Dataset Information

Risk-based breast cancer follow-up stratified by age.

ABSTRACT: Although personalization of cancer care is recommended, current follow-up after the curative treatment of breast cancer is consensus-based and not differentiated for base-line risk. Every patient receives annual follow-up for 5 years without taking into account the individual risk of recurrence. The aim of this study was to introduce personalized follow-up schemes by stratifying for age. Using data from the Netherlands Cancer Registry of 37 230 patients with early breast cancer between 2003 and 2006, the risk of recurrence was determined for four age groups (<50, 50-59, 60-69, >70). Follow-up was modeled with a discrete-time partially observable Markov decision process. The decision to test for recurrences was made two times per year. Recurrences could be detected by mammography as well as by self-detection. For all age groups, it was optimal to have more intensive follow-up around the peak in recurrence risk in the second year after diagnosis. For the first age group (<50) with the highest risk, a slightly more intensive follow-up with one extra visit was proposed compared to the current guideline recommendation. The other age groups were recommended less visits: four for ages 50-59, three for 60-69, and three for ?70. With this model for risk-based follow-up, clinicians can make informed decisions and focus resources on patients with higher risk, while avoiding unnecessary and potentially harmful follow-up visits for women with very low risks. The model can easily be extended to take into account more risk factors and provide even more personalized follow-up schedules.

SUBMITTER: Witteveen A

PROVIDER: S-EPMC6198239 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Risk-based breast cancer follow-up stratified by age.

Witteveen Annemieke A Otten Jan W M JWM Vliegen Ingrid M H IMH Siesling Sabine S Timmer Judith B JB IJzerman Maarten J MJ

Cancer medicine 20180911 10

Although personalization of cancer care is recommended, current follow-up after the curative treatment of breast cancer is consensus-based and not differentiated for base-line risk. Every patient receives annual follow-up for 5 years without taking into account the individual risk of recurrence. The aim of this study was to introduce personalized follow-up schemes by stratifying for age. Using data from the Netherlands Cancer Registry of 37 230 patients with early breast cancer between 2003 and ...[more]

PMID: 30207076

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Project description:Plasma estrogen and androgen levels are positively associated with postmenopausal breast cancer risk, but how long a single blood measurement can predict risk and whether the associations vary by tumor hormone receptor status remain unclear. We conducted nested case-control analyses within the Nurses' Health Study. Blood samples were collected in 1989-1990 and again in 2000-2002. Among postmenopausal women not using postmenopausal hormones at blood collection, 707 cases were diagnosed through June 2010, with two matched controls per case. We used unconditional logistic regression analyses to estimate the relative risks controlling for other breast cancer risk factors. The intra-class correlation coefficients for two blood measurements collected 10 years apart ranged from 0.54 (dehydroepiandrosterone sulfate, DHEAS) to 0.74 (sex hormone-binding globulin, SHBG). Overall, women in the top (vs. bottom) 25 % of levels of estradiol, free estradiol, testosterone, free testosterone, and DHEAS were at a 50-110 % higher risk of breast cancer (p (trend) < 0.001). SHBG was inversely associated with risk (p (trend) = 0.004). RRs were similar when comparing cases diagnosed 1-10 versus 11-20 years (or 16-20 years) after blood collection (p (interaction) > 0.2). Except for DHEAS, the associations varied significantly by hormone receptor status (p (heterogeneity) ? 0.02). For example, the RRs (95 % CIs) comparing the highest versus lowest quartile were 2.8 (2.0-4.0; p (trend) < 0.001) for ER +/PR + tumors versus 1.1 (0.6-2.1; p (trend) = 0.98) for ER-/PR- tumors for estradiol, and 1.8 (1.3-2.5; p (trend) < 0.001) versus 0.6 (0.3-1.2; p (trend) = 0.35) for testosterone. One measure of circulating sex hormones in postmenopausal women can predict risk of hormone receptor positive breast cancer for up to 16-20 years.

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Risk-based breast cancer follow-up stratified by age.

Publications

Risk-based breast cancer follow-up stratified by age.

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