The impact of tumor detection method on genomic and clinical risk and chemotherapy recommendation in early hormone receptor positive breast cancer. (December 2021)

• Record Type: Journal Article
• Authors: Bar, Yael; Bar, Kfir; Itzhak, Itay; Niselbaum, Chen Shitrit; Dershowitz, Nachum; Shachar, Eliya; Weiss-Meilik, Ahuva; Golan, Orit; Wolf, Ido; Menes, Tehillah; Sonnenblick, Amir
• Is Part Of: Breast. Volume 60(2021)
• Page Start: 78
• Page End: 85
• Publication Date: 2021-12
• Subjects: Breast cancer -- Tumor detection method -- OncotypeDX -- Genomic risk -- Clinical risk -- Adjuvant chemotherapy; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2021.09.002
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Background: Symptomatic breast cancers share aggressive clinico-pathological characteristics compared to screen-detected breast cancers. We assessed the association between the method of cancer detection and genomic and clinical risk, and its effect on adjuvant chemotherapy recommendations. Patients and methods: Patients with early hormone receptor positive (HR+) HER2neu-negative (HER2-) breast cancer, and known OncotypeDX Breast Recurrence Score test were included. A natural language processing (NLP) algorithm was used to identify the method of cancer detection. The clinical and genomic risks of symptomatic and screen-detected tumors were compared. Results: The NLP algorithm identified the method of detection of 401 patients, with 216 (54%) diagnosed by routine screening, and the remainder secondary to symptoms. The distribution of OncotypeDX recurrence score (RS) varied between the groups. In the symptomatic group there were lower proportions of low RS (13% vs 23%) and higher proportions of high RS (24% vs. 13%) compared to the screen-detected group. Symptomatic tumors were significantly more likely to have a high clinical risk (59% vs 40%). Based on genomic and clinical risk and current guidelines, we found that women aged 50 and under, with a symptomatic cancer, had an increased probability of receiving adjuvant chemotherapy recommendation compared to women with screen-detected cancers (60% vs. 37%). Conclusions: We demonstrated an association between the method of cancer detection and both genomic and clinical risk. Symptomatic breast cancer, especially in young women, remains a poor prognostic factor that should be taken into account when evaluating patient prognosis and determining adjuvant treatment plans. Highlights: Symptomatic women at diagnosis are often younger, have larger tumors and higher Ki67. Women with symptomatic tumors have both higher genomic risk and higher clinical risk for disease recurrence. Symptomatic presentation significantly increases the likelihood of adjuvant chemotherapy recommendation, especially among younger women. The use of a computational approach (NLP) for extracting medical information was demonstrated to be efficient and valid.