Impact of age-related socio-economic and clinical determinants of quality of life among long-term breast cancer survivors.

a b s t r a c t Objectives: The main purpose of this study was to identify age-related socioeconomic and clinical deter- minants of quality of life among breast cancer survivors five years after the diagnosis. The secondary objective was to describe quality of life in the studied population according to age. Study design: A cross-sectional survey in five-year breast cancer survivors was conducted in women diagnosed with breast cancer in 2007 and 2008 in Cote d'Or. Main outcome measures: Quality of life was assessed with the SF-12, the EORTC-QLQ-C30 and the EORTC- QLQ-BR23 questionnaires. Socio-economic deprivation was assessed by the EPICES questionnaire. Social support was assessed by the …

Incidental findings in a series of 2500 gene panel tests for a genetic predisposition to cancer: Results and impact on patients.

Abstract With next generation sequencing, physicians are faced with more complex and uncertain data, particularly incidental findings (IF). Guidelines for the return of IF have been published by learned societies. However, little is known about how patients are affected by these results in a context of oncogenetic testing. Over 4 years, 2500 patients with an indication for genetic testing underwent a gene cancer panel. If an IF was detected, patients were contacted by a physician/genetic counsellor and invited to take part in a semi-structured interview to assess their understanding of the result, the change in medical care, the psychological impact, and the transmission of results to the f…

Impact of sentinel node biopsy on long-term quality of life in breast cancer patients

Background: The aim of this study was to assess long-term quality of life (QoL) over a period of 6 years in women with breast cancer (BC) who underwent sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), or SLNB followed by ALND. Methods: The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ)-C30 and the EORTC-QLQ-BR-23 questionnaires were used to assess QoL before surgery, just after surgery, 6, 12 and 72 months later. The longitudinal effect of surgical modalities on QoL was assessed with a mixed model analysis of variance for repeated measurements. Results: Five hundred and eighteen BC patients were initially include…

Atypical epithelial hyperplasia of the breast: state of the art.

International audience; Introduction: Atypical epithelial hyperplasia (AEH) of the breast is considered benign histological lesions with breast cancer risk. This review focuses on clinical signification and management of AEH that remains controversial. Areas covered: A review of published studies was performed using medline database. In this review, we fully describe the current evidence available. In particular, we describe 1) data from immunohistochemistry and molecular studies that suggest AEH is a precursor of breast cancer; 2) epidemiological studies demonstrate low rate of breast cancer in women with AEH; 3) surgical excision is necessary after diagnosis of AEH, such as lobular carcin…

Fertility concerns among young breast cancer survivors in Côte d’Or

Introduction Les effets secondaires des traitements utilises dans la prise en charge du cancer du sein (CS) sur la fonction ovarienne et la fertilite ont largement ete documentes. Cependant, les donnees populationnelles sur les difficultes liees a la fertilite des survivantes jeunes apres un CS sont rares et peu d’etudes ont ete realisees sur cette thematique en France. Cette etude visait a decrire les conditions de vie a long terme, en termes de fertilite, des survivantes jeunes apres un CS en Cote d’Or. Methodes Les femmes âgees de 45 ans et moins au diagnostic d’un CS non metastatique entre 2006 et 2015, ont ete selectionnees a partir du Registre des CS et autres cancers gynecologiques d…

Prise en charge des proliférations épithéliales du sein avec et sans atypies : hyperplasie canalaire atypique, métaplasie cylindrique avec atypie, néoplasies lobulaires, proliférations épithéliales sans atypie, mastopathie fibrokystique, adénose, cicatrices radiaires, mucocèles, lésions prolifératives apocrines : recommandations pour la pratique clinique

In the last few years, diagnostics of high-risk breast lesions (atypical ductal hyperplasia [ADH], flat epithelial atypia [FEA], lobular neoplasia: atypical lobular hyperplasia [ALH], lobular carcinoma in situ [LCIS], radial scar [RS], usual ductal hyperplasia [UDH], adenosis, sclerosing adenosis [SA], papillary breast lesions, mucocele-like lesion [MLL]) have increased with the growing number of breast percutaneous biopsies. The management of these lesions is highly conditioned by the enlarged risk of breast cancer combined with either an increased probability of finding cancer after surgery, either a possible malignant transformation (in situ or invasive cancer), or an increased probabili…

What Are Young Women Living Conditions after Breast Cancer? Health-Related Quality of Life, Sexual and Fertility Issues, Professional Reinsertion

In recent decades, the living conditions of young breast cancer (BC) survivors have garnered increasing attention. This population-based study aimed to identify the clinical, social and economic determinants of Health-Related Quality of Life (HRQoL), and to describe other living conditions of young long-term BC survivors. Women with non-metastatic BC diagnosed between 2006 and 2015, aged 45 years and younger at the time of diagnosis, were identified through the Breast and Gynecologic Cancer Registry of the C&ocirc

Tendances de prescription de l’hormonothérapie et survie chez les femmes atteintes d’un cancer du sein non métastatique à récepteurs hormonaux positifs traitées par hormonothérapie - Étude sur base de données populationnelle

Introduction La plupart des donnees sur l’efficacite de l’hormonotherapie proviennent d’essais cliniques randomises. Peu ou moins de donnees existent sur l’efficacite de l’hormonotherapie en vie reelle et sa prescription au cours du temps. Cette etude avait pour objectif d’identifier les facteurs pronostiques de la survie chez les femmes atteintes d’un cancer du sein non metastatique a recepteurs hormonaux positifs (RH +). Methodes Une etude observationnelle retrospective a ete realisee a partir du Registre des cancers du sein et autres cancers gynecologiques de Cote d’Or en France. Toutes les femmes ayant recu un diagnostic de cancer du sein RH + invasif primaire non metastatique entre 199…

Peut-on proposer un prélèvement du ganglion sentinelle en cas de chimiothérapie néoadjuvante dans les cancers du sein et à quel moment ?

The main goal of preoperative chemotherapy is to reduce the size of the tumor and allow conservative treatment. Neoadjuvant treatment can affect axillary status with a downstaging in one third of the cases. For these patients, the benefit of axillary node dissection is questioned and the sentinel node biopsy (SLNB) seems to be a relevant option. However, the timing of performing SLNB is still debated especially for clinical negative patients with negative axillary ultrasound before preoperative chemotherapy. For axillary positive nodes proved by biopsy/cytology before preoperative chemotherapy, SLNB can be an option if there is a good clinical and radiological response.

Erratum à l’article : « Dépistage du cancer du sein : en route vers le futur » [Bull. Cancer 103 (2016) 753–763]

Phase 0/1 of Positron Emission Tomography (PET) imaging agent [18F]-ODS2004436 as a marker of EGFR mutation in patients with non-small cell lung cancer (NSCLC)

e24184Background: Multiple EGFR tyrosine kinase inhibitors (TKIs) are approved for treatment of NSCLC harboring EGFR activating mutations or secondary TKIs resistant mutation. We evaluate a new PET...

Quelle chirurgie après chimiothérapie néoadjuvante ?

La chimiotherapie neoadjuvante (CNA) constitue maintenant une des methodes standards pour traiter les cancers du sein dans le but de permettre, dans certaines conditions, un traitement conservateur pour des tumeurs initialement avancees [1], [2]. Il est necessaire d’optimiser l’approche chirurgicale tant pour le traitement de la tumeur mammaire que pour le geste axillaire.

Stratégies en cas de positivité du ganglion sentinelle dans les cancers du sein

Resume Les strategies de prise en charge en cas de ganglion(s) sentinelle(s) micro ou macrometastatique(s) dans les cancers du sein ont ete profondement modifiees depuis une dizaine d’annees et la publication de cinq essais randomises : ACOSOG Z0011, IBCSG 23-01, et AATRM comparant curage axillaire versus abstention ; et AMAROS et OTOASOR comparant curage axillaire versus radiotherapie axillaire. Malgre les limites methodologiques de certains de ces essais, notamment de l’ACOSOG Z0011, les recommandations internationales (ASCO, NCCN) et le consensus d’experts de St Gallen ne preconisent pas la realisation d’un curage axillaire complementaire en cas d’envahissement macro ou micrometastatique…

Prognostic factors of overall survival for patients with FIGO stage IIIc or IVa ovarian cancer treated with neo-adjuvant chemotherapy followed by interval debulking surgery: A multicenter cohort analysis from the FRANCOGYN study group

International audience; Introduction The aim of this study was to identify prognostic factors of overall survival in patients with FIGO stage IIIc or IVa ovarian cancer (OC) treated by neo-adjuvant chemotherapy (NAC) followed by interval debulking surgery.Materials and methods Data from 483 patients with ovarian cancer were retrospectively collected, from January 1, 2000 to December 31, 2016, from the FRANCOGYN database, regrouping data from 11 centers specialized in ovarian cancer treatment. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analysis were performed to define prognostic factors of overall survival.Results The median overall sur…

Dépistage du cancer du sein : en route vers le futur

Breast cancer remains a potentially lethal disease, which requires aggressive treatments and is associated with long-term consequences. Its prognosis is linked to both tumor biology and burden at diagnosis. Although treatments have allowed important improvements in prognosis over the past 20 years, breast cancer screening remains necessary. Mammographic screening allows earlier stage diagnoses and a decrease of breast cancer specific mortality. However, breast cancer screening modalities should be revised with the objective to address demonstrated limitations of mammographic screening (limited benefit, imperfect sensitivity and specificity, overdiagnoses, radiation-induced morbidity). Furth…

Development of primary early-onset colorectal cancers due to biallelic mutations of the FANCD1/BRCA2 gene

International audience; Fanconi anaemia (FA) is characterized by progressive bone marrow failure, congenital anomalies, and predisposition to malignancy. In a minority of cases, FA results from biallelic FANCD1/BRCA2 mutations that are associated with early-onset leukaemia and solid tumours. Here, we describe the clinical and molecular features of a remarkable family presenting with multiple primary colorectal cancers (CRCs) without detectable mutations in genes involved in the Mendelian predisposition to CRCs. We unexpectedly identified, despite the absence of clinical cardinal features of FA, a biallelic mutation of the FANCD1/BRCA2 corresponding to a frameshift alteration (c.1845_1846del…

Cancer de l’endomètre. Application des recommandations de 2010 : étude multicentrique

Resume Introduction Le cancer de l’endometre est le plus frequent des cancers gynecologiques. Afin d’ameliorer et d’homogeneiser les prises en charge du cancer de l’endometre, des recommandations ont ete elaborees en novembre 2010. Le but de cette etude est d’evaluer l’application de ces recommandations. Materiel et methode Notre etude multicentrique retrospective utilise les bases de donnees de trois centres francais : le CHU de Reims, l’Hopital Tenon de Paris et le Centre de lutte contre le cancer Georges-Francois-Leclerc de Dijon de novembre 2010 a decembre 2012. Cette etude consistait en l’evaluation des modalites de prise en charge diagnostique et therapeutique des patientes presentant…

Omitting axillary lymph node dissection after positive sentinel lymph node in the post-Z0011 era: Compliance with NCCN and ASCO clinical guidelines and Z0011 criteria in a large prospective cohort

Summary Purpose In the ACOSOG Z0011 trial, patients with primary breast cancer and 1–2 tumor-involved sentinel lymph nodes (SLNs) undergoing breast-conserving surgery had no oncological outcome benefit after axillary lymph node dissection (ALND), despite a relevant rate of non-SLN metastases of 27%. According to the St Gallen expert consensus, and NCCN and ASCO clinical guidelines, ALND may be avoided in patients who meet all ACOSOG Z0011 inclusion criteria. This recommendation can also be extended to patients undergoing mastectomy, with 1 or 2 positive SLNs and an indication for chest wall radiation, in whom axillary radiotherapy can be proposed as an alternative to completion ALND. The ai…

Stadification ganglionnaire lombo-aortique dans les cancers du col de stade supérieur ou égal à IB2: comparaison des performances du PETscan au 18FDG et du curage lombo-aortique à partir des données du registre des cancers gynécologiques de Côte d’Or de 2003 à 2016

Resume Introduction Les recommandations actuelles (ASCO, ESTRO, ESGO) preconisent la realisation d’un curage lombo-aortique (CLAO) de stadification ganglionnaire en cas de negativite au PETscan d’evaluation initiale dans les cancers du col localement avance (CCLA), afin d’adapter les champs d’irradiation de la radiochimiotherapie. L’objectif principal etait de comparer la survie globale (SG) entre deux groupes (iN- au PETscan versus iN- et pN- au PETscan et CLAO) qui different par leur technique de stadification ganglionnaire lombo-aortique: stadification par imagerie seule versus imagerie et chirurgie. Les objectifs secondaires etaient de determiner la survie sans recidive (SSR), le taux d…

Seroprevalence of SARs-CoV-2 among the staff and patients of a French cancer centre after first lockdown: the canSEROcov study

Abstract Background In view of the potential gravity of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection for patients with cancer, epidemiological data are vital to assess virus circulation among patients and staff of cancer centres. We performed a prospective study to investigate seroprevalence of SARS-CoV-2 antibodies among staff and patients with cancer at a large cancer centre, at the end of the period of first national lockdown in France and to determine factors associated with the risk of SARS-CoV-2 infection. Methods After the first lockdown, all medical and non-medical staff, as well as all patients attending the medical oncology department were invited to unde…

Evaluation of a 30-gene paclitaxel, fluorouracil, doxorubicin and cyclophosphamide chemotherapy response predictor in a multicenter randomized trial in breast cancer

Abstract Purpose: We examined in a prospective, randomized, international clinical trial the performance of a previously defined 30-gene predictor (DLDA-30) of pathologic complete response (pCR) to preoperative weekly paclitaxel and fluorouracil, doxorubicin, and cyclophosphamide (T/FAC) chemotherapy, and assessed if DLDA-30 also predicts increased sensitivity to FAC-only chemotherapy. We compared the pCR rates after T/FAC versus FACx6 preoperative chemotherapy. We also did an exploratory analysis to identify novel candidate genes that differentially predict response in the two treatment arms. Experimental Design: Two hundred and seventy-three patients were randomly assigned to receive eith…

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer.

Abstract Purpose: To investigate the value of the metabolic tumor response assessed with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), compared with clinicobiologic markers to predict pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in women with triple-negative breast cancer (TNBC). Experimental Design: Fifty consecutive women with TNBC and an indication for NAC were prospectively included. Different pretreatment clinical, biologic, and pathologic biomarkers, including SBR grade, the Ki-67 proliferation index, androgen receptor expression, EGF receptor (EGFR), and cytokeratin 5/6 staining, were assessed. Tumor glucose metabolism at baseline and its chan…

Tumeurs localisées du sein triple négatives en 2016 : définitions et prise en charge

Triple-negative breast cancer (TN), as defined by the triple negativity in immunohistochemistry: the absence of estrogen receptor, progesterone receptor and the absence of overexpression or amplification of HER2, corresponds to 15 % of invasive breast cancers. This is a very heterogeneous group of tumors both at the genomic and transcriptomic level and at morphological, clinical and prognostic level. Although there are some good prognosis forms, the majority of TN tumors is characterized by a poor prognosis with a greater frequency of visceral metastases and a maximum risk of relapse in the first two years after diagnosis. Systemic adjuvant treatment with chemotherapy is almost always indic…

Long term gynaecological cancer survivors in Cote d'Or: health-related quality of life, social and professional reinsertion

IF 2,392 (2017); International audience

Quel impact de l’ACOSOG sur une cohorte multicentrique française de patientes avec ganglion sentinelle positif ?

L’essai americain ACOSOG Z-0011 a remis en cause l’interet du curage axillaire (CA) en cas d’envahissement limite des ganglions sentinelles (GS) chez les patientes presentant un cancer du sein apres traitement conservateur [1]. En Europe, ce nouveau standard est loin d’etre accepte par tous et de fait, de nombreuses questions demeurent. Quelle proportion de patiente europeenne avec GS+ pourrait beneficier d’une abstention de CA en tenant compte des criteres de l’ACOSOG ? Dans quelle mesure une cohorte selectionnee en Europe selon les criteres ACOSOG differerait de la population rapportee dans l’ACOSOG ? a l’inverse, le pronostic des patientes non eligibles par les criteres de l’ACOSOG est-i…