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21,100 | SPECIAL THE RA P EUTIC PROBLEMS | B r east Cancer and P r egnancy | null | nan nan | B r east Cancer and P r egnancy | 6 | 0.05 | 0.075 | 0.1 | 0.09 | 0.08 | 0.06 | 0.1 | 3 |
21,101 | SPECIAL THE RA P EUTIC PROBLEMS | B r east Cancer and P r egnancy | null | nan nan | B r east car c i no m a i s one o f t h e m o st c o mm on l y d ia gno se d mali gn a n cies dur i ng p r egnanc y . O l de r s t ud ies estimate d t h at b reast ca n cer d e v el op e d in 2.2 i n 10,000 p r egnanc i e s ; ho we v e r , t h e tre nd t o war d later a g e at first c h il db i r t h has i nc r eased t he n um b er o f b reast ca n cer cases c o e x iste n t wi th pr e gn a nc y , and b r eas t cance r is no w estimate d t o o cc u r i n 1 i n 1,000 pr e gn a nc i es De l ay i n d i agno sis remai n s a p r ob lem du e t o t h e nodu lari ty of t h e pr e gnan t b r eas t and t he ass u m p ti on t h at n ew b reast masses are nor mal phys i o l og i c changes. D o mi n a n t b reast masses d e v el op i ng du ri ng pr e gn a ncy r equ ir e b i opsy be f o re ass u mi ng t h at t h e y are b e n i gn. T h is can be r ea d il y acco m p li shed w it h a co re-c u tti ng n ee d le b i op s y i n t h e maj o rit y o f wo me n. If exc i s i ona l b i opsy i s n ecessar y , it s hou l d b e und erta k e n ; c on cer ns a bou t t he deve l op m en t o f a mil k fist u la a pp ear t o b e ov erstate d . | 6 | 0.095 | 0.087 | 0.063 | 0.042 | 0.036 | 0.021 | 0.095 | 1 |
21,102 | SPECIAL THE RA P EUTIC PROBLEMS | B r east Cancer and P r egnancy | nan nan | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
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21,103 | SPECIAL THE RA P EUTIC PROBLEMS | B r east Cancer and P r egnancy | nan nan | Mamm og r aphy i s no t as use f u l i n p re gn a n t p atie n ts as i n t ho se w ho are not pr e gn a n t because o f t he i nc r e ase d d e n sit y i n t h e b reast p are n c hy ma | 6 | 0.05 | 0.01 | 0.02 | 0.01 | 0.01 | 0.01 | 0.05 | 1 |
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21,104 | SPECIAL THE RA P EUTIC PROBLEMS | B r east Cancer and P r egnancy | nan nan | ass o ciate d w it h p r egnanc y . Ul tras ound ma y b e h el p f u l i n c on firmi ng t h e pr ese n c e o f a do mi nan t m ass, bu t , as i n t h e nonp re gn a n t p atie n t , no rmal ima g i ng s t ud i es shou l d no t l ead t o a d ecisi on t o f o r go b i op s y i n t h e p atie nt w it h a do mi nan t b r eas t m ass. Af te r a d i agnos i s i s m ade, th e i n itial e v al u ati on s hou l d i n cl ud e a n assessme n t o f t he ex t en t o f t h e d isease . C o m pu te d t o m og ra phy a nd bon e sca n s a re no t r eco mm ended d uri ng p re gn a n c y b eca u se o f c on cer n s a bout r a d iati on exposu r e t o t he f e t u s . I n p atie n ts wit h s y m p t o ms s ugg esti v e o f metasta ses, MR I w it hou t con t r ast ca n b e u se d t o e v al u ate bony sites a nd the i n t r a - a b d o mi na l v i sce r a . B r ea s t cance r s occu rri ng d uri ng p re gn a n c y are u s u all y h i gh - g ra d e i nf ilt r ati ng duc t a l ca r c i no m as. I n a p r o s p ecti v e st udy o f 38 p re gn a n t w omen who d e ve l oped b r eas t cance r , on l y 28 % h a d ER + t u m o rs a nd 24 % h a d P R + t u m or s I n gene r a l , t he cha racteristics o f ca n cers o cc u rri ng du ri ng pr e gn a ncy a r e s imil a r t o t hos e o f nonp re gn a n t w o me n o f t h e same a g e . D ata fro m r etr ospec ti ve case - con tr o l series s ugg est t h at after a d j u sti ng f o r a g e a nd d ise ase s t age, t he p r ognos is o f w o me n wit h b reast ca n cer o cc u rri ng dur i ng p r egnancy d i f f e r s littl e fr o m t h at o f nonp re gn a n t p atie n ts F or w o m en d i agnosed i n t h e first o r sec ond trimeste r , t h e qu esti on o f pr e gn a ncy t e rmi na ti on i s i nev ita b l y raise d. Alt hough s o me treatme n t a ppro ach es a r e f eas i b l e du ri ng p re gn a n c y , o t h ers are c on trai nd icate d. D e p e nd in g on t he pa ti en t ’ s spe cific sit u ati on, c on ti nu i ng t h e p re gn a n c y may or ma y no t co m p r o mi se t he b reast ca n cer treatme n t . E v e n w h e n d e v iati ons fro m sta nda r d tr ea tm en t a r e r equ ire d, it is un clear t o w h at e x te n t s u c h c h a ng es o r de l ays a f f ec t a wo ma n ’ s odd s o f remai n i ng free fr o m rec u rre nt br east c ance r . T he conce r ns abou t c o m p r o misi ng care m u st b e b ala n ce d by t h e wo m an, he r f a mil y , and he r phy sicia n s , wit h t h e d esire t o c on ti nu e t he pr e gn a nc y . T he wo m an f ac i ng t h ese iss u es m u st als o c on si d er t h e po ssi b ili ty t ha t if she r ece i ves c h em o t h era p y , h er a b ilit y t o c on cei v e a nothe r c h il d c ou l d be co m p r o mi sed . T h ere is no clear e v i d e n ce t h at p re gn a n c y te r mi n ati on changes O S . B r ea s t su r ge r y can be sa f e l y p erf o rme d du ri ng a ny trimester o f pr e gn a nc y . Mas t ec t o m y i s t he treatme n t t h at h as tra d iti on all y b ee n | 6 | 0.09 | 0.075 | 0.06 | 0.1 | 0.08 | 0.09 | 0.1 | 4 |
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21,105 | SPECIAL THE RA P EUTIC PROBLEMS | B r east Cancer and P r egnancy | nan nan | und e r ta ken because o f t he i nab ilit y t o safel y d eli v er R T t o t h e b reast w it hou t excess i ve f e t a l exposu re du ri ng a ny trimeste r . T h e e f fect o f d ela y i ng R T on L R, i n t he ab se n ce o f s y stemic t h era p y , is unkno w n a nd i s of c on cer n. Gu i de li nes f o r B C c on si d er t h is a n a pp r op riate a pp r o ac h f o r ca n ce r s d i agnosed i n t he t h ir d trimester a nd on e t h at m u st b e c on si d ere d on a case -by - case bas i s f o r canc ers d ia gno se d earlier i n p re gn a n c y . I n t h e wo ma n w ho w ill r ece i ve sys t e mic c h em o t h era p y , t h e d ela y i n t h e d eli v er y of R T is o ft en no g r ea t e r t han i n t h e nonp re gn a n t p atie n t . T h e s u ccess ra te of l y m pha ti c m app i ng and se nti n el nod e b i op s y i n t h e p re gn a n t w o ma n i s unknown. I sosu lf an b l ue dye i s no t a pp r ov e d by t h e US F ood a nd Dr ug Ad mi n i s tr a ti on f o r use du ri ng p re gn a n c y . T h e ra d iati on e xpo s u re t o t h e f et u s from t he use o f t echne ti u m h as b ee n estimate d t o b e l o w , a nd it h as b ee n s ugges t ed t ha t m app i ng w it h tec hn eti u m al on e c ou l d b e d isc u sse d with p atie n ts a s an app r op ri a t e m an a g eme n t strate g y . I n t h e a b se n ce o f d e f i n iti v e da t a on t he sa f e t y and acc u rac y o f se n ti n el nod e b i op s y i n t h e pr e gn a n t wo m an, A L ND r e mai n s t h e sta nd ar d ma n a g eme n t strate g y . Th e risk o f congen it a l m a lf o rmati on fr o m c y t o t ox ic c h em o t h era py v ar ies w it h t h e f e t a l age a t exposu r e a nd t h e a g e n t u se d. E xpo s u re i n t h e first t r imeste r i s assoc i a t ed w it h ris k s o f 10 % t o 20 % a nd s hou l d b e a vo i d e d. Ris k s dec li ne t o <2 % w it h expo s u re i n t h e sec ond a nd t h ir d trimesters , e n a b li ng che m o t he r apy ad mi n istrati on i n t ho se trimesters . C h em o t h era py dur i ng p r egnancy m ay a l so c o n tri bu te t o i n tra u teri n e g r o wt h retar d ati on, a nd t h e long -t e rm consequen ces o f e xpo s u re remai n un certai n. I n a pro s p ecti ve s t udy o f 24 p r egn a n t w o me n treate d wit h fl uo r ou racil , doxorubic i n, and cyc l ophosph ami d e du ri ng t h e sec ond a nd t h ir d trimest e r s of pr e gn a nc y , no co m p li ca ti o ns were ob ser v e d f o r t h e fet u s o r i n fa n t . | 6 | 0.005 | 0.03 | 0.07 | 0.08 | 0.09 | 0.06 | 0.09 | 5 |
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21,106 | SPECIAL THE RA P EUTIC PROBLEMS | B r east Cancer and P r egnancy | nan nan | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
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21,107 | SPECIAL THE RA P EUTIC PROBLEMS | B r east Cancer and P r egnancy | nan nan | Exp e r ien ce w it h t he t axanes i n p re gn a n c y is limite d, bu t a pp ears feasi b l e a f te r t h e fir s t trim es t e r . Th e use o f tr as t uzu m ab i n pre gn a n c y is ass o ciate d wit h o li gohyd r a m n i os and m o r e i n f o rmati on on t h e safet y o f t h is a g e n t i n pr e gn a ncy i s needed. Me t ho tre x ate s hou l d b e a vo i d e d du ri ng p re gn a n c y b eca u se o f t he ri sk o f abo rti on a nd se v ere fetal malf o rmati on. Similarl y , tam ox i fen shou l d be w it hhe l d un til after d eli v er y b eca u se its safet y is | 6 | 0.05 | 0.01 | 0.02 | 0.01 | 0.01 | 0.01 | 0.05 | 1 |
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21,108 | SPECIAL THE RA P EUTIC PROBLEMS | B r east Cancer and P r egnancy | nan nan | un ce r tain . When che m o t he r a p y o r tam ox ife n is g i v e n po st p art u m , br east f ee d i ng shou l d be avo i d e d, as t h ese a g e n ts ma y b e e x crete d i n t h e br east m il k. Th e m anage m en t o f b r eas t ca n cer du ri ng p re gn a n c y is d iffic u lt , as t h er e is of te n a con fli c t be t ween op timal t h era py f o r t h e m o t h er a nd t h e fet u s . M u lti d isci p li na r y m anage m en t by a team i n cl ud i ng me d ical , s u r g ical , a nd r a d iati on onco l og i s t s, an obs tetricia n, a mater n al-fetal me d ici n e s p eciali st, a nd a p s ycho l og i s t w ill f ac ilitate t h e d e v el op me n t o f a strate gy t h at op timiz es t he ou t co m e f o r both m o t h er a nd c h il d. | 6 | 0.09 | 0.1 | 0.08 | 0.075 | 0.06 | 0.04 | 0.1 | 2 |
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21,109 | SPECIAL THE RA P EUTIC PROBLEMS | Male B r east Cancer | null | nan nan | Male B r east Cancer | 6 | 0.05 | 0.075 | 0.1 | 0.09 | 0.08 | 0.06 | 0.1 | 3 |
21,110 | SPECIAL THE RA P EUTIC PROBLEMS | Male B r east Cancer | nan nan | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.1 | 0.1 | 0.1 | 5 |
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21,111 | SPECIAL THE RA P EUTIC PROBLEMS | Male B r east Cancer | nan nan | Th e r is k o f m a l e b r eas t cancer is relate d t o a n i n crease d lifel ong e xpo s u r e to est rog e n ( as w it h f e m a l e b r ea st ca n cer) o r t o re du ce d a nd r og e n. T h e st rong est assoc i a ti on i s i n m en wit h Kli n efelter s ynd r o me (XXY); t h e y have a 14- t o 50 -f o l d i nc r eased ri s k o f d e v el op i ng male b reast ca n cer a nd acc oun t f o r abou t 3 % o f a ll male b reast ca n cer cases . Als o, me n w ho carr y a BR C A1 o r , pa rti cu l a rl y , a BRCA 2 m u tati on, h a v e a n i n crease d ris k o f d e v el oping b r eas t cance r . T h e f o ll o wi ng c ond iti on s h a v e b ee n re po rte d t o b e ass o ci a t ed w it h an i nc r eased ris k o f b reast ca n cer i n me n : c h r on ic li v er d is ord e rs, such as c irr hos i s, ch r on ic alc oho lism , a nd sc h ist o s o miasis; a h ist ory o f m u m ps o r ch iti s, und esce nd e d testes , o r testic u lar i n j u r y ; a nd f emi n iz a ti on, gene ti ca ll y o r by e nv ir on me n tal e xpo s u re . I n c on trast , gyn ec omas ti a a l one does no t a pp ear t o b e a ris k fact o r Th e c li n i ca l p r esen t a ti on o f male b reast ca n cer is similar t o t h at o f f emale b r eas t cance r , bu t t he me d ia n a g e o f on set is later t h a n i n w o me n ( 60 y ea r s v er sus 53 yea r s ) . Becau se t h e d ia gno sis o f b reast ca n cer is o fte n not | 6 | 0.098 | 0.075 | 0.08 | 0.085 | 0.08 | 0.09 | 0.098 | 1 |
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21,112 | SPECIAL THE RA P EUTIC PROBLEMS | Male B r east Cancer | nan nan | c on si d e red as p r o m p tl y i n m en a nd scree n i ng mamm og ra phy is no t u se d, me n of t en p r esen t w it h m o r e adv a n ce d sta g e t h a n do w o me n. All kno w n h ist op at ho l og i c t ypes o f b r ea st ca n cer h a v e b ee n d escri b e d i n me n, wit h i nf ilt r ati ng duc t a l ca r c i no m a acc oun ti ng f o r at least 70 % o f cases . H o we ve r , IL C i n men i s r a r e. A m a j o rit y o f male b reast ca n cers are ER/P R + , a nd t he p e r ce n ta ge pos iti ve i s g r ea t e r t h a n f o r female b reast ca n ce r . As f o r w o me n, sta g e is t he p r edo mi nan t p r ogno stic i nd icat o r , a nd m o st st ud ies re po rt t h a t sta g e fo r s t age, m en w it h b r ea st ca n cer h a v e t h e same ou tc o me f o ll o wi ng t r eatme n t as wo m en w it h b r e ast ca n ce r . A rece n t st ud y , ho we v e r , fr o m t he V ete r a n s A f f a ir s r epo rt s a wo rse p r ogno sis f o r me n t h a n w o me n i n earl y- sta g e breas t cance r . T he r e app ears t o b e a s ub sta n tial n e g ati v e d is p arit y in ou tc o m e f o r b l acks w it h m a l e b reast ca n cer c o m p are d wit h w h ites . P r im a r y l oca l tr ea tm en t i s typ icall y t o tal mastect o m y . I n s o me p atie nts w it h ea rly d i sease, BC T can b e c on si d ere d. H o we v e r , t h e s ub are o lar l o cati on o f m os t m a l e b r eas t ca n cers a nd t h e small am oun t o f b reast tiss ue pr ese n t i n m os t m en limit s e ligi b ilit y f o r BC T . T h e same c on si d erati on s r e g a rd i ng noda l su r ge r y pe rt ain f o r me n as f o r w o me n, wit h se n ti n el node b i op s y t he p r e f e rr ed tr ea tm en t i n cli n icall y nod e- n e g ati v e p atie n ts . T h e use of po stm as t ec t o m y R T f o ll ows t h e same gu i d eli n es as f o r female b reast ca n ce r . Simil a rl y , t he use o f s ystemic t h era py f o ll o ws t h e same gu i d eli nes as for wo m en w it h pos tm eno pa u sal b reast ca n ce r . A d j uv a n t s y stemic c h em o t he r apy i s used i n m en, alt hough no c on tr o lle d trials h a v e c on firm ed its v al u e . T a m ox if en i s t he mai n sta y f o r a d j uv a n t s y stemic t h era py i n E R + male breas t cance r; a s t udy o f 257 male b reast ca n cer p atie n ts d em on str ated a 1.5-fo l d i nc r ease i n m o rt a lit y i n t ho se treate d wit h a n AI v ers u s tam ox i fen . Me t as t a ti c b r eas t ca n cer i n me n is treate d i d e n ticall y t o metastati c d i sease i n wo m en. | 6 | 0.09 | 0.08 | 0.06 | 0.04 | 0.03 | 0.02 | 0.09 | 1 |
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21,113 | SPECIAL THE RA P EUTIC PROBLEMS | Phyllodes T umor | null | nan nan | Phyllodes T umor | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.055 | 0.045 | 0.09 | 1 |
21,114 | SPECIAL THE RA P EUTIC PROBLEMS | Phyllodes T umor | null | nan nan | Th e te rm phy ll odes t umor i nc l ud es a g r oup o f lesi on s o f v ar y i ng mali gnant po te n tial , r ang i ng fr o m co m p letel y b e n i gn t u m o rs t o f u ll y mali gn a n t sa r c o ma s. C li n i ca ll y , phy ll od es t u m o rs are sm oo t h, r ound e d, u s u all y | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.04 | 0.03 | 0.09 | 1 |
21,115 | SPECIAL THE RA P EUTIC PROBLEMS | Phyllodes T umor | null | nan nan | p ai n less m u lti nodu l a r l es i ons t h at ma y b e i nd isti ngu is h a b le fr o m f i bro a d e no m as. T he ave r age a g e at d ia gno sis is i n t h e f ou rt h d eca d e . S k i n u lce r ati on m ay be seen w it h l a r g e t u m o rs , bu t t h is is u s u all y du e t o p res su r e n ec ro sis r a t he r t han i nvas i on o f t h e s k i n by mali gn a n t cells . Hist o l og ical l y , phy ll odes t u m o r , li ke fi b r oad e no ma , is c o m po se d o f e p it h elial eleme n ts and a c onn e c ti ve ti ssue s tr o m a. P hy ll odes t u m o r s a r e c l assi fie d as b e n i gn, bo r d erli n e , o r mali gn a n t on t h e b asi s o f t he na t u r e o f t he t u m o r ma r g i n s ( pu s h i ng o r i n filtrati v e) a nd pr ese n c e o f ce ll u l a r a t yp i a, m i t o tic acti v it y , a nd ov e r g r o wt h i n t h e str o ma . Th e r e is d i sag r ee m en t abou t wh ic h o f t h ese criteria is m o st im po rta n t , alt hough m os t expe rt s f avo r s tr o mal ov e r g r o wt h. T h e p erce n ta g e o f phy ll odes t u m o r s c l ass ifi ed a s mali gn a n t ra ng es fr o m 23 % t o 50 % . L o ca l e x cisi on t o nega ti ve m a r g i ns is a n a pp r op riate ma n a g eme n t strate gy f o r bo t h b e n i gn and m a li gnan t phy ll od es t u m o rs if t h is ca n b e acc o m p lis h e d w it h a sati s f ac t o r y cos m e ti c ou tc o me . T h e op timal ma r g i n wi d t h is no t known, bu t w i de r exc i s i ons app ear t o re du ce t h e ris k o f LR . A pp r ox imate ly 20% of p hy ll odes t u m o r s r ecu r l o call y if e x cise d wit h no mar g i n o r a ma r g i n o f a f ew millim e t e r s o f no rmal b reast tiss u e , re g ar d less o f w h et he r t h e y a r e ben i gn o r m a li gnan t . I n a re v iew o f 821 p atie n ts wit h non met as t a ti c m a li gnan t phy l lod es t u m o rs re po rte d t o t h e S u r v eilla n ce , Ep i d emi o l og y , and E nd Resu l t s re g istr y b etwee n 1983 a nd 2002, 52 % w e r e t r eate d w it h m as t ec t o m y and th e remai nd er wit h l o cal e x cisi on. T h e 10 - yea r ca u se - s pec ifi c su r v i va l was 89 % , a nd no s u r v i v al b e n efit f o r mastect o m y w as ob s e r ved. Th e ro l e o f R T and sys t e mic t h era py i n phy ll od es t u m o r is un clea r . R T is no t u se d f o r ben i gn o r bo r de r l i n e lesi on s , bu t h as b ee n c o m b i n e d wit h w ide e x cisi on i n t he m anage m en t o f mali gn a n t phy ll od es t u m o rs . W h e n phy ll odes t u m o r s m e t as t as i ze, t h e y te nd t o b e h a v e li k e sarc o mas , wit h th e l ung as t he m os t co mm on s it e. A x illar y metastases are see n i n <5 % o f cases , a nd ax ill a r y su r ge r y i s no t i nd icate d un less w o rris o me nod es are cli n ically ev i den t . When sys temic t h era py is u se d f o r mali gn a n t phy ll odes t u m or s , tr ea tm en t i s based on t h e gu i d eli n es f o r treati ng sarc o mas . | 6 | 0.07 | 0.06 | 0.04 | 0.08 | 0.09 | 0.08 | 0.09 | 5 |
21,116 | SPECIAL THE RA P EUTIC PROBLEMS | Locally Advanced B r east Cancer and Inflammatory B r east Cancer | null | nan nan | Locally Advanced B r east Cancer and Inflammatory B r east Cancer | 6 | 0.05 | 0.075 | 0.1 | 0.09 | 0.08 | 0.06 | 0.1 | 3 |
21,117 | SPECIAL THE RA P EUTIC PROBLEMS | Locally Advanced B r east Cancer and Inflammatory B r east Cancer | null | nan nan | LA BC a nd I BC r e f e r t o a he t e r og e n e ou s g r oup o f b reast ca n cers wit hou t e v i d e n ce o f d i s t an t m e t as t ase s (M 0 ) a nd re p rese n t on l y 2 % t o 5 % o f all br east c ance r s i n t he Un it ed States . T h e term LABC e n c o m p asses p atie nts w it h (1) ope r ab l e d i sease a t p rese n tati on (cli n ical sta g e T 3 N 1 ) , ( 2 ) i nop e r a b l e d i sease a t p r esen t a ti on (cli n ical sta g e T 4 a nd / o r N 2 - 3 ) , a nd (3) I BC ( cli n i ca l s t age T 4dN0 - 3, als o i nop era b le) . (All sta g es refer t o t h e A J CC C an cer St ag i ng M anua l , seven t h e d iti on, 2010 ) S ubd i v i d i ng p atie n ts i nto t h ese t h r ee b r oad g r oups f ac ilitates cli n ical ma n a g eme n t . C o m pa ri son o f s t ud i es o f L ABC a nd IBC is p r ob lematic du e t o a h i gh d e gr ee o f he t e r ogene it y w it h i n T a nd N classificati on, small nu m b ers o f p atie n ts in s t age subg r oups, and v ariati on i n t h e d efi n iti on o f LABC acc ord in g t o AJCC s t ag i ng c riteria ov er time F o r e x am p le , s upr acla v i cu l a r l y m phadenop at h y , no w classifie d as N 3 d isease , was pr e v i ous l y c l ass ifi ed as M1 . IBC acc oun ts f o r 1 % t o 5 % o f all cases of br east c ance r i n t he Un it ed St a tes a nd is a n a gg ressi v e v aria n t o f LABC . I BC is a c li n i copa t ho l og i c en tit y c h aracterize d by d i f f u se er y t h ema a nd e d ema ( p eau d ’ o r ange ) o f t he s k i n o f t h e b reast , o fte n wit hou t a d iscreet , und e r l y i ng pa l pab l e m ass, a lt hough t h e b reast is u s u all y d iff u sel y t h ic k e n ed . I BC t yp i ca ll y has a ra p i d on set a nd is o fte n i n itiall y mista k e n as i nf ecti on and tr ea t ed w it h an ti b i o tics b ef o re t h e d ia gno sis is esta b lis h e d. Th e cli n i ca l p r esen t a ti on r esu lts fr o m t u m o r em bo li i n t h e d ermal l y m ph ati cs. Acco r d i ng t o t he AJCC sta g i ng r u les IBC is p rimaril y a cli n ical di agnos i s. I nvo l ve m en t o f d ermal l y m ph atics i n t h e a b se n ce o f cli n ical f i nd i ngs does no t i nd icate IBC . A s k i n b i op s y ma y b e p erf o rme d to c onf i r m t he c li n i ca l im p r ess i on o f IBC , bu t t h e a b se n ce o f d ermal l y m phatic i nvo l v em en t does no t a f f ec t s ta g i ng. IBCs are m o re li k el y t o b e h i gh - g ra de, HER2 -o v e r exp r ess i ng, and l a c k i ng i n ho rm on e rece p t o r e xp ressi on c o m p a red w it h o t he r p r esen t a ti on s o f b reast ca n ce r . Beca u se bo t h LAB C a nd I BC a r e assoc i a t ed w it h sub sta n tial ris k o f metastatic d isease , p atie nts | 6 | 0.09 | 0.08 | 0.07 | 0.06 | 0.05 | 0.04 | 0.09 | 1 |
21,118 | SPECIAL THE RA P EUTIC PROBLEMS | Locally Advanced B r east Cancer and Inflammatory B r east Cancer | null | nan nan | w it h t h e se cance r s shou l d und e r go f u ll w o r kup f o r d ista n t metastases p ri o r t o i n itiat ion o f t he r ap y . Patie n t s w it h L ABC o r I B C s hou l d b e e v al u ate d by a m u lti d isci p li n ar y team ( i dea ll y , a r ound t he tim e o f d ia gno sis) . T reatme n t t yp icall y i n cl ud es n e o a d j uvan t che m o t he r ap y , su r g er y , a nd R T . Pri o r t o t h e u se o f n e o a d j uvant c h em o t he r ap y , l ong -t e rm su r v i v al was un c o mm on. L ong -term s u r v i v al h as b ee n grea tl y im p r oved w it h agg ressi v e trim od alit y treatme n t . As wit h ear ly -sta g e breas t cance r , b i o l og i c t u m o r mar k ers s hou l d a f fect treatme n t selecti on : pa ti en t s w it h H ER 2 + ca n cers s hou l d recei v e trast u z u ma b - b ase d t h e r a p y , and pa ti en t s w it h ho r mon e rece p t o r –po siti v e ca n cers s hou l d r ecei v e ad j uvan t endoc ri ne t h era p y . A n t h rac y cli n e- a nd ta x a n e- b ase d c h em o t he r apy r eg im ens a r e app r op riate as i ndu cti on c h em o t h era py f o r wo me n wit h L ABC o r I BC. Th e v ast maj o rit y o f p atie n ts will h a v e cli n i cal r es pon s e t o t he r ap y , and r ough l y 15 % t o 25 % will e xp erie n ce a p CR . T he a dd iti on o f pac lit axe l t o an t h rac y cli n e- b ase d t h era py a pp ears t o im p r ov e l ong- te rm d i sease ou t co m es for w o me n wit h LABC a nd IBC . T h ere ar e no st ud i es o f tr as t uzu m ab spe cificall y f o r LABC/IBC; ho we v e r , by e x t r a po l a ti on o f r esu lt s us i ng t rast u z u ma b f o r earl y -sta g e b reast ca n ce r , it s hou l d b e i nco r po r a t ed i n t o t h e treatme n t o f w o me n wit h HER 2 + LABC o r I BC . A s w it h o t he r expe ri ence s u si ng n e o a d j uv a n t c h em o t h era p y , c o m p l ete p at ho l og i c e r ad i ca ti on o f t he tu m o r is ass o ciate d wit h s up eri o r ou tc o mes am ong wo m en w it h L ABC o r IBC . H o we v e r , e v e n am ong p atie n ts wi th p CR t o neoad j uvan t che m o t h era p y , t ho se wit h LABC o r IBC at b aseli n e h a v e a h i ghe r ri sk o f r ecu rr en ce t h a n p atie n ts wit h earlier-sta g e b reast ca n ce r at base li ne . P a ti en t s w it h LABC o r IBC s hou l d b e r ou ti n el y tre ated w it h pos tm as t ec t o m y R T , r ega r d less o f t h e p at ho l og ic res pon se . S o m e wo m en w it h L ABC ma y b e ca nd i d ates f o r BCT f o ll o wi ng n e o a d j uvan t che m o t he r ap y . I n on e series , l o cal-re g i on al c on tr o l f o ll o wi ng t h is a pproach appea r ed t o be e x celle n t e x ce p t i n p atie n ts wit h on e o r m ore of t h e fol l ow i ng f ea t u r es : ( 1 ) c li n ical N 2 - 3 d isease , ( 2 ) l y m phov asc u lar i nv asi on, ( 3 ) r es i dua l p rim a r y p at ho l og ic size >2 cm a nd ( 4 ) m u ltif o cal r esi du al d i sease . Howeve r , t h ere is still limite d e xp erie n ce wit h t h is a ppro ach . I n con tr as t , BC T i s c on trai nd icate d i n p atie n ts wit h IBC , e v e n | 6 | 0.09 | 0.08 | 0.07 | 0.06 | 0.05 | 0.04 | 0.09 | 1 |
21,119 | SPECIAL THE RA P EUTIC PROBLEMS | Locally Advanced B r east Cancer and Inflammatory B r east Cancer | null | nan nan | a f te r a c o m p l e t e c li n i ca l r espon se t o n e o a d j uv a n t t h era p y . I n a small st udy of 13 p ati en t s w it h I BC tr ea t ed wit h p re op erati v e c h em o t h era py a nd BC T , 7 of 13 e xpe ri enced L R T h i s, c oup le d wit h t h e d i f f u se n at u re o f IBC , i nd icates t ha t BC T i s con tr a i n dicate d i n w o me n wit h t h is d ia gno sis . A lt hough m os t wo m en hav e a cli n ical res pon se t o n e o a d j uv a n t c h em o t he r ap y , so m e pa ti en t s will e xp erie n ce t u m o r p r og ressi on o r remai n i nop e r a b l e. S uch pa ti en t s m ay b e ca nd i d ates f o r non– cr o ss-resista n t c h em o t he r apy o r nove l tr ea tme n ts . S u r g er y is c on trai nd icate d i n IBC unless t h e r e is co m p l e t e r eso l u ti on o f t h e i n flammat o r y s k i n c h a ng es . I n m od er n st ud ies , 85 % t o 90 % o f pa ti e nts b ec o me op era b le after i n itial c h em o t he r ap y . R T m ay f ac ilitate c onv ersi on o f i nop era b le t o op era b le d isease . D esp it e m ode r n m u ltim od alit y t h era p y , a pp r ox imatel y 20 % o f p atie n ts wit h I BC tr ea t ed w it h c h em o t h era p y , s u r g er y , a nd R T will e xp e r ien ce L RR . P a ti en t s w it h c h est wall rec u rre n ce after c h em o t h era p y , s u r g e r y , and R T a r e a t h i gh ri sk f o r bo t h e x te n si v e l o cal-re g i on al t u m o r s pr ea d a nd f o r deve l op i ng m et astatic d isease t o v isceral o r g a n sites , a nd a r e t r eate d acco r d i ng t o gu i de li ne s f o r metastatic b reast ca n ce r . | 6 | 0.06 | 0.04 | 0.08 | 0.07 | 0.09 | 0.08 | 0.09 | 5 |
21,120 | MANA GE M E NT OF LOCAL-R EG IONAL RECURR E NCE | null | null | nan nan | MANA GE M E NT OF LOCAL-R EG IONAL RECURR E NCE | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.1 | 0.1 | 0.1 | 5 |
21,121 | MANA GE M E NT OF LOCAL-R EG IONAL RECURR E NCE | null | null | nan nan | L RR a f t e r p rim a r y t he r apy f o r b reast ca n cer i n cl ud es i n - b reast rec u rre n c e a f te r B C S , ches t wa ll r ecu rr e nce after mastect o m y , a nd re g i on al nod al r ec urr e nces, and accoun t s f o r a bou t 15 % o f all b reast ca n cer rec u rre n ces . | 6 | 0.02 | 0.03 | 0.04 | 0.01 | 0.02 | 0.01 | 0.04 | 3 |
21,122 | MANA GE M E NT OF LOCAL-R EG IONAL RECURR E NCE | null | nan nan | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.05 | 0.04 | 0.09 | 1 |
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21,123 | MANA GE M E NT OF LOCAL-R EG IONAL RECURR E NCE | null | nan nan | P r e d ict o r s o f L R i nc l ude h i gh er i n itial t u m o r sta g e , young p atie n t a g e i nvo l v e d, su r g i ca l m a r g i ns, and i n tri n sic s ub t yp e ( g reater ris k wit h b asal-li k e , l u mi na l B, o r H ER 2 + can cers) . M o re t h a n 60 % o f p atie n ts wit h LRR a f te r eit he r BC T o r m as t ec t o m y will e v e n t u all y d e v el op metastatic d isease S ho rt d i sease -fr e e i n ter v als , l y m ph nod e rec u rre n ce , s k i n lesi on s , and t u m o r l ack o f E R e xp ressi on all po rte nd g reater ris k o f d issemi na t ed cance r . P a ti en t s wit h LRR warra n t c o m p re h e n si v e resta g i ng to e x cl ud e c oncu rr en t m e t as t a ti c d isease . | 6 | 0.05 | 0.075 | 0.08 | 0.09 | 0.1 | 0.1 | 0.1 | 5 |
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21,124 | MANA GE M E NT OF LOCAL-R EG IONAL RECURR E NCE | null | nan nan | D es p it e t he h i gh -ri sk na t u re o f LRR , p atie n ts are treate d wit h c u rati ve i n te n t i n m u lti d i sc i p li na r y f as hi on, wit h treatme n t p la n s i nd i v i du alize d b ase d on t he na t u r e o f t he L R R , p ri o r l o cal t h era p y , a nd p ri o r a d j uv a n t s y stemi c t he r ap y . T he i n iti a l ma n a g eme n t ste p is u s u all y s u r g ical resecti on. W o me n p r ev i ous l y tr ea t ed w i th BCS are o f fere d sal v a g e mastect o m y . Patie n ts w it h l oca li zed ches t w all rec u rre n ces s hou l d und e r go s u r g ical e x cisi on, wh il e A L ND i s i nd i c ate d f o r a x illar y nod al rec u rre n ces o cc u rr ing a f te r se n ti ne l l y m ph node b i op s y . R T t o sites o f re g i on al rec u rre n ce a nd a dd iti ona l r eg i ona l l y m ph nod es is sta nd ar d. Patie n ts wit h p ri o r R T after eit h e r BCS o r m as t ec t o m y ne e d caref u l p la nn i ng t o mi n imize ov erla p w ith pr i or R T fi e l ds. C urren t tr ea tm en t s t anda r d s f o r LRR rec o mme nd i n tr odu cti on o f s y stemi c t he r apy f o ll ow i ng l o cal ma n a g eme n t . Rec u rre n ces t h at are E R + w a rr a n t i n tr oduc ti on o r sw it ch i ng o f e ndo cri n e t h era p y . Patie n ts wit h r ec urr e nce on t a m ox if en shou l d c on si d er treatme n t wit h AIs . Patie n ts w ho h a v e r ec u rr ences on A I t he r apy ma y c on si d er tam ox ife n o r f u l v estra n t . Patie n ts w it h H ER 2 + t u m o r s s h ou l d c on si d er i n itiati on o r re-i n stit u ti on o f a n ti - HE R 2 t he r apy i n an ad j u va n t fas h i on. T h e r o le o f c h em o t h era py i n the ma n a g e men t o f L RR has been c on tr ov ersial , es p eciall y am ong t ho se pr e v i ous l y tr ea t ed w it h ad j uvan t c h em o t h era p y . T h e C h em o t h era py as Ad j uv a n t f o r L oca ll y Recu rr en t Breast Ca n cer st udy was a ra ndo mize d tr ial of “a d j uvan t ” che m o t he r apy f o ll o wi ng op timal resecti on o f LRR . | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
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21,125 | MANA GE M E NT OF LOCAL-R EG IONAL RECURR E NCE | null | nan nan | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.05 | 0.04 | 0.09 | 1 |
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21,126 | MANA GE M E NT OF LOCAL-R EG IONAL RECURR E NCE | null | nan nan | C h em o t he r apy r educed t he ri sk o f s ub se qu e n t ca n cer rec u rre n ce a nd im prov e d O S , espec i a ll y i n E R − t u m o rs , t hough m od est b e n efits were se en am ong pa ti en t s w it h E R + t u m o rs . Patie n ts wit hou t p ri o r c h em o t h era py e xpo s ure wou l d be su it ab l e f o r a ny sta nd ar d a d j uv a n t c h em o t h era py r e g ime n. T hose pa ti en t s w it h p ri o r c h em o t h era py treatme n t ma y c on si d er nonov e r l app i ng r eg im ens. | 6 | 0.05 | 0.075 | 0.1 | 0.09 | 0.08 | 0.06 | 0.1 | 3 |
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21,127 | ME T AS T A TIC DISEASE | null | null | nan nan | ME T AS T A TIC DISEASE | 6 | 0.05 | 0.08 | 0.09 | 0.1 | 0.07 | 0.06 | 0.1 | 4 |
21,128 | ME T AS T A TIC DISEASE | null | null | nan nan | Metasta t i c ( s t age I V ) b r eas t c a n cer is d efi n e d by t u m o r s p rea d b e yond t he br east , c hes t wa ll , and i ps il a teral re g i on al l y m ph nod es . T h e m o st c o mm on sites for b r eas t cance r m e t as t a sis i n cl ud e t h e bon e , l ung, li v e r , l y m ph nodes, c h est wa ll , and b r a i n. Howev e r , case re po rts h a v e do c u me n te d b reast ca nce r d issemi na ti on t o a lm os t eve r y o r g a n i n t h e bod y . H o rm on e rece p t o r – po siti v e t u m o r s a r e m o r e li ke l y t o s p rea d t o bon e as t h e i n itial site o f metasta s i s ; ho rm one r ecep t o r –n e g ati v e a nd / o r HER 2 + t u m o rs are m o re li k el y t o r ecu r i n iti a ll y i n v i sc era . L obu lar (as oppo se d t o du ctal) ca n c e r s a r e m ore o ft en assoc i a t ed w it h ser o sal metastases t o t h e p le u ra a nd a bdo me n. Mos t wo m en w it h m etastatic d isease will h a v e b ee n i n itiall y d ia gno se d w it h ea rl y - s t age b reast ca n ce r , treate d wit h c u rati v e i n te n t , a n d t h e n e xpe ri ence m e t as t a ti c r e c u rre n ce . O n l y a bou t 10 % o f p atie n ts wit h n e w l y d i agnosed b r eas t cancer i n t h e U n ite d States h a v e metastatic d ise ase at pr ese n t a ti on ; t h i s p r opo rti on is far h i gh er i n areas w h ere scree n i ng progr ams a r e no t ava il ab l e. S y m p t o m s o f m e t as t a ti c br east ca n cer are relate d t o t h e l o cati on a nd e x te n t o f t he t u m o r . Co mm on s y m p t o ms o r phy sical e x ami n ati on fi nd i ngs i n cl ud e bone d i sco mf o rt , l y m ph a d e nop at h y , s k i n c h a ng es , c ough o r s hor t n es s o f b r ea t h, and f a ti gu e . T h ese cli n ical fi nd i ng s are all non s p ecifi c, a nd a pprop ri a t e eva l ua ti on i s warra n te d i n p atie n ts wit h b reast ca n cer wi th n e w or evo l v i ng sy m p t o m s. I n s o me cases , phy sical e x ami n ati on o r r a d i o l ogic fi nd i ngs w ill de m on strate un e qu i vo cal e v i d e n ce o f metastatic br east c ance r . I n i ns t ances wh e n ra d i o l og ic o r cli n ical fi nd i ng s are e qu i vo cal , ti ssue b i opsy i s im p erati v e . If a b i op s y is p erf o rme d, ER , PR , a nd HE R 2 shou l d be r ede t e rmi n e d. Th e tr ea tm en t goa l s i n wom e n wit h a dv a n ce d b reast ca n cer i n cl ud e pro l onga ti on o f lif e, con tr o l of t u m o r bu r d e n, re du cti on i n ca n cer-related s y m p t o m s o r co m p li ca ti ons, and mai n te n a n ce o f qu alit y o f life a nd fun cti on. T he r apy i s no t gener all y c on si d ere d c u rati v e . A small fracti on o f p atie n ts , o ft en t hose w it h limite d sites o f metastatic d isease o r b eari ng t u m or s w it h exqu i s it e sens itivit y t o treatme n t , ma y e xp erie n ce v er y l ong p e r i od s o f r e mi ss i on and t u m o r c on tr o l . T reatme n t o f metastatic b reast ca n ce r , li ke tr ea tm en t o f ea rl y- sta g e b reast ca n ce r , is b ase d on c on si d era tion | 6 | 0.095 | 0.087 | 0.063 | 0.042 | 0.036 | 0.021 | 0.095 | 1 |
21,129 | ME T AS T A TIC DISEASE | null | null | nan nan | of t u m o r b i o l ogy and c li n i ca l h ist o r y . T hu s , c h aracterizati on o f t u m o r ER , PR , a nd H ER 2 s t a t us i s c riti ca l f o r all p atie n ts , a nd a d etaile d assessme nt o f p ast t r eatm en t , i nc l ud i ng timi ng o f t h era p ies as well as p atie n t s y m p t o m s a nd func ti ona l assess m en t , i s e sse n tial . Patie n ts wit h e ndo cri n e-se n siti v e t u m or s , pa rti cu l a rl y t hose w it h mi n imal s y m p t o ms a nd limite d v isceral i nvo l v em en t , a r e cand i da t es f o r i n itial treatme n t wit h e ndo cri n e t h era py al on e; i n iti a l tr ea tm en t us i ng c o m b i n e d c h em o e ndo cri n e t h era py h as no t b ee n s hown t o im p r ove su r v ival c o m p are d wit h se qu e n tial treatme n t progr ams . P a ti en t s w it h ho rmo n e rece p t o r –n e g ati v e t u m o rs o r t ho se wit h hor m one r ecep t o r –pos iti ve t u m o rs p r og ressi ng d es p ite t h e u se o f e ndo cri ne t h e r a py a r e cand i da t es f o r ch em o t h era p y . If t h e t u m o r is HER 2 +, t h e n a nti - HER2 t rea tm en t i s e m p l oyed i n c o m b i n ati on wit h c h em o t h era p y . W ell- es t ab li shed c li n i ca l f a ct o rs ca n i n f o rm t h e li k eli hood o f res pon s e to t h e r a py and l ong -t e rm ou t com es i n w o me n wit h metastatic b reast ca n ce r . Patie n ts who have r ece i ved l es s t h era p y , a l ong er d isease-free i n ter v al si nce i n itial d ia gnos i s, so ft ti ssue o r bon e metastases , fewer s y m p t o ms a nd b et te r p e rfor ma nce s t a t us, and t u m o rs t h at are ho rm on e rece p t o r –po siti v e o r HER2 + a r e li ke l y t o expe ri enc e l ong er s u r v i v al wit h metastatic d isease t han m or e h e av il y tr ea t ed pa ti en t s wit h s ho rter i n ter v als si n ce treatme n t , v isc e r al metasta ses, and g r ea t e r sy m p toms . In cli n i ca l tri a l s, t he m easu re d e nd po i n ts f o r d efi n i ng efficac y o f t h er apy for metast a ti c b r eas t cance r ar e res pon se rate , time t o t u m o r p r og ressi on, a nd O S . T hese l and m a r ks a r e im po rta n t f o r gu i d i ng cli n ical p ractice as well, alt hough f o rm a l m easu r es o f res pon se/ p r og ressi on are o fte n d iffic u lt t o a pp l y ow i ng t o i ncons i s t enc i e s i n ima g i ng st ud ies , t h e p re v ale n ce o f non meas u r ab l e d i sease such as bon e lesi on s , s ub ce n timeter t u m o r d e po s its, a nd p le u r a l e f f us i ons o r asc it e s . T h e art o f treati ng p atie n ts wit h metastat ic br east c ance r i nvo l ves ca r e f u l , t hough tf u l re p etiti on o f a p r o cess o f t r eatme n t i n iti a ti on, eva l ua ti o n i n cl ud i ng assessme n t o f p atie n t f un cti onal stat u s a nd sy m p t o m p r o fil e, and serial meas u reme n t o f t u m o r bu r d e n a nd r es pon s e t o t he r ap y , t h r ough m u lti p le li n es o f t h era p y . Cli n ical gu i d eli n es for t h e manage m en t o f m e t as tatic carci no m a are o fte n qu ite op e n -e nd e d, ac know le dg i ng t he m u lti p l e t r eatme n t p at h wa y s t h at mi gh t b e le g itimatel y | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
21,130 | ME T AS T A TIC DISEASE | null | null | nan nan | pur s u e d, a r gu i ng f o r j ud i c i ou s u se o f cli n ical d ecisi on ma k i ng a nd treatm ent selecti on based on t u m o r b i o lo g y , a nd f o c u si ng cli n icia n s on t h e c on ti nu o us c on si d e ra ti ons o f pa ti en t p r e f e re n ce a nd ill n ess e xp erie n ce . | 6 | 0.05 | 0.01 | 0.02 | 0.01 | 0.04 | 0.01 | 0.05 | 1 |
21,131 | ME T AS T A TIC DISEASE | Endocrine Therapy for Metastatic Breast Cancer | null | nan nan | Endocrine Therapy for Metastatic Breast Cancer | 6 | 0.05 | 0.075 | 0.1 | 0.09 | 0.08 | 0.06 | 0.1 | 3 |
21,132 | ME T AS T A TIC DISEASE | Endocrine Therapy for Metastatic Breast Cancer | null | nan nan | Endo c r i ne tr ea tm en t i s a key i n ter v e n ti on f o r w o me n wit h ho rm on e r ece p t or–pos iti ve, m e t as t a ti c b reast ca n ce r . lists a v aila b le e ndo c r i ne d r ugs f o r tr ea ti ng adv a n ce d b reast ca n ce r . Si ng le-a g e n t t h era py is t h e sta nda r d app r oach ; co m b i n i ng e ndo cri n e a g e n ts h as no t i n g e n eral b e en s hown t o im p r ove ou t co m es. Ma ny w o me n will b e ca nd i d ates f o r m u lti ple li n es of e ndoc ri ne t he r apy t o con tr o l metastatic b reast ca n ce r . O n a v era ge, f i r st - li ne tr ea tm en t i s assoc i a te d wit h 8 t o 12 m on t h s o f t u m o r c on tr o l , a nd sec ond- l ine tr ea tm en t w it h 4 t o 6 m on t h s . I nd i v i du al p atie n ts ma y e xp e r ien ce subs t an ti a ll y l onge r time t o p r og ressi on. Se qu e n tial si ng le-a gent sec ond- a nd t h ir d -li ne endoc r in e treatme n ts are o fte n effecti v e , alt hough t yp icall y f o r sho rt e r du r a ti ons t h a n i n itial t h era p y . Patie n ts wit h eit h er ove r t t u m or s h ri nkage o r s t ab ili za ti on o f d isease i n res pon se t o e ndo cri n e t r eatme n t can have equ i va l ent l ong -term t u m o r c on tr o l . E ndo cri n e t h era py ca n ca use r eg r ess i on o f so ft tiss u e a nd bon e a nd v isceral metastases . Rece n tl y , seve r a l s t ud i es h a v e e x ami n e d t h e c o m b i n e d u se o f a n AI with fu l v est ran t f o r de novo o r p r og ressi v e , E R + , metastatic b reast ca n ce r | 6 | 0.09 | 0.075 | 0.08 | 0.09 | 0.085 | 0.08 | 0.09 | 1 |
21,133 | ME T AS T A TIC DISEASE | Endocrine Therapy for Metastatic Breast Cancer | null | nan nan | In t r eat men t- na ï ve pa ti en t s, t h e SWOG 0226 trial s ugg este d t h at c o m b i ning a n ast ro z o l e w it h f u l ves tr an t i mp r ov e d p r og ressi on -free s u r v i v al a nd OS . B y c on t r ast , i n pa ti en t s who had recei v e d p ri o r tam ox ife n i n t h e SWOG a nd F u l v est ran t and Anas tr ozo l e C o m b i n ati on T h era py trials , o r p ri o r AI t h e r a py i n t he St udy o f F as l od e x v s E x emesta n e wit h /wit hou t Arimi d e x t r ial , t h e co m b i na ti on o f f u l v estra n t p l u s a n AI was no t s up eri o r t o m ono t he r apy app r oaches. T hu s , t h e c o m b i n e d u se o f a n AI wit h f u l v estr ant is a pprop ri a t e p rim a ril y a m on g w o me n wit h e ndo cri n e- n aï v e ca n cers . Ev e n t ua ll y , m os t wo m en wit h ho rm on e rece p t o r –po siti v e metastatic br east c ance r w ill p r og r ess de s p ite first-li n e e ndo cri n e t h era p y , a nd b e ca nd i d ate s f o r second - , t h ir d - , a nd e v e n s ub se qu e n t li n es o f e ndo cri n e t h e r a p y . Res i s t ance t o tr ea tme n t do es no t seem t o b e ass o ciate d wit h l o s s o f hor m one r ecep t o r exp r ess i on b y t h e t u m o r cells . T h e res u lts o f t h e Brea st Ca n ce r T ri a l s o f O r a l E ve r o lim u s- 2 trial h a v e rece n tl y le d t o t h e a pp r oval o f t h e mamm a li an t a r ge t o f r apamy ci n i nh i b it o r e v er o lim u s i n t h e a dv a n ce d setti ng . I n t h i s r ando mi zed cli n ical trial , p atie n ts wit h a dv a n ce d d isease r esista n t t o l e tr ozo l e o r anas troz o le were assi gn e d t o e x emesta n e p l u s e v e ro lim us o r p l acebo. T he c om b i n ati on o f e x emesta n e a nd e v er o lim u s e x te nd ed p r og r ess i on -fr ee su r v i v al , bu t was ass o ciate d wit h si gn ifica n t si de e f f ects , i nc l ud i ng s t o m a titi s, h yp e r g l y cemia , a nd pn e u m on itis . Ind ic a ti ons f o r che m o t he ra py i n cl ud e s y m p t o matic t u m o r p r og ressi on, p e nd i ng v i sce r a l c ri s i s, o r r es ista n ce t o m u lti p le e ndo cri n e t h era p ies . Patie n ts p r esen ti ng w it h ex t en si v e v isceral metastases o r p r o f ound s y m p t o m s fr o m b r eas t cance r ma y b e n efit fr o m i ndu cti on c h em o t h era p y , wh ic h sh ou l d t hen be f o ll owed wit h e ndo cri n e t h era p y . T am ox if en was t he h i s t o ri c sta nd ar d as treatme n t f o r E R + metastatic br east c ance r , assoc i a t ed w it h a 50 % res pon se rate a nd me d ia n du rati on o f r es pon s e o f 12 t o 18 m on t hs a m ong treatme n t- n aï v e p atie n ts . A “tam ox if en f la r e” r e ac ti on, t yp i ca ll y cha racterize d by i n te n sificati on o f bon e p ai n, t r a n sie n t t u m o r p r og r ess i on, and hyp ercalcemia , ca n arise i n 5 % t o 10 % o f p atie n ts wit h i n t he fir s t days o r wee k s o f tam ox ife n treatme n t . Flare r eacti ons a r e o ft en ha r b i nge r s o f e xqu isite t u m o r se n siti v it y t o e ndo cri n e | 6 | 0.09 | 0.07 | 0.04 | 0.03 | 0.02 | 0.01 | 0.09 | 1 |
21,134 | ME T AS T A TIC DISEASE | Endocrine Therapy for Metastatic Breast Cancer | nan nan | 6 | 0.09 | 0.1 | 0.085 | 0.075 | 0.06 | 0.04 | 0.1 | 2 |
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21,135 | ME T AS T A TIC DISEASE | Endocrine Therapy for Metastatic Breast Cancer | nan nan | a nd ma y have m odes t c li n i ca l a dv a n ta g es ov er tam ox ife n as i n itial t r eatme n t f o r m e t as t a ti c d i sea se . F u l v estra n t a pp ears t o h a v e c o m p a rab l e ac ti v it y t o A I s i n w o me n p re v i ou sl y treate d wit h tam ox i fen . Th e op tim a l sequenc i ng o f e ndo cri n e t h era py f o r po stme nop a u sal wo me n t r ea t ed w it h ad j uvan t AIs is no t clea r , as few trials h a v e ri go r ou s ly e xp l or e d d i f f e r en t tr ea tm en t s am ong s u c h p atie n ts . T am ox ife n, f u l v estra nt, prog esti ns, and poss i b l y d i f f er e n t AIs are all reas on a b le op ti on s am ong such p atie n ts . | 6 | 0.05 | 0.01 | 0.02 | 0.01 | 0.03 | 0.01 | 0.05 | 1 |
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21,136 | ME T AS T A TIC DISEASE | Chemotherapy for Metastatic B r east Cancer | null | nan nan | Chemotherapy for Metastatic B r east Cancer | 6 | 0.05 | 0.075 | 0.1 | 0.09 | 0.08 | 0.06 | 0.1 | 3 |
21,137 | ME T AS T A TIC DISEASE | Chemotherapy for Metastatic B r east Cancer | null | nan nan | C y t o t ox i c che m o t he r apy r e mai n s a mai n sta y o f treatme n t f o r w o me n wi th metastati c b r eas t cance r , irr esp ecti v e o f ho rm on e rece p t o r stat u s , a nd is th e b ac kbon e o f m any nove l tr ea t m e n ts i n c o r po rati ng b i o l og ic t h era p y | 6 | 0.05 | 0.01 | 0.02 | 0.01 | 0.01 | 0.01 | 0.05 | 1 |
21,138 | ME T AS T A TIC DISEASE | Chemotherapy for Metastatic B r east Cancer | nan nan | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.1 | 0.1 | 0.1 | 5 |
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21,139 | ME T AS T A TIC DISEASE | Chemotherapy for Metastatic B r east Cancer | nan nan | C h em o t he r apy has subs t an ti a l si d e e f fects , i n cl ud i ng fati gu e , n a u sea , vo miti n g , m ye l osupp r ess i on, n e u r op at h y , d iarr h ea , a nd al op ecia , ma k i ng f o r t r a d e o f f s be t ween cance r pa lliati on a nd t ox icities o f t h era p y . C h em o t h era py is u se d i n pa ti en t s w it h ho rm on e-refract o r y o r ho rm on e-i n se n siti v e t u m o r s. | 6 | 0.05 | 0.01 | 0.02 | 0.01 | 0.01 | 0.01 | 0.05 | 1 |
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21,140 | ME T AS T A TIC DISEASE | Chemotherapy for Metastatic B r east Cancer | nan nan | T u m o r r esponse t o che m o t h era py is a s u rr og ate f o r l ong er ca n cer c on tr ol a nd s urv i va l . Fir s t-li ne ch em o t h era py is ass o ciate d wit h h i gh er r es pon s e r a t es and l onge r t u m o r c on tr o l t h a n sec ond -li n e , a nd s o f o rt h. Th e r e a r e r e l a ti ve l y f ew s t ud i e s o f f ou rt h o r h i gh er li n es o f c h em o t h era p y , alt hough pa ti en t s o ft en r ece i v e ma ny li n es o f treatme n t . T rials h a v e d em on st ra t ed pa lli a ti ve bene f i ts o f c h em o t h era py i n p atie n ts wit h refrac to r y t u m or s rece i v i ng t h ir d -li ne o r s ub se qu e n t c h em o t h era py treatme n t , bu t t he ma gn it ude o f such ga i ns m us t b e realisticall y wei gh e d a g ai n st t h e si d e e f f ects o f tr ea tm en t . Che m o t h era py treatme n t ca n b e i n terr up te d i n p atie nts who h a ve had s i gn ifi can t r espon se o r p alliati on f o ll o wi ng i n itiati on o f t h e r a py and r e i n tr oduced whe n t h ere is t u m o r p r og ressi on o r s y m p t o m r ec urr e nce. Si n c e t he adven t o f che m o t h era py a d mi n istrati on f o r metastatic b reas t ca n ce r , it has been deba t ed wh et h er si ng le-a g e n t se qu e n tial treatme n t o r c o m b i na ti on tr ea tm en t w it h m u lti p le a g e n ts is t h e b est strate g y . C o m b i na ti on che m o t he r apy m a y b e ass o ciate d wit h h i gh er res pon se rate s a nd im p r oved tim e t o p r og r ess i on c o m p are d wit h si ng le-a g e n t t h era p y . How e v e r , s t ud i es t ha t have sp ecificall y p la nn e d f o r cr o ss ov er treatme n t w it h sec ond -li ne sequen ti a l t h era py h a v e no t s ho w n im p r ov e d s u r v i v al c o m p a red w it h a sequen ti a l tr e atme n t p r og ram . Patie n ts wit h e x te n si v e v isce r al d i sease o r pend i ng v i s ceral crisis ma y p refere n tiall y re qu ire i n itiati on o f co m b i na ti on che m o t h era p y , bu t t h is h as no t b ee n d em on strat ed i n pro s pec ti ve s t ud i es. Becau se si ng le-a g e n t c h em o t h era py facilitates b et te r und e r sta nd i ng o f wh i ch d r ugs are c on tri bu ti ng t o b e n efit o r si d e effects and is g e n e ra ll y assoc i a t ed w it h l e ss t ox icit y , it remai n s t h e p referre d a pp r o ac h. A la r ge nu m be r o f che m o thera py a g e n ts a nd c o m b i n ati on s are effecti ve i n t r eatm en t o f m e t as t a ti c b r ea st ca n cer ( ) . A v ariet y o f s p eci f ic d r ugs and co m b i na tio n s are c on si d ere d p referre d b ase d on a la r ge h ist or ic a l expe ri ence, r esu lt s fr o m ra ndo mize d trials , a nd c on si d erati on o f t ox icit y p r o fil es. A s i ng l e “bes t” a pp r o ac h f o r all p atie n ts wit h metastati c ca n ce r i s no t suppo rt ed by t he literat u re . Alt hough a n t h rac y cli n e- a nd ta x a n e - b ased tr ea tm en t s a r e gen erall y c on si d ere d t o b e am ong t h e m o st acti v e i n tr ea tm en t o f m e t as t at ic b reast ca n ce r , t h eir u tilit y h as le d t o t h e i r | 6 | 0.05 | 0.075 | 0.1 | 0.025 | 0.08 | 0.09 | 0.1 | 3 |
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21,141 | ME T AS T A TIC DISEASE | Chemotherapy for Metastatic B r east Cancer | nan nan | i n c orpor ati on i n t o ad j uvan t ch em o t h era py re g ime n s . T hu s , ma ny w o me n w it h met as t a ti c b r eas t cance r w ill alrea dy h a v e b ee n treate d wit h a n t hr acy c li nes and / o r t axanes, d imi n is h i ng t h e u tilit y o f t h ese a g e n ts i n t he p alliati on o f m e t as t a ti c d i sease. Ca p e c it ab i ne i s an o r a ll y a vaila b le fl uo r opy rimi d i n e , meta bo lize d i n tiss u es int o 5 -fl uo r ou r ac il . Cap ecita b i n e h as cli n ical acti v it y i n a n t hr acy c li ne - and t axane -r es ista n t b reast ca n ce r , a nd im p r ov es res ponse a nd s urv i va l as fir s t-li ne tr ea t m e n t w h e n a dd e d t o si ng le-a g e n t do ceta x el . | 6 | 0.09 | 0.08 | 0.07 | 0.06 | 0.05 | 0.04 | 0.09 | 1 |
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21,142 | ME T AS T A TIC DISEASE | Chemotherapy for Metastatic B r east Cancer | nan nan | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.1 | 0.1 | 0.1 | 5 |
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21,143 | ME T AS T A TIC DISEASE | Chemotherapy for Metastatic B r east Cancer | nan nan | Do se esca l a ti on o f t axane t h era py wit h p aclita x el h as no t b ee n s ho w n to r es u lt i n c li n i ca ll y im po rt an t im p r ov eme n ts . H o we v e r , wee k l y a d mi n is t r a ti on o f pac lit axe l t h era py do es a pp ear t o im p r ov e res pon se rat e a nd tim e t o p r og r ess i on co m pa re d wit h less fre qu e n t , e v er y - 3 -wee k a d mi n is t r a ti on A s a s tr a t egy t o ove r co m e ch em o t h era py resista n ce , ma ny i nv esti g at o r s i n t h e 1990s exp l o r ed h i gh - do se c h em o t h era py wit h a u t o l ogou s bon e ma rrow or s t e m ce ll suppo rt as treatme n t f o r b reast ca n ce r . Prelimi n ar y st ud ies sugges t ed f avo r ab l e c li n ical ou tc o mes , p r o m p ti ng bo t h wi d es p rea d u se of h i gh - dose che m o t he r apy i n cli n ical p ractice a nd ra ndo mize d trial s f o r p atie n ts wit h e it he r m e t as t a ti c o r h i gh -ris k, nod e- po siti v e b reast ca n ce r . D es p ite i n iti a l hopes, c li n i ca l t rials f ound no d iffere n ce i n ou tc o me b etw een sta nd a rd che m o t he r apy f o ll ow e d by treatme n t wit h eit h er h i gh - do se c h em o t he r apy and au t o l ogous stem cell resc u e o r mai n te n a n ce c h em o t he r apy a t conven ti ona l do ses . T h ere is no c u rre n t r o le f o r bon e ma rrow or s t e m ce ll tr ansp l an t i n ma n a g eme n t o f eit h er earl y - o r late-sta ge br east c ance r . | 6 | 0.05 | 0.075 | 0.08 | 0.06 | 0.04 | 0.025 | 0.08 | 3 |
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21,144 | ME T AS T A TIC DISEASE | Anti- HER2 Therapy for Metastatic B r east Cancer | null | nan nan | Anti- HER2 Therapy for Metastatic B r east Cancer | 6 | 0.09 | 0.1 | 0.085 | 0.075 | 0.06 | 0.04 | 0.1 | 2 |
21,145 | ME T AS T A TIC DISEASE | Anti- HER2 Therapy for Metastatic B r east Cancer | First-Line T reatment | nan nan | First-Line T reatment | 6 | 0.05 | 0.075 | 0.09 | 0.1 | 0.08 | 0.06 | 0.1 | 4 |
21,146 | ME T AS T A TIC DISEASE | Anti- HER2 Therapy for Metastatic B r east Cancer | First-Line T reatment | nan nan | J u st as h orm ona l t he r apy r ad icall y alters t h at n at u ral h ist o r y o f E R + metastati c b r eas t cance r , so h as a n ti- HER 2 treatme n t re vo l u ti on ize d ou tc o m es f o r pa ti en t s w it h HE R 2 + b reast ca n ce r . T rast u z u ma b, t h e hu ma n i zed an ti - H ER 2 m onoc l on al a n ti bod y , was t h e first a n ti - HER 2 a g e nt t o e n te r c li n i ca l p r ac ti ce. When a dd e d t o first-li n e c h em o t h era py f o r HER 2 + metastati c b r eas t cance r , tr as tuz u ma b im p r ov e d res pon se rates , time t o progr ess ion, and O S Ca r d i o m yop at hy is a kno w n si d e e f fect o f t r ast u z u m ab t he r ap y , and con c u rre n t a d mi n istrati on o f trast u z u ma b a nd a n t hr acy c li nes shou l d be avo i d e d. Serial d etermi n ati on s o f left v e n tric u l a r ejecti on fr ac ti on shou l d be per f o rme d t o scree n f o r c h a ng es relate d t o t r ast u z u m ab | 6 | 0.05 | 0.075 | 0.1 | 0.09 | 0.08 | 0.06 | 0.1 | 3 |
21,147 | ME T AS T A TIC DISEASE | Anti- HER2 Therapy for Metastatic B r east Cancer | First-Line T reatment | nan nan | Pe r t u z u m ab i s a d i f f e r en t a n ti - HER 2 a n ti body t h a n trast u z u ma b, w h i ch b i nd s t o bo t h H ER 2 and H ER 3 p r o tei n s , a nd is b elie v e d t o p re v e n t d ime r iz a ti on o f t hose r ecep t or s . Cli n icall y , t h e acti v it y o f p ert u z u ma b se ems d e p e nd e n t on coad mi n i s tr a ti on o f trast u z u ma b . T h e Place bo + T r ast u z u m ab + Doce t axe l i n Pre v i ou sl y U n treate d HER 2 - po siti v e Metasta t i c B r eas t Cance r s t u d y c o m p are d do ceta x el/trast u z u ma b v ers u s do ceta x el/tr as t uzu m ab / pe rt uzu ma b as first-li n e treatme n t f o r HER 2 + b re ast ca n ce r , and showed im p r ove me n t i n bo t h p r og ressi on -free s u r v i v al a nd O S w it h t h e add iti on o f pe rt uzu ma b A s t h e fir s t an ti - H ER 2 agen t , trast u z u ma b h as ser v e d as t h e m od el f o r t r eatme n t p ri nc i p l es f o r an ti - HER 2 –b ase d t h era p y . W h ile res pon ses ca n be see n w it h e it he r s i ng l e - agen t trast u z u ma b o r trast u z u ma b p l u s p ert u z u m ab a n ti - HE R 2 t he r ap y , t he maj o r b e n efits o f t h ese t h era p ies h a v e on l y b ee n proven i n co m b i na ti on w it h c h em o t h era p y . T h e a dd iti on o f a n ti - H ER2 t r eatme n t s t o endoc ri ne t he r apy y iel d s m od est im p r ov eme n ts i n progr ess ion -fr ee su r v i va l After a n i ndu cti on ph ase o f t h era p y , t h e c h em o t he r apy can be w it hhe l d, a nd e ndo cri n e t h era py i n itiate d (if a ppropr iat e ) , wh il e con ti nu i ng mai n te n a n ce treatme n ts wit h t h e a n ti bod ie s. C urr e n tl y , da t a f o r use o f pe rt u z u ma b a nd trast u z u ma b are limite d t o c on c urren t ad mi n i s tr a ti on w it h ta x a n e- b ase d c h em o t h era p y . A v ariet y o f c h em o t he r apy agen t s have sho w n cli n ical acti v it y a nd safet y w h e n p aire d w it h t r a s t uzu m ab, i nc l ud i ng ta x a n es , v i no rel b i n e , a nd p lati nu m a n al og s . | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
21,148 | ME T AS T A TIC DISEASE | Anti- HER2 Therapy for Metastatic B r east Cancer | Refractor y , HER2 + Breast Cancer | nan nan | Refractor y , HER2 + Breast Cancer | 6 | 0.09 | 0.1 | 0.085 | 0.07 | 0.06 | 0.04 | 0.1 | 2 |
21,149 | ME T AS T A TIC DISEASE | Anti- HER2 Therapy for Metastatic B r east Cancer | Refractor y , HER2 + Breast Cancer | nan nan | A v a r iet y o f c li n i ca l app r oach es are u se d t o treat trast u z u ma b -refract o r y , HER2 + m e t as t a ti c b r eas t canc e r . C on ti nu ati on o f trast u z u ma b treatme n t b e yond p r og r ess i on i s assoc i a te d wit h im p r ov eme n ts i n time t o progr ess ion, and j us tifi es t h e p ractice o f c on ti nu e d a n ti - HER 2 b l o c kade i n ass o c ia ti on w it h m u lti p l e li n es o f treatme n t f o r HER 2 + metastatic b re ast ca n ce r . L apa ti n i b i s a dua l- k i n ase i nh i b it o r t h at tar g ets bo t h t h e HER 2 a nd EGFR t y r os i ne k i nase s i gna li ng p at h wa y s . La p ati n i b h as b ee n st ud ie d a s sec ond- l ine an ti - H ER 2 t he r apy f o r p atie n ts p r og ressi ng after c h em o t h er apy | 6 | 0.09 | 0.1 | 0.085 | 0.075 | 0.06 | 0.04 | 0.1 | 2 |
21,150 | ME T AS T A TIC DISEASE | Anti- HER2 Therapy for Metastatic B r east Cancer | Refractor y , HER2 + Breast Cancer | nan nan | a nd t r as tuzu m ab I n co m pa ris on wit h t h e a d mi n istrati on o f ca p ecita b i ne c h em o t he r apy a l one, t he co m b i n ati on o f la p ati n i b p l u s ca p ecita b i n e was ass o ciate d w it h a l onge r pe ri od o f t u m o r c on tr o l a nd im p r ov eme n t i n r es pon s e r a t e, bu t no t su r v i va l . T r ast uzu m ab e mt ans i ne (TDM 1 ) is a nov el a n ti body - d r ug c on j ug ate in wh ic h t he tr as t uzu m ab an ti body h as b ee n li nk e d c h emicall y t o a po te n t c h em o t he r apy m o i e t y . T he r e s u lti ng c on j ug ate d a n ti body h as b ee n s ho w n to h a v e s ubs t an ti a l ac ti v it y i n trast u z u ma b -refract o r y b reast ca n ce r , wit hout t h e t r a d i t i ona l s i de e f f ec t s o f ch em o t h era p y , s u c h as n e u tr op e n ia o r al op ecia I n a r ando mi zed t r ial o f trast u z u ma b -resista n t b reast ca n ce r , TD M 1 was f ound t o be supe r io r t o t h e c o m b i n ati on o f la p ati n i b / capec it ab i ne w it h r esp ect t o p r og ressi on -free s u r v i v al , OS , a nd t o le r a b ilit y A s t udy o f fir s t - li n e t h era py f o r HER 2 + b reast ca n cer f oun d t h at TDM1 was m o r e e f f ec ti v e t h a n do ceta x el/trast u z u ma b, a nd le d t o dr amati c im p r ove m en t s i n qua lit y o f life O ngo i ng st ud ies are e x ami ning t h e c o m b i na ti on o f T DM1 w it h p ert u z u ma b, a nd assessi ng w h et h er t r eatme n t beyond p r og r ess i on will p r ov e cli n icall y v al u a b le . Patie n t s w it h H ER 2 + m e t as tatic b reast ca n cer c on ti nu e t o recei v e cli n i cal b e n e f it f r o m m u lti p l e li nes o f a n ti - HER 2 t h era p y a nd ca n h a v e t u m o r r es pon s es even f o ll ow i ng p r og ressi on on TDM 1 . | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.055 | 0.045 | 0.09 | 1 |
21,151 | ME T AS T A TIC DISEASE | Emerging Options for BRCA 1 - or BRCA 2 -Associated B r east Cancer | null | nan nan | Emerging Options for BRCA 1 - or BRCA 2 -Associated B r east Cancer | 6 | 0.05 | 0.075 | 0.09 | 0.08 | 0.06 | 0.04 | 0.09 | 3 |
21,152 | ME T AS T A TIC DISEASE | Emerging Options for BRCA 1 - or BRCA 2 -Associated B r east Cancer | null | nan nan | A nov el c l ass o f t he r apeu ti cs, d r ug s t h at i nh i b it t h e po l y (a d e no si n e d i pho s p h a t e -ri bose ) po l y m e rase ( P ARP) e n z y me , are eme r g i ng as po te n tiall y va l uab l e d r ugs i n t r eatme n t o f a dv a n ce d b reast ca n ce r , p a r tic u l a rl y i n he r ed it a r y b r ea st ca n ce r . I n a p r oo f o f p ri n ci p le op e n -la b el ph ase 2 s t ud y , t he P AR P i nh i b it o r o la p ari b was st ud ie d i n p atie n ts wit h BR C A1 - o r BR C A 2 - assoc i a t ed ca n cers . T h is select g r oup o f p atie n ts was c ho se n because o f p r ec li n i ca l d ata t h at s ugg este d t h at t u m o rs wit h BRC A d e f icie ncy mi gh t be pa rti cu l a rl y d e p e nd e n t on t h e DNA re p air f un cti on o f t h e P A R P enzy m e co m p l ex, and t hu s s u ita b le ta r g ets f o r P ARP i nh i b iti on. | 6 | 0.05 | 0.075 | 0.08 | 0.09 | 0.06 | 0.04 | 0.09 | 4 |
21,153 | ME T AS T A TIC DISEASE | Emerging Options for BRCA 1 - or BRCA 2 -Associated B r east Cancer | null | nan nan | In itial obse r va ti ons have sugg este d r obu st res pon ses am ong BRC A -ass o ciate d b r eas t cance r s when p atie n ts are g i v e n si ng le-a g e n t t h era py with o la p a r i b I n add iti on t o P ARP i nh i b it o rs , p lati nu m- b ase d c h em o t h er apy ma y h a ve a c li n i ca l r o l e i n her e d itar y b reast ca n cers . Limite d e xp erie n ce u si ng p l a ti nu m- based che m o thera py as n e o a d j uv a n t treatme n t f o r earl y -sta g e breas t cance r has shown d ramatic rates o f p CR . It remai n s un cle a r how im po rt an t t hese fi nd i ngs are f o r eit h er t h e l ong -term n at u ral h ist o r y o f BR C A - a ssoc i a t ed b r eas t canc er o r treatme n t o f metastatic d isease . | 6 | 0.05 | 0.075 | 0.08 | 0.09 | 0.06 | 0.04 | 0.09 | 4 |
21,154 | ME T AS T A TIC DISEASE | T r eatment of Special Metastatic Sites in Patients with Breast Cancer | null | nan nan | S p ecializ ed tr ea tm en t op ti ons are a v aila b le f o r p atie n ts wit h b reast ca n c e r w it h met as t ases t o se l ec ti ve an at o mic sites . Patie n ts wit h l y tic bon e metasta ses shou l d r ece i ve bon e ta r g ete d t h era py eit h er wit h i n tra v e nou s b is pho s phona t e t he r ap y , such as p ami d r on ate o r z o le d r on ic aci d, o r t h e R ANK- li gand i nh i b it o r , denosu ma b T h ese a g e n ts lesse n t h e p ai n ass o ciate d w it h bone l es i ons a nd p re v e n t c o m p licati on s o f s k eletal metasta ses, i nc l ud i ng fr ac t u r e a nd hyp ercalcemia . E x te nd e d t h era py c an b e ass o ci a t ed w it h os t eonec r o sis o f t h e ja w , s o p atie n ts s hou l d b e m on it o r ed for at ypica l o r a l l es i ons. P a ti en ts wit h f o cal p ai n at sites o f s k eletal metasta ses, pend i ng fr ac t u r e, or p at ho l og ic fract u re ma y als o b e n efit fr om e x te rn al -bea m R T a t se l ec t ed t u m o r sites a nd, w h e n n ecessar y , s u r g ical sta b ilizati on o r r epa ir o f t he b o n e o r j o i n t . I m prove m en t s i n su r v i va l in metastatic b reast ca n cer ac h ie v e d t h r ough c h em o t he r apy and tr as t uzu ma b - b ase d treatme n t h a v e le d t o a n i n crease i n t h e i n ci dence o f cen tr a l ne r vou s s y stem metastases , es p eciall y t ho se wit h HER2 -o v e r exp r ess i ng o r ho rm on e rece p t o r –n e g ati v e t u m o rs . T h era py f o r br ai n m e t as t ases r e m a i ns i nad e qu ate , bu t g e n erall y i n cl ud es WBI . Patien ts w it h is ola t ed l es i ons, do mi nan t masses , o r rec u rre n ce after WBI ma y a dd iti ona ll y be cand i da t es f o r s u r g ical resecti on o r stere o tactic R T t o s p eci f ic l es i ons. P a ti en t s w it h le p t o me n i ng eal d isease ma y ac h ie v e s y m p t o m a ti c im p r ove m en t wi t h WBI o r , i n s o me cases , i n trat h ecal | 6 | 0.09 | 0.1 | 0.085 | 0.075 | 0.06 | 0.04 | 0.1 | 2 |
21,155 | ME T AS T A TIC DISEASE | T r eatment of Special Metastatic Sites in Patients with Breast Cancer | null | nan nan | c h em o t he r apy w it h m e t ho tr ex ate o r c y tara b i n e . V er y limite d cli n ical e xp e r ien ce sugges t s t ha t so me s y stemic t h era p ies , i n cl ud i ng e ndo cri n e t r eatme n t s, che m o t he r apy ag e n ts i n cl ud i ng a n t h rac y cli n es , al ky lat o rs , a nd ca p ecita b i ne, and l apa ti n i b, ma y h a v e a n tit u m o r acti v it y i n t h e b rai n . | 6 | 0.05 | 0.01 | 0.02 | 0.01 | 0.01 | 0.01 | 0.05 | 1 |
21,156 | ME T AS T A TIC DISEASE | T r eatment of Special Metastatic Sites in Patients with Breast Cancer | nan nan | How e v e r , none o f t hese a r e a s ub stit u te f o r l o cal t h era py t o t h e b rai n. S o m e pa ti en t s w it h b r eas t ca n cer will h a v e limite d sites o f metastatic d isease , s uch as i so l a t ed pu l mon ar y nodu les , is o late d c on tralateral l y m ph nod e r ec u rr ence, o r bone l es io n s . Si ng le-i n stit u ti on al e xp erie n ce fr o m t he M D An d e r son Cance r Cen t e r s ugg ests t h at a fracti on o f s u c h p atie n ts m ay b e t r eate d “agg r ess i ve l y” w it h c u rati v e i n te n t , wit h fa vo ra b le l ong -term r es u lts . I n a coho rt o f pa ti en ts wit hou t p re v i ou s a d j uv a n t t h era py a nd w ith o li go met as t a ti c d i sease t ha t cou l d b e d efi n iti v el y treate d wit h l o cal t h era p y , “sta g e IV–N E D” ( no ev i denc e o f d isease) t h e u se o f a d j uv a n t c h em o t he r ap y , and, whe r e app r op riate , e ndo cri n e t h era py res u lte d i n 25 % to 30% of p a ti en t s r e m a i n i ng fr e e o f f u rt h er rec u rre n ce t h r ough 10 y ears o f fo ll ow-up. Th e tr ea tm en t o f t he p rimar y t u m o r i n t h e b reast i n w o me n w ho p res ent w it h met as t a ti c d i sease i s anoth er area o f c on tr ov ers y . Hist o ricall y , s u r ge r y or R T t o t he b r eas t was limit ed t o p atie n ts wit h l o cal t u m o r c o m p licati o n s, s u c h as p a i n o r sk i n e r os i on, and s y stemic d r ug t h era py was t h e p rimar y for m of tr ea tm en t . An ana l ys is o f 16,023 p atie n ts p rese n ti ng wit h sta g e I V d isease a nd an i n t ac t p rim a r y tu m o r c o m p are d ou tc o mes b etwee n p atie n t s h a v i ng s u r ge r y o f t he p rim a r y t u m o r t o n e g ati v e ma r g i n s o r no s u r g er y . I n a m u lti v a r i a t e ana l ys i s ad j us ti ng f o r kno w n p r ogno stic fact o rs , s u r g er y r e du ce d t he HR f o r dea t h t o 0.61 ( 95 % CI = 0.58 t o 0.65 ) . M u lti p le o t he r r et ro s p e c ti ve s t ud i es fr o m s i ng le i n stit u ti on s , re g istries , a nd popu lati on - b ase d c oho rt s have con firm ed t h is i n itial ob ser v ati on, bu t it is un certai n wh et h e r t hese s t ud i es r e fl ec t a real b e n efit f o r s u r g er y o r c on siste n t selecti on b i as. T h r ee p r ospec t iv e ra ndo mize d trials are e x ami n i ng t h e r ole of s u r g er y i n pa ti en t s p r esen ti ng wit h sta g e IV d isease a nd a n i n tact p ri ma r y t u m o r . Wh il e awa iti ng t he r esu lts o f t h ese trials , it is no t kno w n p recisel y how or w hen t o i n t eg r a t e such s u r g ical ma n a g eme n t i n t o sta nd ar d me d ic al t h e r a py f o r m e t as t a ti c b r eas t ca n cer o r w h ic h p atie n ts i n p artic u lar are m ost | 6 | 0.07 | 0.04 | 0.08 | 0.09 | 0.06 | 0.08 | 0.09 | 4 |
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21,157 | ME T AS T A TIC DISEASE | T r eatment of Special Metastatic Sites in Patients with Breast Cancer | nan nan | li k el y t o bene fit fr o m such tr e atme n t . L o cal t h era py s hou l d no t b e u se d a s a n i n itial app r oach t o t he pa ti en t wit h metastatic d isease , bu t ma y b e c on si d e red i n a h i gh l y se l ec t ed g r oup o f p atie n ts wit h a good res pon se to s y stemi c t he r apy and a limit ed nu m b er o f metastatic sites . | 6 | 0.05 | 0.01 | 0.02 | 0.01 | 0.01 | 0.01 | 0.05 | 1 |
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21,158 | ME T AS T A TIC DISEASE | T r eatment of Special Metastatic Sites in Patients with Breast Cancer | nan nan | Li CI, Daling JR, Malone KE. Age-specific incidence rates of in situ breast carcinomas by histologic type, 1980 to 2001. Cancer Epidemiol Biomarkers P r ev 2005;14:1008–10 1 1. Kilbride KE, Newman LA. Lobular carcinoma in situ: clinical management. In: Harris JR, Lippman ME, Morrow M, et al., eds. Diseases of the B r east , 4th ed. Philadelphia: Lippincott W illiams & W ilkins, 2010:341. Andersen JA. Lobular carcinoma in situ of the breast. An approach to rational treatment. Cancer 1977;39:2597–2602. Mastracci TL, Shadeo A, Colby SM, et al. Genomic alterations in lobular neoplasia: a microarray comparative genomic hybridization signature for early neoplastic proliferationin the breast. Genes Ch r omosomes Cancer 2006;45:1007–1017. Murray M P , Luedtke C, Liberman L, et al. Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: outcomes of prospective excision. Cancer 2013; 1 19:1073–1079. Gapstur SM, Morrow M, Sellers T A. Hormone replacement therapy and risk of breast cancer with a favorable histology: results of the Iowa W omen ’ s Health Stud y . JAMA 1999;281:2091–2097. Solin LJ, Gray R, Baehner FL, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst 2013;105:701–710. EO R TC Breast Cancer Cooperative Group, EO R TC Radiotherapy Group, Bijker N, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European O r ganisation for Research and T reatment of Cancer randomized phase III trial 10853—a study by the EO R TC Breast Cancer Cooperative Group and EO R TC Radiotherapy Group. J Clin Oncol 2006;24:3381–3387. W apnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 20 1 1;103:478–488. Boyages J, Delaney G, T aylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Cancer 1999;85:616–628. Gradishar WJ, Anderson BO, Blair SL, et al. NCCN Clinical Practice Guidelines in Oncology for B r east Cancer V .1.2016. © 2016 National Comprehensive Cancer Network, Inc. . Accessed February 6, 2016. Holland R, Hendriks JH. Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol 1994; 1 1:181–192. Pilewskie M, Kennedy C, Shappell C, et al. Effect of MRI on the management of ductal carcinoma in situ of the breast. Ann Su r g Oncol 2013;20:1522–1529. Cuzick J, Sestak I, Pinder SE, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol 20 1 1;12:21–29. Holmbe r g L, Garmo H, Granstrand B, et al. Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast. J Clin Oncol 2008;26:1247–1252. Early Breast Cancer T rialists’ Collaborative Group, Correa C, McGale P , et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 2010;2010:162–177. McCormick B, Stock K, Moughan VJ, et al. Low-risk breast ductal carcinoma in situ (DCIS): results from the Radiation Therapy Oncology Group 9804 phase 3 trial. Int J Radiat Oncol 2012;84:S5. | 6 | 0.01 | 0.01 | 0.01 | 0.01 | 0.01 | 0.01 | 0.01 | 1 |
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21,159 | ME T AS T A TIC DISEASE | T r eatment of Special Metastatic Sites in Patients with Breast Cancer | nan nan | 0101 (E5188). J Clin Oncol 2005;23:5973–5982. Adjuvant Breast Cancer T rialists’ Group. Ovarian ablation or suppression in premenopausal early breast cancer: results from the international adjuvant breast cancer ovarian ablation or suppression randomized trial. J Natl Cancer Inst 2007;99:516–525. Goetz M P , Knox SK, Suman VJ, et al. The impact of cytochrome P450 2D6 metabolism in women receiving adjuvant tamoxifen. B r east Cancer Res T r eat 2007;101: 1 13–121. Goetz M P , Rae JM, Suman VJ, et al. Pharmacogenetics of tamoxifen biotransformation is associated with clinical outcomes of efficacy and hot flashes. J Clin Oncol 2005;23:9312–9318. Jin Y , Desta Z, Stearns V , et al. CYP2D6 genotype, antidepressant use, and tamoxifen metabolism during adjuvant breast cancer treatment. J Natl Cancer Inst 2005;97:30–39. Schroth W , Goetz M P , Hamann U, et al. Association between CYP2D6 polymorphisms and outcomes among women with early stage breast cancer treated with tamoxifen. JAMA 2009;302:1429–1436. Stearns V , Johnson MD, Rae JM, et al. Active tamoxifen metabolite plasma concentrations after coadministration of tamoxifen and the selective serotonin reuptake inhibitor paroxetine. J Natl Cancer Inst 2003;95:1758–1764. Rae JM, Drury S, Hayes D F , et al. CYP2D6 and UGT2B7 genotype and risk of recurrence in tamoxifen-treated breast cancer patients. J Natl Cancer Inst 2012;104:452–460. Regan MM, Leyland-Jones B, Bouzyk M, et al. CYP2D6 genotype and tamoxifen response in postmenopausal women with endocrine-responsive breast cancer: the breast international group 1-98 trial. J Natl Cancer Inst 2012;104:441–451. Murphy CC, Bartholomew LK, Carpentier M Y , et al. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic revie w . B r east Cancer Res T r eat 2012;134:459–478. Peto R, Davies C, Godwin J, et al. Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 2012;379:432–444. Goldhirsch A, W iner E P , Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol 2013;24:2206–2223. Henderson IC, Berry DA, Demetri GD, et al. Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cance r . J Clin Oncol 2003;21:976–983. Fisher B, Jeong JH, Anderson S, et al. T reatment of axillary lymph node-negative, estrogen recepto r -negative breast cancer: updated findings from National Su r gical Adjuvant Breast and Bowel Project clinical trials. J Natl Cancer Inst 2004;96:1823–1831. Sparano JA, W ang M, Martino S, et al. W eekly paclitaxel in the adjuvant treatment of breast cance r . N Engl J Med 2008;358:1663–1671. Swain SM, Jeong JH, Geyer CE J r , et al. Longer therap y , iatrogenic amenorrhea, and survival in early breast cance r . N Engl J Med 2010;362:2053–2065. Swain SM, T ang G, Geyer CE J r , et al. Definitive results of a phase III adjuvant trial comparing three chemotherapy regimens in women with operable, node-positive breast cancer: the NSABP B-38 trial. J Clin Oncol 2013;31:3197–3204. Fisher B, Anderson S, DeCillis A, et al. Further evaluation of intensified and increased total dose of cyclophosphamide for the treatment of primary breast cancer: findings from National Su r gical Adjuvant Breast and Bowel Project B-25. J Clin Oncol 1999;17:3374–3388. | 6 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
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21,160 | ME T AS T A TIC DISEASE | T r eatment of Special Metastatic Sites in Patients with Breast Cancer | nan nan | Singletary SE, Allred C, Ashley P , et al. Revision of the American Joint Committee on Cancer staging system for breast cance r . J Clin Oncol 2002;20:3628–3636. Cristofanilli M, Gonzalez-Angulo AM, Buzdar AU, et al. Paclitaxel improves the prognosis in estrogen receptor negative inflammatory breast cancer: the M. D. Anderson Cancer Center experience. Clin B r east Cancer 2004;4:415–419. Hennessy B T , Gonzalez-Angulo AM, Hortobagyi GN, et al. Disease-free and overall survival after pathologic complete disease remission of cytologically proven inflammatory breast carcinoma axillary lymph node metastases after primary systemic chemotherap y . Cancer 2006;106:1000–1006. Gonzalez-Angulo AM, McGuire SE, Buchholz T A, et al. Factors predictive of distant metastases in patients with breast cancer who have a pathologic complete response after neoadjuvant chemotherap y . J Clin Oncol 2005;23:7098–7104. McGuire SE, Gonzalez-Angulo AM, Huang EH, et al. Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherap y . Int J Radiat Oncol Biol Phys 2007;68:1004–1009. Huang EH, Strom EA, Perkins GH, et al. Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients t reated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score. Int J Radiat Oncol Biol Phys 2006;66:352– 357. Brun B, Otmezguine Y , Feuilhade F , et al. T reatment of inflammatory breast cancer with combination chemotherapy and mastectomy versus breast conservation. Cancer 1988;61:1096– 1 103. Kell MR, Morrow M. Su r gical aspects of inflammatory breast cance r . B r east Dis 2005;22:67–73. Chagpar A, Meric-Bernstam F , Hunt KK, et al. Chest wall recurrence after mastectomy does not always portend a dismal outcome. Ann Su r g Oncol 2003;10:628–634. Galper S, Blood E, Gelman R, et al. Prognosis after local recurrence after conservative su r gery and radiation for early-stage breast cance r . Int J Radiat Oncol Biol Phys 2005;61:348–357. Aebi S, Gelber S, Lang I, et al. Chemotherapy prolongs survival for isolated local or regional recurrence of breast cancer: The CALOR trial (Chemotherapy as Adjuvant for Locally Recurrent breast cancer; IBCSG 27-02, NSABP B-37, BIG 1-02). Cancer Res 2012;72:3227–3231. Lin Y , Y in W , Y an T , et al. Site-specific relapse pattern of the triple negative tumors in Chinese breast cancer patients. BMC Cancer 2009;9:342. Be r gh J, Jonsson PE, Lidbrink EK, et al. F AC T : an open-label randomized phase III study of fulvestrant and anastrozole in combination compared with anastrozole alone as first-line therapy for patients with recepto r -positive postmenopausal breast cance r . J Clin Oncol 2012;30:1919–1925. Johnston SR, Kilburn LS, Ellis P , et al. Fulvestrant plus anastrozole or placebo versus exemestane alone after progression on non-steroidal aromatase inhibitors in postmenopausal patients with hormone-recepto r -positive locally advanced or metastatic breast cancer (SoFEA): a composite, multicentre, phase 3 randomised trial. Lancet Oncol 2013;14:989–998. Mehta RS, Barlow WE, Albain KS, et al. Combination anastrozole and fulvestrant in metastatic breast cance r . N Engl J Med 2012;367:435–444. Baselga J, Campone M, Piccart M, et al. Everolimus in postmenopausal hormone-recepto r -positive advanced breast cance r . N Engl J Med 2012;366:520–529. Buzdar AU, Jonat W , Howell A, et al. Anastrozole versus megestrol acetate in the treatment of postmenopausal women with advanced breast carcinoma: results of a survival update based on a combined analysis of data from two mature phase III trials. Arimidex Study Group. Cancer 1998;83: 1 142– 1 152. | 6 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 1 |
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21,161 | ME T AS T A TIC DISEASE | T r eatment of Special Metastatic Sites in Patients with Breast Cancer | Gene t ic T esting in Bre a st C anc e r | nan nan | Gene t ic T esting in Bre a st C anc e r | 6 | 0.05 | 0.075 | 0.1 | 0.09 | 0.08 | 0.06 | 0.1 | 3 |
21,162 | ID E NTI F IC A TI O N OF HI G H-RISK INDIVIDUA L S | null | null | nan nan | ID E NTI F IC A TI O N OF HI G H-RISK INDIVIDUA L S | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.1 | 0.1 | 0.1 | 5 |
21,163 | ID E NTI F IC A TI O N OF HI G H-RISK INDIVIDUA L S | null | null | nan nan | An acc u r a t e and co m p r ehens ive famil y h ist o r y o f ca n cer is esse n tial f o r i d e n ti fy i ng i nd i v i dua l s who m a y b e at ris k f o r i nh erite d b reast ca n ce r . A s w it h a ny f a mil y h i s t o r y , it i s im po rta n t t o g at h er a t h ree- g e n erati on famil y h ist ory w it h i n f o rm a ti on on b ot h mater n al a nd p ater n al li n ea g es . | 6 | 0.05 | 0.01 | 0.02 | 0.01 | 0.03 | 0.01 | 0.05 | 1 |
21,164 | ID E NTI F IC A TI O N OF HI G H-RISK INDIVIDUA L S | null | null | nan nan | Pa r tic u lar f ocus shou l d be on i nd i v i du als wit h mali gn a n cies (a f fecte d ) , but t ho se f amil y m e m be r s w it hou t a p ers on al h ist o r y o f ca n cer ( un affecte d ) s hou l d a lso be i nc l uded. It i s als o im po rta n t t o i n cl ud e t h e p rese n ce o f non mali gnan t fi nd i ngs i n t he p r ob a nd a nd famil y mem b ers , as s o me i nh e r ite d cance r synd r o m es h a v e o t h er phy sical c h aracteristics ass o ciate d w it h t h em ( e.g., tri ch il e mm om as wit h C o w d e n s ynd r o me [CS]) . Wh e n t ak i ng t he f a mil y h i s t o r y , t h e acc u rac y o f t h e i n f o rmati on ob tai ned fro m a n ind i v i dua l pa ti en t sh o u l d b e c on si d ere d. Ma ny fact o rs ca n i n fl uence a n i nd i v i dua l ’ s know l edge o f his/ h er famil y h ist o r y , a nd err o rs i n t h e r e por ti ng o f f a mil y h i s t o r y hav e b ee n do c u me n te d . A rece n t st udy i nd icates t ha t i nd i v i dua l s a r e o fte n c on fi d e n t t h at a famil y mem b er h as had ca n ce r bu t a r e t yp i ca ll y unsu r e o f t h e d etails s u rr ound i ng t h at d ia gno sis . | 6 | 0.05 | 0.075 | 0.1 | 0.025 | 0.08 | 0.09 | 0.1 | 3 |
21,165 | ID E NTI F IC A TI O N OF HI G H-RISK INDIVIDUA L S | null | nan nan | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.1 | 0.1 | 0.1 | 5 |
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21,166 | ID E NTI F IC A TI O N OF HI G H-RISK INDIVIDUA L S | null | nan nan | Re por ts of b r eas t cance r t end to b e acc u rate , w h ereas re po rts o f ov aria n ca n ce r ar e l ess tr us t wo rt h y It is im po rta n t t o no te t h at famil y h ist o ries c an c h a ng e ove r tim e, w it h c li n i c all y rele v a n t d ia gno ses arisi ng i n famil y mem b e rs, espec i a ll y be t ween t h e a g es o f 30 a nd 50 y ears . Fi n all y , t h e phy sical exa mi na ti on o f t he prob a nd a nd famil y mem b ers ca n b e i n cre d i bly h el pfu l i n t he i den tifi ca ti on o f s o me i nh erite d b reast ca n cer s ynd r o mes , s u c h as CS . | 6 | 0.02 | 0.01 | 0.04 | 0.01 | 0.02 | 0.01 | 0.04 | 3 |
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21,167 | G E NETIC TES T ING | null | null | nan nan | G E NETIC TES T ING | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.1 | 0.1 | 0.1 | 5 |
21,168 | G E NETIC TES T ING | null | null | nan nan | p e rfor m t he t es ti ng i s ve r y imp o rta n t b eca u se la bo rat o r y tec hn i qu es (as well as se n siti v it y o f t he t echn i que ) v ar y . M o st g e n etic testi ng i n cl ud es se qu e n ci ng o f t he gene i n que sti on. H o we v e r , t h ere are eme r g i ng d ata t h a t s ugg est de l e ti on / dup li ca ti on s t ud ies are im p erati v e f o r g e n etic testi ng as the m u tati ona l spec tr a i nc l ude va ri ou s rare , y et im po rta n t g e no mic r ea rr a nge m en t s . Rece n t changes i n gene ti c t esti ng, a nd s p ecificall y t h e a dv e n t o f n e x t- g e n e r atio n sequenc i ng t es t s, h a v e le d v ari ou s g e n etic testi ng c o m p a n ies to esta b lis h “pane l ” t es ti ng f o r mu lti p le b reast ca n cer s u sce p ti b ilit y g e n es . In t h is sce na ri o, up t o 14 d i f f e r en t b reast ca n cer s u sce p ti b ilit y g e n es are a n al y ze d fr o m one b l ood spec ime n. T h ese g e n es v ar y i n cli n ical si gn i f ic ance fr o m t he ve r y h i gh l y p e n etra n t b reast ca n cer s u sce p ti b ilit y gene T P53 t o t he l ow pene tr an t b r ea st ca n cer g e n e CHEK 2 . H o w t h is testi ng will e vo l v e an d t he r o l e it w ill p l ay i n cli n ical care remai n s t o b e see n. | 6 | 0.09 | 0.08 | 0.07 | 0.06 | 0.05 | 0.04 | 0.09 | 1 |
21,169 | BRCA1 AND BRCA2 | null | null | nan nan | BRCA1 AND BRCA2 | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.06 | 0.08 | 0.09 | 4 |
21,170 | BRCA1 AND BRCA2 | Description | null | nan nan | Description | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.04 | 0.03 | 0.09 | 1 |
21,171 | BRCA1 AND BRCA2 | Description | null | nan nan | ca n ce r s . BR C A 1 -r e l a t ed br east ca n cers are o fte n o f h i gh er h ist o l og ic gr a d e , sh ow an excess o f m edu llar y h ist op at ho l og y , a nd are m o re li k el y t h a n s porad i c t u m o r s t o be “ tri p le n e g ati v e” (i . e ., estr og e n rece p t o r – n e g ati v e, p r oges t e r one r ecep t o r –n e g ati v e , a nd are less li k el y t o d em on str ate HE R 2 / neu ove r exp r ess i on ) . Ser ou s p a p illar y ov aria n carci no ma is a k e y f eat ur e o f he r ed it a r y cance r s i n BRCA 1 m u tati on carriers; it is less c o mm on i n BR C A2 ca rri e r s. E ndo m e tr io i d a nd clea r -cell s ub t yp es o f ov aria n ca nce r h a v e b e en obse r ved bu t bo r d erli n e ov aria n t u m o rs do no t seem t o b e a p a r t of t he pheno t ype Bo t h p rimar y t u m o rs o f t h e fall op ia n t ub es a nd p e r it on e u m occu r w it h i nc r eas e d fre qu e n c y i n m u tati on carriers . T h e progno si s o f ova ri an cance r in BRCA 1 a nd BRCA 2 carriers is b etter t h a n a g e - matc hed con tr o l s | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.045 | 0.035 | 0.09 | 1 |
21,172 | BRCA1 AND BRCA2 | Identifying BRCA1/2 Carriers | null | nan nan | Identifying BRCA1/2 Carriers | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.05 | 0.04 | 0.09 | 1 |
21,173 | BRCA1 AND BRCA2 | Identifying BRCA1/2 Carriers | null | nan nan | Id e n ti fying t hose i nd i v i dua l s at h i gh est ris k f o r h ar bo ri ng a m u tati on i n BR C A1 o r BR C A 2 i s o f u tm o st im po rta n ce s o t h at t h e y ca n b e n efit fr o m s urv eill ance and p r even ti on op ti on s . T h ere e x ist v ari ou s m od els d esi gn ed to estimate t he li ke li hood o f i den tif y i ng a m u tati on i n t h e BRCA 1 o r BRCA 2 g e n , ; t hese m ode l s have stre ng t h s a nd limitati on s t h at h ealt h -care prov i d e r s need t o be f a mili a r wit h t o u se a nd i n ter p ret t h em a pp r op riatel y – Th e B RCA P RO m ode l , li k el y t h e m o st o fte n u se d i n cli n ical ca n cer g e n etics , es tim a t es t he p r obab ilit y t h at a n i nd i v i du al is a carrier o f a BR CA m u tati on us i ng f a mil y h i s t o r y a nd Ba y es t h e o rem . It is im po rta n t w h e n u si ng t hese ri sk m ode l s t o und ersta nd t h e limitati on s o f t h ese ris k calc u lati ons and t o p l ace ri sk estimates i n t o t h e a pp r op riate c on te x t . It is im por ta n t t o no t e t ha t ri sk es timates calc u late d by d i f fere n t m od els ma y v a r y , a fac t o r t ha t co m p li ca t e s t h e u se o f qu a n titati v e t h res ho l d s f o r ma king sc r ee n i ng r eco mm enda ti ons T h e h ealt h -care p r ov i d er s hou l d u se cli n i cal j udg me n t i n con j unc ti on w it h estimates fr o m m od els t o p r ov i d e t h e m o st pr ecise ri sk assess m en t f o r an i nd i v i du al p atie n t . | 6 | 0.05 | 0.03 | 0.07 | 0.08 | 0.06 | 0.09 | 0.09 | 6 |
21,174 | BRCA1 AND BRCA2 | Cancer Risks | null | nan nan | Cancer Risks | 6 | 0.005 | 0.03 | 0.04 | 0.07 | 0.08 | 0.09 | 0.09 | 6 |
21,175 | BRCA1 AND BRCA2 | Management | null | nan nan | Management | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.055 | 0.045 | 0.09 | 1 |
21,176 | BRCA1 AND BRCA2 | Psychosocial Considerations | null | nan nan | Psychosocial Considerations | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.06 | 0.04 | 0.09 | 4 |
21,177 | BRCA1 AND BRCA2 | Psychosocial Considerations | null | nan nan | Th e p s y c hosoc i a l needs o f BRC A - po siti v e w o me n h a v e b ee n st ud ie d fai rly w i d el y . St ud i es have shown that alt hough t h ere is sli gh t w o rse n i ng o f d ist r ess sy m p t o m s f o ll ow i ng c a n cer g e n etic c oun seli ng i n BRCA 1 / BRC A2 m u tati on ca rri e r s, t hese sy m pto ms were mi n imal , d i d no t a f fect e v er yd a y li f e acti v iti es, and had a lm os t d isa pp eare d at 1 - y ear f o ll o w- up . – | 6 | 0.05 | 0.075 | 0.09 | 0.08 | 0.06 | 0.04 | 0.09 | 3 |
21,178 | BRCA1 AND BRCA2 | Psychosocial Considerations | nan nan | 6 | 0.09 | 0.085 | 0.075 | 0.065 | 0.055 | 0.045 | 0.09 | 1 |
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21,179 | BRCA1 AND BRCA2 | Psychosocial Considerations | nan nan | Approx i ma t e l y 20 % o f BR C A 1 / 2 m u tati on carrier w o me n e xp erie n ce h ig h d ist r ess a ft e r l ea r n i ng t he ir t e st res u lt . Fact o rs t h at are relate d t o h i gh po sttest d i s tr ess i nc l ude a h i gh le v el o f p retest a nx iet y , h i gh er p retest p e r cei v e d ri sk, and whe t he r the y are op ti ng f o r p r ophy lactic s u r g er y t o | 6 | 0.005 | 0.03 | 0.04 | 0.07 | 0.08 | 0.09 | 0.09 | 6 |
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21,180 | BRCA1 AND BRCA2 | Psychosocial Considerations | nan nan | r e du ce t he ir ri sk . It i s im po rta n t t o no te , ho we v e r , t h at e v e n i n w o me n w ho e xp e r ien ced d i s tr ess a ft e r r ece i p t o f g e n etic test i n f o rmati on, w o me n do not “ r e gr et” t he ir dec i s i on t o be t e ste d It h as b ee n s ugg este d t h at h ealt h -car e prov i d e r s cons i de r i nc l ud i ng a b rief p retest p s y c ho l og ical assessme n t b ef o r e i n itiati ng gene ti c t es ti ng f o r BRCA 1 a nd BRCA s o t h at t h ese w o me n c an b e ta r g et ed f o r m o r e co m p r ehen si v e s uppo rt on ce test res u lts are a v aila b l e . Th e anx i e t y - assoc i a t ed symp t o ms re po rte d by BRCA 1 / 2 carriers i n cl ude slee p less ness and “bad m ood. O n e o t h er p s y c ho s o cial iss u e re po rte d by si ng l e wo m en w it h BR C A 1 / 2 m u tati on s is t h at t h e y e xp erie n ce i n creas ed u r g e n c y a t fi nd i ng a lif e pa rt ne r ca p a b le o f h a nd li ng t h e em o ti on al strai n o f t h e ca n c e r wo rl d and open t o pu rs u i ng m u lti p le p at h s t o war d p are n t hood . V a r i ous s t ud i es have sugg este d t h at e x isti ng s o cial s uppo rt n etw o r k s a r e i n a d e qu at e f o r BR C A 1 / 2 m u tati on carriers a nd t h at f o rmal ser v ices are un a v ailabl e o r unde r u tili zed . T o a dd ress t h is lac k o f f o rmal s uppo rt se rv ices , a r e tr ea t f o r BR C A 1 / 2 carriers t h at i n cl ud es e du cati on al upd ates a bou t m ed i ca l m anage m en t , g e n etic p ri v ac y , a nd d iscrimi n ati on a nd a ddr ess es psycho l og i ca l and famil y iss u es ma y p r ov i d e a v al u a b le oppor t un it y f o r BR C A ca rri e rs a nd t h eir families t o recei v e upd ate d me d i cal i nfor ma t i on, sha r e pe r sona l e x p erie n ces , p r ov i d e a nd recei v e s uppo rt , a nd c h a ng e hea lt h behav i o r s . D ist ress i n m a l e BR C A ca rriers h as no t b e st ud ie d qu ite as wi d el y , but on e st udy no t ed t ha t h i gh d i s tress after d iscl o s u re o f t h e res u lt was re po r ted by on e o f f ou r m a l e m u t a ti on c arriers | 6 | 0.05 | 0.075 | 0.08 | 0.09 | 0.06 | 0.04 | 0.09 | 4 |
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21,181 | T P 53 | null | null | nan nan | T P 53 | 6 | 0.09 | 0.08 | 0.07 | 0.06 | 0.05 | 0.04 | 0.09 | 1 |
21,182 | T P 53 | Description | null | nan nan | Description | 6 | 0.09 | 0.08 | 0.07 | 0.06 | 0.05 | 0.04 | 0.09 | 1 |
21,183 | T P 53 | Identifying Li-Fraumeni Synd r ome | null | nan nan | Identifying Li-Fraumeni Synd r ome | 6 | 0.09 | 0.1 | 0.08 | 0.07 | 0.06 | 0.04 | 0.1 | 2 |
21,184 | T P 53 | Identifying Li-Fraumeni Synd r ome | null | nan nan | L i et al fir s t de fi ned LFS i n 1988 at w h ic h po i n t cli n ical criteria were esta b lis hed, now known as c l a ssic LFS criteria ( ) . I n 1994, Bir ch et al . wen t on t o de fi ne l ess stri ng e n t criteria (see i n a n atte mpt t o ca p t u r e f a mili es w it h p53 m u tati on s w ho d i d no t n ecessaril y c on f o rm to t h e clas s i c c rit e ri a. F a mili es w ho met t h e b r o a d er criteria o f Birc h et al . | 6 | 0.02 | 0.06 | 0.07 | 0.01 | 0.01 | 0.01 | 0.07 | 3 |
21,185 | T P 53 | Identifying Li-Fraumeni Synd r ome | nan nan | 6 | 0.09 | 0.1 | 0.08 | 0.07 | 0.06 | 0.04 | 0.1 | 2 |
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21,186 | T P 53 | Identifying Li-Fraumeni Synd r ome | nan nan | w e r e r e fe rr ed t o as “ LFS-li ke (LFL)” families . B o t h classic a nd LFL crit e r ia a r e b ase d on f a mil y h i s t o r y and fail t o rec ogn ize po te n tial p53 m u tati on ca rr ie r s who have de novo ge rmli n e p53 m u tati on s . Alt hough t h e d e novo r ate is no t we ll de fi ned f o r p53 , on e st udy s ho we d as h i gh as a 24 % rate . | 6 | 0.09 | 0.1 | 0.08 | 0.07 | 0.06 | 0.08 | 0.1 | 2 |
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21,187 | T P 53 | Identifying Li-Fraumeni Synd r ome | nan nan | M ore r ecen tl y i n 2001, Cho m p ret et al . d e v el op e d criteria f o r i d e n ti fy i ng pa ti en t s li ke l y t o c arr y p53 m u tati on s (see ) a nd i n cl ud e d c rit e ri a t ha t add r ess families w ho d is p la y a c o llecti on o f c o m ponen t t u m o r s bu t a l so add ress i nd i v i du als w ho se p ers on al h ist o ries a r e s ugg esti ve o f p53 m u t a ti on ev e n i n t h e a b se n ce o f a s ugg esti v e famil y h ist or y . T he Cho m p r e t c rit e ria were d esi gn e d t o i n cl ud e i nd i v i du als w ho ma y po t en ti a ll y ca rr y de novo p53 m u tati on s . Fi f t y t o seven t y pe r cen t o f i nd i v i du als w ho meet t h e classic d efi n iti on o f LFS w ill have a m u t a ti on i n p53 . I nd i v i du als w ho meet t h e LFL | 6 | 0.09 | 0.08 | 0.07 | 0.06 | 0.05 | 0.04 | 0.09 | 1 |
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21,188 | T P 53 | Cancer Risks | null | nan nan | T yp icall y , LFS- assoc i a t ed t umo rs o cc u r at si gn ifica n tl y young er a g es t han wh e n t h e y occu r spo r ad i ca ll y . H o we v e r , d e p e nd i ng on t u m o r t yp e , t h e mean a g e at d ia gnos i s va ri es fr o m ch il dhood well i n t o a du lt hood . U nd ersta nding ca n ce r risk f o r LFS i s so m ewh at c o m p licate d as t h e ra ng es o f ris k v ar y gr eatl y be t ween s t ud i es and d e p e nd la r g el y on st udy popu lati on. W h e n poo li ng s t ud i es t ha t exa mi ne ov erall ca n cer ris k i n p53 m u tati on carriers (bo t h f e ma l e and m a l e ) , t he ris k o f d e v el op i ng ca n cer by a g es 15 t o 20 y ea r s is 12 % t o 42 % , by ages 40 t o 45 y ears is 52 % t o 66 % , by a g e 50 yea r s is 80%, and by age 85 yea r s i s 85 % W h e n se p arati ng ou t t h e se xes, it is a ppa r en t t ha t f e m a l e p53 m u tati on carriers h a v e g e n erall y a h i gh er li f etime cance r ri sk i n co m pa ris on t o males . Ind i v i dua l s w it h a d i agnos is o f LFS are als o at mar k e d l y i n crease d ri sk of d e v el op i ng m u lti p l e p rim a r y t u m o rs . Hisa d a et al . f ound t h at , f o ll owing a f i r st c ance r d i agnos i s, t he r e is a 57 % ris k f o r a sec ond p rimar y t u m o r w it h i n 30 yea r s o f t he fir s t d i agno sis , f o ll o we d by a 38 % ris k f o r a t h ir d pr ima ry t u m o r w it h i n 10 yea rs o f t h e sec ond ca n cer d ia gno sis . I n a dd iti on, it h as b e en w i de l y obse r ved t h at sec ond, t h ir d, a nd s o on p rimar y ca n cer s c o mm on l y occu r i n t he r ad i a t ion fiel d o f p re v i ou sl y treate d ca n cers . , | 6 | 0.09 | 0.08 | 0.07 | 0.06 | 0.05 | 0.04 | 0.09 | 1 |
21,189 | COWD E N SYNDROME ( P HOS P H A TE AND T E NSIN H OMOLO G) | null | null | nan nan | COWD E N SYNDROME ( P HOS P H A TE AND T E NSIN H OMOLO G) | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.05 | 0.04 | 0.09 | 1 |
21,190 | COWD E N SYNDROME ( P HOS P H A TE AND T E NSIN H OMOLO G) | Description | null | nan nan | Description | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.04 | 0.03 | 0.09 | 1 |
21,191 | COWD E N SYNDROME ( P HOS P H A TE AND T E NSIN H OMOLO G) | Description | null | nan nan | C S is a r a r e he r ed it a r y cance r s ynd r o me t h at is c h aracterize d by ov e r g r owth i n d i f f e ren t o r gan sys t e m s. T h e i n ci d e n ce o f CS is t hough t t o b e a bou t 1 in 200,000, bu t it m ay be unde r d ia gno se d CS b el ong s t o t h e set o f s yndro m es known as t he phosph atase a nd te n si n ho m o l og (PTEN) h ama r t o m a t u m o r synd r o m es . PTEN m u tati on s are f ound i n t h e v ast maj or it y o f pa ti en t s w it h C S , a lt hough m u tati on s i n o t h er g e n es s u c h as BMPR1A and t he succ i na t e d e hyd r og e n ase g e n es h a v e b ee n re po rte d i n a small nu m be r o f pa ti en t s who h a v e feat u res o f CS bu t do no t meet d ia gno st ic c rit e ri a ( C S-li ke ) . | 6 | 0.095 | 0.087 | 0.063 | 0.042 | 0.036 | 0.021 | 0.095 | 1 |
21,192 | COWD E N SYNDROME ( P HOS P H A TE AND T E NSIN H OMOLO G) | Diagnostic Criteria T esting Criteria | null | nan nan | Diagnostic Criteria T esting Criteria | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
21,193 | COWD E N SYNDROME ( P HOS P H A TE AND T E NSIN H OMOLO G) | Diagnostic Criteria T esting Criteria | null | nan nan | T r a d iti ona ll y , one o f t he ha llmar k feat u res o f CS is t h e d e v el op me n t o f m u lti p le ha m a rt o m as o f t he sk i n a nd m u c o sa . A t ho r ough phy sical e x ami n a t i on, i nc l ud i ng head circ u mfere n ce meas u reme n t a nd e x ami n ati on for s k i n m an if es t a ti ons, i s an im po rta n t c o m pon e n t o f assessi ng f o r CS . How e v e r , a l ack o f ha m a rt o mas do es no t e x cl ud e CS; d ia gno stic criteria a r e c o m p lic a t ed T he NCCN ’ s m o st rece n t gu i d eli n es ( V .1.2016 ) f o r testi ng for CS ar e i n | 6 | 0.095 | 0.087 | 0.093 | 0.094 | 0.092 | 0.091 | 0.095 | 1 |
21,194 | COWD E N SYNDROME ( P HOS P H A TE AND T E NSIN H OMOLO G) | Identifying Cowden Synd r ome | null | nan nan | Identifying Cowden Synd r ome | 6 | 0.09 | 0.085 | 0.07 | 0.065 | 0.1 | 0.095 | 0.1 | 5 |
21,195 | COWD E N SYNDROME ( P HOS P H A TE AND T E NSIN H OMOLO G) | Cancer Risks | null | nan nan | Th e h i ghes t ri sk o f cance r asso ciate d wit h CS is f o r female b reast ca n ce r . O t h e r c ance r s t ha t a r e t hought t o b e a p art o f t h e s p ectr u m o f ca n cers see n i n CS i nc l ude t hy r o i d cance r and u teri n e ca n cer; m o re rece n tl y , re n al cel l ca n ce r , m e l ano m a, and co l o r ec tal ca n cer h a v e als o b ee n re po rte d. T h e ma gn it ude o f ri sk f o r t he can cers ass o ciate d wit h CS v aries wi d el y . , A r ece n t arti c l e fr o m C l eve l and C li n ic estimate d t h e lifetime ris k s o f ca n c e r to b e m u c h h i ghe r t han p r ev i ously re po rte d ; ho we v e r , it is li k el y t h at t h ere is si gn i f ic an t asce rt a i n m en t b i as p rese n t i n t h is c oho rt . A c o m p aris on o f t wo pub licati ons r ev i ew i ng t he can cer ris k s ass o ciate d wit h CS is p rese n te d i n | 6 | 0.05 | 0.01 | 0.02 | 0.01 | 0.01 | 0.01 | 0.05 | 1 |
21,196 | COWD E N SYNDROME ( P HOS P H A TE AND T E NSIN H OMOLO G) | Management | null | nan nan | Management | 6 | 0.09 | 0.1 | 0.085 | 0.075 | 0.06 | 0.04 | 0.1 | 2 |
21,197 | COWD E N SYNDROME ( P HOS P H A TE AND T E NSIN H OMOLO G) | Psychosocial Issues | null | nan nan | Th e r e is a dea rt h o f lit e r a t u r e a dd ressi ng t h e p s y c ho l og ical iss u es f o r i nd i v i du al s and f a mili es w it h a cli n ical a nd / o r g e n etic d ia gno sis o f CS , | 6 | 0.05 | 0.075 | 0.1 | 0.025 | 0.08 | 0.09 | 0.1 | 3 |
21,198 | O THE R GEN ET IC M U T A TIONS AND BR E AST CANCER | null | null | nan nan | O THE R GEN ET IC M U T A TIONS AND BR E AST CANCER | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.1 | 0.1 | 0.1 | 5 |
21,199 | O THE R GEN ET IC M U T A TIONS AND BR E AST CANCER | STK 1 1 | null | nan nan | STK 1 1 | 6 | 0.05 | 0.07 | 0.08 | 0.09 | 0.06 | 0.04 | 0.09 | 4 |