Pub Date : 2026-02-01Epub Date: 2025-12-08DOI: 10.1016/j.breast.2025.104677
Antonella Grasso , Andrea Salerno , Alessandra Micera , Alessandro Ferraro , Emilio Fornaro , Graziana Esposito , Marco Coassin , Vittorio Altomare , Antonio Di Zazzo
Purpose
To investigate ocular surface alterations associated with oncological therapy in patients with hormone receptor-positive (HR+) breast cancer.
Methods
In this prospective pilot study, 30 HR + breast cancer patients and 10 age-matched healthy controls were evaluated at three time points: before surgery (T0), one week after surgery before starting therapy (T1), and after 12 months of antiestrogenic treatment (T2). Clinical assessments included Ocular Surface Disease Index (OSDI), Visual Function Questionnaire-25 (VFQ-25), Schirmer test type I, tear break-up time (TBUT), Meibomian gland dysfunction (MGD) score, and corneal and conjunctival staining. Gene expression of IL-6 and ICAM-1 was analyzed via impression cytology.
Results
No differences were observed between cancer patients and controls at baseline. After surgery (T1), patients reported increased OSDI scores (p < 0.05), reduced TBUT (p < 0.01), and worse MGD scores (p < 0.01). After 12 months of treatment (T2), MGD scores, Schirmer test values, and ocular staining worsened significantly (p < 0.01), along with a decline in VFQ-25 scores (p < 0.05). IL-6 and ICAM-1 expression were significantly upregulated at T2. Postmenopausal women experienced more severe ocular surface dysfunction than premenopausal patients.
Conclusions
Antiestrogen therapy in HR + breast cancer patients induces progressive ocular surface dysfunction, driven by chronic inflammation and epithelial damage. These findings highlight the importance of recognizing ocular symptoms in this population and support further studies evaluating the role of routine ophthalmologic monitoring in survivorship care.
{"title":"Secondary dry eye disease in breast cancer patients: a pilot study","authors":"Antonella Grasso , Andrea Salerno , Alessandra Micera , Alessandro Ferraro , Emilio Fornaro , Graziana Esposito , Marco Coassin , Vittorio Altomare , Antonio Di Zazzo","doi":"10.1016/j.breast.2025.104677","DOIUrl":"10.1016/j.breast.2025.104677","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate ocular surface alterations associated with oncological therapy in patients with hormone receptor-positive (HR+) breast cancer.</div></div><div><h3>Methods</h3><div>In this prospective pilot study, 30 HR + breast cancer patients and 10 age-matched healthy controls were evaluated at three time points: before surgery (T0), one week after surgery before starting therapy (T1), and after 12 months of antiestrogenic treatment (T2). Clinical assessments included Ocular Surface Disease Index (OSDI), Visual Function Questionnaire-25 (VFQ-25), Schirmer test type I, tear break-up time (TBUT), Meibomian gland dysfunction (MGD) score, and corneal and conjunctival staining. Gene expression of IL-6 and ICAM-1 was analyzed via impression cytology.</div></div><div><h3>Results</h3><div>No differences were observed between cancer patients and controls at baseline. After surgery (T1), patients reported increased OSDI scores (<em>p</em> < 0.05), reduced TBUT (<em>p</em> < 0.01), and worse MGD scores (p < 0.01). After 12 months of treatment (T2), MGD scores, Schirmer test values, and ocular staining worsened significantly (<em>p</em> < 0.01), along with a decline in VFQ-25 scores (<em>p</em> < 0.05). IL-6 and ICAM-1 expression were significantly upregulated at T2. Postmenopausal women experienced more severe ocular surface dysfunction than premenopausal patients.</div></div><div><h3>Conclusions</h3><div>Antiestrogen therapy in HR + breast cancer patients induces progressive ocular surface dysfunction, driven by chronic inflammation and epithelial damage. These findings highlight the importance of recognizing ocular symptoms in this population and support further studies evaluating the role of routine ophthalmologic monitoring in survivorship care.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104677"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-07DOI: 10.1016/j.breast.2025.104641
Martin Heidinger , Tibor A. Zwimpfer , Florian S. Halbeisen , Nadia Maggi , Marie Louise Frevert , Rama Kiblawi , Julie M. Loesch , Fabienne D. Schwab , Christian Kurzeder , Giacomo Montagna , Walter P. Weber
Background
Sentinel lymph node biopsy (SLNB) omission is safe in many patients with small, clinically and imaging node-negative (cN0/iN0), hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC). However, recruitment of the pivotal SOUND/INSEMA trials ended prior to approval of adjuvant cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). Therefore, the impact of SLNB omission on eligibility for CDK4/6i and associated oncological outcomes is unknown.
Methods
Single-center, retrospective study including patients with ≤cT2, cN0/iN0, HR-positive/HER2-negative early BC who underwent breast-conserving surgery and SLNB between 01/2014-12/2024. CDK4/6i eligibility was based on monarchE inclusion criteria and FDA approval (abemaciclib) and NATALEE inclusion criteria (ribociclib). Predictors of CDK4/6i eligibility and node-positivity were identified using multivariable logistic regression analysis. Impact on invasive disease-free survival was estimated based on published number needed to treat values in stage II disease (abemaciclib 28; ribociclib 63).
Results
Among 309 patients, eligibility was 6.1 % (19/309), 3.2 % (10/309), and 7.8 % (24/309) for abemaciclib (monarchE), abemaciclib (FDA approval), and ribociclib based on node-criteria; consequently, the number of SLNB necessary to identify one eligible patient was 17 (95 %CI 11–27), 31 (95 %CI 17–64) and 13 (95 %CI 9–20). Lymphovascular invasion was identified as a predictor for CDK4/6i eligibility and node-positivity. Omitting SLNB could increase recurrences by 0.3 % (95 %CI 0.2–0.4), 0.2 % (95 %CI 0.1–0.3), and 0.2 % (95 %CI 0.1–0.2) due to missed treatment with abemaciclib (monarchE), abemaciclib (FDA approval), and ribociclib, respectively.
Conclusion
Omission of SLNB in patients with small HR-positive/HER2-negative tumors results in a missed indication for CDK4/6i in <8 % with minimal impact on recurrence.
背景:前哨淋巴结活检(SLNB)遗漏对于许多临床和影像学淋巴结阴性(cN0/iN0)、激素受体(HR)阳性、人表皮生长因子受体2 (HER2)阴性乳腺癌(BC)患者是安全的。然而,关键SOUND/INSEMA试验的招募在辅助细胞周期蛋白依赖性激酶4/6抑制剂(CDK4/6i)获批之前就结束了。因此,SLNB缺失对CDK4/6i治疗资格和相关肿瘤预后的影响尚不清楚。方法采用单中心回顾性研究,纳入2014年1月- 2024年12月期间接受保乳手术和SLNB的≤cT2、cN0/iN0、hr阳性/ her2阴性早期BC患者。CDK4/6i的资格基于monarchE纳入标准、FDA批准(abemaciclib)和NATALEE纳入标准(ribociclib)。使用多变量logistic回归分析确定CDK4/6i适格性和节点阳性的预测因子。对侵袭性无病生存的影响是基于II期疾病治疗价值所需的已发表数量(abemaciclib 28; ribociclib 63)。结果309例患者中,基于淋巴结标准的abemaciclib (monarchE)、abemaciclib (FDA批准)和ribociclib的适格率分别为6.1%(19/309)、3.2%(10/309)和7.8% (24/309);因此,确定一名合格患者所需的SLNB数量为17 (95% CI 11-27), 31 (95% CI 17 - 64)和13 (95% CI 9-20)。淋巴血管侵袭被确定为CDK4/6i适格性和淋巴结阳性的预测因子。由于错过了abemaciclib (monarchE)、abemaciclib (FDA批准)和ribociclib的治疗,忽略SLNB可能会增加0.3% (95% CI 0.2 - 0.4)、0.2% (95% CI 0.1-0.3)和0.2% (95% CI 0.1-0.2)的复发率。结论在小的hr阳性/ her2阴性肿瘤患者中进行SLNB治疗会导致遗漏CDK4/6i指征的比例为8%,对复发的影响很小。
{"title":"Omission of sentinel lymph node biopsy in early stage luminal breast cancer: impact on adjuvant CDK4/6 inhibitor recommendation and oncological outcomes","authors":"Martin Heidinger , Tibor A. Zwimpfer , Florian S. Halbeisen , Nadia Maggi , Marie Louise Frevert , Rama Kiblawi , Julie M. Loesch , Fabienne D. Schwab , Christian Kurzeder , Giacomo Montagna , Walter P. Weber","doi":"10.1016/j.breast.2025.104641","DOIUrl":"10.1016/j.breast.2025.104641","url":null,"abstract":"<div><h3>Background</h3><div>Sentinel lymph node biopsy (SLNB) omission is safe in many patients with small, clinically and imaging node-negative (cN0/iN0), hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC). However, recruitment of the pivotal SOUND/INSEMA trials ended prior to approval of adjuvant cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). Therefore, the impact of SLNB omission on eligibility for CDK4/6i and associated oncological outcomes is unknown.</div></div><div><h3>Methods</h3><div>Single-center, retrospective study including patients with ≤cT2, cN0/iN0, HR-positive/HER2-negative early BC who underwent breast-conserving surgery and SLNB between 01/2014-12/2024. CDK4/6i eligibility was based on monarchE inclusion criteria and FDA approval (abemaciclib) and NATALEE inclusion criteria (ribociclib). Predictors of CDK4/6i eligibility and node-positivity were identified using multivariable logistic regression analysis. Impact on invasive disease-free survival was estimated based on published number needed to treat values in stage II disease (abemaciclib 28; ribociclib 63).</div></div><div><h3>Results</h3><div>Among 309 patients, eligibility was 6.1 % (19/309), 3.2 % (10/309), and 7.8 % (24/309) for abemaciclib (monarchE), abemaciclib (FDA approval), and ribociclib based on node-criteria; consequently, the number of SLNB necessary to identify one eligible patient was 17 (95 %CI 11–27), 31 (95 %CI 17–64) and 13 (95 %CI 9–20). Lymphovascular invasion was identified as a predictor for CDK4/6i eligibility and node-positivity. Omitting SLNB could increase recurrences by 0.3 % (95 %CI 0.2–0.4), 0.2 % (95 %CI 0.1–0.3), and 0.2 % (95 %CI 0.1–0.2) due to missed treatment with abemaciclib (monarchE), abemaciclib (FDA approval), and ribociclib, respectively.</div></div><div><h3>Conclusion</h3><div>Omission of SLNB in patients with small HR-positive/HER2-negative tumors results in a missed indication for CDK4/6i in <8 % with minimal impact on recurrence.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104641"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-10DOI: 10.1016/j.breast.2026.104697
Doyoun Woen , Danbee Kang , Juwon Park , Hyunsoo Kim , Su Min Lee , Seok Jin Nam , Seok Won Kim , Jeong Eon Lee , Jong Han Yu , Byung Joo Chae , Jai Min Ryu , Woong Ki Park , Juhee Cho , Se Kyung Lee
Background
Perceived financial toxicity (FT) is an increasingly recognized concern among cancer survivors. However, its association with long-term oncologic outcomes, particularly after completion of active treatment, remains underexplored.
Methods
We conducted a prospective cohort study of 4163 breast cancer survivors from a tertiary cancer center in South Korea. Eligible participants were within 18 months of diagnosis, had completed surgery and any adjuvant chemotherapy or radiotherapy, and had no evidence of recurrence at enrollment. Perceived FT was assessed using the Comprehensive Score for Financial Toxicity (COST) questionnaire. FT was defined by a COST score <26. Primary outcome was recurrence-free survival (RFS), and secondary outcomes included all-cause mortality and quality-of-life (QoL) domains. Multivariable Cox proportional hazard models adjusted for age, stage, treatment, and socioeconomic factors.
Results
Among the cohort, 2109 (50.7 %) patients reported perceived FT after active treatment. FT was independently associated with increased risk of recurrence or death (HR 1.42, 95 % CI 1.08–1.87), and higher all-cause mortality (HR 1.74, 95 % CI 1.02–2.97). FT was also associated with significantly worse emotional functioning, social functioning, and future outlook.
Conclusions
Perceived financial toxicity following active breast cancer treatment was associated with worse oncologic and quality-of-life outcomes, regardless of objective socioeconomic status. These findings underscore the need for routine assessment of perceived financial burden during survivorship care and targeted financial interventions, even in patients without traditionally defined financial vulnerability.
背景:感知经济毒性(FT)是癌症幸存者日益关注的问题。然而,其与长期肿瘤预后的关系,特别是在完成积极治疗后,仍未得到充分探讨。方法:我们对来自韩国三级癌症中心的4163名乳腺癌幸存者进行了一项前瞻性队列研究。符合条件的参与者在诊断18个月内,完成手术和任何辅助化疗或放疗,并且在入组时没有复发的证据。感知FT使用财务毒性综合评分(COST)问卷进行评估。结果:在队列中,2109例(50.7%)患者报告在积极治疗后出现FT。FT与复发或死亡风险增加(HR 1.42, 95% CI 1.08-1.87)和全因死亡率升高(HR 1.74, 95% CI 1.02-2.97)独立相关。FT还与情绪功能、社会功能和未来前景明显恶化有关。结论:无论客观社会经济地位如何,积极乳腺癌治疗后的经济毒性与更差的肿瘤和生活质量结果相关。这些发现强调了在生存护理期间对感知到的经济负担进行常规评估和有针对性的经济干预的必要性,即使在没有传统上定义的经济脆弱性的患者中也是如此。
{"title":"Perceived financial toxicity after active treatment and its association with clinical outcomes among breast cancer survivors: A prospective cohort study","authors":"Doyoun Woen , Danbee Kang , Juwon Park , Hyunsoo Kim , Su Min Lee , Seok Jin Nam , Seok Won Kim , Jeong Eon Lee , Jong Han Yu , Byung Joo Chae , Jai Min Ryu , Woong Ki Park , Juhee Cho , Se Kyung Lee","doi":"10.1016/j.breast.2026.104697","DOIUrl":"10.1016/j.breast.2026.104697","url":null,"abstract":"<div><h3>Background</h3><div>Perceived financial toxicity (FT) is an increasingly recognized concern among cancer survivors. However, its association with long-term oncologic outcomes, particularly after completion of active treatment, remains underexplored.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study of 4163 breast cancer survivors from a tertiary cancer center in South Korea. Eligible participants were within 18 months of diagnosis, had completed surgery and any adjuvant chemotherapy or radiotherapy, and had no evidence of recurrence at enrollment. Perceived FT was assessed using the Comprehensive Score for Financial Toxicity (COST) questionnaire. FT was defined by a COST score <26. Primary outcome was recurrence-free survival (RFS), and secondary outcomes included all-cause mortality and quality-of-life (QoL) domains. Multivariable Cox proportional hazard models adjusted for age, stage, treatment, and socioeconomic factors.</div></div><div><h3>Results</h3><div>Among the cohort, 2109 (50.7 %) patients reported perceived FT after active treatment. FT was independently associated with increased risk of recurrence or death (HR 1.42, 95 % CI 1.08–1.87), and higher all-cause mortality (HR 1.74, 95 % CI 1.02–2.97). FT was also associated with significantly worse emotional functioning, social functioning, and future outlook.</div></div><div><h3>Conclusions</h3><div>Perceived financial toxicity following active breast cancer treatment was associated with worse oncologic and quality-of-life outcomes, regardless of objective socioeconomic status. These findings underscore the need for routine assessment of perceived financial burden during survivorship care and targeted financial interventions, even in patients without traditionally defined financial vulnerability.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104697"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.breast.2025.104681
Lara W.A. Vreven , Elfi M. Verheul , Marissa C. van Maaren , Frank Doornkamp , Robert-Jan Schipper , Sabine Siesling , Paul D.P. Pharoah , Vivianne C.G. Tjan-Heijnen , Adri C. Voogd
Background
PREDICT Breast is a clinical decision-support tool estimating prognosis and the absolute benefit of adjuvant systemic therapies in early breast cancer. PREDICT v2.2 is recommended in Dutch guidelines. Both v2.2 and the recently updated v3.1 have not been validated in the Dutch population. This study compares the predictive performance of PREDICT v3.1 and v2.2 for 10-year OS in Dutch breast cancer patients.
Methods
Women diagnosed between 2005 and 2013 with primary invasive breast cancer were selected from the Netherlands Cancer Registry. Ten-year OS predictions from v2.2 and v3.1 were compared with observed OS for the overall cohort and 36 subgroups defined by oestrogen receptor (ER) status, HER2-status, age, and tumour stage. Discrimination (ability to distinguish patients with different outcomes) and calibration (agreement between predicted and observed outcomes) of both models were assessed.
Results
Among 101,282 patients, both versions showed moderate discrimination (AUC v2.2 = 0.768; v3.1 = 0.775) and calibration (v2.2 intercept: 0.07; slope: 1.09; v3.1 intercept: 0.12, slope: 1.00). V3.1 slightly overestimated (1.9%), whereas v2.2 slightly underestimated (1.6%) 10-year OS. Across subgroups, v3.1 generally outperformed v2.2 except in patients aged >75 years, where v2.2 provided more accurate estimates. In ER-/HER- patients aged 50–75 years, v3.1 overestimated (1.5–2.8%) and v2.2 underestimated (2.8–5.3%) 10-year OS.
Conclusion
Both PREDICT v2.2 and v3.1 accurately predict 10-year OS in Dutch breast cancer patients, with small differences between versions that vary by subgroup. No single model is optimal for all patients highlighting the need for subgroup-specific recalibration and careful interpretation when applying PREDICT.
{"title":"Comparative validation of PREDICT versions 3.1 and 2.2 for overall survival in the Dutch breast cancer population","authors":"Lara W.A. Vreven , Elfi M. Verheul , Marissa C. van Maaren , Frank Doornkamp , Robert-Jan Schipper , Sabine Siesling , Paul D.P. Pharoah , Vivianne C.G. Tjan-Heijnen , Adri C. Voogd","doi":"10.1016/j.breast.2025.104681","DOIUrl":"10.1016/j.breast.2025.104681","url":null,"abstract":"<div><h3>Background</h3><div>PREDICT Breast is a clinical decision-support tool estimating prognosis and the absolute benefit of adjuvant systemic therapies in early breast cancer. PREDICT v2.2 is recommended in Dutch guidelines. Both v2.2 and the recently updated v3.1 have not been validated in the Dutch population. This study compares the predictive performance of PREDICT v3.1 and v2.2 for 10-year OS in Dutch breast cancer patients.</div></div><div><h3>Methods</h3><div>Women diagnosed between 2005 and 2013 with primary invasive breast cancer were selected from the Netherlands Cancer Registry. Ten-year OS predictions from v2.2 and v3.1 were compared with observed OS for the overall cohort and 36 subgroups defined by oestrogen receptor (ER) status, HER2-status, age, and tumour stage. Discrimination (ability to distinguish patients with different outcomes) and calibration (agreement between predicted and observed outcomes) of both models were assessed.</div></div><div><h3>Results</h3><div>Among 101,282 patients, both versions showed moderate discrimination (AUC v2.2 = 0.768; v3.1 = 0.775) and calibration (v2.2 intercept: 0.07; slope: 1.09; v3.1 intercept: 0.12, slope: 1.00). V3.1 slightly overestimated (1.9%), whereas v2.2 slightly underestimated (1.6%) 10-year OS. Across subgroups, v3.1 generally outperformed v2.2 except in patients aged >75 years, where v2.2 provided more accurate estimates. In ER-/HER- patients aged 50–75 years, v3.1 overestimated (1.5–2.8%) and v2.2 underestimated (2.8–5.3%) 10-year OS.</div></div><div><h3>Conclusion</h3><div>Both PREDICT v2.2 and v3.1 accurately predict 10-year OS in Dutch breast cancer patients, with small differences between versions that vary by subgroup. No single model is optimal for all patients highlighting the need for subgroup-specific recalibration and careful interpretation when applying PREDICT.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104681"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-12DOI: 10.1016/j.breast.2025.104675
Chihwan David Cha , Somin Jeon , Jihyun Keum , Shin Jeong Pak , Boyoung Park , Min Sung Chung
Background
Young survivors of breast cancer often consider pregnancy after completing or interrupting endocrine therapy. However, concerns remain regarding the safety of tamoxifen interruption for pregnancy and its impact on survival outcomes. We aimed to evaluate the impact of interrupting and resuming tamoxifen for pregnancy on recurrence and mortality in patients with breast cancer, using real-world data.
Methods
We conducted a retrospective cohort study using data from the Korean National Health Insurance Service National Health Information Database. Among 32,378 women aged 18–45 years diagnosed with invasive breast cancer and who underwent surgery between 2009 and 2014, patients were categorized into groups based on tamoxifen interruption and pregnancy: Group 1 (interruption and resumption, n = 126), Group 2 (interruption without resumption, n = 261), Group 3 (initiation of tamoxifen after childbirth, n = 41), and Control (no interruption nor pregnancy, n =428). The control group was age-matched to the interruption groups in a 1:1 ratio. Clinical outcomes, including recurrence and mortality, were compared among groups.
Results
Over a median follow-up of 8.5 years, Groups 1 and 2 showed significantly lower risks of recurrence than the control group did (hazard ratio [HR] 0.41, 95 % confidence interval [CI]: 0.22–0.76, P = 0.005; HR 0.30, 95 % CI: 0.18–0.50, P < 0.001). In multivariate analysis, Group 2 also showed better survival outcomes (HR 0.18, 95% CI: 0.08–0.41, P < 0.001). Pregnancy outcomes differed across groups: Groups 1 and 2 had higher rates of full-term pregnancies, whereas Group 3 had a significantly higher abortion rate (23.8 %, 23.4 % vs. 56.1 %, respectively).
Conclusion
These findings suggest that temporary tamoxifen interruption for pregnancy may be a viable option for young survivors of breast cancer. Further studies are warranted to clarify the long-term impact of tamoxifen interruption on prognosis.
背景:年轻的乳腺癌幸存者在完成或中断内分泌治疗后经常考虑怀孕。然而,人们仍然关注他莫昔芬中断妊娠的安全性及其对生存结果的影响。我们的目的是评估妊娠期中断和恢复他莫昔芬对乳腺癌患者复发和死亡率的影响,使用真实世界的数据。方法采用韩国国民健康保险局国民健康信息数据库的数据进行回顾性队列研究。在2009年至2014年间接受手术的32378名18-45岁的浸润性乳腺癌患者中,根据他莫昔芬中断和妊娠情况将患者分为:1组(中断并恢复,n = 126), 2组(中断但未恢复,n = 261), 3组(分娩后开始使用他莫昔芬,n = 41)和对照组(未中断也未妊娠,n =428)。对照组与中断组按1:1的比例进行年龄匹配。临床结果,包括复发率和死亡率,在组间进行比较。结果中位随访8.5年,1、2组患者的复发风险明显低于对照组(风险比[HR] 0.41, 95%可信区间[CI]: 0.22-0.76, P = 0.005;风险比[HR] 0.30, 95% CI: 0.18-0.50, P < 0.001)。在多变量分析中,第2组也显示出更好的生存结果(HR 0.18, 95% CI: 0.08-0.41, P < 0.001)。妊娠结局在各组之间存在差异:1组和2组足月妊娠率较高,而3组的流产率明显较高(分别为23.8%、23.4%和56.1%)。结论:对于年轻的乳腺癌幸存者来说,妊娠期暂时停用他莫昔芬可能是一个可行的选择。需要进一步的研究来阐明他莫昔芬中断对预后的长期影响。
{"title":"Impact of the interruption of tamoxifen for pregnancy on the recurrence and survival outcomes among young women with breast cancer","authors":"Chihwan David Cha , Somin Jeon , Jihyun Keum , Shin Jeong Pak , Boyoung Park , Min Sung Chung","doi":"10.1016/j.breast.2025.104675","DOIUrl":"10.1016/j.breast.2025.104675","url":null,"abstract":"<div><h3>Background</h3><div>Young survivors of breast cancer often consider pregnancy after completing or interrupting endocrine therapy. However, concerns remain regarding the safety of tamoxifen interruption for pregnancy and its impact on survival outcomes. We aimed to evaluate the impact of interrupting and resuming tamoxifen for pregnancy on recurrence and mortality in patients with breast cancer, using real-world data.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the Korean National Health Insurance Service National Health Information Database. Among 32,378 women aged 18–45 years diagnosed with invasive breast cancer and who underwent surgery between 2009 and 2014, patients were categorized into groups based on tamoxifen interruption and pregnancy: Group 1 (interruption and resumption, n = 126), Group 2 (interruption without resumption, n = 261), Group 3 (initiation of tamoxifen after childbirth, n = 41), and Control (no interruption nor pregnancy, n =428). The control group was age-matched to the interruption groups in a 1:1 ratio. Clinical outcomes, including recurrence and mortality, were compared among groups.</div></div><div><h3>Results</h3><div>Over a median follow-up of 8.5 years, Groups 1 and 2 showed significantly lower risks of recurrence than the control group did (hazard ratio [HR] 0.41, 95 % confidence interval [CI]: 0.22–0.76, <em>P</em> = 0.005; HR 0.30, 95 % CI: 0.18–0.50, <em>P</em> < 0.001). In multivariate analysis, Group 2 also showed better survival outcomes (HR 0.18, 95% CI: 0.08–0.41, <em>P</em> < 0.001). Pregnancy outcomes differed across groups: Groups 1 and 2 had higher rates of full-term pregnancies, whereas Group 3 had a significantly higher abortion rate (23.8 %, 23.4 % vs. 56.1 %, respectively).</div></div><div><h3>Conclusion</h3><div>These findings suggest that temporary tamoxifen interruption for pregnancy may be a viable option for young survivors of breast cancer. Further studies are warranted to clarify the long-term impact of tamoxifen interruption on prognosis.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104675"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-23DOI: 10.1016/j.breast.2025.104662
Ilana Graetz
{"title":"Response to the letter “Targeted digital intervention boosts endocrine therapy adherence in breast cancer patients with low health literacy”","authors":"Ilana Graetz","doi":"10.1016/j.breast.2025.104662","DOIUrl":"10.1016/j.breast.2025.104662","url":null,"abstract":"","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104662"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-13DOI: 10.1016/j.breast.2025.104647
Paola Mosconi , Secondo Folli , Rosalba Miceli , Serena Scrudato , Massimiliano Gennaro , Gabriele Tinè , Maria Carmen De Santis , Cristina Ferraris , Gabriele Martelli , Immacolata Di Carlo , Ilaria Maugeri , Alessio Arata , Maria Grazia Carnevale , Chiara Listorti , Roberto Agresti , Claudia Borreani , Claudio Vernieri , Giancarlo Pruneri , Paolo Baili , Valentina Appierto , Giovanni Apolone
Background
The growing population of breast cancer survivors has raised attention to the long-term effects of treatment and follow-up. This study explored how survivors experience follow-up care and its impact on quality of life, focusing on fear of cancer recurrence (FCR), work and financial burden.
Methods
In this monocentric observational study, survivors completed a questionnaire including validated items from GIVIO, EORTC QLQ-C30, and FCR Inventory Short-Form. Fourteen domains were assessed. Scores were scaled 0–100, with higher values indicating better outcomes, except for FCR, where higher scores indicate greater concern. Data were stratified by age, time since diagnosis, education, income. Cluster analysis uncovered patterns of survivor experience across questionnaire domains.
Results
Of 1565 women scheduled for follow-up over six months, 681 (43.5 %) agreed to participate and, after excluding patients not fulfilling the protocol, and questionnaires with >50 % missing data, 656 entered the final analysis. Mean quality of life (73.3), physical (75.6), and social functioning (82.7) scored high, while emotional (55.6) and cognitive functioning (61.6) were lower. Satisfaction with care was mixed, with lower ratings for the national health system-level (56.8). FCR was moderate overall (38), with recurrent/intrusive thoughts in 2.9 % and 5.6 % of respondents. Lower income was significantly associated with worse outcomes across several domains, while no relevant differences were observed by age, education, or time since diagnosis. Cluster analysis revealed two distinct response profiles, clearly distinguished only by socioeconomic status.
Conclusions
Breast cancer survivors reported overall good levels of functioning, with lower scores in emotional and cognitive domains. Socioeconomic status was the only factor clearly associated with distinct response patterns.
{"title":"Health-related quality of life and fear of recurrence after early breast cancer treatment: Results from a cross-sectional survey","authors":"Paola Mosconi , Secondo Folli , Rosalba Miceli , Serena Scrudato , Massimiliano Gennaro , Gabriele Tinè , Maria Carmen De Santis , Cristina Ferraris , Gabriele Martelli , Immacolata Di Carlo , Ilaria Maugeri , Alessio Arata , Maria Grazia Carnevale , Chiara Listorti , Roberto Agresti , Claudia Borreani , Claudio Vernieri , Giancarlo Pruneri , Paolo Baili , Valentina Appierto , Giovanni Apolone","doi":"10.1016/j.breast.2025.104647","DOIUrl":"10.1016/j.breast.2025.104647","url":null,"abstract":"<div><h3>Background</h3><div>The growing population of breast cancer survivors has raised attention to the long-term effects of treatment and follow-up. This study explored how survivors experience follow-up care and its impact on quality of life, focusing on fear of cancer recurrence (FCR), work and financial burden.</div></div><div><h3>Methods</h3><div>In this monocentric observational study, survivors completed a questionnaire including validated items from GIVIO, EORTC QLQ-C30, and FCR Inventory Short-Form. Fourteen domains were assessed. Scores were scaled 0–100, with higher values indicating better outcomes, except for FCR, where higher scores indicate greater concern. Data were stratified by age, time since diagnosis, education, income. Cluster analysis uncovered patterns of survivor experience across questionnaire domains.</div></div><div><h3>Results</h3><div>Of 1565 women scheduled for follow-up over six months, 681 (43.5 %) agreed to participate and, after excluding patients not fulfilling the protocol, and questionnaires with >50 % missing data, 656 entered the final analysis. Mean quality of life (73.3), physical (75.6), and social functioning (82.7) scored high, while emotional (55.6) and cognitive functioning (61.6) were lower. Satisfaction with care was mixed, with lower ratings for the national health system-level (56.8). FCR was moderate overall (38), with recurrent/intrusive thoughts in 2.9 % and 5.6 % of respondents. Lower income was significantly associated with worse outcomes across several domains, while no relevant differences were observed by age, education, or time since diagnosis. Cluster analysis revealed two distinct response profiles, clearly distinguished only by socioeconomic status.</div></div><div><h3>Conclusions</h3><div>Breast cancer survivors reported overall good levels of functioning, with lower scores in emotional and cognitive domains. Socioeconomic status was the only factor clearly associated with distinct response patterns.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104647"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-26DOI: 10.1016/j.breast.2025.104685
Lorenzo Vinante , Jerry Polesel , Andrea Sacilotto , Anna Giroldi , Angela Caroli , Alberto Revelant , Cristina Cappelletto , Paola Chiovati , Alessia Chiofalo , Samuele Massarut , Barbara Belletti , Maurizio Mascarin , Agostino Steffan , Lorena Baboci
Radiation therapy (RT) is a standard component of treatment for early breast cancer and ductal carcinoma in situ. Although survival is excellent, RT-related side effects can impair long-term quality of life. We aimed to develop models to predict the risk of Grade ≥2 fibrosis and other late toxicities by combining clinical risk factors with baseline systemic inflammatory indices.
In this prospective study, 324 women underwent breast-conserving surgery followed by whole-breast RT and were followed for 24 months. Pre-surgical blood counts were used to calculate inflammatory indices, including NLR, dNLR, PLR, MLR, NLPR, SII, SIRI and AISI. Optimal cut-offs for each index was determined using ROC curves. Predictive models integrated clinical factors (surgical complications, post-menopausal status, chemotherapy, smoking, RT dose) with individual inflammatory indices to predict Grade ≥2 fibrosis and overall late side effects (fibrosis, skin side effects, chronic pain, lymphoedema).
At 24 months, 13.0 % of patients had developed Grade ≥2 fibrosis and 17.9 % had at least one Grade ≥2 late side effect. Patients who developed fibrosis had higher baseline NLR, dNLR, MLR, NLPR and SIRI. Models incorporating MLR or NLPR achieved area under the curve values > 0.70 and negative predictive values ≥ 93 %, outperforming models based on clinical risk factors alone. These findings suggest that routinely measured systemic inflammatory indices can identify patients at low risk of late RT side effects. If validated in external cohorts, these models may help tailor RT regimens to minimize long-term complications while maintaining therapeutic benefit.
{"title":"Baseline systemic inflammatory indices predict late radiation-induced fibrosis and toxicity in patients with early breast cancer","authors":"Lorenzo Vinante , Jerry Polesel , Andrea Sacilotto , Anna Giroldi , Angela Caroli , Alberto Revelant , Cristina Cappelletto , Paola Chiovati , Alessia Chiofalo , Samuele Massarut , Barbara Belletti , Maurizio Mascarin , Agostino Steffan , Lorena Baboci","doi":"10.1016/j.breast.2025.104685","DOIUrl":"10.1016/j.breast.2025.104685","url":null,"abstract":"<div><div>Radiation therapy (RT) is a standard component of treatment for early breast cancer and ductal carcinoma in situ. Although survival is excellent, RT-related side effects can impair long-term quality of life. We aimed to develop models to predict the risk of Grade ≥2 fibrosis and other late toxicities by combining clinical risk factors with baseline systemic inflammatory indices.</div><div>In this prospective study, 324 women underwent breast-conserving surgery followed by whole-breast RT and were followed for 24 months. Pre-surgical blood counts were used to calculate inflammatory indices, including NLR, dNLR, PLR, MLR, NLPR, SII, SIRI and AISI. Optimal cut-offs for each index was determined using ROC curves. Predictive models integrated clinical factors (surgical complications, post-menopausal status, chemotherapy, smoking, RT dose) with individual inflammatory indices to predict Grade ≥2 fibrosis and overall late side effects (fibrosis, skin side effects, chronic pain, lymphoedema).</div><div>At 24 months, 13.0 % of patients had developed Grade ≥2 fibrosis and 17.9 % had at least one Grade ≥2 late side effect. Patients who developed fibrosis had higher baseline NLR, dNLR, MLR, NLPR and SIRI. Models incorporating MLR or NLPR achieved area under the curve values > 0.70 and negative predictive values ≥ 93 %, outperforming models based on clinical risk factors alone. These findings suggest that routinely measured systemic inflammatory indices can identify patients at low risk of late RT side effects. If validated in external cohorts, these models may help tailor RT regimens to minimize long-term complications while maintaining therapeutic benefit.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104685"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-29DOI: 10.1016/j.breast.2025.104688
Wiebren A. Tjalma M.D., Ph.D., FEBS (Hon)
{"title":"The overlooked publication: Forrest (1880) as the earliest report of male mammary Paget's disease","authors":"Wiebren A. Tjalma M.D., Ph.D., FEBS (Hon)","doi":"10.1016/j.breast.2025.104688","DOIUrl":"10.1016/j.breast.2025.104688","url":null,"abstract":"","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104688"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-11DOI: 10.1016/j.breast.2025.104646
Xiaoyang Du , Leo Gkekos , Balram Rai , Anna L.V. Johansson , Irma Fredriksson , Mattias Rantalainen , Emelie Heintz , Shuang Hao , Mark Clements
Background
With new emerging technologies for diagnostics and treatment for breast cancer, there is a demand for updated breast cancer costs based on current clinical practice. The objectives of this study were to estimate recent societal costs of breast cancer in Sweden and provide population-based patient-level cost estimates for health economic evaluations.
Methods
This prevalence-based cost-of-illness study was based on 2019 data linking multiple Swedish national registers. The analysis employed a societal perspective considering direct health care, informal care, and productivity losses. Total costs were estimated using a bottom-up micro-costing approach. Direct costs per patient-year were also estimated by subgroups, including age group, breast cancer subtype, breast cancer stage at diagnosis, and disease state defined by metastatic status.
Findings
82,960 breast cancer patients diagnosed since 2008 were alive by the end of 2019. The annual societal cost of breast cancer in Sweden was €632 million, where the direct health care, informal care, and productivity losses accounted for 37 %, 5 %, and 57 %, respectively. The cost per capita was €61. Costs of direct health care, including inpatient/outpatient care and prescribed drugs, varied by subgroups, where younger age, higher stage, and more adverse subtypes were associated with higher costs per patient-year. Patients with a diagnosis of de novo metastatic cancer incurred the highest mean cost per patient-year.
Conclusion
Breast cancer represents a large economic burden in Sweden. The mean cost estimates per patient-year are informative to future health economic evaluations for breast cancer screening and treatment.
{"title":"Breaking down the costs for breast cancer: Insights from Sweden's national quality register","authors":"Xiaoyang Du , Leo Gkekos , Balram Rai , Anna L.V. Johansson , Irma Fredriksson , Mattias Rantalainen , Emelie Heintz , Shuang Hao , Mark Clements","doi":"10.1016/j.breast.2025.104646","DOIUrl":"10.1016/j.breast.2025.104646","url":null,"abstract":"<div><h3>Background</h3><div>With new emerging technologies for diagnostics and treatment for breast cancer, there is a demand for updated breast cancer costs based on current clinical practice. The objectives of this study were to estimate recent societal costs of breast cancer in Sweden and provide population-based patient-level cost estimates for health economic evaluations.</div></div><div><h3>Methods</h3><div>This prevalence-based cost-of-illness study was based on 2019 data linking multiple Swedish national registers. The analysis employed a societal perspective considering direct health care, informal care, and productivity losses. Total costs were estimated using a bottom-up micro-costing approach. Direct costs per patient-year were also estimated by subgroups, including age group, breast cancer subtype, breast cancer stage at diagnosis, and disease state defined by metastatic status.</div></div><div><h3>Findings</h3><div>82,960 breast cancer patients diagnosed since 2008 were alive by the end of 2019. The annual societal cost of breast cancer in Sweden was €632 million, where the direct health care, informal care, and productivity losses accounted for 37 %, 5 %, and 57 %, respectively. The cost per capita was €61. Costs of direct health care, including inpatient/outpatient care and prescribed drugs, varied by subgroups, where younger age, higher stage, and more adverse subtypes were associated with higher costs per patient-year. Patients with a diagnosis of de novo metastatic cancer incurred the highest mean cost per patient-year.</div></div><div><h3>Conclusion</h3><div>Breast cancer represents a large economic burden in Sweden. The mean cost estimates per patient-year are informative to future health economic evaluations for breast cancer screening and treatment.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104646"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145518957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}