Miranda Lankas, Assistant Editor for CURE®, started at MJH Life sciences in August 2022. She completed an undergraduate and Master of Arts degree in literature at Temple University. Miranda’s passions include embroidery, color guard, and picking up new languages. Email her in English, French, or Japanese at mlankas@mjhlifesciences.com.

Miranda Lankas

The current rate of BRCA1/2 testing for patients with newly diagnosed HER2-negative breast cancer is only 68% in the United States, according to data presented at the 2023 Miami Breast Cancer Conference.

BRCA1 and 2 are genes that help repair damaged DNA, a vital tool for combatting cancerous tumors. When individuals have a mutation in either of these genes, they may have an increased risk of several types of cancer, but it is named for its association to breast cancers, with the BR and CA indicating the first two letters of the words breast and cancer. The mutations are also linked to ovarian cancer, prostate cancer and pancreatic cancer.

According to the National Cancer Institute, 13% of women with unmutated BRCA1/2 genes will develop breast cancer, while 55% to 72% of women with a harmful BRCA1 variant and 45% to 69% of women with a harmful BRCA2 variant will develop breast cancer.

Adult patients with newly diagnosed stage 1, 2 or 3 HER2-negative resected breast cancer in active treatment were included in the study’s data analysis. A total of 395 patients were retrospectively enrolled, then divided into a group of 199 patients with hormone receptor (HR)-positive disease and 189 patients with triple-negative disease.

A total 68% patients with HER2-negative breaast cancer had documented BRCA1/2 testing. Additionally, 61% (122) of the HR-positive group and 74% (139) of the triple-negative group were tested.

Of the entire HER2-negative group, 68% (267) had documented BRCA1/2 testing. Additionally, 61% (122) of the HR-positive group and 74% (139) of the triple-negative group were tested.

Patients who had received BRCA1/2 testing were younger and more likely to be premenopausal than untested patients. Among premenopausal women, testing rates were 89% for HER2-negative disease, 92% for HR-positive and 87% for triple-negative patients. These numbers fell to 61%, 51% and 70% for HER2-negative, HR-positive and triple-negative disease, respectively, for postmenopausal patients.

Those with HR-positive disease were not only less likely to be tested for BRCA1/2 mutations, but were found to also be less likely to receive diverse testing for those mutations. The highest proportion of tests for all groups was through germline testing, which are DNA tests like blood tests or cheek swabs, as well as the current standard for BRCA mutation testing. Patients with triple-negative disease were the most likely to be tested for mutations on multiple sample types, such as tumors samples or circulating tumor DNA tests.

Race and ethnicity are contributing risk factors to BRCA mutations, with those most at risk being members of the Ashkenazi Jewish population as well as Icelandic and Norwegian peoples, and the majority of patients enrolled in this study were white. Patients in the Asian and other categories had the highest rates of testing in this study, but this is likely due to the extremely small sample sizes in these groups.

Study authors concluded by saying, “efforts should focus on increasing adoption of BRCA1/2 testing for all eligible patients to enhance adherence to guideline recommended precision medicine options and subsequent outcomes.”

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Articles

The current testing rate for BRCA 1/2 mutations is currently 68% in HER2-negative early breast cancer, but eligible patients could receive better care if tested.

Increased BRCA1/2 Testing May Improve Patient Outcomes

Among the many treatment advances made in early stage breast cancer care, surgical interventions have become much less invasive over the years, helping patients to live longer and disease free, according to Dr. Patrick Borgen.

At the CURE® Educated Patient® Breast Cancer Summit, held live and virtually at the Miami Breast Cancer Conference, Borgen, chairman of the Department of Surgery at the Maimonides Medical Center in Brooklyn, New York, and also co-chair of the meeting, discussed multiple facets of the current breast cancer treatment landscape. Further, he addressed current survival rates, and the role that “pinkwashing” has played in the space over the years.

Positive Advancements for Breast Cancer Treatment

As physicians advance their understanding of tumor biology and apply that understanding to their patients, surgery continues to be less invasive and less painful for patients with breast cancer who require surgical interventions.

Educated Patient® Breast Cancer Summit at the Miami Breast Cancer Conference, held March 4, 2023.

Borgen emphasized the future of breast cancer treatment is a de-escalation of surgery to treat active disease, and the hope that fewer patients will need to be treated with surgery at all.

There are twice as many reported cases of breast cancer than any other solid tumor type, in part, because women who would have perhaps died of other causes are now living longer and developing breast cancer later in life. Despite this increase, the number of deaths due to breast cancer in the United States has remained consistent since the 1950s.

Five-year survival rates for women aged 15 to 49 and initially diagnosed with metastatic breast cancer has doubled in recent years, from 18% in 1992 to 1994 to 36% in 2005 to2012. Some of the advancements that led to increased survival include earlier disease detection and screenings, the development of new drugs and other treatments, a better understanding of disease and tumors, in general, and the participation of patients in larger-scale clinical trials.

One current problem for breast cancer treatment, as a whole, is that it remains one of the most expensive in the United States, according to Borgen. This has led to the ubiquity of pinkwashing – when companies take advantage of the desire to support breast cancer foundations and research to boost sales on products that otherwise wouldn’t sell well. This is why random objects in stores are colored pink and donate only a fraction of their profits to breast cancer.


However, he noted, none of these products is of any benefit to a patient with breast cancer, and their association with the space’s philanthropy is, at best, nonsensical and, at worst, dangerous.

The danger of pinkwashing is trivializing the efforts of breast cancer advocates who do such important work, Borgen said. “By painting everything pink we lose the importance of the message,” he said. “We lose the fact that 40,000 women per year die of this disease. So I’m an opponent of pinkwashing.”

Videos

Watch Dr. Patrick Borgen, from Maimonides Medical Center, discuss the de-escalation of surgery during the CURE Educated Patient® Breast Cancer Summit at MBCC.

Educated Patient® Breast Cancer Summit at MBCC De-Escalation of Surgery Presentation: March 4, 2023

Patients with breast cancer who were treated with radiation therapy saw a benefit in reduced recurrence for the first 10 years after treatment, but overall survival 10 years later was “almost identical” to patients who skipped radiation, according to a recent study.

However, one expert highlighted the importance of patients following their prescribed regimen for the best possible outcome. In his opinion, patients should not forego radiation therapy just yet — especially without discussing it with their health care team.

, analyzed 1,326 patients: 658 women were randomly assigned to receive whole-breast irradiation (meaning that the whole breast is being treated with, and absorbing radiation) and 668 received no radiation therapy.

Ten-year breast cancer outcomes were not much different between patients who underwent radiation and those who did not, but one expert cautioned patients to be sure to discuss their treatment plan with providers.

Within 10 years of ending treatment, patients who received radiation therapy saw a local recurrence rate (which, according to the American Cancer Society means that the cancer came back in the same breast) of 0.9%, as opposed to 9.5% in the group who did not receive radiotherapy. Distant recurrence (meaning that breast cancer came back in another body part) was 1.6% in the group that did not receive radiation and 3% in the radiation group, as radiation only affects the area where a tumor is initially treated.

However, although there was a difference in local recurrence early on, the study authors reported similar rates of overall survival (percentage of patients who were still alive) 10 years after treatment, at 80.8% for those without radiation and 80.7% for those treated with radiation.

“Omission of radiotherapy was associated with an increased incidence of local recurrence but had no detrimental effect on distant recurrence as the first event or overall survival among women 65 years of age or older with low-risk, hormone receptor–positive early breast cancer,” the study authors concluded.

However, Joseph Panoff, a radiation oncologist specializing in breast cancer at the Baptist Health Miami Cancer Institute in Florida, expressed concerns about patients rejecting radiation oncology in light of these data:

“The media has picked up on this and the story that they're telling is you don't need radiation,” he said in an interview with CURE®. “But if you look deeper at that article and read it carefully, what you find is that 60 to 70% of those patients were not complying with endocrine therapy. When you're not complying with endocrine therapy, the risk of recurrence goes up four times — it's quadrupled. Additionally, in patients that have estrogen-low tumors, the recurrence is 20%, not 9%.”

Panoff was clear that while radiation therapy may not be the correct treatment course for all patients, some may reject radiation therapy out of misplaced concerns and a lack of education on the safety of modern radiation practices.

“What I'm concerned about is that a lot of patients, are not going to not be educated properly on this, they're going to not do radiation, and there's going to be a very high risk of recurrence that we're going to see in patients because they're non-compliant with endocrine therapy many years out.”

Panoff concluded by encouraging patients to stick to their care plans to keep risk of recurrence as low as possible.

“The message is, if you're not going to do radiation and you're above 65 years old, and you've talked with a radiation oncologist and medical oncologist, make sure you're compliant with five years of endocrine therapy, or else your risk of recurrence is going to be inappropriately high.”

Skipping radiation therapy for breast cancer may not affect 10-year survival, but one radiation oncologist suggests patient noncompliance with endocrine therapy is the real reason for reduced benefits.

Radiation May Not Affect Long-Term Breast Cancer Survival, But Expert Warns Patients to Discuss Treatment With Providers

While there have been many advances made in the breast cancer treatment paradigm, radiation therapy remains a mainstay in early stage disease, according to Dr. Joseph Panoff.

At the CURE® Educated Patient® Breast Cancer Summit, held live and virtually at the Miami Breast Cancer Conference, Panoff, a radiation oncologist specializing in breast cancer at the Miami Cancer Institute, Baptist Health South Florida, presented radiation treatment options for early-stage breast cancer patients.

Radiation therapy works by damaging the DNA of tumors and cancer cells, causing them to stop replicating and spreading within the body. This ultimately stops disease from progressing while also killing the existing tumor and allowing the body to remove the dead cells like any other non-cancerous tissue.

While radiation therapy can be extremely effective when correctly administered, there are risks, such as damaging surrounding healthy cells while attempting to irradiate the original tumor.

Panoff explained that treating breast cancer with radiation therapy can differ from other cancer types because patients will almost always receive radiation after surgery to eliminate whatever cancer cells remain, and radiation oncologists strive to use very little radiation on patients in general.

In modern radiation therapy “the trend has been de-escalation. There are some patients where we don't treat (with radiation) at all,” Panoff said in an interview with CURE®. “We now do what's called hypofractionation — we do a shortened treatment scheme for the majority of our patients, which we really didn't do 10 years ago. There are other (disease) sites that do that, but (breast cancer radiation oncologists) really have pioneered that shorter course of radiation, in addition to partial breast (radiation). So now we're not even treating the whole breast anymore for many patients that are candidates. I think that sets us apart from other organ sites.”

Though some patients worry radiation is a more severe or dangerous treatment course than surgery or chemotherapy, Panoff was clear that radiation oncology has made many advancements and is now one of the safer treatment options in those who need it. “Modern radiation is very well tolerated, for the most part,” he said. “Patients do really well, and it has a very good toxicity profile, especially when you compare it with chemotherapy.”

Successful radiation therapy is one of the most effective treatment options to reduce the risk of disease recurrence, but Panoff emphasized compliance with the post-radiation care plan is imperative to truly reduce risk of recurrence. Patients with breast cancer who are prescribed endocrine therapy after radiation, but do not follow their treatment plan, see four times the risk of recurrence than those who follow their entire plan.

If you are a candidate for radiation oncology, Panoff strongly discourages new patients from looking on the internet or speaking to friends to find educational materials about it. “Be careful using Google for radiation oncology education. I really mean that. There's a lot of misinformation, it will rarely help to Google,” he said. “Be careful speaking to your friends about it, because frequently, they're going to have either misinformed information or anecdotal stories from people who may have had radiation in a different era where we treated differently, and there was a lot more toxicity in the past.”

Watch Dr. Joseph Panoff, from Miami Cancer Institute, Baptist Health South Florida, discuss radiation therapy in early stage disease during the CURE Educated Patient® Breast Cancer Summit at MBCC.

Miranda Lankas

Increased BRCA1/2 Testing May Improve Patient Outcomes

Educated Patient® Breast Cancer Summit at MBCC De-Escalation of Surgery Presentation: March 4, 2023

Radiation May Not Affect Long-Term Breast Cancer Survival, But Expert Warns Patients to Discuss Treatment With Providers

Educated Patient® Breast Cancer Summit at MBCC Radiation Therapy Presentation: March 4, 2023

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