Patterns and risk of first and subsequent recurrences in women within ten years after primary invasive breast cancer

Background: Previous studies suggest a distinct pattern and a number of predictive factors for breast cancer recurrence. However, only few studies include data on recurrence site and no study provides data regarding second and third breast cancer recurrence after local and regional recurrence. The aim of this study was to analyse the occurrence, timing and predictive factors of first and subsequent local (LR), regional (RR) or distant (DM) recurrence during the first 10 years after treatment for primary invasive breast cancer in women. Methods: Women with stage I-III invasive breast cancer diagnosed in 2003 and treated with curative intent were selected from the Netherlands Cancer Registry (N = 9797). Median follow-up was 10 years. Multivariable cox proportional hazards regression was used to model the hazard of recurrence over time for site-specific first recurrence and for subsequent recurrences after LR or RR. Predictive factors were identified for first and for subsequent recurrences. All tests were two-sided and probability values of 2 cm, grade III and negative ER were predictive factors for first RR and tumour size >2 cm, grade II or III, increasing number of involved lymph nodes and negative progesterone-receptor (PR) status were predictive factors for first DM. After a LR 109/379 patients (28.7%) developed subsequent recurrence: 11 patients had another LR (2.9%), 13 patients had RR (3.4%) and 85 patients (22.4%) had DM. Median time to second recurrence was 1.1 year (IQR 0.3–2.5 year). Tumour size >2 cm, grade III, primary tumour histology (other vs invasive ductal), >3 positive lymph nodes and negative PR-status were predictive factors for a second recurrence after LR. After a first RR 79/156 patients (50.6%) developed subsequent recurrence: 8 patients had LR (5.1%), 3 patients had RR (1.9%) and 68 patients (43.6%) had DM. Median time to second recurrence was 1.1 year (IQR 0.5–2.1 year). In multivariable analysis, no predictive factor for a second recurrence after RR was identified. After previous LR or RR a third subsequent recurrence occurred in 18 patients (9.6%). Conclusions: The pattern of first recurrence was similar for LR, RR and DM. To improve personalized follow-up, predictive factors could be taken into account. However, this study showed no explicit predictive factor for site specific recurrence and subsequent recurrences after LR and RR. Future studies that take treatment characteristics into account are needed

Patterns and risk of first and subsequent recurrences in women within ten years after primary invasive breast cancer

Background: Previous studies suggest a distinct pattern and a number of predictive factors for breast cancer recurrence. However, only few studies include data on recurrence site and no study provides data regarding second and third breast cancer recurrence after local and regional recurrence. The aim of this study was to analyse the occurrence, timing and predictive factors of first and subsequent local (LR), regional (RR) or distant (DM) recurrence during the first 10 years after treatment for primary invasive breast cancer in women. Methods: Women with stage I-III invasive breast cancer diagnosed in 2003 and treated with curative intent were selected from the Netherlands Cancer Registry (N = 9797). Median follow-up was 10 years. Multivariable cox proportional hazards regression was used to model the hazard of recurrence over time for site-specific first recurrence and for subsequent recurrences after LR or RR. Predictive factors were identified for first and for subsequent recurrences. All tests were two-sided and probability values of <0.05 were considered statistically significant. Results: In total 379 patients had LR, 156 patients had RR and 1412 patients had DM as first recurrence. The risk of first recurrence was highest around 2 years post-diagnosis (HR 0.040 95% CI 0.036–0.044) with a similar pattern for LR, RR and DM. Multivariable analysis showed that lower age and negative estrogen-receptor (ER) status were predictive factors for first LR. Tumour size >2 cm, grade III and negative ER were predictive factors for first RR and tumour size >2 cm, grade II or III, increasing number of involved lymph nodes and negative progesterone-receptor (PR) status were predictive factors for first DM. After a LR 109/379 patients (28.7%) developed subsequent recurrence: 11 patients had another LR (2.9%), 13 patients had RR (3.4%) and 85 patients (22.4%) had DM. Median time to second recurrence was 1.1 year (IQR 0.3–2.5 year). Tumour size >2 cm, grade III, primary tumour histology (other vs invasive ductal), >3 positive lymph nodes and negative PR-status were predictive factors for a second recurrence after LR. After a first RR 79/156 patients (50.6%) developed subsequent recurrence: 8 patients had LR (5.1%), 3 patients had RR (1.9%) and 68 patients (43.6%) had DM. Median time to second recurrence was 1.1 year (IQR 0.5–2.1 year). In multivariable analysis, no predictive factor for a second recurrence after RR was identified. After previous LR or RR a third subsequent recurrence occurred in 18 patients (9.6%). Conclusions: The pattern of first recurrence was similar for LR, RR and DM. To improve personalized follow-up, predictive factors could be taken into account. However, this study showed no explicit predictive factor for site specific recurrence and subsequent recurrences after LR and RR. Future studies that take treatment characteristics into account are needed

Genome-Wide Association Study in BRCA1 Mutation Carriers Identifies Novel Loci Associated with Breast and Ovarian Cancer Risk

BRCA1-associated breast and ovarian cancer risks can be modified by common genetic variants. To identify further cancer risk-modifying loci, we performed a multi-stage GWAS of 11,705 BRCA1 carriers (of whom 5,920 were diagnosed with breast and 1,839 were diagnosed with ovarian cancer), with a further replication in an additional sample of 2,646 BRCA1 carriers. We identified a novel breast cancer risk modifier locus at 1q32 for BRCA1 carriers (rs2290854, P = 2.7×10-8, HR = 1.14, 95% CI: 1.09-1.20). In addition, we identified two novel ovarian cancer risk modifier loci: 17q21.31 (rs17631303, P = 1.4×10-8, HR = 1.27, 95% CI: 1.17-1.38) and 4q32.3 (rs4691139, P = 3.4×10-8, HR = 1.20, 95% CI: 1.17-1.38). The 4q32.3 locus was not associated with ovarian cancer risk in the general population or BRCA2 carriers, suggesting a BRCA1-specific associat

Optimal adjuvant endocrine treatment of ER+/HER2+ breast cancer patients by age at diagnosis: A population-based cohort study

Background Prior randomised controlled trials on adjuvant hormonal therapy included HER2any patients; however, a differential effect of aromatase inhibitors (AIs) versus tamoxifen (TAM) may have been missed in ER+/HER2+ patients that comprise 7–15% of all breast cancer patients. In addition, a woman's hormonal microenvironment may influence sensitivity to TAM and AIs in the adjuvant setting, which changes during menopausal transition, a process that takes years. We studied the efficacy of AIs versus TAM in ER+/HER2+ breast cancer patients grouped by age at diagnosis as a proxy for menopausal status using treatment and outcome data from the nationwide population-based Netherlands Cancer Registry (NCR). Patients and methods All women diagnosed between 2005 and 2007 with endocrine-treated, TanyNanyM0, ER+/HER2+ breast cancer were identified through the NCR (n = 1155). Patients were divided by age at diagnosis: premenopausal (≤45 years; n = 326), perimenopausal (4555 years; n = 525). A time-dependent variable, indicating whether AI or TAM was received for >50% of endocrine treatment duration, was applied to subdivide groups by predominant treatment received. Recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan–Meier survival estimation and Cox regression. Hazard ratios (HRs) were adjusted for chemotherapy, trastuzumab, age at diagnosis, N-status, grade, pT-stage and ovarian ablation. Results During follow-up, 237 recurrences and 182 deaths occurred. Perimenopausal women derived significant RFS and OS benefit from AI compared with TAM, HR 0.47 (95% CI 0.25–0.91; P = 0.03) and HR 0.37 (95% CI 0.18–0.79; P = 0.01), respectively, whereas premenopausal women derived no benefit from AI compared with TAM. Treatment effects differed significantly between these age groups (interaction P = 0.03 and P = 0.02, respectively). Among postmenopausal women a small but non-significant AI benefit was observed. Conclusion AI treatment, preferably without any TAM treatment, was associated with the best RFS and OS outcome in ER+/HER2+ perimenopausal breast cancer patients

Analyse de dispositifs innovants de la promotion de la réussite: focus sur les déclencheurs d'une évolution constante des actions d'accompagnement pédagogique

info:eu-repo/semantics/publishe

Focus sur les déclencheurs de l’évolution des actions d’accompagnement pédagogique

Les déclencheurs du processus d’innovation s’enracinent dans des impositions institutionnelles, des sollicitations d’enseignants, des demandes d’étudiants, dans l’observation de dysfonctionnements ou encore dans le seul désir d’innover par rapport à des pratiques devenues routinières. La conception d’une nouvelle action d’accompagnement pédagogique tient compte de nombreux éléments de contextualisation et peut être alimentée, en fonction du statut, du parcours et de la professionnalisation de l’accompagnateur, tant par les apports de recherches récentes dans différents domaines que par des échanges de pratiques entre collègues. Enfin, la mise en œuvre d’une action mène à une démarche cyclique d’évaluation et de régulation, amenant un éclairage nouveau sur les déclencheurs initiaux de l’innovation et un éventuel processus de réajustement des modalités d’action. Ce processus d’innovation en trois étapes est présenté et illustré par trois actions mises en place dans différents contextes d’enseignement en Communauté française de Belgique.info:eu-repo/semantics/publishe