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- Karlsson, E., et al.
(författare)
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Clonal alteration of breast cancer receptors between primary ductal carcinoma in situ (DCIS) and corresponding local events
- 2014
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Ingår i: European Journal of Cancer. - : Elsevier BV. - 1879-0852 .- 0959-8049. ; 50:3, s. 517-524
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Tidskriftsartikel (refereegranskat)abstract
- Background: Emerging data propose biomarker alteration due to clonal selection between the primary invasive breast cancer and corresponding metastases. In addition, impact on survival has been demonstrated. The present study investigates the relationship between the oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) between primary ductal carcinoma in situ (DCIS) and intra-individually matched ipsilateral event. Materials and methods: The cohort includes 1504 patients, diagnosed with a primary DCIS between 1986 and 2004. Of the 274 patients who developed a local relapse, 135 developed a new in situ carcinoma and 139 an invasive cancer up to 31st December 2011. ER and PR were identified by immunohistochemistry (IHC) and HER2 by silver-enhanced in situ hybridisation (SISH) as well as IHC. Results: ER (n = 112), PR (n = 113) and HER2 (n = 114) status from both the primary DCIS and the corresponding relapse were assessed and were demonstrated to be discordant in 15.1%, 29.2% and 10.5% respectively. The receptor conversion was both from negative to positive and from positive to negative with no general pattern being seen in spite of sub-dividing into in situ relapse and invasive relapse. However, primary DCIS was HER2 positive in 40.3% whereas in situ and invasive relapses were HER2 positive in 42.9% and 34.5% respectively. Conclusions: Receptor conversion for ER, PR and HER2 status occurred between primary DCIS and corresponding local relapse in 10-30%. This study could not confirm that HER2 overexpression in primary DCIS had any impact on tumour progression to invasive cancer which has been proposed. (C) 2013 Elsevier Ltd. All rights reserved.
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- Ringberg, Anita, et al.
(författare)
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Histopathological risk factors for ipsilateral breast events after breast conserving treatment for ductal carcinoma in situ of the breast--results from the Swedish randomised trial.
- 2007
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Ingår i: European journal of cancer (Oxford, England : 1990). - : Elsevier BV. - 0959-8049 .- 1879-0852. ; 43:2, s. 291-8
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The primary aims were to study risk factors for an ipsilateral breast event (IBE) after sector resection for ductal carcinoma in situ of the breast (DCIS) in a trial comparing adjuvant radiotherapy to no therapy and to assess predictive factors for response to radiotherapy. Secondary aims were to analyse reproducibility of the histopathological evaluation and to estimate correctness of diagnosis in the trial. SETTING: A randomised trial in Sweden (the SweDCIS trial), including 1046 women with a median of 5.2 years of follow-up in a population, offered routine mammographic screening. METHODS: A case-cohort design with a total of 161 cases of IBE (42 of those being members of the subcohort) and 284 sampled for the sub-cohort. Ninety five percent of the participants' slides could be retrieved and were re-evaluated by three experienced pathologists. RESULTS: Low nuclear grade (NG 1-2) and absence of necrosis halves the risk of IBE in both irradiated and non-irradiated patients. Lesion size, margins of excision and age at diagnosis did not modify these associations. The presence of necrosis modified the effect of radiotherapy: relative risk was 0.40 with necrosis present and 0.07 with necrosis absent (p-value for interaction 0.068). In all subsets of prognostic factors, radiotherapy conferred a substantial benefit. The risk factors for in situ and invasive IBE were similar. The agreement between pathologists was moderate (kappa=0.486). Correctness of diagnosis in the subcohort of SweDCIS was 84.8%. CONCLUSION: Although nuclear grade and necrosis carry prognostic information, we could not define a group with very low risk after sector resection alone. Radiotherapy has a protective effect in all substrata of risk factors studied. The interaction between the presence of necrosis and radiotherapy is a clinically and biologically relevant research area.
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- Wengström, Yvonne, 1959-, et al.
(författare)
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Developing patient reported outcome measures (PROM) for implementation in the Swedish National Breast Cancer Quality Register
- 2013
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Ingår i: European Journal of Cancer. - 0959-8049 .- 1879-0852. ; 49, s. S329-S329
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Tidskriftsartikel (refereegranskat)abstract
- Background: The local authorities for health and welfare support the introduction of Patient Reported Outcome Measures (PROM) in the quality registers in Sweden. Valid and reliable instruments measuring PROM do not exist that could be used throughout the whole breast cancer process. We sought to develop and implement PROM for breast cancer at different stages in the disease course in different Swedish geographic regions for later use in the Swedish National Quality Register for breast cancer. The aim was to develop appropriate PROM to assess symptoms and problems among patients with breast cancer about one year after diagnosis.Materials and Methods: A scoping review and focus group discussions were conducted with women invited by the breast cancer association Amazona (Stockholm). The symptoms that emerged from the scoping review and focus group discussions formed the basis for the development of a web based questionnaire consisting of validated instruments (EORTC QLQ-C30, BR 23, MSAS) for measuring PROM. The women who participated in the focus group discussions were invited to respond to a pilot version of the web based questionnaire. The results were used to revise the web based questionnaire. An invitation was sent to a national random sample from the Swedish National Breast Cancer Quality Register diagnosed one year earlier to respond to the revised version of the web based questionnaire.Results: The results will present the work process of the development of the PROM as well as plans for further work on the implementation of the PROM in the Swedish National Quality Register for breast cancer. Preliminary data shows that about 70% responded to the revised version of the web based questionnaire. However, some women requested a paper version of the questionnaire mostly because they did not have access to a computer.Conclusion: In the development of PROM in quality registers it is important to include patients experiences in order to develop relevant outcome measures to influence the quality of the health care delivery.
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