (HR 1.32; P < .001, and HR 1.44; P = .008, respectively) without increasing the risk for LRR (P = .14 and P = .70, respectively) in patients with clinical node-negative and node-positive BC.

Study details: Findings are from an analysis including 13,914 women with T1-3N0-3 BC (clinically node-negative BC n = 12,537 and clinically node-positive BC n = 1,377) from a prospectively maintained database, the majority of whom received systemic therapy.

Disclosures: This study did not declare the source of funding. The authors did not report any conflicts of interest.

Source: Vasilyeva E et al. Breast-conserving therapy is associated with improved survival without an increased risk of locoregional recurrence compared with mastectomy in both clinically node-positive and node-negative breast cancer patients. Ann Surg Oncol. 2023 (Jun 26). Doi: 10.1245/s10434-023-13784-x

Key clinical point: A neoadjuvant chemotherapy regimen with three cycles of fluorouracil, epirubicin, and cyclophosphamide followed by three cycles of docetaxel (FEC3‑D3) had comparable survival outcomes as four cycles of adriamycin and cyclophosphamide followed by four cycles of docetaxel (AC4‑D4) in patients with stage II/III breast cancer (BC).

Major finding: In the FEC3-D3 vs AC4-D4 treatment group, the pathological complete response rate was 12.4% vs 14.3%, respectively, and the 3-year disease-free survival rate was comparable (75.8% vs 75.6%). Grade 3/4 neutropenia was the most common adverse event in both groups (~20%).

Study details: Findings are from the phase 3, Neo-shorter study including 248 patients with stage II/III BC who were randomly assigned to receive FEC3-D3 or AC4-D4.

Disclosures: This study was supported by Sanofi-Aventis. Two authors declared serving as consultants, founders, or advisors; owning stocks in; or receiving research funding from various sources, including Sanofi. Other authors declared no conflicts of interest.

Source: Hwang I et al. Randomized phase III trial of a neoadjuvant regimen of four cycles of adriamycin plus cyclophosphamide followed by four cycles of docetaxel (AC4-D4) versus a shorter treatment of three cycles of FEC followed by three cycles of docetaxel (FEC3-D3) in node-positive breast cancer (Neo-shorter; NCT02001506). Breast Cancer Res Treat. 2023 (Jun 26). Doi: 10.1007/s10549-023-06971-7

Key clinical point: A neoadjuvant chemotherapy regimen with three cycles of fluorouracil, epirubicin, and cyclophosphamide followed by three cycles of docetaxel (FEC3‑D3) had comparable survival outcomes as four cycles of adriamycin and cyclophosphamide followed by four cycles of docetaxel (AC4‑D4) in patients with stage II/III breast cancer (BC).

Major finding: In the FEC3-D3 vs AC4-D4 treatment group, the pathological complete response rate was 12.4% vs 14.3%, respectively, and the 3-year disease-free survival rate was comparable (75.8% vs 75.6%). Grade 3/4 neutropenia was the most common adverse event in both groups (~20%).

Study details: Findings are from the phase 3, Neo-shorter study including 248 patients with stage II/III BC who were randomly assigned to receive FEC3-D3 or AC4-D4.

Disclosures: This study was supported by Sanofi-Aventis. Two authors declared serving as consultants, founders, or advisors; owning stocks in; or receiving research funding from various sources, including Sanofi. Other authors declared no conflicts of interest.

Source: Hwang I et al. Randomized phase III trial of a neoadjuvant regimen of four cycles of adriamycin plus cyclophosphamide followed by four cycles of docetaxel (AC4-D4) versus a shorter treatment of three cycles of FEC followed by three cycles of docetaxel (FEC3-D3) in node-positive breast cancer (Neo-shorter; NCT02001506). Breast Cancer Res Treat. 2023 (Jun 26). Doi: 10.1007/s10549-023-06971-7

Key clinical point: A neoadjuvant chemotherapy regimen with three cycles of fluorouracil, epirubicin, and cyclophosphamide followed by three cycles of docetaxel (FEC3‑D3) had comparable survival outcomes as four cycles of adriamycin and cyclophosphamide followed by four cycles of docetaxel (AC4‑D4) in patients with stage II/III breast cancer (BC).

Major finding: In the FEC3-D3 vs AC4-D4 treatment group, the pathological complete response rate was 12.4% vs 14.3%, respectively, and the 3-year disease-free survival rate was comparable (75.8% vs 75.6%). Grade 3/4 neutropenia was the most common adverse event in both groups (~20%).

Study details: Findings are from the phase 3, Neo-shorter study including 248 patients with stage II/III BC who were randomly assigned to receive FEC3-D3 or AC4-D4.

Disclosures: This study was supported by Sanofi-Aventis. Two authors declared serving as consultants, founders, or advisors; owning stocks in; or receiving research funding from various sources, including Sanofi. Other authors declared no conflicts of interest.

Source: Hwang I et al. Randomized phase III trial of a neoadjuvant regimen of four cycles of adriamycin plus cyclophosphamide followed by four cycles of docetaxel (AC4-D4) versus a shorter treatment of three cycles of FEC followed by three cycles of docetaxel (FEC3-D3) in node-positive breast cancer (Neo-shorter; NCT02001506). Breast Cancer Res Treat. 2023 (Jun 26). Doi: 10.1007/s10549-023-06971-7

Key clinical point: Rates of locoregional recurrence after surgery were different for different molecular subtypes of breast cancer (BC).

Major finding: Compared with patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor-negative (ERBB2− aka HER2−) BC, those with HR−/ERBB2+ BC had approximately three times worse ipsilateral breast tumor recurrence (IBTR)-free survival (adjusted hazard ratio [aHR] 2.95;  95% CI 2.15-4.06), whereas patients with triple-negative BC had the worst regional recurrence-free survival (aHR 2.95;  95% CI 2.37-3.67) and contralateral BC-free survival (aHR 2.12;  95% CI 1.64-2.75). IBTR was lower in older patients with BC (P < .001).

Study details: Findings are from a retrospective cohort study including 16,462 women with BC who underwent surgery.

Disclosures: This study was funded by the Ministry of Health and Welfare, Republic of Korea. Some authors declared being members of a board of directors, stockholders of, or receiving grants from various sources.

Source: Cheun JH et al. Locoregional recurrence patterns in patients with different molecular subtypes of breast cancer. JAMA Surg. 2023 (Jun 21). Doi: 10.1001/jamasurg.2023.2150

Key clinical point: Rates of locoregional recurrence after surgery were different for different molecular subtypes of breast cancer (BC).

Major finding: Compared with patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor-negative (ERBB2− aka HER2−) BC, those with HR−/ERBB2+ BC had approximately three times worse ipsilateral breast tumor recurrence (IBTR)-free survival (adjusted hazard ratio [aHR] 2.95;  95% CI 2.15-4.06), whereas patients with triple-negative BC had the worst regional recurrence-free survival (aHR 2.95;  95% CI 2.37-3.67) and contralateral BC-free survival (aHR 2.12;  95% CI 1.64-2.75). IBTR was lower in older patients with BC (P < .001).

Study details: Findings are from a retrospective cohort study including 16,462 women with BC who underwent surgery.

Disclosures: This study was funded by the Ministry of Health and Welfare, Republic of Korea. Some authors declared being members of a board of directors, stockholders of, or receiving grants from various sources.

Source: Cheun JH et al. Locoregional recurrence patterns in patients with different molecular subtypes of breast cancer. JAMA Surg. 2023 (Jun 21). Doi: 10.1001/jamasurg.2023.2150

Key clinical point: Rates of locoregional recurrence after surgery were different for different molecular subtypes of breast cancer (BC).

Major finding: Compared with patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor-negative (ERBB2− aka HER2−) BC, those with HR−/ERBB2+ BC had approximately three times worse ipsilateral breast tumor recurrence (IBTR)-free survival (adjusted hazard ratio [aHR] 2.95;  95% CI 2.15-4.06), whereas patients with triple-negative BC had the worst regional recurrence-free survival (aHR 2.95;  95% CI 2.37-3.67) and contralateral BC-free survival (aHR 2.12;  95% CI 1.64-2.75). IBTR was lower in older patients with BC (P < .001).

Study details: Findings are from a retrospective cohort study including 16,462 women with BC who underwent surgery.

Disclosures: This study was funded by the Ministry of Health and Welfare, Republic of Korea. Some authors declared being members of a board of directors, stockholders of, or receiving grants from various sources.

Source: Cheun JH et al. Locoregional recurrence patterns in patients with different molecular subtypes of breast cancer. JAMA Surg. 2023 (Jun 21). Doi: 10.1001/jamasurg.2023.2150

Key clinical point: Pathologic regional lymph node stages I-III (pN1-3) and pathologic tumor size stage IV (pT4) were associated with worse long-term breast-cancer–specific survival (BCSS) outcomes in patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC).

Major finding: In patients who were followed up for more than 60 months, increasing vs no nodal involvement (pN1-3 vs pN0; all hazard ratios [HR] >3; all P ≤ .001) and a tumor size of pT4 vs pT1 (HR 4.528; P = .007) were associated with poor BCSS outcomes.

Study details: This study used data from a registry to analyze 20,672 patients with HER2+ stage I-III BC who underwent surgery.

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

Source: Kang YJ et al. Predictive biological factors for late survival in patients with HER2-positive breast cancer. Sci Rep. 2023;13:11008 (Jul 7). Doi: 10.1038/s41598-023-38200-y

Key clinical point: Pathologic regional lymph node stages I-III (pN1-3) and pathologic tumor size stage IV (pT4) were associated with worse long-term breast-cancer–specific survival (BCSS) outcomes in patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC).

Major finding: In patients who were followed up for more than 60 months, increasing vs no nodal involvement (pN1-3 vs pN0; all hazard ratios [HR] >3; all P ≤ .001) and a tumor size of pT4 vs pT1 (HR 4.528; P = .007) were associated with poor BCSS outcomes.

Study details: This study used data from a registry to analyze 20,672 patients with HER2+ stage I-III BC who underwent surgery.

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

Source: Kang YJ et al. Predictive biological factors for late survival in patients with HER2-positive breast cancer. Sci Rep. 2023;13:11008 (Jul 7). Doi: 10.1038/s41598-023-38200-y

Key clinical point: Pathologic regional lymph node stages I-III (pN1-3) and pathologic tumor size stage IV (pT4) were associated with worse long-term breast-cancer–specific survival (BCSS) outcomes in patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC).

Major finding: In patients who were followed up for more than 60 months, increasing vs no nodal involvement (pN1-3 vs pN0; all hazard ratios [HR] >3; all P ≤ .001) and a tumor size of pT4 vs pT1 (HR 4.528; P = .007) were associated with poor BCSS outcomes.

Study details: This study used data from a registry to analyze 20,672 patients with HER2+ stage I-III BC who underwent surgery.

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

Source: Kang YJ et al. Predictive biological factors for late survival in patients with HER2-positive breast cancer. Sci Rep. 2023;13:11008 (Jul 7). Doi: 10.1038/s41598-023-38200-y

Key clinical point:Although the cumulative incidence of myeloid neoplasms, such as myelodysplastic syndromes (MDS) and acute myeloid leukemias (AML), was low in breast cancer (BC) survivors, the receipt of anthracycline-based adjuvant therapy was associated with a long-term risk for both AML and MDS.

Major finding: The 10-year cumulative incidences of both AML and MDS were very low (~0.2%) in the anthracycline group and <0.2% in the chemotherapy without anthracycline and no chemotherapy groups. However, the risk for AML (hazard ratio [HR] 9.531;  95% CI 4.156-21.861) and MDS (HR 2.559;  95% CI 1.600-4.095) was significantly higher in the anthracycline group vs no chemotherapy group.

Study details: Findings are from a retrospective cohort study including 153,565 patients with BC who underwent surgery and received adjuvant treatment with anthracyclines (n = 79,321), chemotherapy without anthracyclines (n = 15,475), or no chemotherapy (n = 46,657).

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

Source: Lee JW et al. Therapy related myeloid neoplasm in early breast cancer patients treated with adjuvant chemotherapy. Eur J Cancer. 2023;191:112952 (Jun 22). Doi: 10.1016/j.ejca.2023.112952

Key clinical point:Although the cumulative incidence of myeloid neoplasms, such as myelodysplastic syndromes (MDS) and acute myeloid leukemias (AML), was low in breast cancer (BC) survivors, the receipt of anthracycline-based adjuvant therapy was associated with a long-term risk for both AML and MDS.

Major finding: The 10-year cumulative incidences of both AML and MDS were very low (~0.2%) in the anthracycline group and <0.2% in the chemotherapy without anthracycline and no chemotherapy groups. However, the risk for AML (hazard ratio [HR] 9.531;  95% CI 4.156-21.861) and MDS (HR 2.559;  95% CI 1.600-4.095) was significantly higher in the anthracycline group vs no chemotherapy group.

Study details: Findings are from a retrospective cohort study including 153,565 patients with BC who underwent surgery and received adjuvant treatment with anthracyclines (n = 79,321), chemotherapy without anthracyclines (n = 15,475), or no chemotherapy (n = 46,657).

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

Source: Lee JW et al. Therapy related myeloid neoplasm in early breast cancer patients treated with adjuvant chemotherapy. Eur J Cancer. 2023;191:112952 (Jun 22). Doi: 10.1016/j.ejca.2023.112952

Key clinical point:Although the cumulative incidence of myeloid neoplasms, such as myelodysplastic syndromes (MDS) and acute myeloid leukemias (AML), was low in breast cancer (BC) survivors, the receipt of anthracycline-based adjuvant therapy was associated with a long-term risk for both AML and MDS.

Major finding: The 10-year cumulative incidences of both AML and MDS were very low (~0.2%) in the anthracycline group and <0.2% in the chemotherapy without anthracycline and no chemotherapy groups. However, the risk for AML (hazard ratio [HR] 9.531;  95% CI 4.156-21.861) and MDS (HR 2.559;  95% CI 1.600-4.095) was significantly higher in the anthracycline group vs no chemotherapy group.

Study details: Findings are from a retrospective cohort study including 153,565 patients with BC who underwent surgery and received adjuvant treatment with anthracyclines (n = 79,321), chemotherapy without anthracyclines (n = 15,475), or no chemotherapy (n = 46,657).

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

Source: Lee JW et al. Therapy related myeloid neoplasm in early breast cancer patients treated with adjuvant chemotherapy. Eur J Cancer. 2023;191:112952 (Jun 22). Doi: 10.1016/j.ejca.2023.112952

Key clinical point: Patients with germline (g) BRCA1/2-associated primary breast cancer (BC), particularly those with gBRCA2 pathogenic mutations, faced a moderately increased risk of developing contralateral breast cancer (CBC) after receiving adjuvant radiotherapy.

Major finding: The risk for invasive and in situ CBC increased by 44% in patients with gBRCA1/2 mutations who did vs did not receive radiotherapy (adjusted hazard ratio [HR] 1.44;  95% CI 1.12-1.86), with the risk being even more prominent in gBRCA2 pathogenic variant carriers (adjusted HR 1.77;  95% CI 1.13-2.77).

Study details: Findings are from an analysis including 3602 patients with gBRCA1/2-associated primary BC from the prospective international BRCA1/2 Carrier Cohort Study, of whom 64% of patients received adjuvant radiotherapy.

Disclosures: This study did not receive any specific external funding. DG Evans reported ties with AstraZeneca and AmGen, K Kast declared ties with Roche Pharma AG, and J Simard declared holding patents related to BRCA1 and BRCA2.

Source: van Barele M et al. Contralateral breast cancer risk in irradiated breast cancer patients with a germline-BRCA1/2 pathogenic variant. J Natl Cancer Inst. 2023 (Jun 27). Doi: 10.1093/jnci/djad116

Key clinical point: Patients with germline (g) BRCA1/2-associated primary breast cancer (BC), particularly those with gBRCA2 pathogenic mutations, faced a moderately increased risk of developing contralateral breast cancer (CBC) after receiving adjuvant radiotherapy.

Major finding: The risk for invasive and in situ CBC increased by 44% in patients with gBRCA1/2 mutations who did vs did not receive radiotherapy (adjusted hazard ratio [HR] 1.44;  95% CI 1.12-1.86), with the risk being even more prominent in gBRCA2 pathogenic variant carriers (adjusted HR 1.77;  95% CI 1.13-2.77).

Study details: Findings are from an analysis including 3602 patients with gBRCA1/2-associated primary BC from the prospective international BRCA1/2 Carrier Cohort Study, of whom 64% of patients received adjuvant radiotherapy.

Disclosures: This study did not receive any specific external funding. DG Evans reported ties with AstraZeneca and AmGen, K Kast declared ties with Roche Pharma AG, and J Simard declared holding patents related to BRCA1 and BRCA2.

Source: van Barele M et al. Contralateral breast cancer risk in irradiated breast cancer patients with a germline-BRCA1/2 pathogenic variant. J Natl Cancer Inst. 2023 (Jun 27). Doi: 10.1093/jnci/djad116

Key clinical point: Patients with germline (g) BRCA1/2-associated primary breast cancer (BC), particularly those with gBRCA2 pathogenic mutations, faced a moderately increased risk of developing contralateral breast cancer (CBC) after receiving adjuvant radiotherapy.

Major finding: The risk for invasive and in situ CBC increased by 44% in patients with gBRCA1/2 mutations who did vs did not receive radiotherapy (adjusted hazard ratio [HR] 1.44;  95% CI 1.12-1.86), with the risk being even more prominent in gBRCA2 pathogenic variant carriers (adjusted HR 1.77;  95% CI 1.13-2.77).

Study details: Findings are from an analysis including 3602 patients with gBRCA1/2-associated primary BC from the prospective international BRCA1/2 Carrier Cohort Study, of whom 64% of patients received adjuvant radiotherapy.

Disclosures: This study did not receive any specific external funding. DG Evans reported ties with AstraZeneca and AmGen, K Kast declared ties with Roche Pharma AG, and J Simard declared holding patents related to BRCA1 and BRCA2.

Source: van Barele M et al. Contralateral breast cancer risk in irradiated breast cancer patients with a germline-BRCA1/2 pathogenic variant. J Natl Cancer Inst. 2023 (Jun 27). Doi: 10.1093/jnci/djad116

Key clinical point: Patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (ERBB2−, aka HER2-) breast cancer (BC) experienced very low locoregional recurrence (LRR) events and comparable invasive disease-free survival (iDFS) outcomes both with and without receiving regional nodal irradiation (RNI) after surgery.

Major finding: The cumulative incidence of LRR at 5 years was low among patients who underwent breast-conserving surgery and radiotherapy with RNI (0.85%), breast-conserving surgery and radiotherapy without RNI (0.55%), mastectomy followed by radiotherapy (0.11%), or mastectomy without radiotherapy (1.7%). Receiving RNI was not associated with better iDFS outcomes (P > .1 for both pre- and postmenopausal women).

Study details: Findings are from the secondary analysis of the SWOG S1007 trial including 4871 women with HR+/ERBB2− node-positive BC, of whom 2274 women received RNI.

Disclosures: This study was supported by the US National Institutes of Health (NIH) and other sources. Some authors declared serving as consultants or receiving grants and personal fees from various sources, including NIH.

Source: Jagsi R et al. Radiotherapy use and incidence of locoregional recurrence in patients with favorable-risk, node-positive breast cancer enrolled in the SWOG S1007 trial. JAMA Oncol. 2023 (Jul 6). Doi: 10.1001/jamaoncol.2023.1984

Key clinical point: Patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (ERBB2−, aka HER2-) breast cancer (BC) experienced very low locoregional recurrence (LRR) events and comparable invasive disease-free survival (iDFS) outcomes both with and without receiving regional nodal irradiation (RNI) after surgery.

Major finding: The cumulative incidence of LRR at 5 years was low among patients who underwent breast-conserving surgery and radiotherapy with RNI (0.85%), breast-conserving surgery and radiotherapy without RNI (0.55%), mastectomy followed by radiotherapy (0.11%), or mastectomy without radiotherapy (1.7%). Receiving RNI was not associated with better iDFS outcomes (P > .1 for both pre- and postmenopausal women).

Study details: Findings are from the secondary analysis of the SWOG S1007 trial including 4871 women with HR+/ERBB2− node-positive BC, of whom 2274 women received RNI.

Disclosures: This study was supported by the US National Institutes of Health (NIH) and other sources. Some authors declared serving as consultants or receiving grants and personal fees from various sources, including NIH.

Source: Jagsi R et al. Radiotherapy use and incidence of locoregional recurrence in patients with favorable-risk, node-positive breast cancer enrolled in the SWOG S1007 trial. JAMA Oncol. 2023 (Jul 6). Doi: 10.1001/jamaoncol.2023.1984

Key clinical point: Patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (ERBB2−, aka HER2-) breast cancer (BC) experienced very low locoregional recurrence (LRR) events and comparable invasive disease-free survival (iDFS) outcomes both with and without receiving regional nodal irradiation (RNI) after surgery.

Major finding: The cumulative incidence of LRR at 5 years was low among patients who underwent breast-conserving surgery and radiotherapy with RNI (0.85%), breast-conserving surgery and radiotherapy without RNI (0.55%), mastectomy followed by radiotherapy (0.11%), or mastectomy without radiotherapy (1.7%). Receiving RNI was not associated with better iDFS outcomes (P > .1 for both pre- and postmenopausal women).

Study details: Findings are from the secondary analysis of the SWOG S1007 trial including 4871 women with HR+/ERBB2− node-positive BC, of whom 2274 women received RNI.

Disclosures: This study was supported by the US National Institutes of Health (NIH) and other sources. Some authors declared serving as consultants or receiving grants and personal fees from various sources, including NIH.

Source: Jagsi R et al. Radiotherapy use and incidence of locoregional recurrence in patients with favorable-risk, node-positive breast cancer enrolled in the SWOG S1007 trial. JAMA Oncol. 2023 (Jul 6). Doi: 10.1001/jamaoncol.2023.1984

A recent update to the U.S. recommendations for breast cancer screening is raising concerns about the costs associated with potential follow-up tests, while also renewing debates about the timing of these tests and the screening approaches used.
 

The U.S. Preventive Services Task Force is currently finalizing an update to its recommendations on breast cancer screening. In May, the task force released a proposed update that dropped the initial age for routine mammogram screening from 50 to 40.

The task force intends to give a “B” rating to this recommendation, which covers screening every other year up to age 74 for women deemed average risk for breast cancer.

The task force’s rating carries clout, A. Mark Fendrick, MD, director of the Value-Based Insurance Design at the University of Michigan, Ann Arbor, said in an interview.

For one, the Affordable Care Act requires that private insurers cover services that get top A or B marks from USPSTF without charging copays.

However, Dr. Fendrick noted, such coverage does not necessarily apply to follow-up testing when a routine mammogram comes back with a positive finding. The expense of follow-up testing may deter some women from seeking follow-up diagnostic imaging or biopsies after an abnormal result on a screening mammogram.

A recent analysis in JAMA Network Open found that women facing higher anticipated out-of-pocket costs for breast cancer diagnostic tests, based on their health insurance plan, were less likely to get that follow-up screening. For instance, the use of breast MRI decreased by nearly 24% between patients undergoing subsequent diagnostic testing in plans with the lowest out-of-pocket costs vs. those with the highest.

“The study’s central finding that some women who have an abnormal result on a mammogram may not get appropriate follow-up because of cost is worrisome,” said Dr. Fendrick and Ilana B. Richman, MD, MHS, in an accompanying commentary to the JAMA analysis. “On an individual level, high out-of-pocket costs may directly contribute to worse health outcomes or require individuals to use scarce financial resources that may otherwise be used for critical items such as food or rent.”

For patients to fully benefit from early detection, the USPSTF would also need to make clear that follow-up diagnostic mammograms are covered, Dr. Fendrick said.
 

The ongoing debates

Concerns over the costs of potential follow-up tests are not the only issues experts have highlighted since USPSTF released its updated draft guidance on screening mammography.

The task force’s proposed update has also reignited questions and uncertainties surrounding when to screen, how often, and what types are best.

When it comes to frequency, the major organizations that provide screening guidance don’t see eye to eye. The USPSTF recommends breast cancer screening every other year, while the American College of Radiology recommends screening every year because that approach leads to saves “the most lives.”

At this time, the American College of Obstetricians and Gynecologists guidance currently teeters in the middle, suggesting either annual or biennial screening and highlighting the pros and cons of either approach. According to ACOG, “annual screening intervals appear to result in the least number of breast cancer deaths, particularly in younger women, but at the cost of additional callbacks and biopsies.”

When to begin screening represents another point of contention. While some experts, such as ACOG, agree with the task force’s decision to lower the screening start age to 40, others point to the need for greater nuance on setting the appropriate screening age. The main issue: the task force’s draft sets a uniform age to begin screening, but the risk for breast cancer and breast cancer mortality is not uniform across different racial and ethnic groups.

A recent study published in JAMA Network Open found that, among women aged 40-49, breast cancer mortality was highest among Black women (27 deaths per 100,000 person-years) followed by White women (15 deaths per 100,000 person-years). Based on a recommended screening age of 50, the authors suggested that Black women should start screening at age 42, whereas White women could start at 51.

“These findings suggest that health policy makers and clinicians could consider an alternative, race and ethnicity–adapted approach in which Black female patients start screening earlier,” writes Tianhui Chen, PhD, of China’s Zhejiang Cancer Hospital and coauthor of the study.

Weighing in on the guidance, the nonprofit National Center for Health Research urged the task force to consider suggesting different screening schedules based on race and ethnicity data. That would mean the recommendation to start at age 40 should only apply to Black women and other groups with higher-than-average risk for breast cancer at a younger age.

“Women are capable of understanding why the age to start mammography screening may be different for women with different risk factors,” the National Center for Health Research wrote in a comment to USPSTF, provided to this news organization by request. “What is confusing is when some physician groups recommend annual mammograms for all women starting at age 40, even though the data do not support that recommendation.”

While the ACR agreed with the task force’s recommendation to lower the screening age, the organization suggested starting risk assessments based on racial variations in breast cancer incidence and death even earlier. Specifically, the ACR recommended that high-risk groups, such as Black women, get risk assessments by age 25 to determine whether mammography before age 40 is needed.

Screening options for women with dense breasts may be some of the most challenging to weigh. Having dense breasts increases an individual’s risk for breast cancer, and mammography alone is not as effective at identifying breast cancer among these women. However, the evidence on the benefits vs. harms of additional screening beyond mammography remains mixed.

As a result, the task force decided to maintain its “I” grade on additional screening beyond mammography for these women – a grade that indicates insufficient evidence to determine the benefits and harms for a service.

The task force largely based its decision on the findings of two key reports. One report from the Cancer Intervention and Surveillance Modeling Network, which modeled potential outcomes of different screening strategies, indicated that extra screening might reduce breast cancer mortality in those with dense breasts, but at a cost of more false-positive reports.

The second report, a review from the Kaiser Permanente Evidence-based Practice Center, reaffirmed the benefits of routine mammography for reducing deaths from breast cancer, but found no solid evidence that different strategies – including supplemental screening in women with denser breasts – lowered breast cancer mortality or the risk of progression to advanced cancer. Further studies may show which approaches work best to reduce breast cancer deaths, the report said.

In this instance, ACOG agreed with USPSTF: “Based on the lack of data, ACOG does not recommend routine use of alternative or adjunctive tests to screening mammography in women with dense breasts who are asymptomatic and have no additional risk factors.”

Women with dense breasts should still be encouraged to receive regular screening mammography, even if the results they get may not be as accurate as those for women with less dense breasts, said Diana L. Miglioretti, PhD, of the University of California, Davis, who worked on a report for the USPSTF guidelines.
 

What’s next?

Despite ongoing debate and uncertainties surrounding some breast screening guidance, support for ending copay requirements for follow-up tests after a positive mammogram finding is widespread.

According to Dr. Fendrick, the USPSTF should expand coverage of follow-up testing after a positive mammogram to ensure people receive routine screening and any necessary diagnostic tests, as it did with colon cancer.

Before 2021, patients could face high costs for a colonoscopy following a positive stool-based Cologuard test. But in 2021, the USPSTF said that positive results on stool-based tests would require follow-up with colonoscopy, defining this follow-up as part of the screening benefit. In 2022, Medicare followed by setting a policy that ended the copay for these follow-up colonoscopies.

For breast screening, there are efforts underway in Congress to end copays for breast screening. In May, Rep. Rosa DeLauro (D-Conn.) introduced a bill, the Find It Early Act, that would require both private and government insurers to cover the out-of-pocket costs for many women receiving screening with ultrasound and MRI.

When the USPSTF finalizes its breast screening guidelines, the recommendations will be woven into discussions between primary care physicians and patients about breast cancer screening.

As guidelines and evidence evolve, “we’re learning to adjust” and communicate these changes to patients, said Tochi Iroku-Malize, MD, president of the American Academy of Family Physicians.

However, gaps in the guidance will leave some open-ended questions about optimal screening practices and how much screening may cost.

Given that, Dr. Iroku-Malize takes many factors into account when discussing screening options with her patients. Based on the new information and the patient’s information, she said she will tell her patients, “We’re going to adjust our guidance as to what you need.”

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

A recent update to the U.S. recommendations for breast cancer screening is raising concerns about the costs associated with potential follow-up tests, while also renewing debates about the timing of these tests and the screening approaches used.
 

The U.S. Preventive Services Task Force is currently finalizing an update to its recommendations on breast cancer screening. In May, the task force released a proposed update that dropped the initial age for routine mammogram screening from 50 to 40.

The task force intends to give a “B” rating to this recommendation, which covers screening every other year up to age 74 for women deemed average risk for breast cancer.

The task force’s rating carries clout, A. Mark Fendrick, MD, director of the Value-Based Insurance Design at the University of Michigan, Ann Arbor, said in an interview.

For one, the Affordable Care Act requires that private insurers cover services that get top A or B marks from USPSTF without charging copays.

However, Dr. Fendrick noted, such coverage does not necessarily apply to follow-up testing when a routine mammogram comes back with a positive finding. The expense of follow-up testing may deter some women from seeking follow-up diagnostic imaging or biopsies after an abnormal result on a screening mammogram.

A recent analysis in JAMA Network Open found that women facing higher anticipated out-of-pocket costs for breast cancer diagnostic tests, based on their health insurance plan, were less likely to get that follow-up screening. For instance, the use of breast MRI decreased by nearly 24% between patients undergoing subsequent diagnostic testing in plans with the lowest out-of-pocket costs vs. those with the highest.

“The study’s central finding that some women who have an abnormal result on a mammogram may not get appropriate follow-up because of cost is worrisome,” said Dr. Fendrick and Ilana B. Richman, MD, MHS, in an accompanying commentary to the JAMA analysis. “On an individual level, high out-of-pocket costs may directly contribute to worse health outcomes or require individuals to use scarce financial resources that may otherwise be used for critical items such as food or rent.”

For patients to fully benefit from early detection, the USPSTF would also need to make clear that follow-up diagnostic mammograms are covered, Dr. Fendrick said.
 

The ongoing debates

Concerns over the costs of potential follow-up tests are not the only issues experts have highlighted since USPSTF released its updated draft guidance on screening mammography.

The task force’s proposed update has also reignited questions and uncertainties surrounding when to screen, how often, and what types are best.

When it comes to frequency, the major organizations that provide screening guidance don’t see eye to eye. The USPSTF recommends breast cancer screening every other year, while the American College of Radiology recommends screening every year because that approach leads to saves “the most lives.”

At this time, the American College of Obstetricians and Gynecologists guidance currently teeters in the middle, suggesting either annual or biennial screening and highlighting the pros and cons of either approach. According to ACOG, “annual screening intervals appear to result in the least number of breast cancer deaths, particularly in younger women, but at the cost of additional callbacks and biopsies.”

When to begin screening represents another point of contention. While some experts, such as ACOG, agree with the task force’s decision to lower the screening start age to 40, others point to the need for greater nuance on setting the appropriate screening age. The main issue: the task force’s draft sets a uniform age to begin screening, but the risk for breast cancer and breast cancer mortality is not uniform across different racial and ethnic groups.

A recent study published in JAMA Network Open found that, among women aged 40-49, breast cancer mortality was highest among Black women (27 deaths per 100,000 person-years) followed by White women (15 deaths per 100,000 person-years). Based on a recommended screening age of 50, the authors suggested that Black women should start screening at age 42, whereas White women could start at 51.

“These findings suggest that health policy makers and clinicians could consider an alternative, race and ethnicity–adapted approach in which Black female patients start screening earlier,” writes Tianhui Chen, PhD, of China’s Zhejiang Cancer Hospital and coauthor of the study.

Weighing in on the guidance, the nonprofit National Center for Health Research urged the task force to consider suggesting different screening schedules based on race and ethnicity data. That would mean the recommendation to start at age 40 should only apply to Black women and other groups with higher-than-average risk for breast cancer at a younger age.

“Women are capable of understanding why the age to start mammography screening may be different for women with different risk factors,” the National Center for Health Research wrote in a comment to USPSTF, provided to this news organization by request. “What is confusing is when some physician groups recommend annual mammograms for all women starting at age 40, even though the data do not support that recommendation.”

While the ACR agreed with the task force’s recommendation to lower the screening age, the organization suggested starting risk assessments based on racial variations in breast cancer incidence and death even earlier. Specifically, the ACR recommended that high-risk groups, such as Black women, get risk assessments by age 25 to determine whether mammography before age 40 is needed.

Screening options for women with dense breasts may be some of the most challenging to weigh. Having dense breasts increases an individual’s risk for breast cancer, and mammography alone is not as effective at identifying breast cancer among these women. However, the evidence on the benefits vs. harms of additional screening beyond mammography remains mixed.

As a result, the task force decided to maintain its “I” grade on additional screening beyond mammography for these women – a grade that indicates insufficient evidence to determine the benefits and harms for a service.

The task force largely based its decision on the findings of two key reports. One report from the Cancer Intervention and Surveillance Modeling Network, which modeled potential outcomes of different screening strategies, indicated that extra screening might reduce breast cancer mortality in those with dense breasts, but at a cost of more false-positive reports.

The second report, a review from the Kaiser Permanente Evidence-based Practice Center, reaffirmed the benefits of routine mammography for reducing deaths from breast cancer, but found no solid evidence that different strategies – including supplemental screening in women with denser breasts – lowered breast cancer mortality or the risk of progression to advanced cancer. Further studies may show which approaches work best to reduce breast cancer deaths, the report said.

In this instance, ACOG agreed with USPSTF: “Based on the lack of data, ACOG does not recommend routine use of alternative or adjunctive tests to screening mammography in women with dense breasts who are asymptomatic and have no additional risk factors.”

Women with dense breasts should still be encouraged to receive regular screening mammography, even if the results they get may not be as accurate as those for women with less dense breasts, said Diana L. Miglioretti, PhD, of the University of California, Davis, who worked on a report for the USPSTF guidelines.
 

What’s next?

Despite ongoing debate and uncertainties surrounding some breast screening guidance, support for ending copay requirements for follow-up tests after a positive mammogram finding is widespread.

According to Dr. Fendrick, the USPSTF should expand coverage of follow-up testing after a positive mammogram to ensure people receive routine screening and any necessary diagnostic tests, as it did with colon cancer.

Before 2021, patients could face high costs for a colonoscopy following a positive stool-based Cologuard test. But in 2021, the USPSTF said that positive results on stool-based tests would require follow-up with colonoscopy, defining this follow-up as part of the screening benefit. In 2022, Medicare followed by setting a policy that ended the copay for these follow-up colonoscopies.

For breast screening, there are efforts underway in Congress to end copays for breast screening. In May, Rep. Rosa DeLauro (D-Conn.) introduced a bill, the Find It Early Act, that would require both private and government insurers to cover the out-of-pocket costs for many women receiving screening with ultrasound and MRI.

When the USPSTF finalizes its breast screening guidelines, the recommendations will be woven into discussions between primary care physicians and patients about breast cancer screening.

As guidelines and evidence evolve, “we’re learning to adjust” and communicate these changes to patients, said Tochi Iroku-Malize, MD, president of the American Academy of Family Physicians.

However, gaps in the guidance will leave some open-ended questions about optimal screening practices and how much screening may cost.

Given that, Dr. Iroku-Malize takes many factors into account when discussing screening options with her patients. Based on the new information and the patient’s information, she said she will tell her patients, “We’re going to adjust our guidance as to what you need.”

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

A recent update to the U.S. recommendations for breast cancer screening is raising concerns about the costs associated with potential follow-up tests, while also renewing debates about the timing of these tests and the screening approaches used.
 

The U.S. Preventive Services Task Force is currently finalizing an update to its recommendations on breast cancer screening. In May, the task force released a proposed update that dropped the initial age for routine mammogram screening from 50 to 40.

The task force intends to give a “B” rating to this recommendation, which covers screening every other year up to age 74 for women deemed average risk for breast cancer.

The task force’s rating carries clout, A. Mark Fendrick, MD, director of the Value-Based Insurance Design at the University of Michigan, Ann Arbor, said in an interview.

For one, the Affordable Care Act requires that private insurers cover services that get top A or B marks from USPSTF without charging copays.

However, Dr. Fendrick noted, such coverage does not necessarily apply to follow-up testing when a routine mammogram comes back with a positive finding. The expense of follow-up testing may deter some women from seeking follow-up diagnostic imaging or biopsies after an abnormal result on a screening mammogram.

A recent analysis in JAMA Network Open found that women facing higher anticipated out-of-pocket costs for breast cancer diagnostic tests, based on their health insurance plan, were less likely to get that follow-up screening. For instance, the use of breast MRI decreased by nearly 24% between patients undergoing subsequent diagnostic testing in plans with the lowest out-of-pocket costs vs. those with the highest.

“The study’s central finding that some women who have an abnormal result on a mammogram may not get appropriate follow-up because of cost is worrisome,” said Dr. Fendrick and Ilana B. Richman, MD, MHS, in an accompanying commentary to the JAMA analysis. “On an individual level, high out-of-pocket costs may directly contribute to worse health outcomes or require individuals to use scarce financial resources that may otherwise be used for critical items such as food or rent.”

For patients to fully benefit from early detection, the USPSTF would also need to make clear that follow-up diagnostic mammograms are covered, Dr. Fendrick said.
 

The ongoing debates

Concerns over the costs of potential follow-up tests are not the only issues experts have highlighted since USPSTF released its updated draft guidance on screening mammography.

The task force’s proposed update has also reignited questions and uncertainties surrounding when to screen, how often, and what types are best.

When it comes to frequency, the major organizations that provide screening guidance don’t see eye to eye. The USPSTF recommends breast cancer screening every other year, while the American College of Radiology recommends screening every year because that approach leads to saves “the most lives.”

At this time, the American College of Obstetricians and Gynecologists guidance currently teeters in the middle, suggesting either annual or biennial screening and highlighting the pros and cons of either approach. According to ACOG, “annual screening intervals appear to result in the least number of breast cancer deaths, particularly in younger women, but at the cost of additional callbacks and biopsies.”

When to begin screening represents another point of contention. While some experts, such as ACOG, agree with the task force’s decision to lower the screening start age to 40, others point to the need for greater nuance on setting the appropriate screening age. The main issue: the task force’s draft sets a uniform age to begin screening, but the risk for breast cancer and breast cancer mortality is not uniform across different racial and ethnic groups.

A recent study published in JAMA Network Open found that, among women aged 40-49, breast cancer mortality was highest among Black women (27 deaths per 100,000 person-years) followed by White women (15 deaths per 100,000 person-years). Based on a recommended screening age of 50, the authors suggested that Black women should start screening at age 42, whereas White women could start at 51.

“These findings suggest that health policy makers and clinicians could consider an alternative, race and ethnicity–adapted approach in which Black female patients start screening earlier,” writes Tianhui Chen, PhD, of China’s Zhejiang Cancer Hospital and coauthor of the study.

Weighing in on the guidance, the nonprofit National Center for Health Research urged the task force to consider suggesting different screening schedules based on race and ethnicity data. That would mean the recommendation to start at age 40 should only apply to Black women and other groups with higher-than-average risk for breast cancer at a younger age.

“Women are capable of understanding why the age to start mammography screening may be different for women with different risk factors,” the National Center for Health Research wrote in a comment to USPSTF, provided to this news organization by request. “What is confusing is when some physician groups recommend annual mammograms for all women starting at age 40, even though the data do not support that recommendation.”

While the ACR agreed with the task force’s recommendation to lower the screening age, the organization suggested starting risk assessments based on racial variations in breast cancer incidence and death even earlier. Specifically, the ACR recommended that high-risk groups, such as Black women, get risk assessments by age 25 to determine whether mammography before age 40 is needed.

Screening options for women with dense breasts may be some of the most challenging to weigh. Having dense breasts increases an individual’s risk for breast cancer, and mammography alone is not as effective at identifying breast cancer among these women. However, the evidence on the benefits vs. harms of additional screening beyond mammography remains mixed.

As a result, the task force decided to maintain its “I” grade on additional screening beyond mammography for these women – a grade that indicates insufficient evidence to determine the benefits and harms for a service.

The task force largely based its decision on the findings of two key reports. One report from the Cancer Intervention and Surveillance Modeling Network, which modeled potential outcomes of different screening strategies, indicated that extra screening might reduce breast cancer mortality in those with dense breasts, but at a cost of more false-positive reports.

The second report, a review from the Kaiser Permanente Evidence-based Practice Center, reaffirmed the benefits of routine mammography for reducing deaths from breast cancer, but found no solid evidence that different strategies – including supplemental screening in women with denser breasts – lowered breast cancer mortality or the risk of progression to advanced cancer. Further studies may show which approaches work best to reduce breast cancer deaths, the report said.

In this instance, ACOG agreed with USPSTF: “Based on the lack of data, ACOG does not recommend routine use of alternative or adjunctive tests to screening mammography in women with dense breasts who are asymptomatic and have no additional risk factors.”

Women with dense breasts should still be encouraged to receive regular screening mammography, even if the results they get may not be as accurate as those for women with less dense breasts, said Diana L. Miglioretti, PhD, of the University of California, Davis, who worked on a report for the USPSTF guidelines.
 

What’s next?

Despite ongoing debate and uncertainties surrounding some breast screening guidance, support for ending copay requirements for follow-up tests after a positive mammogram finding is widespread.

According to Dr. Fendrick, the USPSTF should expand coverage of follow-up testing after a positive mammogram to ensure people receive routine screening and any necessary diagnostic tests, as it did with colon cancer.

Before 2021, patients could face high costs for a colonoscopy following a positive stool-based Cologuard test. But in 2021, the USPSTF said that positive results on stool-based tests would require follow-up with colonoscopy, defining this follow-up as part of the screening benefit. In 2022, Medicare followed by setting a policy that ended the copay for these follow-up colonoscopies.

For breast screening, there are efforts underway in Congress to end copays for breast screening. In May, Rep. Rosa DeLauro (D-Conn.) introduced a bill, the Find It Early Act, that would require both private and government insurers to cover the out-of-pocket costs for many women receiving screening with ultrasound and MRI.

When the USPSTF finalizes its breast screening guidelines, the recommendations will be woven into discussions between primary care physicians and patients about breast cancer screening.

As guidelines and evidence evolve, “we’re learning to adjust” and communicate these changes to patients, said Tochi Iroku-Malize, MD, president of the American Academy of Family Physicians.

However, gaps in the guidance will leave some open-ended questions about optimal screening practices and how much screening may cost.

Given that, Dr. Iroku-Malize takes many factors into account when discussing screening options with her patients. Based on the new information and the patient’s information, she said she will tell her patients, “We’re going to adjust our guidance as to what you need.”

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