Breast Surgery
RCT: Omission of axillary dissection noninferior to complete dissection in clinically node-negative breast cancer with sentinel-node metastases – N Engl J Med
25 May, 2024 | 18:57h | UTCStudy Design and Population: This noninferiority trial explored the effects of omitting completion axillary-lymph-node dissection in patients with clinically node-negative primary T1 to T3 breast cancer who had one or two sentinel-node macrometastases. A total of 2766 patients were enrolled and randomized 1:1 to either undergo sentinel-node biopsy only or completion dissection. Patients received adjuvant treatment and radiation therapy as per national guidelines, focusing on recurrence-free survival as a secondary end point.
Main Findings: The study reported that the 5-year recurrence-free survival rates were 89.7% in the sentinel-node biopsy-only group and 88.7% in the dissection group, with a country-adjusted hazard ratio for recurrence or death at 0.89 (95% CI, 0.66 to 1.19), significantly below the noninferiority margin (P<0.001). This outcome demonstrates the noninferiority of the less invasive sentinel-node biopsy approach compared to the traditional dissection method in managing sentinel-node macrometastases.
Implications for Practice: The findings suggest that for clinically node-negative breast cancer patients with sentinel-node macrometastases, omitting axillary-lymph-node dissection could be considered a viable treatment option, potentially reducing the surgical burden without compromising recurrence-free survival outcomes. This could lead to adjustments in surgical practice and patient care strategies, emphasizing a less invasive approach while maintaining clinical efficacy.
Reference (link to abstract – $ for full-text):
USPSTF Guideline: Biennial screening mammography recommended for women aged 40-74 to reduce breast cancer morbidity and mortality
1 May, 2024 | 21:45h | UTCStudy Design and Population:
The US Preventive Services Task Force (USPSTF) performed a systematic review and collaborated on modeling studies to evaluate the effectiveness of various mammography-based breast cancer screening strategies. This assessment included factors such as age of initiation and cessation of screening, screening intervals, modalities, and the use of supplemental imaging. The population studied consisted of cisgender women and all other persons assigned female at birth who are 40 years or older and at average risk of breast cancer.
Main Findings:
The USPSTF concludes with moderate certainty that biennial screening mammography for women aged 40 to 74 years provides a moderate net benefit in reducing the incidence of and progression to advanced breast cancer, as well as in decreasing breast cancer morbidity and mortality. However, the evidence is insufficient to assess the benefits and harms of mammography screening in women aged 75 and older, as well as the use of supplemental screening with ultrasound or MRI in women with dense breasts.
Implications for Practice:
Based on these findings, the USPSTF recommends biennial screening mammography for women aged 40 to 74 years. This recommendation aims to optimize breast cancer outcomes while considering the balance of benefits and harms of screening. There is a need for further research to clarify the benefits and risks associated with mammography in women older than 75 and for those with dense breasts considering supplemental screening.
Commentary on X (thread – click for more)
???? Just published: USPSTF recommends all women undergo routine #breastcancer screening every other year beginning at age 40, an update from the 2016 recommendation to start at age 50.
https://t.co/xDPK4qu7JH pic.twitter.com/3zVBMWeuKb— JAMA (@JAMA_current) April 30, 2024
Reference (link to free full-text):
RCT: Aspirin fails to improve invasive disease-free survival in breast cancer patients
1 May, 2024 | 21:37h | UTCThis randomized clinical trial assessed the efficacy of daily aspirin (300 mg) as adjuvant therapy in reducing breast cancer recurrence among 3020 participants with high-risk nonmetastatic breast cancer across the United States and Canada. The study, which followed participants for a median of 33.8 months, found no significant benefit of aspirin on invasive disease-free survival or overall survival, with the hazard ratio for disease-free survival being 1.27 (95% CI, 0.99-1.63; P = .06) and for overall survival 1.19 (95% CI, 0.82-1.72). Given these findings, aspirin is not recommended as an adjuvant treatment for breast cancer, challenging earlier observational data that suggested a potential survival benefit in breast cancer survivors. The trial was concluded early due to the lack of observed benefits, with adverse event rates being similar in both the aspirin and placebo groups.
Commentary on X:
Among participants with high-risk nonmetastatic breast cancer, daily aspirin therapy did not improve risk of breast cancer recurrence or survival in early follow-up. https://t.co/uPWTeaqXdJ pic.twitter.com/x6Qb4bRlqF
— JAMA (@JAMA_current) April 29, 2024
Reference (link to abstract – $ for full-text):
RCT | Mammography screening with AI reduces workload by 44.3% without loss in detection efficacy
4 Aug, 2023 | 12:13h | UTCArtificial intelligence-supported screen reading versus standard double reading in the Mammography Screening with Artificial Intelligence trial (MASAI): a clinical safety analysis of a randomised, controlled, non-inferiority, single-blinded, screening accuracy study – The Lancet Oncology (link to abstract – $ for full-text)
News Release: First randomized trial finds AI-supported mammography screening is safe and almost halves radiologist workload – Lancet
Commentaries:
Large Mammography Study Shows Significant Benefits with AI-Aided Screening – Diagnostic Imaging
Review | Atypical hyperplasia of the breast: Clinical cases and management strategies
3 Aug, 2023 | 13:07h | UTC
Systematic Review | Post-mastectomy RT likely lowers recurrence and improves survival in early breast cancer with 1-3 positive nodes
25 Jul, 2023 | 13:34h | UTC
Changes to breast structure and function across a woman’s lifespan: implications for managing and modeling female breast injuries
19 Jul, 2023 | 14:29h | UTC
RCT | Total breast reconstruction with autologous fat transfer using an expansion device vs implants in patients with breast cancer
28 Jun, 2023 | 13:12h | UTCEffect of Total Breast Reconstruction With Autologous Fat Transfer Using an Expansion Device vs Implants on Quality of Life Among Patients With Breast Cancer: A Randomized Clinical Trial – JAMA Surgery (link to abstract – $ for full-text)
See also: Visual Abstract
Author Interview: Effect of Breast Reconstruction With Autologous Fat Transfer vs Implants on Quality of Life – JAMA
M-A | Effectiveness of physical therapy in axillary web syndrome after breast cancer
27 Jun, 2023 | 13:28h | UTC
Cohort Study | Steady reduction in breast cancer mortality from 1993-2015 in England
22 Jun, 2023 | 14:58h | UTCInvited Commentary: Risk of breast cancer death after a diagnosis of early invasive breast cancer – The BMJ
Commentary on Twitter
NEW research finds that most women diagnosed with early breast cancer can expect to become long term cancer survivors https://t.co/TaYqRJD6Lu pic.twitter.com/V15bLdmI2H
— The BMJ (@bmj_latest) June 14, 2023
Updated Guidance | Diagnosis and treatment of Early and locally advanced breast cancer
22 Jun, 2023 | 14:52h | UTC
RCT | Increased detection of metastases via PET-CT alters treatment path in locally advanced breast cancer
16 Jun, 2023 | 14:02h | UTCImpact of 18F-Labeled Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Versus Conventional Staging in Patients With Locally Advanced Breast Cancer – Journal of Clinical Oncology (link to abstract – $ for full-text)
ASCO Guideline Update | Human epidermal growth factor receptor 2 testing in breast cancer
14 Jun, 2023 | 14:15h | UTC
Review | Inflammatory lesions of the breast
2 Jun, 2023 | 12:10h | UTCInflammatory Lesions of the Breast – Archives of Pathology and Laboratory Medicine
Review | Managing menopausal symptoms, fertility, and bone health in breast cancer women on endocrine therapy
30 May, 2023 | 11:40h | UTC
USPSTF Draft Statement recommends biennial screening mammography for women ages 40 to 74 years
22 May, 2023 | 13:56h | UTCBreast Cancer: Screening – U.S. Preventive Services Task Force
Critical perspectives on the statement:
Earlier screening for breast cancer: Benefits and harms – Lown Institute
Why more mammograms aren’t the solution to breast cancer – Vox
Cohort Study | Following lifestyle recommendations linked to lower recurrence in high-risk breast cancer
15 May, 2023 | 12:48h | UTCCommentary: Adherence to healthy lifestyle found to cut breast cancer recurrence, mortality – HealthDay
Commentary on Twitter
Adherence to the @AmericanCancer and the @aicrtweets lifestyle recommendations before and after high-risk breast cancer treatment was associated with a 37% reduced risk of disease recurrence and a 58% reduction in mortality. https://t.co/sy6b8CGgr1
— JAMA Network Open (@JAMANetworkOpen) May 4, 2023
Uncertainties and controversies in axillary management of patients with breast cancer
11 May, 2023 | 11:53h | UTC
Single-arm study | Halting endocrine therapy for pregnancy not linked to increased breast cancer events vs. a control cohort
10 May, 2023 | 16:01h | UTCInterrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In women with previous breast cancer who temporarily discontinued adjuvant endocrine therapy to attempt pregnancy, the frequency of breast cancer events was below the prespecified safety threshold and similar to that in controls (POSITIVE trial). https://t.co/zM3f4SbgjE
— NEJM (@NEJM) May 3, 2023
New ACR breast cancer screening guidelines call for earlier and more-intensive screening for high-risk women
9 May, 2023 | 14:50h | UTCGuideline: Breast Cancer Screening for Women at Higher-than-Average Risk: Updated Recommendations from the ACR
Effects of intraoperative fluorescence guidance for breast cancer lumpectomy surgery
9 May, 2023 | 14:48h | UTCIntraoperative Fluorescence Guidance for Breast Cancer Lumpectomy Surgery – NEJM Evidence
News Release: Study finds fluorescent guide can help detect tumor left behind after breast cancer surgery – Mass General Brigham
M-A | Quality of life after risk-reducing surgery for breast and ovarian cancer prevention
9 May, 2023 | 14:21h | UTC
Study suggests that routine axillary scanning in diagnostic breast ultrasound has limited impact on cancer detection
19 Apr, 2023 | 13:06h | UTCTo scan or not to scan: effect of scanning the axilla of all patients undergoing diagnostic breast ultrasound – Clinical Imaging (link to abstract – $ for full-text)
Commentary: Is scanning the axilla during diagnostic breast ultrasound necessary? – Health Imaging
M-A | Postoperative analgesic effects of serratus anterior plane block for thoracic and breast surgery
18 Apr, 2023 | 13:01h | UTC
RCT | 10-year results show low-dose tamoxifen reduces noninvasive breast cancer recurrence
17 Apr, 2023 | 12:50h | UTCRandomized Placebo Controlled Trial of Low-Dose Tamoxifen to Prevent Recurrence in Breast Noninvasive Neoplasia: A 10-Year Follow-Up of TAM-01 Study – Journal of Clinical Oncology (link to abstract – $ for full-text)