Breast Cancer

Key clinical point: A chemotherapy-free combination of pyrotinib, letrozole, and dalpiciclib demonstrated promising antitumor activity and an acceptable safety profile in the neoadjuvant setting in patients with triple-positive breast cancer (TPBC).

Major finding: After 5 cycles of the 4-week treatment, a substantial proportion (30.4%) of patients achieved pathological complete response in both the breast and lymph nodes. The most common adverse events were neutropenia (93%), leukopenia (90%), diarrhea (86%), anemia (68%), and oral mucositis (63%).

Study details: Findings are from the phase 2, MUKDEN 01 trial including 81 patients with stage II-III TPBC who were assigned to receive neoadjuvant treatment with pyrotinib+letrozole+dalpiciclib.

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

Source: Niu N et al. A multicentre single arm phase 2 trial of neoadjuvant pyrotinib and letrozole plus dalpiciclib for triple-positive breast cancer. Nat Commun. 2022;13:7043 (Nov 17). Doi: 10.1038/s41467-022-34838-w

Key clinical point: A chemotherapy-free combination of pyrotinib, letrozole, and dalpiciclib demonstrated promising antitumor activity and an acceptable safety profile in the neoadjuvant setting in patients with triple-positive breast cancer (TPBC).

Major finding: After 5 cycles of the 4-week treatment, a substantial proportion (30.4%) of patients achieved pathological complete response in both the breast and lymph nodes. The most common adverse events were neutropenia (93%), leukopenia (90%), diarrhea (86%), anemia (68%), and oral mucositis (63%).

Study details: Findings are from the phase 2, MUKDEN 01 trial including 81 patients with stage II-III TPBC who were assigned to receive neoadjuvant treatment with pyrotinib+letrozole+dalpiciclib.

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

Source: Niu N et al. A multicentre single arm phase 2 trial of neoadjuvant pyrotinib and letrozole plus dalpiciclib for triple-positive breast cancer. Nat Commun. 2022;13:7043 (Nov 17). Doi: 10.1038/s41467-022-34838-w

Key clinical point: A chemotherapy-free combination of pyrotinib, letrozole, and dalpiciclib demonstrated promising antitumor activity and an acceptable safety profile in the neoadjuvant setting in patients with triple-positive breast cancer (TPBC).

Major finding: After 5 cycles of the 4-week treatment, a substantial proportion (30.4%) of patients achieved pathological complete response in both the breast and lymph nodes. The most common adverse events were neutropenia (93%), leukopenia (90%), diarrhea (86%), anemia (68%), and oral mucositis (63%).

Study details: Findings are from the phase 2, MUKDEN 01 trial including 81 patients with stage II-III TPBC who were assigned to receive neoadjuvant treatment with pyrotinib+letrozole+dalpiciclib.

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

Source: Niu N et al. A multicentre single arm phase 2 trial of neoadjuvant pyrotinib and letrozole plus dalpiciclib for triple-positive breast cancer. Nat Commun. 2022;13:7043 (Nov 17). Doi: 10.1038/s41467-022-34838-w

Key clinical point: In patients with early-stage breast cancer (BC), a 12-week true acupuncture (TA) treatment was more effective than sham acupuncture (SA) or no acupuncture (waiting list control; WC) treatment in reducing aromatase inhibitor (AI)-related joint pain through 52 weeks.

Major finding: At week 52, the TA group reported a significantly higher improvement in the mean Brief Pain Inventory Worst Pain (BPI-WP) item score than the SA group (difference 1.08 points; P = .01) or the WC group (difference 0.99 points; P = .03).

Study details: Findings are from a multicenter trial including 226 postmenopausal women with stage I-III BC receiving a third-generation AI who had a BPI-WP item score of ≥3 and were randomly assigned to receive TA, SA, or WC.

Disclosures: This study was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health and other sources. Some authors declared being employees of or receiving payments and personal fees from several sources.

Source: Hershman DL et al. Comparison of acupuncture vs sham acupuncture or waiting list control in the treatment of aromatase inhibitor-related joint pain: A randomized clinical trial. JAMA Netw Open. 2022;5(11):e2241720 (Nov 11). Doi: 10.1001/jamanetworkopen.2022.41720

Key clinical point: In patients with early-stage breast cancer (BC), a 12-week true acupuncture (TA) treatment was more effective than sham acupuncture (SA) or no acupuncture (waiting list control; WC) treatment in reducing aromatase inhibitor (AI)-related joint pain through 52 weeks.

Major finding: At week 52, the TA group reported a significantly higher improvement in the mean Brief Pain Inventory Worst Pain (BPI-WP) item score than the SA group (difference 1.08 points; P = .01) or the WC group (difference 0.99 points; P = .03).

Study details: Findings are from a multicenter trial including 226 postmenopausal women with stage I-III BC receiving a third-generation AI who had a BPI-WP item score of ≥3 and were randomly assigned to receive TA, SA, or WC.

Disclosures: This study was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health and other sources. Some authors declared being employees of or receiving payments and personal fees from several sources.

Source: Hershman DL et al. Comparison of acupuncture vs sham acupuncture or waiting list control in the treatment of aromatase inhibitor-related joint pain: A randomized clinical trial. JAMA Netw Open. 2022;5(11):e2241720 (Nov 11). Doi: 10.1001/jamanetworkopen.2022.41720

Key clinical point: In patients with early-stage breast cancer (BC), a 12-week true acupuncture (TA) treatment was more effective than sham acupuncture (SA) or no acupuncture (waiting list control; WC) treatment in reducing aromatase inhibitor (AI)-related joint pain through 52 weeks.

Major finding: At week 52, the TA group reported a significantly higher improvement in the mean Brief Pain Inventory Worst Pain (BPI-WP) item score than the SA group (difference 1.08 points; P = .01) or the WC group (difference 0.99 points; P = .03).

Study details: Findings are from a multicenter trial including 226 postmenopausal women with stage I-III BC receiving a third-generation AI who had a BPI-WP item score of ≥3 and were randomly assigned to receive TA, SA, or WC.

Disclosures: This study was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health and other sources. Some authors declared being employees of or receiving payments and personal fees from several sources.

Source: Hershman DL et al. Comparison of acupuncture vs sham acupuncture or waiting list control in the treatment of aromatase inhibitor-related joint pain: A randomized clinical trial. JAMA Netw Open. 2022;5(11):e2241720 (Nov 11). Doi: 10.1001/jamanetworkopen.2022.41720

Key clinical point: In patients with sentinel node (SN)-positive cT1-2 primary breast cancer (BC), both axillary radiotherapy (ART) and axillary lymph node dissection (ALND) led to similar recurrence rates, but the rate of lymphedema was lower with ART.

Major finding: The 10-year axillary recurrence rates were similar between the ALND and ART treatment groups (hazard ratio 1.71; 95% CI 0.67-4.39), with a lower proportion of patients reporting lymphedema in the ART vs  ALND group (28.6% vs  44.2%).

Study details: Findings are from the phase 3, AMAROS trial including 1425 patients with clinically node-negative cT1-2 primary BC and a positive SN who were randomly assigned to receive ALND or ART.

Disclosures: This trial was sponsored by the European Organization for Research and Treatment of Cancer. The authors declared serving in leadership, consulting, or advisory roles or receiving honoraria or travel, accommodation, and expenses from several sources.

Source: Bartels SAL, Donker M et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981-22023 AMAROS trial. J Clin Oncol. 2022 (Nov 16). Doi: 10.1200/JCO.22.01565

Key clinical point: In patients with sentinel node (SN)-positive cT1-2 primary breast cancer (BC), both axillary radiotherapy (ART) and axillary lymph node dissection (ALND) led to similar recurrence rates, but the rate of lymphedema was lower with ART.

Major finding: The 10-year axillary recurrence rates were similar between the ALND and ART treatment groups (hazard ratio 1.71; 95% CI 0.67-4.39), with a lower proportion of patients reporting lymphedema in the ART vs  ALND group (28.6% vs  44.2%).

Study details: Findings are from the phase 3, AMAROS trial including 1425 patients with clinically node-negative cT1-2 primary BC and a positive SN who were randomly assigned to receive ALND or ART.

Disclosures: This trial was sponsored by the European Organization for Research and Treatment of Cancer. The authors declared serving in leadership, consulting, or advisory roles or receiving honoraria or travel, accommodation, and expenses from several sources.

Source: Bartels SAL, Donker M et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981-22023 AMAROS trial. J Clin Oncol. 2022 (Nov 16). Doi: 10.1200/JCO.22.01565

Key clinical point: In patients with sentinel node (SN)-positive cT1-2 primary breast cancer (BC), both axillary radiotherapy (ART) and axillary lymph node dissection (ALND) led to similar recurrence rates, but the rate of lymphedema was lower with ART.

Major finding: The 10-year axillary recurrence rates were similar between the ALND and ART treatment groups (hazard ratio 1.71; 95% CI 0.67-4.39), with a lower proportion of patients reporting lymphedema in the ART vs  ALND group (28.6% vs  44.2%).

Study details: Findings are from the phase 3, AMAROS trial including 1425 patients with clinically node-negative cT1-2 primary BC and a positive SN who were randomly assigned to receive ALND or ART.

Disclosures: This trial was sponsored by the European Organization for Research and Treatment of Cancer. The authors declared serving in leadership, consulting, or advisory roles or receiving honoraria or travel, accommodation, and expenses from several sources.

Source: Bartels SAL, Donker M et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981-22023 AMAROS trial. J Clin Oncol. 2022 (Nov 16). Doi: 10.1200/JCO.22.01565

Key clinical point: In patients with sentinel node (SN)-positive cT1-2 primary breast cancer (BC), both axillary radiotherapy (ART) and axillary lymph node dissection (ALND) led to similar recurrence rates, but the rate of lymphedema was lower with ART.

Major finding: The 10-year axillary recurrence rates were similar between the ALND and ART treatment groups (hazard ratio 1.71; 95% CI 0.67-4.39), with a lower proportion of patients reporting lymphedema in the ART vs  ALND group (28.6% vs  44.2%).

Study details: Findings are from the phase 3, AMAROS trial including 1425 patients with clinically node-negative cT1-2 primary BC and a positive SN who were randomly assigned to receive ALND or ART.

Disclosures: This trial was sponsored by the European Organization for Research and Treatment of Cancer. The authors declared serving in leadership, consulting, or advisory roles or receiving honoraria or travel, accommodation, and expenses from several sources.

Source: Bartels SAL, Donker M et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981-22023 AMAROS trial. J Clin Oncol. 2022 (Nov 16). Doi: 10.1200/JCO.22.01565

Key clinical point: In patients with sentinel node (SN)-positive cT1-2 primary breast cancer (BC), both axillary radiotherapy (ART) and axillary lymph node dissection (ALND) led to similar recurrence rates, but the rate of lymphedema was lower with ART.

Major finding: The 10-year axillary recurrence rates were similar between the ALND and ART treatment groups (hazard ratio 1.71; 95% CI 0.67-4.39), with a lower proportion of patients reporting lymphedema in the ART vs  ALND group (28.6% vs  44.2%).

Study details: Findings are from the phase 3, AMAROS trial including 1425 patients with clinically node-negative cT1-2 primary BC and a positive SN who were randomly assigned to receive ALND or ART.

Disclosures: This trial was sponsored by the European Organization for Research and Treatment of Cancer. The authors declared serving in leadership, consulting, or advisory roles or receiving honoraria or travel, accommodation, and expenses from several sources.

Source: Bartels SAL, Donker M et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981-22023 AMAROS trial. J Clin Oncol. 2022 (Nov 16). Doi: 10.1200/JCO.22.01565

Key clinical point: In patients with sentinel node (SN)-positive cT1-2 primary breast cancer (BC), both axillary radiotherapy (ART) and axillary lymph node dissection (ALND) led to similar recurrence rates, but the rate of lymphedema was lower with ART.

Major finding: The 10-year axillary recurrence rates were similar between the ALND and ART treatment groups (hazard ratio 1.71; 95% CI 0.67-4.39), with a lower proportion of patients reporting lymphedema in the ART vs  ALND group (28.6% vs  44.2%).

Study details: Findings are from the phase 3, AMAROS trial including 1425 patients with clinically node-negative cT1-2 primary BC and a positive SN who were randomly assigned to receive ALND or ART.

Disclosures: This trial was sponsored by the European Organization for Research and Treatment of Cancer. The authors declared serving in leadership, consulting, or advisory roles or receiving honoraria or travel, accommodation, and expenses from several sources.

Source: Bartels SAL, Donker M et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981-22023 AMAROS trial. J Clin Oncol. 2022 (Nov 16). Doi: 10.1200/JCO.22.01565

Key clinical point: The relative risk for anaplastic large cell lymphoma (ALCL) was significantly increased in women who underwent implant reconstruction after mastectomy for breast cancer (BC) or ductal carcinoma in situ.

Major finding: The relative risk for ALCL (standardized incidence ratio [SIR] 40.9; 95% CI 13.3-95.5) and T-cell lymphoma (SIR 34.8; 95% CI 12.8-75.8) increased significantly after postmastectomy implant reconstruction.

Study details: This study evaluated 56,784 women with ductal carcinoma in situ of the breast (18%) or invasive BC (72%) from the Surveillance, Epidemiology, and End Results 17 database who had undergone postmastectomy implant reconstruction.

Disclosures: This study did not report a source of funding. The authors declared serving as consultants or receiving grants, royalties, licenses, or personal fees from several sources.

Source: Kinslow CJ et al. Risk of anaplastic large cell lymphoma following postmastectomy implant reconstruction in women with breast cancer and ductal carcinoma in situ. JAMA Netw Open. 2022;5(11):e2243396 (Nov 22). Doi: 10.1001/jamanetworkopen.2022.43396

Key clinical point: The relative risk for anaplastic large cell lymphoma (ALCL) was significantly increased in women who underwent implant reconstruction after mastectomy for breast cancer (BC) or ductal carcinoma in situ.

Major finding: The relative risk for ALCL (standardized incidence ratio [SIR] 40.9; 95% CI 13.3-95.5) and T-cell lymphoma (SIR 34.8; 95% CI 12.8-75.8) increased significantly after postmastectomy implant reconstruction.

Study details: This study evaluated 56,784 women with ductal carcinoma in situ of the breast (18%) or invasive BC (72%) from the Surveillance, Epidemiology, and End Results 17 database who had undergone postmastectomy implant reconstruction.

Disclosures: This study did not report a source of funding. The authors declared serving as consultants or receiving grants, royalties, licenses, or personal fees from several sources.

Source: Kinslow CJ et al. Risk of anaplastic large cell lymphoma following postmastectomy implant reconstruction in women with breast cancer and ductal carcinoma in situ. JAMA Netw Open. 2022;5(11):e2243396 (Nov 22). Doi: 10.1001/jamanetworkopen.2022.43396

Key clinical point: The relative risk for anaplastic large cell lymphoma (ALCL) was significantly increased in women who underwent implant reconstruction after mastectomy for breast cancer (BC) or ductal carcinoma in situ.

Major finding: The relative risk for ALCL (standardized incidence ratio [SIR] 40.9; 95% CI 13.3-95.5) and T-cell lymphoma (SIR 34.8; 95% CI 12.8-75.8) increased significantly after postmastectomy implant reconstruction.

Study details: This study evaluated 56,784 women with ductal carcinoma in situ of the breast (18%) or invasive BC (72%) from the Surveillance, Epidemiology, and End Results 17 database who had undergone postmastectomy implant reconstruction.

Disclosures: This study did not report a source of funding. The authors declared serving as consultants or receiving grants, royalties, licenses, or personal fees from several sources.

Source: Kinslow CJ et al. Risk of anaplastic large cell lymphoma following postmastectomy implant reconstruction in women with breast cancer and ductal carcinoma in situ. JAMA Netw Open. 2022;5(11):e2243396 (Nov 22). Doi: 10.1001/jamanetworkopen.2022.43396

Key clinical point: Adjuvant abemaciclib plus endocrine therapy (ET) reduced the risk for recurrence and demonstrated a favorable safety profile in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) early breast cancer (BC) at a high risk for recurrence.

Major finding: Abemaciclib+ET helped sustain the invasive disease-free survival benefit compared with only ET even at 42 months of median follow-up (hazard ratio 0.664; nominal P < .0001). Although the frequency of grade ≥3 adverse events was higher with abemaciclib+ET (49.9%) vs  ET alone (16.9%), it was considered manageable and acceptable for patients with high-risk early BC.

Study details: Findings are from the phase 3, monarchE trial including 5637 patients with HR+/HER2−, node-positive, early BC who were randomly assigned to receive adjuvant ET with or without abemaciclib.

Disclosures: This study was funded by Eli Lilly. Five authors declared being employees and shareholders of Eli Lilly, and the other authors reported ties with several sources, including Eli Lilly.

Source: Johnston SRD et al on behalf of the monarchE Committee Members. Abemaciclib plus endocrine therapy for hormone receptor-positive, HER2-negative, node-positive, high-risk early breast cancer (monarchE): Results from a preplanned interim analysis of a randomised, open-label, phase 3 trial. Lancet Oncol. 2022 (Dec 6). Doi: 10.1016/S1470-2045(22)00694-5

Key clinical point: Adjuvant abemaciclib plus endocrine therapy (ET) reduced the risk for recurrence and demonstrated a favorable safety profile in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) early breast cancer (BC) at a high risk for recurrence.

Major finding: Abemaciclib+ET helped sustain the invasive disease-free survival benefit compared with only ET even at 42 months of median follow-up (hazard ratio 0.664; nominal P < .0001). Although the frequency of grade ≥3 adverse events was higher with abemaciclib+ET (49.9%) vs  ET alone (16.9%), it was considered manageable and acceptable for patients with high-risk early BC.

Study details: Findings are from the phase 3, monarchE trial including 5637 patients with HR+/HER2−, node-positive, early BC who were randomly assigned to receive adjuvant ET with or without abemaciclib.

Disclosures: This study was funded by Eli Lilly. Five authors declared being employees and shareholders of Eli Lilly, and the other authors reported ties with several sources, including Eli Lilly.

Source: Johnston SRD et al on behalf of the monarchE Committee Members. Abemaciclib plus endocrine therapy for hormone receptor-positive, HER2-negative, node-positive, high-risk early breast cancer (monarchE): Results from a preplanned interim analysis of a randomised, open-label, phase 3 trial. Lancet Oncol. 2022 (Dec 6). Doi: 10.1016/S1470-2045(22)00694-5

Key clinical point: Adjuvant abemaciclib plus endocrine therapy (ET) reduced the risk for recurrence and demonstrated a favorable safety profile in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) early breast cancer (BC) at a high risk for recurrence.

Major finding: Abemaciclib+ET helped sustain the invasive disease-free survival benefit compared with only ET even at 42 months of median follow-up (hazard ratio 0.664; nominal P < .0001). Although the frequency of grade ≥3 adverse events was higher with abemaciclib+ET (49.9%) vs  ET alone (16.9%), it was considered manageable and acceptable for patients with high-risk early BC.

Study details: Findings are from the phase 3, monarchE trial including 5637 patients with HR+/HER2−, node-positive, early BC who were randomly assigned to receive adjuvant ET with or without abemaciclib.

Disclosures: This study was funded by Eli Lilly. Five authors declared being employees and shareholders of Eli Lilly, and the other authors reported ties with several sources, including Eli Lilly.

Source: Johnston SRD et al on behalf of the monarchE Committee Members. Abemaciclib plus endocrine therapy for hormone receptor-positive, HER2-negative, node-positive, high-risk early breast cancer (monarchE): Results from a preplanned interim analysis of a randomised, open-label, phase 3 trial. Lancet Oncol. 2022 (Dec 6). Doi: 10.1016/S1470-2045(22)00694-5

Key clinical point: In patients with high-risk early breast cancer (BC), a dose-dense adjuvant chemotherapy improved disease-free survival (DFS), whereas the addition of fluorouracil to the chemotherapy regimen failed to demonstrate any survival benefits.

Major finding: After a median follow-up of 15.1 years, the median DFS was similar with and without the addition of fluorouracil to the combination therapy of epirubicin, cyclophosphamide, and paclitaxel (EC-P; log-rank P = .11) and was significantly improved in the dose-dense vs  standard interval group (hazard ratio 0.77; P = .0004). The most common grade 3-4 adverse events were neutropenia and alopecia.

Study details: Findings are end of study results from the GIM2 trial including 2091 patients with node-positive early BC who were randomly assigned to receive standard-interval EC-P, standard-interval fluorouracil+EC-P (FEC-P), dose-dense EC-P, or dose-dense FEC-P.

Disclosures: This study was funded by Bristol-Myers Squibb, Pharmacia, Dompè Biotec Italy, Italian Ministry of Health, Fondazione Italiana per la Ricerca sul Cancro, and Alliance Against Cancer. The authors declared receiving fees, research grants, honoraria, or support for attending meetings or travel from several sources.

Source: Del Mastro L et al on behalf of the Gruppo Italiano Mammella Investigators. Fluorouracil and dose-dense adjuvant chemotherapy in patients with early-stage breast cancer (GIM2): End-of-study results from a randomised, phase 3 trial. Lancet Oncol. 2022;23(12):1571-1582 (Nov 9). Doi: 10.1016/S1470-2045(22)00632-5

Key clinical point: In patients with high-risk early breast cancer (BC), a dose-dense adjuvant chemotherapy improved disease-free survival (DFS), whereas the addition of fluorouracil to the chemotherapy regimen failed to demonstrate any survival benefits.

Major finding: After a median follow-up of 15.1 years, the median DFS was similar with and without the addition of fluorouracil to the combination therapy of epirubicin, cyclophosphamide, and paclitaxel (EC-P; log-rank P = .11) and was significantly improved in the dose-dense vs  standard interval group (hazard ratio 0.77; P = .0004). The most common grade 3-4 adverse events were neutropenia and alopecia.

Study details: Findings are end of study results from the GIM2 trial including 2091 patients with node-positive early BC who were randomly assigned to receive standard-interval EC-P, standard-interval fluorouracil+EC-P (FEC-P), dose-dense EC-P, or dose-dense FEC-P.

Disclosures: This study was funded by Bristol-Myers Squibb, Pharmacia, Dompè Biotec Italy, Italian Ministry of Health, Fondazione Italiana per la Ricerca sul Cancro, and Alliance Against Cancer. The authors declared receiving fees, research grants, honoraria, or support for attending meetings or travel from several sources.

Source: Del Mastro L et al on behalf of the Gruppo Italiano Mammella Investigators. Fluorouracil and dose-dense adjuvant chemotherapy in patients with early-stage breast cancer (GIM2): End-of-study results from a randomised, phase 3 trial. Lancet Oncol. 2022;23(12):1571-1582 (Nov 9). Doi: 10.1016/S1470-2045(22)00632-5

Key clinical point: In patients with high-risk early breast cancer (BC), a dose-dense adjuvant chemotherapy improved disease-free survival (DFS), whereas the addition of fluorouracil to the chemotherapy regimen failed to demonstrate any survival benefits.

Major finding: After a median follow-up of 15.1 years, the median DFS was similar with and without the addition of fluorouracil to the combination therapy of epirubicin, cyclophosphamide, and paclitaxel (EC-P; log-rank P = .11) and was significantly improved in the dose-dense vs  standard interval group (hazard ratio 0.77; P = .0004). The most common grade 3-4 adverse events were neutropenia and alopecia.

Study details: Findings are end of study results from the GIM2 trial including 2091 patients with node-positive early BC who were randomly assigned to receive standard-interval EC-P, standard-interval fluorouracil+EC-P (FEC-P), dose-dense EC-P, or dose-dense FEC-P.

Disclosures: This study was funded by Bristol-Myers Squibb, Pharmacia, Dompè Biotec Italy, Italian Ministry of Health, Fondazione Italiana per la Ricerca sul Cancro, and Alliance Against Cancer. The authors declared receiving fees, research grants, honoraria, or support for attending meetings or travel from several sources.

Source: Del Mastro L et al on behalf of the Gruppo Italiano Mammella Investigators. Fluorouracil and dose-dense adjuvant chemotherapy in patients with early-stage breast cancer (GIM2): End-of-study results from a randomised, phase 3 trial. Lancet Oncol. 2022;23(12):1571-1582 (Nov 9). Doi: 10.1016/S1470-2045(22)00632-5

Findings from the LymphVAX study recently presented at the San Antonio Breast Cancer Symposium show that relatively few women with breast cancer who are at risk for lymphedema develop lymph node swelling after receiving an mRNA COVID-19 vaccine.

Lymph node swelling can be a particularly troubling side effect, since it could be mistaken for breast cancer progression. In this study, of 621 women who received the first dose of an mRNA COVID-19 vaccine, 9.8% developed lymph node swelling as compared with 12.9% of 621 women who received the second dose, and 11.3% of 469 women who received the third dose. The findings were comparable to those of studies conducted of the general population, said study author Brooke C. Juhel, BS, a clinical research coordinator in the lymphedema research program at Massachusetts General Hospital and a student at Harvard Medical School, both in Boston. In the general population, 10.2% experienced lymph node swelling after the first dose and 14% after the second dose, according to the Centers for Disease Control and studies of the Pfizer and Moderna vaccines.

“This is consistent with the hypothesis that, after repeated vaccine doses, the immune system already has the antigens ready to fight the virus, thus the side effects may worsen as the immune response has increased,” she said. “Having screened over 6,500 women for breast cancer–related lymphedema, and with our patients reaching out with concerns about vaccine side effects, we were in a unique position to conduct this study.”

The study also confirmed that the most common side effects of receiving mRNA COVID-19 vaccines for women treated for breast cancer included injection site soreness, fatigue, muscle soreness, headache and chills lasting an average of 48 hours, which are symptoms comparable with those experienced by the general population.

“The side-effect profiles reported in this study for a cohort of women treated for breast cancer can be used to provide evidence-based patient education regarding future COVID-19 vaccine administration. The effect of the COVID-19 vaccines on breast cancer–related lymphedema risk is currently unknown and more research is required. In the interim, we would recommend vaccination away from the side of lymph node removal, either in the contralateral arm or in the thigh,” Ms. Juhel said.

The median duration of lymph node swelling was less than 1 week. In cases where lymph node swelling occurred after the first dose, 54.1% had swelling in ipsilateral axillary lymph nodes, and 45.9% in contralateral axillary lymph nodes. About 29.5% experienced swelling in ipsilateral supraclavicular lymph nodes, and 18.0% in contralateral supraclavicular lymph nodes.

Injection-site soreness, fatigue, GMS, headache, and chills occurred less often among older individuals (P < .001), and fatigue, muscle soreness, headache, and chills occurred more frequently after the second dose than the first (P < .001). The median duration of all side effects was 48 hours or less.

“The informed education that can be produced based on these results will hopefully ease the fears of women treated for breast cancer and empower them to make informed decisions regarding future vaccine doses,” Ms. Juhel said.

Ms. Juhel has no relevant financial disclosures.

Findings from the LymphVAX study recently presented at the San Antonio Breast Cancer Symposium show that relatively few women with breast cancer who are at risk for lymphedema develop lymph node swelling after receiving an mRNA COVID-19 vaccine.

Lymph node swelling can be a particularly troubling side effect, since it could be mistaken for breast cancer progression. In this study, of 621 women who received the first dose of an mRNA COVID-19 vaccine, 9.8% developed lymph node swelling as compared with 12.9% of 621 women who received the second dose, and 11.3% of 469 women who received the third dose. The findings were comparable to those of studies conducted of the general population, said study author Brooke C. Juhel, BS, a clinical research coordinator in the lymphedema research program at Massachusetts General Hospital and a student at Harvard Medical School, both in Boston. In the general population, 10.2% experienced lymph node swelling after the first dose and 14% after the second dose, according to the Centers for Disease Control and studies of the Pfizer and Moderna vaccines.

“This is consistent with the hypothesis that, after repeated vaccine doses, the immune system already has the antigens ready to fight the virus, thus the side effects may worsen as the immune response has increased,” she said. “Having screened over 6,500 women for breast cancer–related lymphedema, and with our patients reaching out with concerns about vaccine side effects, we were in a unique position to conduct this study.”

The study also confirmed that the most common side effects of receiving mRNA COVID-19 vaccines for women treated for breast cancer included injection site soreness, fatigue, muscle soreness, headache and chills lasting an average of 48 hours, which are symptoms comparable with those experienced by the general population.

“The side-effect profiles reported in this study for a cohort of women treated for breast cancer can be used to provide evidence-based patient education regarding future COVID-19 vaccine administration. The effect of the COVID-19 vaccines on breast cancer–related lymphedema risk is currently unknown and more research is required. In the interim, we would recommend vaccination away from the side of lymph node removal, either in the contralateral arm or in the thigh,” Ms. Juhel said.

The median duration of lymph node swelling was less than 1 week. In cases where lymph node swelling occurred after the first dose, 54.1% had swelling in ipsilateral axillary lymph nodes, and 45.9% in contralateral axillary lymph nodes. About 29.5% experienced swelling in ipsilateral supraclavicular lymph nodes, and 18.0% in contralateral supraclavicular lymph nodes.

Injection-site soreness, fatigue, GMS, headache, and chills occurred less often among older individuals (P < .001), and fatigue, muscle soreness, headache, and chills occurred more frequently after the second dose than the first (P < .001). The median duration of all side effects was 48 hours or less.

“The informed education that can be produced based on these results will hopefully ease the fears of women treated for breast cancer and empower them to make informed decisions regarding future vaccine doses,” Ms. Juhel said.

Ms. Juhel has no relevant financial disclosures.

Findings from the LymphVAX study recently presented at the San Antonio Breast Cancer Symposium show that relatively few women with breast cancer who are at risk for lymphedema develop lymph node swelling after receiving an mRNA COVID-19 vaccine.

Lymph node swelling can be a particularly troubling side effect, since it could be mistaken for breast cancer progression. In this study, of 621 women who received the first dose of an mRNA COVID-19 vaccine, 9.8% developed lymph node swelling as compared with 12.9% of 621 women who received the second dose, and 11.3% of 469 women who received the third dose. The findings were comparable to those of studies conducted of the general population, said study author Brooke C. Juhel, BS, a clinical research coordinator in the lymphedema research program at Massachusetts General Hospital and a student at Harvard Medical School, both in Boston. In the general population, 10.2% experienced lymph node swelling after the first dose and 14% after the second dose, according to the Centers for Disease Control and studies of the Pfizer and Moderna vaccines.

“This is consistent with the hypothesis that, after repeated vaccine doses, the immune system already has the antigens ready to fight the virus, thus the side effects may worsen as the immune response has increased,” she said. “Having screened over 6,500 women for breast cancer–related lymphedema, and with our patients reaching out with concerns about vaccine side effects, we were in a unique position to conduct this study.”

The study also confirmed that the most common side effects of receiving mRNA COVID-19 vaccines for women treated for breast cancer included injection site soreness, fatigue, muscle soreness, headache and chills lasting an average of 48 hours, which are symptoms comparable with those experienced by the general population.

“The side-effect profiles reported in this study for a cohort of women treated for breast cancer can be used to provide evidence-based patient education regarding future COVID-19 vaccine administration. The effect of the COVID-19 vaccines on breast cancer–related lymphedema risk is currently unknown and more research is required. In the interim, we would recommend vaccination away from the side of lymph node removal, either in the contralateral arm or in the thigh,” Ms. Juhel said.

The median duration of lymph node swelling was less than 1 week. In cases where lymph node swelling occurred after the first dose, 54.1% had swelling in ipsilateral axillary lymph nodes, and 45.9% in contralateral axillary lymph nodes. About 29.5% experienced swelling in ipsilateral supraclavicular lymph nodes, and 18.0% in contralateral supraclavicular lymph nodes.

Injection-site soreness, fatigue, GMS, headache, and chills occurred less often among older individuals (P < .001), and fatigue, muscle soreness, headache, and chills occurred more frequently after the second dose than the first (P < .001). The median duration of all side effects was 48 hours or less.

“The informed education that can be produced based on these results will hopefully ease the fears of women treated for breast cancer and empower them to make informed decisions regarding future vaccine doses,” Ms. Juhel said.

Ms. Juhel has no relevant financial disclosures.

In a series of studies recently presented at the San Antonio Breast Cancer Symposium that examine the effects of the COVID-19 pandemic on women with breast cancer, researchers report that ethnicity played a role in later diagnoses, Hispanics presented with more advanced and aggressive disease, and a focus on a single hospital in San Antonio finds a statistical difference between stage at diagnosis prior to the pandemic, compared with the postvaccine era.

Patients treated at the Mays Cancer Center, a cancer hospital of University of Texas Health and MD Anderson Cancer Center in San Antonio, during the pandemic were found to more likely present with advanced disease between March and December 2020, according to Marcela Mazo, MD, an oncologist with UT Health, San Antonio, and an author of each of three studies.

“We learned that Hispanic patients were presenting with more aggressive histologies such as HER2-positive and triple-negative disease. We also confirmed what we were suspecting, which is that Latina women had less access to medical coverage. We had a higher proportion of Hispanic patients presenting to us without medical coverage, which of course made the treatment extremely challenging,” said Dr. Mazo.

Hispanics are one of the fastest-growing minority groups in the United States, and understanding the factors that affect their healthcare is critical to formulating health policies.

“The findings confirmed my suspicion that most patients did not get a mammogram during the lockdown. And I’m sad to say that, even after everything opened up and people could get vaccinated, I still saw some patients who, for whatever reason, did not get a mammogram – which led to [more] clinical presentations of advanced cancer by the time they were seen by us,” she said.

Dr. Mazo said that underscreened women could also be considered victims of the pandemic. “I tell my patients to get their vaccines so they’re protected and they can feel more comfortable going to the doctor where there is a higher proportion of people who could potentially have COVID.”

Other studies have shown that patients in general, regardless of race or ethnicity, have been diagnosed with later-stage breast cancer diagnoses during the pandemic.

The three studies are based on an analysis of 696 patients treated at Mays Cancer Center. Of these, 264 were diagnosed before the pandemic (cohort A), 171 during the lockdown (Apr. 1 to Dec. 31, 2020, cohort B) and 261 after vaccines were introduced (Jan. 1 to Dec. 31, 2021, cohort C). Overall, there was a slight trend toward a higher incidence of HER2-positive disease during the lockdown period (odds ratio, 1.45) and in the postvaccine period (OR, 1.40), though neither relationship was statistically significant (P = .2). No relationships were seen between time period and incidence of triple-negative breast cancer.

The researchers found that Hispanic patients were more likely to be diagnosed with advanced disease in the pandemic years, compared with pre-COVID times. For example, the likelihood of being diagnosed with carcinoma in situ (Tis) versus T1 disease was lower in the postvaccine era than the pre-COVID era (OR, 0.38; P < .001), although there was no significant difference in Tis versus T1 during the lockdown period, compared with the pre-COVID era. The researchers concluded the difference was likely caused by the latency period of breast cancer.

The postvaccine era saw a 15% increase in patients diagnosed with HER2-positive disease, compared with the pre-COVID era. Patients diagnosed in the COVID era (cohorts B and C) were more likely to require neoadjuvant therapy than patients diagnosed in the pre-COVID era (OR, 1.78; P = .009).

They also found significant disparities in health insurance coverage. 91% of non-Hispanic patients were covered by insurance, compared with 70% of Hispanic patients.

Overall, the findings hint at the depth of health care inequities faced by Hispanic women in the region, and should be a call for action, Dr. Mazo said. “I wish that we as physicians would take the lead to do the best we can to support legislative changes that could help all of our patients get treated – independent of where they come from.”

Dr. Mazo has no relevant financial disclosures.

In a series of studies recently presented at the San Antonio Breast Cancer Symposium that examine the effects of the COVID-19 pandemic on women with breast cancer, researchers report that ethnicity played a role in later diagnoses, Hispanics presented with more advanced and aggressive disease, and a focus on a single hospital in San Antonio finds a statistical difference between stage at diagnosis prior to the pandemic, compared with the postvaccine era.

Patients treated at the Mays Cancer Center, a cancer hospital of University of Texas Health and MD Anderson Cancer Center in San Antonio, during the pandemic were found to more likely present with advanced disease between March and December 2020, according to Marcela Mazo, MD, an oncologist with UT Health, San Antonio, and an author of each of three studies.

“We learned that Hispanic patients were presenting with more aggressive histologies such as HER2-positive and triple-negative disease. We also confirmed what we were suspecting, which is that Latina women had less access to medical coverage. We had a higher proportion of Hispanic patients presenting to us without medical coverage, which of course made the treatment extremely challenging,” said Dr. Mazo.

Hispanics are one of the fastest-growing minority groups in the United States, and understanding the factors that affect their healthcare is critical to formulating health policies.

“The findings confirmed my suspicion that most patients did not get a mammogram during the lockdown. And I’m sad to say that, even after everything opened up and people could get vaccinated, I still saw some patients who, for whatever reason, did not get a mammogram – which led to [more] clinical presentations of advanced cancer by the time they were seen by us,” she said.

Dr. Mazo said that underscreened women could also be considered victims of the pandemic. “I tell my patients to get their vaccines so they’re protected and they can feel more comfortable going to the doctor where there is a higher proportion of people who could potentially have COVID.”

Other studies have shown that patients in general, regardless of race or ethnicity, have been diagnosed with later-stage breast cancer diagnoses during the pandemic.

The three studies are based on an analysis of 696 patients treated at Mays Cancer Center. Of these, 264 were diagnosed before the pandemic (cohort A), 171 during the lockdown (Apr. 1 to Dec. 31, 2020, cohort B) and 261 after vaccines were introduced (Jan. 1 to Dec. 31, 2021, cohort C). Overall, there was a slight trend toward a higher incidence of HER2-positive disease during the lockdown period (odds ratio, 1.45) and in the postvaccine period (OR, 1.40), though neither relationship was statistically significant (P = .2). No relationships were seen between time period and incidence of triple-negative breast cancer.

The researchers found that Hispanic patients were more likely to be diagnosed with advanced disease in the pandemic years, compared with pre-COVID times. For example, the likelihood of being diagnosed with carcinoma in situ (Tis) versus T1 disease was lower in the postvaccine era than the pre-COVID era (OR, 0.38; P < .001), although there was no significant difference in Tis versus T1 during the lockdown period, compared with the pre-COVID era. The researchers concluded the difference was likely caused by the latency period of breast cancer.

The postvaccine era saw a 15% increase in patients diagnosed with HER2-positive disease, compared with the pre-COVID era. Patients diagnosed in the COVID era (cohorts B and C) were more likely to require neoadjuvant therapy than patients diagnosed in the pre-COVID era (OR, 1.78; P = .009).

They also found significant disparities in health insurance coverage. 91% of non-Hispanic patients were covered by insurance, compared with 70% of Hispanic patients.

Overall, the findings hint at the depth of health care inequities faced by Hispanic women in the region, and should be a call for action, Dr. Mazo said. “I wish that we as physicians would take the lead to do the best we can to support legislative changes that could help all of our patients get treated – independent of where they come from.”

Dr. Mazo has no relevant financial disclosures.

In a series of studies recently presented at the San Antonio Breast Cancer Symposium that examine the effects of the COVID-19 pandemic on women with breast cancer, researchers report that ethnicity played a role in later diagnoses, Hispanics presented with more advanced and aggressive disease, and a focus on a single hospital in San Antonio finds a statistical difference between stage at diagnosis prior to the pandemic, compared with the postvaccine era.

Patients treated at the Mays Cancer Center, a cancer hospital of University of Texas Health and MD Anderson Cancer Center in San Antonio, during the pandemic were found to more likely present with advanced disease between March and December 2020, according to Marcela Mazo, MD, an oncologist with UT Health, San Antonio, and an author of each of three studies.

“We learned that Hispanic patients were presenting with more aggressive histologies such as HER2-positive and triple-negative disease. We also confirmed what we were suspecting, which is that Latina women had less access to medical coverage. We had a higher proportion of Hispanic patients presenting to us without medical coverage, which of course made the treatment extremely challenging,” said Dr. Mazo.

Hispanics are one of the fastest-growing minority groups in the United States, and understanding the factors that affect their healthcare is critical to formulating health policies.

“The findings confirmed my suspicion that most patients did not get a mammogram during the lockdown. And I’m sad to say that, even after everything opened up and people could get vaccinated, I still saw some patients who, for whatever reason, did not get a mammogram – which led to [more] clinical presentations of advanced cancer by the time they were seen by us,” she said.

Dr. Mazo said that underscreened women could also be considered victims of the pandemic. “I tell my patients to get their vaccines so they’re protected and they can feel more comfortable going to the doctor where there is a higher proportion of people who could potentially have COVID.”

Other studies have shown that patients in general, regardless of race or ethnicity, have been diagnosed with later-stage breast cancer diagnoses during the pandemic.

The three studies are based on an analysis of 696 patients treated at Mays Cancer Center. Of these, 264 were diagnosed before the pandemic (cohort A), 171 during the lockdown (Apr. 1 to Dec. 31, 2020, cohort B) and 261 after vaccines were introduced (Jan. 1 to Dec. 31, 2021, cohort C). Overall, there was a slight trend toward a higher incidence of HER2-positive disease during the lockdown period (odds ratio, 1.45) and in the postvaccine period (OR, 1.40), though neither relationship was statistically significant (P = .2). No relationships were seen between time period and incidence of triple-negative breast cancer.

The researchers found that Hispanic patients were more likely to be diagnosed with advanced disease in the pandemic years, compared with pre-COVID times. For example, the likelihood of being diagnosed with carcinoma in situ (Tis) versus T1 disease was lower in the postvaccine era than the pre-COVID era (OR, 0.38; P < .001), although there was no significant difference in Tis versus T1 during the lockdown period, compared with the pre-COVID era. The researchers concluded the difference was likely caused by the latency period of breast cancer.

The postvaccine era saw a 15% increase in patients diagnosed with HER2-positive disease, compared with the pre-COVID era. Patients diagnosed in the COVID era (cohorts B and C) were more likely to require neoadjuvant therapy than patients diagnosed in the pre-COVID era (OR, 1.78; P = .009).

They also found significant disparities in health insurance coverage. 91% of non-Hispanic patients were covered by insurance, compared with 70% of Hispanic patients.

Overall, the findings hint at the depth of health care inequities faced by Hispanic women in the region, and should be a call for action, Dr. Mazo said. “I wish that we as physicians would take the lead to do the best we can to support legislative changes that could help all of our patients get treated – independent of where they come from.”

Dr. Mazo has no relevant financial disclosures.

A new study recently presented at the San Antonio Breast Cancer Symposium found that patients in economically and racially/ethnically marginalized neighborhoods are more likely to present with breast cancer at later stages of the disease.

“Neighborhood economic status and residential segregation can shape cancer outcomes such as later-stage diagnosis through several mechanisms, such as access to health care, particularly through limited breast cancer mammographic screening,” said the study’s author, Neha Goel, MD, an assistant professor of surgery at the University of Miami.

The findings are based on an analysis of data from the neighborhood indicator called the Index of Concentration at the Extremes, a database that focuses on the distribution of concentrations of privilege and deprivation, rather than comparing individual or household levels. This is important because growing concentrations of extreme wealth and extreme poverty are becoming increasingly common, and these are not properties discernible by measures by individuals or households. The indicator considers concentration of privilege and deprivation independently, unlike typical models that combine these factors. Doing so reduces bias that can occur in statistical models where these two factors can influence one another. “It brings subtle social inequalities and polarization to the forefront and maps a critical dimension of social inequality,” Dr. Goel said.

Researchers defined structural racism based on its effects, such as separation of marginalized economic and racial/ethnic groups, as well as classism that occurs as a result of discriminatory housing policies over decades. The American Medical Association defines structural racism as the “totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care and criminal justice.” It considers racism, structural racism, and unconscious biases within medical research and health care delivery to be public health threats. The AMA calls for educational and continuing medical education programs to promote an understanding of all forms of racism, and methods for preventing or reducing the health effects of racism.

The final analysis included 6,145 patients (52.6% Hispanic, 26.3 White, and 17.2% Black) who were treated for breast cancer between 2005 and 2017. At 45.2%, nearly half of participants were privately insured.

Five models were created comparing the likelihood of being diagnosed with a more advance stage tumor (stage 3-4 vs. stage 1-2) between the most disadvantage quartile and the most advantaged group quartile. They found significant relationships for low versus high economic segregation for both the most disadvantaged quartile (odds ratio, 1.36; P < .05) and the second-most disadvantaged quartile (OR, 1.43; P < .05); low-income Black versus high-income White patients in both the most disadvantage quartile (OR, 1.55; P < .05) and the second-most disadvantaged quartile (OR, 1.44; P < .05); Hispanic versus non-Hispanic ethnicity in the most disadvantaged quartile (OR, 1.32; P < .05), and low-income Hispanics versus high-income Whites in both the most disadvantaged quartile (OR, 1.43; P < .05) and the second-most disadvantaged quartile (OR, 1.56; P < .05).

Black patients were more likely to be diagnosed with triple-negative breast cancer than White patients (25.1% vs. 12.5%; P < .001).

The findings suggest that both economically disadvantaged patients and those in racially or ethnically marginalized neighborhoods had a greater probability of having later-stage disease at diagnosis. The researchers controlled for age, insurance status, tumor subtype, and comorbidities like diabetes, coronary artery disease, and hyperlipidemia.

“This study adds insight to a growing body of literature that demonstrate how the ecological effects of structural racism – expressed through poverty and residential segregation – shape cancer outcomes across patients of all races [and] ethnicities,” Dr. Goel said.

Dr. Goel has no relevant financial disclosures.

A new study recently presented at the San Antonio Breast Cancer Symposium found that patients in economically and racially/ethnically marginalized neighborhoods are more likely to present with breast cancer at later stages of the disease.

“Neighborhood economic status and residential segregation can shape cancer outcomes such as later-stage diagnosis through several mechanisms, such as access to health care, particularly through limited breast cancer mammographic screening,” said the study’s author, Neha Goel, MD, an assistant professor of surgery at the University of Miami.

The findings are based on an analysis of data from the neighborhood indicator called the Index of Concentration at the Extremes, a database that focuses on the distribution of concentrations of privilege and deprivation, rather than comparing individual or household levels. This is important because growing concentrations of extreme wealth and extreme poverty are becoming increasingly common, and these are not properties discernible by measures by individuals or households. The indicator considers concentration of privilege and deprivation independently, unlike typical models that combine these factors. Doing so reduces bias that can occur in statistical models where these two factors can influence one another. “It brings subtle social inequalities and polarization to the forefront and maps a critical dimension of social inequality,” Dr. Goel said.

Researchers defined structural racism based on its effects, such as separation of marginalized economic and racial/ethnic groups, as well as classism that occurs as a result of discriminatory housing policies over decades. The American Medical Association defines structural racism as the “totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care and criminal justice.” It considers racism, structural racism, and unconscious biases within medical research and health care delivery to be public health threats. The AMA calls for educational and continuing medical education programs to promote an understanding of all forms of racism, and methods for preventing or reducing the health effects of racism.

The final analysis included 6,145 patients (52.6% Hispanic, 26.3 White, and 17.2% Black) who were treated for breast cancer between 2005 and 2017. At 45.2%, nearly half of participants were privately insured.

Five models were created comparing the likelihood of being diagnosed with a more advance stage tumor (stage 3-4 vs. stage 1-2) between the most disadvantage quartile and the most advantaged group quartile. They found significant relationships for low versus high economic segregation for both the most disadvantaged quartile (odds ratio, 1.36; P < .05) and the second-most disadvantaged quartile (OR, 1.43; P < .05); low-income Black versus high-income White patients in both the most disadvantage quartile (OR, 1.55; P < .05) and the second-most disadvantaged quartile (OR, 1.44; P < .05); Hispanic versus non-Hispanic ethnicity in the most disadvantaged quartile (OR, 1.32; P < .05), and low-income Hispanics versus high-income Whites in both the most disadvantaged quartile (OR, 1.43; P < .05) and the second-most disadvantaged quartile (OR, 1.56; P < .05).

Black patients were more likely to be diagnosed with triple-negative breast cancer than White patients (25.1% vs. 12.5%; P < .001).

The findings suggest that both economically disadvantaged patients and those in racially or ethnically marginalized neighborhoods had a greater probability of having later-stage disease at diagnosis. The researchers controlled for age, insurance status, tumor subtype, and comorbidities like diabetes, coronary artery disease, and hyperlipidemia.

“This study adds insight to a growing body of literature that demonstrate how the ecological effects of structural racism – expressed through poverty and residential segregation – shape cancer outcomes across patients of all races [and] ethnicities,” Dr. Goel said.

Dr. Goel has no relevant financial disclosures.

A new study recently presented at the San Antonio Breast Cancer Symposium found that patients in economically and racially/ethnically marginalized neighborhoods are more likely to present with breast cancer at later stages of the disease.

“Neighborhood economic status and residential segregation can shape cancer outcomes such as later-stage diagnosis through several mechanisms, such as access to health care, particularly through limited breast cancer mammographic screening,” said the study’s author, Neha Goel, MD, an assistant professor of surgery at the University of Miami.

The findings are based on an analysis of data from the neighborhood indicator called the Index of Concentration at the Extremes, a database that focuses on the distribution of concentrations of privilege and deprivation, rather than comparing individual or household levels. This is important because growing concentrations of extreme wealth and extreme poverty are becoming increasingly common, and these are not properties discernible by measures by individuals or households. The indicator considers concentration of privilege and deprivation independently, unlike typical models that combine these factors. Doing so reduces bias that can occur in statistical models where these two factors can influence one another. “It brings subtle social inequalities and polarization to the forefront and maps a critical dimension of social inequality,” Dr. Goel said.

Researchers defined structural racism based on its effects, such as separation of marginalized economic and racial/ethnic groups, as well as classism that occurs as a result of discriminatory housing policies over decades. The American Medical Association defines structural racism as the “totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care and criminal justice.” It considers racism, structural racism, and unconscious biases within medical research and health care delivery to be public health threats. The AMA calls for educational and continuing medical education programs to promote an understanding of all forms of racism, and methods for preventing or reducing the health effects of racism.

The final analysis included 6,145 patients (52.6% Hispanic, 26.3 White, and 17.2% Black) who were treated for breast cancer between 2005 and 2017. At 45.2%, nearly half of participants were privately insured.

Five models were created comparing the likelihood of being diagnosed with a more advance stage tumor (stage 3-4 vs. stage 1-2) between the most disadvantage quartile and the most advantaged group quartile. They found significant relationships for low versus high economic segregation for both the most disadvantaged quartile (odds ratio, 1.36; P < .05) and the second-most disadvantaged quartile (OR, 1.43; P < .05); low-income Black versus high-income White patients in both the most disadvantage quartile (OR, 1.55; P < .05) and the second-most disadvantaged quartile (OR, 1.44; P < .05); Hispanic versus non-Hispanic ethnicity in the most disadvantaged quartile (OR, 1.32; P < .05), and low-income Hispanics versus high-income Whites in both the most disadvantaged quartile (OR, 1.43; P < .05) and the second-most disadvantaged quartile (OR, 1.56; P < .05).

Black patients were more likely to be diagnosed with triple-negative breast cancer than White patients (25.1% vs. 12.5%; P < .001).

The findings suggest that both economically disadvantaged patients and those in racially or ethnically marginalized neighborhoods had a greater probability of having later-stage disease at diagnosis. The researchers controlled for age, insurance status, tumor subtype, and comorbidities like diabetes, coronary artery disease, and hyperlipidemia.

“This study adds insight to a growing body of literature that demonstrate how the ecological effects of structural racism – expressed through poverty and residential segregation – shape cancer outcomes across patients of all races [and] ethnicities,” Dr. Goel said.

Dr. Goel has no relevant financial disclosures.