Breast cancer stage one
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Summary
10 papers analyzed
These studies suggest that breast-conserving surgery alone is non-inferior to breast-conserving surgery plus radiotherapy for in-breast recurrence and breast preservation in women with stage 1 breast cancer intending endocrine therapy, while early detection, individualized risk estimation, and treatment based on molecular subtype are crucial for improving outcomes.
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Understanding Stage 1 Breast Cancer: Treatment and Prognosis
Overview of Stage 1 Breast Cancer
Stage 1 breast cancer is characterized by tumors that are up to 2 centimeters in size and have not spread to lymph nodes or distant sites. Approximately 50% of newly diagnosed breast cancers fall into this category, with the majority being estrogen receptor (ER) and/or progesterone receptor (PR) positive and human epidermal growth factor receptor 2 (HER2) negative . This early stage of breast cancer is considered highly treatable with a favorable prognosis.
Treatment Approaches for Stage 1 Breast Cancer
Breast-Conserving Surgery (BCS) and Radiation Therapy (RT)
Breast-conserving surgery (BCS), also known as lumpectomy, is a common treatment for stage 1 breast cancer. It involves the removal of the tumor and a small margin of surrounding tissue. Post-surgery, radiation therapy (RT) is typically recommended to eliminate any remaining cancer cells and reduce the risk of recurrence. However, recent studies are exploring the possibility of de-escalating RT in certain low-risk patients .
De-escalation of Radiation Therapy
The NRG-BR007 trial is investigating whether BCS alone, followed by endocrine therapy (ET), is non-inferior to BCS plus RT in terms of in-breast recurrence and breast preservation for women with stage 1, hormone receptor-positive, HER2-negative breast cancer with a low Oncotype DX Recurrence Score (RS) of ≤18 . This trial aims to reduce overtreatment and its associated toxicities, which is of significant interest to patients, providers, and payers.
Endocrine Therapy (ET)
Endocrine therapy is a cornerstone in the treatment of hormone receptor-positive breast cancer. It involves the use of medications such as tamoxifen or aromatase inhibitors to block the effects of estrogen, thereby slowing the growth of hormone receptor-positive cancer cells. In the NRG-BR007 trial, patients receive at least five years of ET, regardless of whether they also receive RT .
Prognostic Factors and Risk Assessment
Genomic Assays
Genomic assays like Oncotype DX play a crucial role in assessing the risk of recurrence and guiding treatment decisions. These assays help identify patients who are at low risk of distant metastasis and may not benefit from chemotherapy, thus sparing them from unnecessary toxicity . Additionally, these assays are prognostic for local-regional recurrence (LRR) and can inform decisions about the necessity of RT after BCS.
Histological Characteristics
Certain histological features, such as poor cytologic differentiation, lymphatic permeation, blood vessel invasion, and invasion into surrounding soft tissue, are associated with a higher risk of recurrence in stage 1 breast cancer. Identifying these features can help in stratifying patients based on their risk and tailoring their treatment accordingly.
Trends and Outcomes
Survival Rates
The prevalence of stage 1 breast cancer has increased over the past two decades, and despite the excellent overall prognosis, stage 1 cancers still contribute significantly to breast cancer-specific deaths. Five-year survival rates for stage 1 breast cancer have remained stable, highlighting the importance of identifying the minority of patients who remain at risk for recurrence and death.
Psychosocial and Immunological Predictors
Research has shown that natural killer (NK) cell activity and psychosocial factors can predict disease recurrence in early-stage breast cancer patients. Higher NK cell activity is associated with better disease-free survival, while psychosocial factors can influence the rate of disease progression.
Conclusion
Stage 1 breast cancer, predominantly ER/PR-positive and HER2-negative, has a favorable prognosis with appropriate treatment. Current research is focused on optimizing treatment strategies to minimize overtreatment and its associated toxicities. Genomic assays and histological characteristics are essential tools in risk assessment and treatment planning. Ongoing trials like NRG-BR007 are crucial in determining the best approaches to balance treatment efficacy and quality of life for patients.
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