Surgical Oncology

MIAMI BEACH – Although many women with breast cancer who choose a mastectomy believe they will lower their risk for recurrence, compared with breast conservation therapy, physicians should counsel them about this misperception for most instances, Dr. Mike Dixon said in a video interview at the annual Miami Breast Cancer Conference.

Multiple factors suggest that the risk of cancer recurrence with breast conservation therapy have declined over time. When combined with advances in imaging and gains in systemic therapy and radiation therapy, offering women with early breast cancer a choice between mastectomy and breast conservation may no longer make sense, said Dr. Dixon, professor of surgery at the University of Edinburgh.

More favorable patient outcomes and lower overall costs also favor breast conservation therapy over mastectomy for most women, he explained.

The conference was held by Physicians’ Education Resource. Dr. Dixon has no relevant disclosures.

MIAMI BEACH – Although many women with breast cancer who choose a mastectomy believe they will lower their risk for recurrence, compared with breast conservation therapy, physicians should counsel them about this misperception for most instances, Dr. Mike Dixon said in a video interview at the annual Miami Breast Cancer Conference.

Multiple factors suggest that the risk of cancer recurrence with breast conservation therapy have declined over time. When combined with advances in imaging and gains in systemic therapy and radiation therapy, offering women with early breast cancer a choice between mastectomy and breast conservation may no longer make sense, said Dr. Dixon, professor of surgery at the University of Edinburgh.

More favorable patient outcomes and lower overall costs also favor breast conservation therapy over mastectomy for most women, he explained.

The conference was held by Physicians’ Education Resource. Dr. Dixon has no relevant disclosures.

MIAMI BEACH – Although many women with breast cancer who choose a mastectomy believe they will lower their risk for recurrence, compared with breast conservation therapy, physicians should counsel them about this misperception for most instances, Dr. Mike Dixon said in a video interview at the annual Miami Breast Cancer Conference.

Multiple factors suggest that the risk of cancer recurrence with breast conservation therapy have declined over time. When combined with advances in imaging and gains in systemic therapy and radiation therapy, offering women with early breast cancer a choice between mastectomy and breast conservation may no longer make sense, said Dr. Dixon, professor of surgery at the University of Edinburgh.

More favorable patient outcomes and lower overall costs also favor breast conservation therapy over mastectomy for most women, he explained.

The conference was held by Physicians’ Education Resource. Dr. Dixon has no relevant disclosures.

BOSTON – The majority of patients with hormone receptor–negative breast cancer in the United States get chemotherapy in the adjuvant setting, but neoadjuvant chemotherapy is gaining in use, and is associated with a higher likelihood of breast-conserving surgery for some women with advanced disease, as well as less extensive axillary node dissection.

A review of data on more than 130,000 patients with breast tumors negative for both estrogen and progesterone receptors (ER–/PR–) showed that among patients with clinical stage T3 disease, 26% of those who had received neoadjuvant chemotherapy were able to have breast-conserving surgery, compared with 20% of patients who had received adjuvant chemotherapy, reported Dr. Carlos A. Puig and his colleagues from the Mayo Clinic in Rochester, Minn.

“Patients treated with neoadjuvant chemotherapy have less extensive axillary surgery and a lower rate of nodal positivity,” he added at the annual Society of Surgical Oncology Cancer Symposium.

The data showed that nearly a third of all patients with clinically node-positive disease (cN1-3) who received neoadjuvant chemotherapy had pathologically node-negative disease at the end of therapy.

The aggressive biology of ER–/PR– tumors makes them suitable targets for chemotherapy in the neoadjuvant setting, Dr. Puig said. Overall survival among patients with ER–/PR– who receive neoadjuvant chemotherapy is comparable to that of patients who receive chemotherapy in the adjuvant setting. Neoadjuvant regimens can also downstage tumors before surgery, and a pathologic complete response to chemotherapy delivered prior to surgery is prognostic for outcomes.

Trends in chemotherapy

Dr. Puig and his colleagues combed through the National Cancer Data Base, looking for trends in national practice patterns of use of neoadjuvant chemotherapy in ER–/PR– breast cancer from 2004 through 2012.

They identified a total of 108,128 patients with invasive ER–/PR– breast cancer who received adjuvant chemotherapy, and 24,848 who received neoadjuvant chemo; an additional 43,969 patients who did not receive chemotherapy were excluded from the analysis.

Factors significantly associated with the choice to administer neoadjuvant chemotherapy included age younger than 50, no comorbidities vs. one or two comorbidities on the Charlson/Deyo index, academic/research center vs. community cancer program, higher clinical T stage, and higher clinical N stage.

There was a gradual increase in the use of neoadjuvant chemotherapy over time, from 14.2% in 2004 to 22.3% of all patients in 2012 (P less than .001).

The overall breast-conserving surgery rates were lower among patients who had chemotherapy in the neoadjuvant setting – 33.2% vs. 54.7% (P less than .001). The rates of conservative surgery increased over time, from 32% in 2004 to 36% in 2012 (P less than .001), but decreased over the same period in patients who had adjuvant chemotherapy, from 58% to 51%, respectively.

In a breakdown of surgery type by clinical T stage, mastectomy was more frequently performed in patients who had undergone neoadjuvant treatment, compared with adjuvant therapy, except for stage T3 disease. A higher percentage of those with T3 tumors who had neoadjuvant therapy had breast-conserving surgery in comparison with women who had T3 tumors and adjuvant therapy (26.2% vs. 20.2%, respectively; P less than .001).

To identify the extent of axillary surgery, the authors considered one to five nodes removed to be a surrogate for sentinel lymph node biopsy, and six or more nodes as a surrogate for axillary lymph node dissection.

They found that among patients with clinical stage N1 through N3 who received neoadjuvant chemotherapy, 31.8% converted to pathologically node-negative status.

Dr. Puig noted that the study was limited by the retrospective design and the lack of data on HER2 receptor status, making it impossible to distinguish between ER–/PR– and triple-negative tumors. In addition, they did not have data on genetic testing that could affect surgical choices, such as the presence of BRCA1 or BRCA2.

Following Dr. Puig’s presentation, Dr. Monica Morrow, chief of breast surgery at Memorial Sloan-Kettering Cancer Center, New York, commented that the study put together “patients in whom we would consider there to be an absolute indication for neoadjuvant chemotherapy – meaning T4, N2-N3 – and patients where it’s optional.” The study results suggested that not all patients who should receive neoadjuvant therapy were getting it “which is a little disturbing,” Dr. Morrow said.

She also noted that the decrease in the use of axillary lymph node dissection began prior to publication of studies suggesting that it might be safe to do so.

Dr. Puig and Dr. Morrow had no relevant disclosures.

BOSTON – The majority of patients with hormone receptor–negative breast cancer in the United States get chemotherapy in the adjuvant setting, but neoadjuvant chemotherapy is gaining in use, and is associated with a higher likelihood of breast-conserving surgery for some women with advanced disease, as well as less extensive axillary node dissection.

A review of data on more than 130,000 patients with breast tumors negative for both estrogen and progesterone receptors (ER–/PR–) showed that among patients with clinical stage T3 disease, 26% of those who had received neoadjuvant chemotherapy were able to have breast-conserving surgery, compared with 20% of patients who had received adjuvant chemotherapy, reported Dr. Carlos A. Puig and his colleagues from the Mayo Clinic in Rochester, Minn.

“Patients treated with neoadjuvant chemotherapy have less extensive axillary surgery and a lower rate of nodal positivity,” he added at the annual Society of Surgical Oncology Cancer Symposium.

The data showed that nearly a third of all patients with clinically node-positive disease (cN1-3) who received neoadjuvant chemotherapy had pathologically node-negative disease at the end of therapy.

The aggressive biology of ER–/PR– tumors makes them suitable targets for chemotherapy in the neoadjuvant setting, Dr. Puig said. Overall survival among patients with ER–/PR– who receive neoadjuvant chemotherapy is comparable to that of patients who receive chemotherapy in the adjuvant setting. Neoadjuvant regimens can also downstage tumors before surgery, and a pathologic complete response to chemotherapy delivered prior to surgery is prognostic for outcomes.

Trends in chemotherapy

Dr. Puig and his colleagues combed through the National Cancer Data Base, looking for trends in national practice patterns of use of neoadjuvant chemotherapy in ER–/PR– breast cancer from 2004 through 2012.

They identified a total of 108,128 patients with invasive ER–/PR– breast cancer who received adjuvant chemotherapy, and 24,848 who received neoadjuvant chemo; an additional 43,969 patients who did not receive chemotherapy were excluded from the analysis.

Factors significantly associated with the choice to administer neoadjuvant chemotherapy included age younger than 50, no comorbidities vs. one or two comorbidities on the Charlson/Deyo index, academic/research center vs. community cancer program, higher clinical T stage, and higher clinical N stage.

There was a gradual increase in the use of neoadjuvant chemotherapy over time, from 14.2% in 2004 to 22.3% of all patients in 2012 (P less than .001).

The overall breast-conserving surgery rates were lower among patients who had chemotherapy in the neoadjuvant setting – 33.2% vs. 54.7% (P less than .001). The rates of conservative surgery increased over time, from 32% in 2004 to 36% in 2012 (P less than .001), but decreased over the same period in patients who had adjuvant chemotherapy, from 58% to 51%, respectively.

In a breakdown of surgery type by clinical T stage, mastectomy was more frequently performed in patients who had undergone neoadjuvant treatment, compared with adjuvant therapy, except for stage T3 disease. A higher percentage of those with T3 tumors who had neoadjuvant therapy had breast-conserving surgery in comparison with women who had T3 tumors and adjuvant therapy (26.2% vs. 20.2%, respectively; P less than .001).

To identify the extent of axillary surgery, the authors considered one to five nodes removed to be a surrogate for sentinel lymph node biopsy, and six or more nodes as a surrogate for axillary lymph node dissection.

They found that among patients with clinical stage N1 through N3 who received neoadjuvant chemotherapy, 31.8% converted to pathologically node-negative status.

Dr. Puig noted that the study was limited by the retrospective design and the lack of data on HER2 receptor status, making it impossible to distinguish between ER–/PR– and triple-negative tumors. In addition, they did not have data on genetic testing that could affect surgical choices, such as the presence of BRCA1 or BRCA2.

Following Dr. Puig’s presentation, Dr. Monica Morrow, chief of breast surgery at Memorial Sloan-Kettering Cancer Center, New York, commented that the study put together “patients in whom we would consider there to be an absolute indication for neoadjuvant chemotherapy – meaning T4, N2-N3 – and patients where it’s optional.” The study results suggested that not all patients who should receive neoadjuvant therapy were getting it “which is a little disturbing,” Dr. Morrow said.

She also noted that the decrease in the use of axillary lymph node dissection began prior to publication of studies suggesting that it might be safe to do so.

Dr. Puig and Dr. Morrow had no relevant disclosures.

BOSTON – The majority of patients with hormone receptor–negative breast cancer in the United States get chemotherapy in the adjuvant setting, but neoadjuvant chemotherapy is gaining in use, and is associated with a higher likelihood of breast-conserving surgery for some women with advanced disease, as well as less extensive axillary node dissection.

A review of data on more than 130,000 patients with breast tumors negative for both estrogen and progesterone receptors (ER–/PR–) showed that among patients with clinical stage T3 disease, 26% of those who had received neoadjuvant chemotherapy were able to have breast-conserving surgery, compared with 20% of patients who had received adjuvant chemotherapy, reported Dr. Carlos A. Puig and his colleagues from the Mayo Clinic in Rochester, Minn.

“Patients treated with neoadjuvant chemotherapy have less extensive axillary surgery and a lower rate of nodal positivity,” he added at the annual Society of Surgical Oncology Cancer Symposium.

The data showed that nearly a third of all patients with clinically node-positive disease (cN1-3) who received neoadjuvant chemotherapy had pathologically node-negative disease at the end of therapy.

The aggressive biology of ER–/PR– tumors makes them suitable targets for chemotherapy in the neoadjuvant setting, Dr. Puig said. Overall survival among patients with ER–/PR– who receive neoadjuvant chemotherapy is comparable to that of patients who receive chemotherapy in the adjuvant setting. Neoadjuvant regimens can also downstage tumors before surgery, and a pathologic complete response to chemotherapy delivered prior to surgery is prognostic for outcomes.

Trends in chemotherapy

Dr. Puig and his colleagues combed through the National Cancer Data Base, looking for trends in national practice patterns of use of neoadjuvant chemotherapy in ER–/PR– breast cancer from 2004 through 2012.

They identified a total of 108,128 patients with invasive ER–/PR– breast cancer who received adjuvant chemotherapy, and 24,848 who received neoadjuvant chemo; an additional 43,969 patients who did not receive chemotherapy were excluded from the analysis.

Factors significantly associated with the choice to administer neoadjuvant chemotherapy included age younger than 50, no comorbidities vs. one or two comorbidities on the Charlson/Deyo index, academic/research center vs. community cancer program, higher clinical T stage, and higher clinical N stage.

There was a gradual increase in the use of neoadjuvant chemotherapy over time, from 14.2% in 2004 to 22.3% of all patients in 2012 (P less than .001).

The overall breast-conserving surgery rates were lower among patients who had chemotherapy in the neoadjuvant setting – 33.2% vs. 54.7% (P less than .001). The rates of conservative surgery increased over time, from 32% in 2004 to 36% in 2012 (P less than .001), but decreased over the same period in patients who had adjuvant chemotherapy, from 58% to 51%, respectively.

In a breakdown of surgery type by clinical T stage, mastectomy was more frequently performed in patients who had undergone neoadjuvant treatment, compared with adjuvant therapy, except for stage T3 disease. A higher percentage of those with T3 tumors who had neoadjuvant therapy had breast-conserving surgery in comparison with women who had T3 tumors and adjuvant therapy (26.2% vs. 20.2%, respectively; P less than .001).

To identify the extent of axillary surgery, the authors considered one to five nodes removed to be a surrogate for sentinel lymph node biopsy, and six or more nodes as a surrogate for axillary lymph node dissection.

They found that among patients with clinical stage N1 through N3 who received neoadjuvant chemotherapy, 31.8% converted to pathologically node-negative status.

Dr. Puig noted that the study was limited by the retrospective design and the lack of data on HER2 receptor status, making it impossible to distinguish between ER–/PR– and triple-negative tumors. In addition, they did not have data on genetic testing that could affect surgical choices, such as the presence of BRCA1 or BRCA2.

Following Dr. Puig’s presentation, Dr. Monica Morrow, chief of breast surgery at Memorial Sloan-Kettering Cancer Center, New York, commented that the study put together “patients in whom we would consider there to be an absolute indication for neoadjuvant chemotherapy – meaning T4, N2-N3 – and patients where it’s optional.” The study results suggested that not all patients who should receive neoadjuvant therapy were getting it “which is a little disturbing,” Dr. Morrow said.

She also noted that the decrease in the use of axillary lymph node dissection began prior to publication of studies suggesting that it might be safe to do so.

Dr. Puig and Dr. Morrow had no relevant disclosures.

BOSTON – Good results come to those who wait, suggest the findings of a study of optimal timing of surgical decisions in patients with advanced stage cancers in the distal rectum.

When surgeons waited 8 to 12 weeks after the completion of neoadjuvant chemoradiation to decide whether to proceed with radical sphincter preservation surgery (SPS) or abdominoperineal resection (APR) in patients with T3 cancers of the distal third of the rectum, they were able to avoid creating a colostomy with no adverse oncologic outcomes in 79% of patients, reported Dr. Elizabeth A. Myers and her colleagues from the Lankenau Medical Center and Institute for Medical Research in Wynnewood, Pennsylvania.

Neil Osterweil/Frontline Medical News

“An interesting thing, but still quite controversial, is the timing of when you do surgery,” Dr. Myers said in an interview during a poster session at the annual Society of Surgical Oncology Cancer Symposium.

“There is a large school of thought that still believes you should base your surgical plan on the tumor at its presentation, versus making the decision once the patient has undergone neoadjuvant chemoradiation treatment. The purpose of our study is to show with our data that you can safely alter your decision making based on what the cancer presents as following neoadjuvant chemoradiation,” she said.

The investigators looked at 192 consecutive patients with T3 cancers of the distal third of the rectum who were included in a prospectively maintained database. At the time of presentation, all of the patients would have met criteria for requiring APR and colostomy, due to unfavorable factors for pelvic surgery such as prior radiation (97%), male sex (68%), preoperative fixed tumor (59%), or obesity (23%).

The patients underwent neoadjuvant radiation given at a mean of dose of 5,580 cGy, consisting of a 4,500 cGy standard dose and a 1,080 cGy boost to the area of tumor. Most (87%) also received concurrent 5-fluorauracil-based chemotherapy.

“We have found that this helps to downgrade the tumor quite well,” Dr. Myers said.

Following the completion of therapy, they waited for 8 to 12 additional weeks before planning surgery to allow for the maximum benefit of radiation.

All patients, except those who at the end of neoadjuvant chemotherapy still had a fixed cancer at the 3 cm level or below, were offered SPS. The mean time from completion of chemotherapy to surgery was 11 weeks.

Of the 192 patients, 41 underwent APR, 109 had radical SPS, including 107 receiving transanal transabdominal proctocolectomy with coloanal anastomosis (TATA), and 2 receiving low anterior resection. The remaining patients had local excision with either a transanal technique (TAE; 15 patients) or transanal endoscopic microsurgery (TEM, 27 patients).

After a mean follow-up of 55.4 months (range, 1-242 months) the 5-year stoma-free survival rate was 79%. Kaplan-Meier 5-year actuarial survival rates were 98% for all patients who underwent radical SPS, 100% for those who had local excision with TEM, 82% for those who had local excision with TAE (combined SPS procedures, 95%), and 72% for patients who underwent APR.

Local recurrences occurred in 6.6% of all patients who underwent SPS, compared with 7.3% of those who underwent APR. Distant metastases occurred in 22.5% and 24.4%, respectively.

“Holding surgical decision-making until after completion of neoadjuvant therapy allows for increased sphincter preservation with good oncologic outcomes in rectal cancer patients,” the investigators concluded.

BOSTON – Good results come to those who wait, suggest the findings of a study of optimal timing of surgical decisions in patients with advanced stage cancers in the distal rectum.

When surgeons waited 8 to 12 weeks after the completion of neoadjuvant chemoradiation to decide whether to proceed with radical sphincter preservation surgery (SPS) or abdominoperineal resection (APR) in patients with T3 cancers of the distal third of the rectum, they were able to avoid creating a colostomy with no adverse oncologic outcomes in 79% of patients, reported Dr. Elizabeth A. Myers and her colleagues from the Lankenau Medical Center and Institute for Medical Research in Wynnewood, Pennsylvania.

Neil Osterweil/Frontline Medical News

“An interesting thing, but still quite controversial, is the timing of when you do surgery,” Dr. Myers said in an interview during a poster session at the annual Society of Surgical Oncology Cancer Symposium.

“There is a large school of thought that still believes you should base your surgical plan on the tumor at its presentation, versus making the decision once the patient has undergone neoadjuvant chemoradiation treatment. The purpose of our study is to show with our data that you can safely alter your decision making based on what the cancer presents as following neoadjuvant chemoradiation,” she said.

The investigators looked at 192 consecutive patients with T3 cancers of the distal third of the rectum who were included in a prospectively maintained database. At the time of presentation, all of the patients would have met criteria for requiring APR and colostomy, due to unfavorable factors for pelvic surgery such as prior radiation (97%), male sex (68%), preoperative fixed tumor (59%), or obesity (23%).

The patients underwent neoadjuvant radiation given at a mean of dose of 5,580 cGy, consisting of a 4,500 cGy standard dose and a 1,080 cGy boost to the area of tumor. Most (87%) also received concurrent 5-fluorauracil-based chemotherapy.

“We have found that this helps to downgrade the tumor quite well,” Dr. Myers said.

Following the completion of therapy, they waited for 8 to 12 additional weeks before planning surgery to allow for the maximum benefit of radiation.

All patients, except those who at the end of neoadjuvant chemotherapy still had a fixed cancer at the 3 cm level or below, were offered SPS. The mean time from completion of chemotherapy to surgery was 11 weeks.

Of the 192 patients, 41 underwent APR, 109 had radical SPS, including 107 receiving transanal transabdominal proctocolectomy with coloanal anastomosis (TATA), and 2 receiving low anterior resection. The remaining patients had local excision with either a transanal technique (TAE; 15 patients) or transanal endoscopic microsurgery (TEM, 27 patients).

After a mean follow-up of 55.4 months (range, 1-242 months) the 5-year stoma-free survival rate was 79%. Kaplan-Meier 5-year actuarial survival rates were 98% for all patients who underwent radical SPS, 100% for those who had local excision with TEM, 82% for those who had local excision with TAE (combined SPS procedures, 95%), and 72% for patients who underwent APR.

Local recurrences occurred in 6.6% of all patients who underwent SPS, compared with 7.3% of those who underwent APR. Distant metastases occurred in 22.5% and 24.4%, respectively.

“Holding surgical decision-making until after completion of neoadjuvant therapy allows for increased sphincter preservation with good oncologic outcomes in rectal cancer patients,” the investigators concluded.

BOSTON – Good results come to those who wait, suggest the findings of a study of optimal timing of surgical decisions in patients with advanced stage cancers in the distal rectum.

When surgeons waited 8 to 12 weeks after the completion of neoadjuvant chemoradiation to decide whether to proceed with radical sphincter preservation surgery (SPS) or abdominoperineal resection (APR) in patients with T3 cancers of the distal third of the rectum, they were able to avoid creating a colostomy with no adverse oncologic outcomes in 79% of patients, reported Dr. Elizabeth A. Myers and her colleagues from the Lankenau Medical Center and Institute for Medical Research in Wynnewood, Pennsylvania.

Neil Osterweil/Frontline Medical News

“An interesting thing, but still quite controversial, is the timing of when you do surgery,” Dr. Myers said in an interview during a poster session at the annual Society of Surgical Oncology Cancer Symposium.

“There is a large school of thought that still believes you should base your surgical plan on the tumor at its presentation, versus making the decision once the patient has undergone neoadjuvant chemoradiation treatment. The purpose of our study is to show with our data that you can safely alter your decision making based on what the cancer presents as following neoadjuvant chemoradiation,” she said.

The investigators looked at 192 consecutive patients with T3 cancers of the distal third of the rectum who were included in a prospectively maintained database. At the time of presentation, all of the patients would have met criteria for requiring APR and colostomy, due to unfavorable factors for pelvic surgery such as prior radiation (97%), male sex (68%), preoperative fixed tumor (59%), or obesity (23%).

The patients underwent neoadjuvant radiation given at a mean of dose of 5,580 cGy, consisting of a 4,500 cGy standard dose and a 1,080 cGy boost to the area of tumor. Most (87%) also received concurrent 5-fluorauracil-based chemotherapy.

“We have found that this helps to downgrade the tumor quite well,” Dr. Myers said.

Following the completion of therapy, they waited for 8 to 12 additional weeks before planning surgery to allow for the maximum benefit of radiation.

All patients, except those who at the end of neoadjuvant chemotherapy still had a fixed cancer at the 3 cm level or below, were offered SPS. The mean time from completion of chemotherapy to surgery was 11 weeks.

Of the 192 patients, 41 underwent APR, 109 had radical SPS, including 107 receiving transanal transabdominal proctocolectomy with coloanal anastomosis (TATA), and 2 receiving low anterior resection. The remaining patients had local excision with either a transanal technique (TAE; 15 patients) or transanal endoscopic microsurgery (TEM, 27 patients).

After a mean follow-up of 55.4 months (range, 1-242 months) the 5-year stoma-free survival rate was 79%. Kaplan-Meier 5-year actuarial survival rates were 98% for all patients who underwent radical SPS, 100% for those who had local excision with TEM, 82% for those who had local excision with TAE (combined SPS procedures, 95%), and 72% for patients who underwent APR.

Local recurrences occurred in 6.6% of all patients who underwent SPS, compared with 7.3% of those who underwent APR. Distant metastases occurred in 22.5% and 24.4%, respectively.

“Holding surgical decision-making until after completion of neoadjuvant therapy allows for increased sphincter preservation with good oncologic outcomes in rectal cancer patients,” the investigators concluded.

Ultrasound was about 1.8 times more sensitive than tomosynthesis for the incremental detection of breast cancer in women with radiologically dense breasts and negative two-dimensional mammography screening, according to interim results from the first prospective trial to directly compare the two modalities.

“However, future application of adjunct screening should consider that tomosynthesis detected more than 50% of the additional breast cancers in these women, and could potentially be [a] primary screening modality,” wrote Dr. Alberto Tagliafico of the University of Genoa (Italy) and his associates. The study was published online March 9 in the Journal of Clinical Oncology and presented simultaneously at the European Breast Cancer Conference.

Radiologically dense breast tissue undermines the sensitivity of mammography and is itself an independent risk factor for breast cancer. Recently, many states began requiring that women be informed of their breast density and adjunct screening measures, such as ultrasound. But estimates of the sensitivity of ultrasound have ranged from about 1.9 to 4.2 cancers for every 1,000 screens, said the researchers. This variance, combined with costs and concerns about false-positive recalls, have fueled debates about the value of adjunct measures in breast cancer screening, they added. To help clarify these issues, the multicenter ASTOUND (Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts) study compared physician-performed ultrasound and tomosynthesis results for 3,231 asymptomatic women aged 44 to 71 years, whose median age was 51 years (J Clin Oncol. 2016 Mar 9. doi: 10.1200/JCO.2015.63.4147).

In all, the researchers detected 24 additional breast cancers, 23 of which were invasive. Thus, ultrasound detected about 7.1 additional cancers for every 1,000 screens (95% confidence interval, 4.2-10), compared with 4.0 additional cancers per 1,000 screens for tomosynthesis (95% CI, 1.8-6.2; P = .006). Only one cancer was detected by tomosynthesis alone. The rate of false-positive recalls was similar for the two modalities – 53 cases for tomosynthesis, versus 63 for ultrasound (P = .26). Rates of false-positive recalls leading to biopsy also were similar. Needle biopsies usually sufficed in recalled cases, but two women underwent surgical biopsies, both of which revealed radial scars.

If the final results of ASTOUND confirm these interim data, “it could be argued that breast tomosynthesis has little value in a setting where adjunct ultrasound is frequently used for screening women with mammography-dense breasts,” said the researchers. But tomosynthesis may have a role as a primary screening modality in other setting, especially because tomosynthesis acquisitions that also provide reconstructed 2D mammography are now available, lessening concerns about unjustified radiation exposure, they added.

The “modest” number of cancers in the interim report led to relatively wide confidence intervals, the investigators noted. Biomarker data were not available for all cancers, and both prevalent and incident ultrasound data were compared with prevalent tomosynthesis data, which might bias false-positive recall results in favor of ultrasound, they added.

Ultrasound was about 1.8 times more sensitive than tomosynthesis for the incremental detection of breast cancer in women with radiologically dense breasts and negative two-dimensional mammography screening, according to interim results from the first prospective trial to directly compare the two modalities.

“However, future application of adjunct screening should consider that tomosynthesis detected more than 50% of the additional breast cancers in these women, and could potentially be [a] primary screening modality,” wrote Dr. Alberto Tagliafico of the University of Genoa (Italy) and his associates. The study was published online March 9 in the Journal of Clinical Oncology and presented simultaneously at the European Breast Cancer Conference.

Radiologically dense breast tissue undermines the sensitivity of mammography and is itself an independent risk factor for breast cancer. Recently, many states began requiring that women be informed of their breast density and adjunct screening measures, such as ultrasound. But estimates of the sensitivity of ultrasound have ranged from about 1.9 to 4.2 cancers for every 1,000 screens, said the researchers. This variance, combined with costs and concerns about false-positive recalls, have fueled debates about the value of adjunct measures in breast cancer screening, they added. To help clarify these issues, the multicenter ASTOUND (Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts) study compared physician-performed ultrasound and tomosynthesis results for 3,231 asymptomatic women aged 44 to 71 years, whose median age was 51 years (J Clin Oncol. 2016 Mar 9. doi: 10.1200/JCO.2015.63.4147).

In all, the researchers detected 24 additional breast cancers, 23 of which were invasive. Thus, ultrasound detected about 7.1 additional cancers for every 1,000 screens (95% confidence interval, 4.2-10), compared with 4.0 additional cancers per 1,000 screens for tomosynthesis (95% CI, 1.8-6.2; P = .006). Only one cancer was detected by tomosynthesis alone. The rate of false-positive recalls was similar for the two modalities – 53 cases for tomosynthesis, versus 63 for ultrasound (P = .26). Rates of false-positive recalls leading to biopsy also were similar. Needle biopsies usually sufficed in recalled cases, but two women underwent surgical biopsies, both of which revealed radial scars.

If the final results of ASTOUND confirm these interim data, “it could be argued that breast tomosynthesis has little value in a setting where adjunct ultrasound is frequently used for screening women with mammography-dense breasts,” said the researchers. But tomosynthesis may have a role as a primary screening modality in other setting, especially because tomosynthesis acquisitions that also provide reconstructed 2D mammography are now available, lessening concerns about unjustified radiation exposure, they added.

The “modest” number of cancers in the interim report led to relatively wide confidence intervals, the investigators noted. Biomarker data were not available for all cancers, and both prevalent and incident ultrasound data were compared with prevalent tomosynthesis data, which might bias false-positive recall results in favor of ultrasound, they added.

Ultrasound was about 1.8 times more sensitive than tomosynthesis for the incremental detection of breast cancer in women with radiologically dense breasts and negative two-dimensional mammography screening, according to interim results from the first prospective trial to directly compare the two modalities.

“However, future application of adjunct screening should consider that tomosynthesis detected more than 50% of the additional breast cancers in these women, and could potentially be [a] primary screening modality,” wrote Dr. Alberto Tagliafico of the University of Genoa (Italy) and his associates. The study was published online March 9 in the Journal of Clinical Oncology and presented simultaneously at the European Breast Cancer Conference.

Radiologically dense breast tissue undermines the sensitivity of mammography and is itself an independent risk factor for breast cancer. Recently, many states began requiring that women be informed of their breast density and adjunct screening measures, such as ultrasound. But estimates of the sensitivity of ultrasound have ranged from about 1.9 to 4.2 cancers for every 1,000 screens, said the researchers. This variance, combined with costs and concerns about false-positive recalls, have fueled debates about the value of adjunct measures in breast cancer screening, they added. To help clarify these issues, the multicenter ASTOUND (Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts) study compared physician-performed ultrasound and tomosynthesis results for 3,231 asymptomatic women aged 44 to 71 years, whose median age was 51 years (J Clin Oncol. 2016 Mar 9. doi: 10.1200/JCO.2015.63.4147).

In all, the researchers detected 24 additional breast cancers, 23 of which were invasive. Thus, ultrasound detected about 7.1 additional cancers for every 1,000 screens (95% confidence interval, 4.2-10), compared with 4.0 additional cancers per 1,000 screens for tomosynthesis (95% CI, 1.8-6.2; P = .006). Only one cancer was detected by tomosynthesis alone. The rate of false-positive recalls was similar for the two modalities – 53 cases for tomosynthesis, versus 63 for ultrasound (P = .26). Rates of false-positive recalls leading to biopsy also were similar. Needle biopsies usually sufficed in recalled cases, but two women underwent surgical biopsies, both of which revealed radial scars.

If the final results of ASTOUND confirm these interim data, “it could be argued that breast tomosynthesis has little value in a setting where adjunct ultrasound is frequently used for screening women with mammography-dense breasts,” said the researchers. But tomosynthesis may have a role as a primary screening modality in other setting, especially because tomosynthesis acquisitions that also provide reconstructed 2D mammography are now available, lessening concerns about unjustified radiation exposure, they added.

The “modest” number of cancers in the interim report led to relatively wide confidence intervals, the investigators noted. Biomarker data were not available for all cancers, and both prevalent and incident ultrasound data were compared with prevalent tomosynthesis data, which might bias false-positive recall results in favor of ultrasound, they added.

Ovarian cancer is not a single disease, but a heterogeneous constellation of cancers – an emerging idea that should shape the paths of research, prevention, diagnosis, and treatment.

The recent understanding that most ovarian cancers do not arise from ovarian tissue poses a unique set of challenges in all of these areas, according to a new, congressionally mandated report by the National Academies of Sciences. The 400-page report discusses research opportunities that could – if addressed – greatly affect the number of women who are diagnosed with or die from ovarian cancers.

ThinkStock/vitanovski

“We are at an inflection point,” in this understanding, and how it will shape ovarian cancer research, Dr. Jerome F. Strauss III, chair of the writing committee, said during a press briefing. “This new knowledge will help us classify subtypes and have a profound impact, and help improve the lives of women who at risk of, or who have been diagnosed, with ovarian cancer.”

The report, “Ovarian Cancers: Evolving Paradigms in Research and Care,” was authored by a panel of 15 experts. It plumbed not only their own expertise, but a wealth of clinical, research, and policy data.

The committee made 11 recommendations in four key areas: preclinical research into ovarian cancer biology; prevention and early detection; diagnosis and treatment; and supportive care during survivorship.

One of the most important points, though, relates not to the acquisition of knowledge, but to its dissemination, said Mary Scroggins, an ovarian cancer survivor, patient advocate, and a member of the writing committee.

“Gathering evidence about risks and treatment and prevention strategies doesn’t ensure that the knowledge will be used,” she said. “We need to act on what we learn. We are calling for coordination among stakeholders to develop and implement rapid dissemination of new findings – and to find out why we are not adopting the current evidence-based practices.”

Recommendation 1

There is an urgent need to elucidate the biology and pathophysiology of the diverse subtypes of ovarian cancers. As these are more fully understood, appropriate research agendas may be constructed to determine each subtype’s unique biomarkers, which could be used as screening and diagnosis tools, and its unique vulnerabilities, which can be exploited in targeted treatments.

In addition to learning about the tumors themselves, Dr. Strauss said it’s important to understand why the ovary appears to be such a hospitable environment for the proliferation of premalignant and malignant seed cells shed from other reproductive tissues, including the Fallopian tube and endometrium.

Recommendation 2

As tumor subtypes are identified, they need to be described in a common language. Consensus must be reached on diagnostic criteria, nomenclature, and classification systems.

“This is terribly important,” Dr. Strauss said. “Without it, we cannot build a research agenda and move forward.”

Recommendation 3

Some tumor subtypes are genetically driven; others are not. Some genetically driven tumors are familial; others arise from spontaneous mutation. Understanding these genetic underpinnings will be crucial to developing targeted therapy. There is a need to increase both genetic testing and counseling, not just for the patient but for her immediate family. This will certainly extend beyond the BRCA 1 and 2 genes as knowledge of tumor subtypes unfolds.

“Our ability to identify women at high risk will have a significant impact on morbidity and mortality,” said committee member Dr. Beth Y. Karlan, a gynecologic oncologist from the University of California, Los Angeles. “We already know that family history and genetic mutations are all strong risk factors that call for genetic counseling, but the referral often doesn’t happen.”

Recommendation 4

Most of the now-known ovarian cancers are not genetically driven. Research should delve into the underlying mechanisms and risk factors for these tumors as well. Findings here may lead to more effective prevention strategies, as well as risk assessment tools.

Recommendation 5

Both surgical and nonsurgical treatment approaches should be tailored to individual tumor subtypes. These, as well as preventive measures, should be studied in light of their benefits and potential harms, both for diagnosed patients and those at high risk of developing the disease.

Recommendation 6

Ovarian cancers are highly lethal, in part, because they are often diagnosed at a late stage. Developing effective early-identification methods will be key to reducing morbidity and improving long-term survival.

“Our efforts at early detection have improved, but have not had a substantial impact on mortality,” Dr. Karlan said. “And, since many tumors don’t arise in the ovary, looking at the ovary may not really be much help in early detection. We need to expand the development of new techniques,” which may differ by tumor subtypes.

Recommendation 7

Studies consistently show that women who have access to expert care conducted according to evidence-based standards respond better to treatment and live significantly longer. But the distribution of this care is unequal; older women and those with comorbidities; women of color; lower socioeconomic status; and who live in rural areas are much less likely to receive such care. These disparities must be reduced.

“Our efforts here will require adopting innovative models of care, which may include telemedicine,” and other ways of bringing high-quality care to underserved women, Dr. Karlan said.

Recommendation 8

Little is known about why some ovarian tumors become treatment resistant. As subtypes become categorized, this knowledge gap may become even greater. A comprehensive biological categorization of tumor subtypes will help pave the way for targeted, personalized treatment strategies with both existing and yet-to-be developed agents.

“We also need more research on the optimal timing of surgeries and the impact of the multiple subsequent surgeries that most women undergo,” Dr. Karlan said.

Recommendation 9

In addition to more effective therapies, more varied therapies are also needed. These could be both pharmacologic and nonpharmacologic. Their development requires an organized and effective clinical trial system and an improved understanding of tumors’ basic biology.

Recommendation 10

Supportive care is not just necessary at the end of life. Physical and psychosocial factors are important determinants of treatment success as well as quality of life, from diagnosis through treatment and into terminal stages. Optimizing these factors and removing barriers to improving them can lead to benefits all along this spectrum, said Ms. Scroggins.

“We need research not only into improving how we can survive, but how well we survive,” she said. “It’s not an either-or proposition. Both are important.”

Recommendation 11

Knowledge gained is helpful only if that knowledge is shared. Learning how to disseminate new findings is the only way to ensure that patients benefit from them. “We need to examine what keeps us from fully implementing current standards of care, and to investigate multiple modalities and innovative pathways to communicate new understandings,” Ms. Scroggins said.

The document was created under the auspices of the National Academy of Sciences and supported by federal funds. None of the committee members declared any financial conflicts.

[email protected]

Ovarian cancer is not a single disease, but a heterogeneous constellation of cancers – an emerging idea that should shape the paths of research, prevention, diagnosis, and treatment.

The recent understanding that most ovarian cancers do not arise from ovarian tissue poses a unique set of challenges in all of these areas, according to a new, congressionally mandated report by the National Academies of Sciences. The 400-page report discusses research opportunities that could – if addressed – greatly affect the number of women who are diagnosed with or die from ovarian cancers.

ThinkStock/vitanovski

“We are at an inflection point,” in this understanding, and how it will shape ovarian cancer research, Dr. Jerome F. Strauss III, chair of the writing committee, said during a press briefing. “This new knowledge will help us classify subtypes and have a profound impact, and help improve the lives of women who at risk of, or who have been diagnosed, with ovarian cancer.”

The report, “Ovarian Cancers: Evolving Paradigms in Research and Care,” was authored by a panel of 15 experts. It plumbed not only their own expertise, but a wealth of clinical, research, and policy data.

The committee made 11 recommendations in four key areas: preclinical research into ovarian cancer biology; prevention and early detection; diagnosis and treatment; and supportive care during survivorship.

One of the most important points, though, relates not to the acquisition of knowledge, but to its dissemination, said Mary Scroggins, an ovarian cancer survivor, patient advocate, and a member of the writing committee.

“Gathering evidence about risks and treatment and prevention strategies doesn’t ensure that the knowledge will be used,” she said. “We need to act on what we learn. We are calling for coordination among stakeholders to develop and implement rapid dissemination of new findings – and to find out why we are not adopting the current evidence-based practices.”

Recommendation 1

There is an urgent need to elucidate the biology and pathophysiology of the diverse subtypes of ovarian cancers. As these are more fully understood, appropriate research agendas may be constructed to determine each subtype’s unique biomarkers, which could be used as screening and diagnosis tools, and its unique vulnerabilities, which can be exploited in targeted treatments.

In addition to learning about the tumors themselves, Dr. Strauss said it’s important to understand why the ovary appears to be such a hospitable environment for the proliferation of premalignant and malignant seed cells shed from other reproductive tissues, including the Fallopian tube and endometrium.

Recommendation 2

As tumor subtypes are identified, they need to be described in a common language. Consensus must be reached on diagnostic criteria, nomenclature, and classification systems.

“This is terribly important,” Dr. Strauss said. “Without it, we cannot build a research agenda and move forward.”

Recommendation 3

Some tumor subtypes are genetically driven; others are not. Some genetically driven tumors are familial; others arise from spontaneous mutation. Understanding these genetic underpinnings will be crucial to developing targeted therapy. There is a need to increase both genetic testing and counseling, not just for the patient but for her immediate family. This will certainly extend beyond the BRCA 1 and 2 genes as knowledge of tumor subtypes unfolds.

“Our ability to identify women at high risk will have a significant impact on morbidity and mortality,” said committee member Dr. Beth Y. Karlan, a gynecologic oncologist from the University of California, Los Angeles. “We already know that family history and genetic mutations are all strong risk factors that call for genetic counseling, but the referral often doesn’t happen.”

Recommendation 4

Most of the now-known ovarian cancers are not genetically driven. Research should delve into the underlying mechanisms and risk factors for these tumors as well. Findings here may lead to more effective prevention strategies, as well as risk assessment tools.

Recommendation 5

Both surgical and nonsurgical treatment approaches should be tailored to individual tumor subtypes. These, as well as preventive measures, should be studied in light of their benefits and potential harms, both for diagnosed patients and those at high risk of developing the disease.

Recommendation 6

Ovarian cancers are highly lethal, in part, because they are often diagnosed at a late stage. Developing effective early-identification methods will be key to reducing morbidity and improving long-term survival.

“Our efforts at early detection have improved, but have not had a substantial impact on mortality,” Dr. Karlan said. “And, since many tumors don’t arise in the ovary, looking at the ovary may not really be much help in early detection. We need to expand the development of new techniques,” which may differ by tumor subtypes.

Recommendation 7

Studies consistently show that women who have access to expert care conducted according to evidence-based standards respond better to treatment and live significantly longer. But the distribution of this care is unequal; older women and those with comorbidities; women of color; lower socioeconomic status; and who live in rural areas are much less likely to receive such care. These disparities must be reduced.

“Our efforts here will require adopting innovative models of care, which may include telemedicine,” and other ways of bringing high-quality care to underserved women, Dr. Karlan said.

Recommendation 8

Little is known about why some ovarian tumors become treatment resistant. As subtypes become categorized, this knowledge gap may become even greater. A comprehensive biological categorization of tumor subtypes will help pave the way for targeted, personalized treatment strategies with both existing and yet-to-be developed agents.

“We also need more research on the optimal timing of surgeries and the impact of the multiple subsequent surgeries that most women undergo,” Dr. Karlan said.

Recommendation 9

In addition to more effective therapies, more varied therapies are also needed. These could be both pharmacologic and nonpharmacologic. Their development requires an organized and effective clinical trial system and an improved understanding of tumors’ basic biology.

Recommendation 10

Supportive care is not just necessary at the end of life. Physical and psychosocial factors are important determinants of treatment success as well as quality of life, from diagnosis through treatment and into terminal stages. Optimizing these factors and removing barriers to improving them can lead to benefits all along this spectrum, said Ms. Scroggins.

“We need research not only into improving how we can survive, but how well we survive,” she said. “It’s not an either-or proposition. Both are important.”

Recommendation 11

Knowledge gained is helpful only if that knowledge is shared. Learning how to disseminate new findings is the only way to ensure that patients benefit from them. “We need to examine what keeps us from fully implementing current standards of care, and to investigate multiple modalities and innovative pathways to communicate new understandings,” Ms. Scroggins said.

The document was created under the auspices of the National Academy of Sciences and supported by federal funds. None of the committee members declared any financial conflicts.

[email protected]

Ovarian cancer is not a single disease, but a heterogeneous constellation of cancers – an emerging idea that should shape the paths of research, prevention, diagnosis, and treatment.

The recent understanding that most ovarian cancers do not arise from ovarian tissue poses a unique set of challenges in all of these areas, according to a new, congressionally mandated report by the National Academies of Sciences. The 400-page report discusses research opportunities that could – if addressed – greatly affect the number of women who are diagnosed with or die from ovarian cancers.

ThinkStock/vitanovski

“We are at an inflection point,” in this understanding, and how it will shape ovarian cancer research, Dr. Jerome F. Strauss III, chair of the writing committee, said during a press briefing. “This new knowledge will help us classify subtypes and have a profound impact, and help improve the lives of women who at risk of, or who have been diagnosed, with ovarian cancer.”

The report, “Ovarian Cancers: Evolving Paradigms in Research and Care,” was authored by a panel of 15 experts. It plumbed not only their own expertise, but a wealth of clinical, research, and policy data.

The committee made 11 recommendations in four key areas: preclinical research into ovarian cancer biology; prevention and early detection; diagnosis and treatment; and supportive care during survivorship.

One of the most important points, though, relates not to the acquisition of knowledge, but to its dissemination, said Mary Scroggins, an ovarian cancer survivor, patient advocate, and a member of the writing committee.

“Gathering evidence about risks and treatment and prevention strategies doesn’t ensure that the knowledge will be used,” she said. “We need to act on what we learn. We are calling for coordination among stakeholders to develop and implement rapid dissemination of new findings – and to find out why we are not adopting the current evidence-based practices.”

Recommendation 1

There is an urgent need to elucidate the biology and pathophysiology of the diverse subtypes of ovarian cancers. As these are more fully understood, appropriate research agendas may be constructed to determine each subtype’s unique biomarkers, which could be used as screening and diagnosis tools, and its unique vulnerabilities, which can be exploited in targeted treatments.

In addition to learning about the tumors themselves, Dr. Strauss said it’s important to understand why the ovary appears to be such a hospitable environment for the proliferation of premalignant and malignant seed cells shed from other reproductive tissues, including the Fallopian tube and endometrium.

Recommendation 2

As tumor subtypes are identified, they need to be described in a common language. Consensus must be reached on diagnostic criteria, nomenclature, and classification systems.

“This is terribly important,” Dr. Strauss said. “Without it, we cannot build a research agenda and move forward.”

Recommendation 3

Some tumor subtypes are genetically driven; others are not. Some genetically driven tumors are familial; others arise from spontaneous mutation. Understanding these genetic underpinnings will be crucial to developing targeted therapy. There is a need to increase both genetic testing and counseling, not just for the patient but for her immediate family. This will certainly extend beyond the BRCA 1 and 2 genes as knowledge of tumor subtypes unfolds.

“Our ability to identify women at high risk will have a significant impact on morbidity and mortality,” said committee member Dr. Beth Y. Karlan, a gynecologic oncologist from the University of California, Los Angeles. “We already know that family history and genetic mutations are all strong risk factors that call for genetic counseling, but the referral often doesn’t happen.”

Recommendation 4

Most of the now-known ovarian cancers are not genetically driven. Research should delve into the underlying mechanisms and risk factors for these tumors as well. Findings here may lead to more effective prevention strategies, as well as risk assessment tools.

Recommendation 5

Both surgical and nonsurgical treatment approaches should be tailored to individual tumor subtypes. These, as well as preventive measures, should be studied in light of their benefits and potential harms, both for diagnosed patients and those at high risk of developing the disease.

Recommendation 6

Ovarian cancers are highly lethal, in part, because they are often diagnosed at a late stage. Developing effective early-identification methods will be key to reducing morbidity and improving long-term survival.

“Our efforts at early detection have improved, but have not had a substantial impact on mortality,” Dr. Karlan said. “And, since many tumors don’t arise in the ovary, looking at the ovary may not really be much help in early detection. We need to expand the development of new techniques,” which may differ by tumor subtypes.

Recommendation 7

Studies consistently show that women who have access to expert care conducted according to evidence-based standards respond better to treatment and live significantly longer. But the distribution of this care is unequal; older women and those with comorbidities; women of color; lower socioeconomic status; and who live in rural areas are much less likely to receive such care. These disparities must be reduced.

“Our efforts here will require adopting innovative models of care, which may include telemedicine,” and other ways of bringing high-quality care to underserved women, Dr. Karlan said.

Recommendation 8

Little is known about why some ovarian tumors become treatment resistant. As subtypes become categorized, this knowledge gap may become even greater. A comprehensive biological categorization of tumor subtypes will help pave the way for targeted, personalized treatment strategies with both existing and yet-to-be developed agents.

“We also need more research on the optimal timing of surgeries and the impact of the multiple subsequent surgeries that most women undergo,” Dr. Karlan said.

Recommendation 9

In addition to more effective therapies, more varied therapies are also needed. These could be both pharmacologic and nonpharmacologic. Their development requires an organized and effective clinical trial system and an improved understanding of tumors’ basic biology.

Recommendation 10

Supportive care is not just necessary at the end of life. Physical and psychosocial factors are important determinants of treatment success as well as quality of life, from diagnosis through treatment and into terminal stages. Optimizing these factors and removing barriers to improving them can lead to benefits all along this spectrum, said Ms. Scroggins.

“We need research not only into improving how we can survive, but how well we survive,” she said. “It’s not an either-or proposition. Both are important.”

Recommendation 11

Knowledge gained is helpful only if that knowledge is shared. Learning how to disseminate new findings is the only way to ensure that patients benefit from them. “We need to examine what keeps us from fully implementing current standards of care, and to investigate multiple modalities and innovative pathways to communicate new understandings,” Ms. Scroggins said.

The document was created under the auspices of the National Academy of Sciences and supported by federal funds. None of the committee members declared any financial conflicts.

[email protected]

The overall mastectomy rate rose 36% from 2005 to 2013, even though “the incidence of breast cancer overall remained stable,” according to the Agency for Healthcare Research and Quality (AHRQ).

The rate of bilateral mastectomies jumped 226% over that time period, going from 9.1 per 100,000 adult women in 2005 to 29.7 per 100,000 in 2013. The unilateral mastectomy rate, starting at 57.3 per 100,000 women in 2005, rose to 69.8 in 2009 and then fell to 60.6 in 2013, for an increase of 6% overall, the AHRQ reported.

The rate of bilateral mastectomies without any cancer diagnosis increased from 2.0 to 4.4 per 100,000 from 2005 to 2013, and the unilateral rate rose from 2.7 to 3.7 per 100,000, the report noted.

Both unilateral and bilateral mastectomies are increasingly performed as outpatient procedures. The rate done in hospital-based ambulatory surgery settings nearly doubled from 16.1 to 31 per 100,000 women, and the overall proportion performed in ambulatory settings reached 45% in 2013, the AHRQ said.

The analysis shows that “more women are opting for mastectomies, particularly preventive double mastectomies, and more of those surgeries are being done as outpatient procedures,” AHRQ Director Rick Kronick, Ph.D., said in a written statement. These “changing patterns of care for breast cancer [highlight] the need for further evidence about the effects of choices women are making on their health, well-being, and safety.”

The analysis of the State Inpatient Databases and the State Ambulatory Surgery and Services Databases involved data from 13 states that had cases in both databases and used coding that allowed identification of unilateral versus bilateral mastectomies. Those 13 states represent more than 25% of the U.S. population.

[email protected]

The overall mastectomy rate rose 36% from 2005 to 2013, even though “the incidence of breast cancer overall remained stable,” according to the Agency for Healthcare Research and Quality (AHRQ).

The rate of bilateral mastectomies jumped 226% over that time period, going from 9.1 per 100,000 adult women in 2005 to 29.7 per 100,000 in 2013. The unilateral mastectomy rate, starting at 57.3 per 100,000 women in 2005, rose to 69.8 in 2009 and then fell to 60.6 in 2013, for an increase of 6% overall, the AHRQ reported.

The rate of bilateral mastectomies without any cancer diagnosis increased from 2.0 to 4.4 per 100,000 from 2005 to 2013, and the unilateral rate rose from 2.7 to 3.7 per 100,000, the report noted.

Both unilateral and bilateral mastectomies are increasingly performed as outpatient procedures. The rate done in hospital-based ambulatory surgery settings nearly doubled from 16.1 to 31 per 100,000 women, and the overall proportion performed in ambulatory settings reached 45% in 2013, the AHRQ said.

The analysis shows that “more women are opting for mastectomies, particularly preventive double mastectomies, and more of those surgeries are being done as outpatient procedures,” AHRQ Director Rick Kronick, Ph.D., said in a written statement. These “changing patterns of care for breast cancer [highlight] the need for further evidence about the effects of choices women are making on their health, well-being, and safety.”

The analysis of the State Inpatient Databases and the State Ambulatory Surgery and Services Databases involved data from 13 states that had cases in both databases and used coding that allowed identification of unilateral versus bilateral mastectomies. Those 13 states represent more than 25% of the U.S. population.

[email protected]

The overall mastectomy rate rose 36% from 2005 to 2013, even though “the incidence of breast cancer overall remained stable,” according to the Agency for Healthcare Research and Quality (AHRQ).

The rate of bilateral mastectomies jumped 226% over that time period, going from 9.1 per 100,000 adult women in 2005 to 29.7 per 100,000 in 2013. The unilateral mastectomy rate, starting at 57.3 per 100,000 women in 2005, rose to 69.8 in 2009 and then fell to 60.6 in 2013, for an increase of 6% overall, the AHRQ reported.

The rate of bilateral mastectomies without any cancer diagnosis increased from 2.0 to 4.4 per 100,000 from 2005 to 2013, and the unilateral rate rose from 2.7 to 3.7 per 100,000, the report noted.

Both unilateral and bilateral mastectomies are increasingly performed as outpatient procedures. The rate done in hospital-based ambulatory surgery settings nearly doubled from 16.1 to 31 per 100,000 women, and the overall proportion performed in ambulatory settings reached 45% in 2013, the AHRQ said.

The analysis shows that “more women are opting for mastectomies, particularly preventive double mastectomies, and more of those surgeries are being done as outpatient procedures,” AHRQ Director Rick Kronick, Ph.D., said in a written statement. These “changing patterns of care for breast cancer [highlight] the need for further evidence about the effects of choices women are making on their health, well-being, and safety.”

The analysis of the State Inpatient Databases and the State Ambulatory Surgery and Services Databases involved data from 13 states that had cases in both databases and used coding that allowed identification of unilateral versus bilateral mastectomies. Those 13 states represent more than 25% of the U.S. population.

[email protected]

Over 595,000 cancer deaths – an average of about 1,600 each day – are expected in the United States in 2016, but those deaths are not evenly distributed among the states, according to investigators from the American Cancer Society.

Estimates from the ACS show that, in 2016, Utah will have a cancer death rate of 99 per 100,000 population, the lowest in the country. Those same estimates predict that West Virginia will have a highest-in-the-country death rate of 258.2 per 100,000 – 2.6 times higher than Utah’s. Other states with high estimated death rates include Maine, Kentucky, Arkansas, and Pennsylvania, noted Rebecca L. Siegel and her associates at the ACS (CA Cancer J Clin. 2016 Jan;66[1]:7-30).

Besides Utah, the states with the lowest estimated cancer death rates in 2016 are Colorado, Texas, and Alaska, along with the District of Columbia. The national death rate for cancer has dropped 23% since 1991, the investigators said, but cancer is now the leading cause of death in 21 states. This good news/bad news situation comes about mainly as a result of “exceptionally large reductions in death from heart disease,” they added.

Ms. Siegel and her associates calculated the expected number of cancer deaths “based on the annual percent change in reported numbers of cancer deaths from 1998 through 2012 at the state and national levels as reported to the [National Center for Health Statistics].” Death rates were calculated here using estimated populations for 2015 from the U.S. Census Bureau.

[email protected]

Over 595,000 cancer deaths – an average of about 1,600 each day – are expected in the United States in 2016, but those deaths are not evenly distributed among the states, according to investigators from the American Cancer Society.

Estimates from the ACS show that, in 2016, Utah will have a cancer death rate of 99 per 100,000 population, the lowest in the country. Those same estimates predict that West Virginia will have a highest-in-the-country death rate of 258.2 per 100,000 – 2.6 times higher than Utah’s. Other states with high estimated death rates include Maine, Kentucky, Arkansas, and Pennsylvania, noted Rebecca L. Siegel and her associates at the ACS (CA Cancer J Clin. 2016 Jan;66[1]:7-30).

Besides Utah, the states with the lowest estimated cancer death rates in 2016 are Colorado, Texas, and Alaska, along with the District of Columbia. The national death rate for cancer has dropped 23% since 1991, the investigators said, but cancer is now the leading cause of death in 21 states. This good news/bad news situation comes about mainly as a result of “exceptionally large reductions in death from heart disease,” they added.

Ms. Siegel and her associates calculated the expected number of cancer deaths “based on the annual percent change in reported numbers of cancer deaths from 1998 through 2012 at the state and national levels as reported to the [National Center for Health Statistics].” Death rates were calculated here using estimated populations for 2015 from the U.S. Census Bureau.

[email protected]

Over 595,000 cancer deaths – an average of about 1,600 each day – are expected in the United States in 2016, but those deaths are not evenly distributed among the states, according to investigators from the American Cancer Society.

Estimates from the ACS show that, in 2016, Utah will have a cancer death rate of 99 per 100,000 population, the lowest in the country. Those same estimates predict that West Virginia will have a highest-in-the-country death rate of 258.2 per 100,000 – 2.6 times higher than Utah’s. Other states with high estimated death rates include Maine, Kentucky, Arkansas, and Pennsylvania, noted Rebecca L. Siegel and her associates at the ACS (CA Cancer J Clin. 2016 Jan;66[1]:7-30).

Besides Utah, the states with the lowest estimated cancer death rates in 2016 are Colorado, Texas, and Alaska, along with the District of Columbia. The national death rate for cancer has dropped 23% since 1991, the investigators said, but cancer is now the leading cause of death in 21 states. This good news/bad news situation comes about mainly as a result of “exceptionally large reductions in death from heart disease,” they added.

Ms. Siegel and her associates calculated the expected number of cancer deaths “based on the annual percent change in reported numbers of cancer deaths from 1998 through 2012 at the state and national levels as reported to the [National Center for Health Statistics].” Death rates were calculated here using estimated populations for 2015 from the U.S. Census Bureau.

[email protected]