The first day of the 2013 San Antonio Breast Cancer Symposium (SABCS) featured the findings of a few breast cancer screening studies in the morning. The afternoon sessions discussed interesting results from surgical trials and updates on managing the axilla. Here are a few observations from the deliberations of Wednesday, December 11.
2013 San Antonio Breast Cancer Symposium Wednesday Morning Observations
Although the benefit of mammography on decreasing late stage cancer presentation are under question the overall decrease in breast cancer mortality is undeniable and commendable.
One study evaluated the benefit of screening MRI on average risk patients showing an increase in cancer detection in 11 women per 1000 screened. All cancers were node negative and most were smaller than 1cm.
2013 San Antonio Breast Cancer Symposium Wednesday Afternoon Observations
A few of the interesting breast cancer surgery studies presented in the afternoon discussions included:
PRIME 2 trial: this trial compared lumpectomy and hormonal therapy with and without radiation for women with invasive ER+ breast cancer who were 65 and older. At five years follow-up, recurrence was only 4.1 percent for women randomized to NO radiation compared to 1.3 percent with external beam therapy (XRT). There was no difference in survival.
Metastatic Breast Cancer Surgery Trials. There were two randomized trials evaluating the benefit of surgery on women who presented with metastatic breast cancer. Surprisingly no benefit in survival with surgery was identified in either trial.
NSABP B-32 Update. This was a phase III study of several thousand women comparing sentinel lymph node biopsy to axillary lymph node dissection for negative macroscopic disease in the lymph nodes. In the follow-up presented today, the effect of micrometastases (micromets) and isolated tumor cells (ITCs) were reported. Of the almost 4,000 women who had negative macroscopic disease< in the sentinel lymph nodes and NO axillary dissection, there was NO difference in survival for women who had occult disease or who didn’t. This helps reassure us not to worry about more surgery for micro-metastatic disease only in the lymph nodes.
The impact on neoadjuvant chemotherapy (NAC) on lymph node disease was reviewed. Once again, we were reminded that NAC can convert almost 40 percent of patients with lymph node-positive disease to lymph node negative disease.