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Prognostic impact of interval breast cancer detection in women with pT1aN0M0 breast cancer with HER2-positive status: results from a multicenter population-based cancer registry study

Date

08 Oct 2016

Session

Breast cancer, early

Presenters

Antonino Musolino

Citation

Annals of Oncology (2016) 27 (6): 43-67. 10.1093/annonc/mdw364

Authors

A. Musolino1, A. Sikokis2, D. Boggiani2, A. Rimanti2, B. Pellegrino2, E.M. Silini3, N. Campanini3, E. Barbieri4, L. Cortesi5, M. Panebianco6, R. Porzio7, A. Frassoldati8, P. Sgargi1, F. Falcini9, M. Michiara1

Author affiliations

  • 1 Medical Oncology Unit And Cancer Registry Of Parma Province, University Hospital of Parma, 43126 - Parma/IT
  • 2 Medical Oncology Unit And Cancer Registry Of Parma Province, University Hospital of Parma, Parma/IT
  • 3 Section Of Anatomy And Pathology, University Hospital of Parma, Parma/IT
  • 4 Ssd Oncologia Medica Addarii, Policlinico S. Orsola-Malpighi, Bologna/IT
  • 5 Department Of Oncology, Hematology And Respiratory Diseases, Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena/IT
  • 6 Department Of Oncology And Advanced Technologies, Oncology Unit, Azienda Ospedaliera Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia/IT
  • 7 Department Of Oncology-hematology, G. Da Saliceto Hospital, Azienda Ospedaliera Piacenza, Piacenza/IT
  • 8 Dept Of Clinical Oncology, Azienda Ospedaliera di Ferrara St. Anna, 44100 - Ferrara/IT
  • 9 Romagna Tumor Registry, Istituto Tumori della Romagna I.R.S.T., Meldola/IT
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Resources

Background

Patients (pts) with pT1aN0M0 breast cancers (BCs) have an excellent outcome across all biologic subtypes. HER2 overexpression occurs in 15-20% of primary BCs, and is associated with poor prognosis. Women with BCs diagnosed in the interval between scheduled screening rounds have poorer stage-specific survival than women with screen-detected (SD) tumors, and an association has been reported between interval cancers (ICs) and HER2 overexpression. We aimed to determine, in a general population of pT1aN0M0 BCs with known screening status, if HER2-positive status maintains its negative prognostic value only in tumors diagnosed as ICs.

Methods

All incident pT1aN0M0 BCs (n = 874), systematically collected by the Cancer Registries of Emilia Romagna Region (northern Italy) and diagnosed in women aged 50-69 from 2003 to 2009 were evaluated. Pts unexposed to screening, with unknown HER2 status and/or treated with adjuvant trastuzumab were excluded from analysis.

Results

Twenty percent of BCs were HER2-positive. Fifty-three percent were SD tumors, while 18% were ICs. BCs with high histologic grade (odds ratio [OR] =2.2; 95%CI, 1.1–5.7), hormone receptor negative (OR =2.6; 95%CI, 1.4–4.9), or HER2-positive status (OR =2.4; 95% CI, 1.2–5.5) were more likely to be diagnosed as ICs. With a median follow-up of 115 months, the 8-year invasive disease-free survival (iDFS) for ICs was lower than that for SD tumors: 92% (95%CI, 88% to 94%) vs. 97% (95%CI, 95% to 99%; P = 0.01). Eight-year iDFS rates were 88% (95%CI, 82% to 94%) and 96% (95%CI, 94% to 98%) in pts with HER2-positive and HER2-negative tumors, respectively (P = 0.0004). Notably, HER2-positive ICs showed poorer iDFS than HER2-positive SD tumors (78% vs. 95%, respectively; P = 0.003). An interaction between IC detection and HER2-positive status was found for poorer iDFS after adjusting for prognostic variables (P = 0.0074).

Conclusions

In a general population of pT1aN0M0 early BCs with known screening status, IC detection may identify pts with HER2-positive pT1aN0M0 tumors in whom the rate of recurrence justifies consideration for conventional anti-HER2 adjuvant treatment.

Clinical trial identification

N/A

Legal entity responsible for the study

University Hospital of Parma

Funding

“Alessandro Liberati Programme” for young investigators; Programma di ricerca Regione-Università 2010-2012 – Regione Emilia-Romagna (Italy)

Disclosure

All authors have declared no conflicts of interest.

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