Current Breast Cancer Reports

Cobb, Adrienne; DeSnyder, Sarah M.

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00474-6

Purpose of ReviewIdentifying and treating long-term complications of cancer treatment, including breast cancer-related lymphedema (BCRL), is important as BCRL negatively impacts the quality of life in both physical and psychosocial domains. The purpose of this review is to discuss recent literature regarding risk factors for lymphedema, review risk reduction strategies, and dispel myths about precautionary behaviors.Recent FindingsEarly detection and treatment of BCRL, including subclinical lymphedema, is encouraged. Lymphovenous bypass and LYMPHA may reduce the incidence of BCRL. Patients no longer need to avoid blood pressure measurements, needle sticks, and flying as they do not increase the risk of nor incite BCRL.SummaryRisk factors such as the type of axillary surgery and radiation therapy remain the leading contributors to BCRL development. Blanketed recommendations regarding precautionary behaviors should be avoided. Surgical treatment and prevention of BCRL continue to mature and appropriate patients should be counseled regarding these options.

Brunelle, Cheryl L.; Taghian, Alphonse G.

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00471-9

PurposeThis study is to review current evidence for prospective surveillance, early intervention and conservative treatment of breast cancer-related lymphedema (BCRL).Recent FindingsBCRL screening is imperative. It must begin at preoperative baseline to avoid misdiagnosis and should include subjective and objective measures and clinical exam. Screening allows for early intervention; however, further research is needed to definitively establish its benefit and identify the appropriate treatment threshold to minimize progression. Complete decongestive therapy (CDT) has remained the gold standard for treatment; however, this is resource intensive, and supporting evidence for its components is lacking. Further research regarding the effectiveness of manual lymphatic drainage and CDT is indicated to guide clinical practice.SummaryBCRL has a tremendous negative impact on quality of life, and efforts to maximize patient outcome should be aggressively pursued. Screening, accurate diagnosis, and evidence-based management are mutually supporting and necessary for a comprehensive BCRL program throughout survivorship.

Pesce, Catherine

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00477-3

Fulfilling the desire to have children is important to breast cancer survivors; however, treatment for breast cancer places women of reproductive age at real risk of reduced fertility or infertility.Purpose of reviewThe purpose of this review is to review family building options for patients with infertility after breast cancer treatment, including the use of donor oocytes, surrogacy, and adoption.Recent findingsPatients with a history of cancer who use donor oocytes seem to have similar implantation, miscarriage, and delivery rates as patients without cancer. For women unable to carry a pregnancy, surrogacy is a good, although expensive, option, and women with a history of breast cancer are more likely to consider adoption than women without a history of malignancy. Follow-up counseling and guidance regarding infertility in breast cancer survivors is lacking.SummaryFurther research is needed to understand the challenges faced by breast cancer survivors in family building after treatment, and fertility-related information and guided support need to be integrated into post-treatment survivorship care.

Williams, Austin D.; Moo, Tracy-Ann

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00473-7

Purpose of ReviewDifferences in socioeconomic status (SES) and social determinants of health (SDH) account for many of the disparities seen among patients diagnosed with breast cancer. This review outlines how low SES/SDH factors impact patients along the continuum of breast cancer care from screening to survivorship.Recent FindingsFactors such as place of residence, race, income, insurance status, and social networks all strongly correlate with the degree to which patients have access to and utilize breast cancer screening, their composite treatment once diagnosed, the financial impact of treatment, and ultimately, their disease and survival outcomes. The increased complexity of community and social networks creates difficulty in understanding the interplay of SES/SDH factors and breast cancer outcomes and has provided challenges in targeted interventions to reduce disparities.SummaryRecent research has underscored that non-biologic SES/SDH factors have important and sizable impacts on breast cancer care. Targeted efforts to address these disparities must respond to a dynamic and complex interplay between biologic and SES/SDH factors. Providing high-quality, guideline-concordant, multidisciplinary care to all patients regardless of social factors remains the most important strategy across all healthcare settings.

Plichta, Jennifer K.; Taskindoust, Mahsa; Greenup, Rachel A.

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00476-4

Purpose of ReviewAmong individuals with metastatic breast cancer, surgical resection of the primary tumor remains controversial, and its benefit is unclear. In this review, we highlight select retrospective and prospective studies which have sought to address this clinical scenario. In addition, we discuss further considerations that may be relevant.Recent FindingsNumerous retrospective studies have suggested a potential survival benefit associated with surgical resection of the primary breast tumor in women with metastatic disease; however, three randomized controlled trials more recently have challenged these findings. Mixed results have demonstrated no survival benefit with locoregional treatment versus limited benefit in select patient groups.SummaryProspective studies suggest that most patients with metastatic breast cancer are unlikely to experience a survival benefit related to resection of their primary tumor. However, ongoing work seeks to further define if there may be select subgroups that could benefit from surgery.

Bushara, Omar; Hansen, Nora M.

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00478-2

Purpose of ReviewBreast cancer is the most commonly diagnosed cancer and is the second leading cause of cancer death in women. Breast cancer screening has significantly improved detection of cancer and reduced mortality however, mortality has plateaued in recent years. As such, identifying ways to improve management decisions to further reduce mortality remains a high priority. Herein, we review the current evidence for locoregional management recommendations in patients with hereditary breast cancer mutations. Additionally, we discuss the potential utility of gene assays in locoregional management decision-making.Recent FindingsGene assays are currently used to identify patients who would benefit from systemic adjuvant therapy, and their uptake has improved clinical outcomes. There is growing evidence supporting their utility in determining patients at a higher risk for locoregional recurrence. As such, gene assays may have a role in decision-making regarding the locoregional management of breast cancer, and specifically the use of adjuvant RT.SummaryRisk reduction is central to the management of patients with hereditary breast cancer mutations. In patients with BRCA1/2 mutations, risk-reducing mastectomy (RRM) ± adjuvant radiotherapy (RT) or breast conserving therapy (BCS) with adjuvant RT is often an appropriate treatment regimen. A similar treatment approach is likely appropriate in other high-penetrance mutations, although RT should be used cautiously in patients with TP53 mutations. In patients with low-moderate penetrance mutations, BCS with adjuvant RT or RRM in conjunction with patient preference is likely appropriate, although RT should be avoided in patients with ATM mutations.

Nash, Amanda L.; Wang, Sabrina; McDuff, Susan; Hwang, E. Shelley

2023 Current Breast Cancer Reports

doi: 10.1007/s12609-023-00475-5

Purpose of ReviewStandard DCIS management consists of surgery with consideration of adjuvant radiation and endocrine therapy. However, widespread recognition of the overdiagnosis and overtreatment burden in DCIS has led to a reevaluation of this standard. The purpose of this review is to summarize the foundational clinical trials in DCIS and to discuss ongoing efforts in treatment de-escalation.Recent FindingsStandard of care DCIS management is based on large high-quality randomized clinical trials. The results of those trials have been durable over more than a decade of follow-up. However, we now better appreciate that DCIS is a heterogeneous disease with variable risk of progression. Clinicopathologic and molecular tools are helping better define which patients with DCIS would benefit from de-escalation. Modern clinical trials have proven the safety of shorter and lower dose radiation regimens in low-risk patients, and results from active monitoring trials are highly anticipated. In addition, decision support tools, shared decision-making, and molecular testing promise to help guide patients through an increasingly complex decision-making process.SummaryCurrent treatment of DCIS has moved towards successful de-escalation of treatment for those patients with low risk of progression. Further incorporation of molecular tools will allow for personalized treatment based on individual risk and preferences.