Annual Meeting Proceedings Part 1 - American Society of Clinical ...

108s Cancer Prevention/Epidemiology
1592 General Poster Session (Board #8B), Sat, 1:15 PM-5:15 PM
Secondary breast cancer (s-BC) after hematopoietic cell transplantation
(HCT) for leukemia: Role of total body irradiation (TBI). Presenting Author:
Can-Lan Sun, City of Hope, Duarte, CA
Background: s-BC after conventional chest radiation for histologically
distinct cancer is well-recognized, and has resulted in radiologic screening
recommendations by American Cancer Society. However, risk of s-BC after
TBI is not well-defined. Methods: We determined the risk of s-BC in 648
consecutive females transplanted for leukemia (ALL [19%], AML/MDS
[57%], CML [24%]) between 1976 and 2008 with a post-HCT survival of
�2 years. The study was restricted to leukemia to understand the role of
TBI without the influence of pre-HCT chest radiation. Near-complete
ascertainment of s-BC was assured by combining institutional follow-up
with California Cancer Registry data. Results: Median age at HCT was 38
years (range, 0-71); 14% had received autologous HCT, 64% related and
22% unrelated donor HCT; 70% had received TBI for myeloablative
conditioning. After 5,675 person-years of observation, 16 patients developed
s-BC (14 after TBI). Median latency from HCT to s-BC was 16y
(2-27). Median age at s-BC was 50y (29-66). Cumulative incidence of s-BC
was 6% at 20y after HCT, contributed to largely by TBI (s-BC incidence
after TBI: 5.7%). Among TBI-exposed, 8.6% were projected to develop
s-BC by age 65y (1.6% among non-TBI-exposed, p�0.03). TBI-exposed
patients were 2.4 times more likely to develop s-BC compared with general
population (p�0.001); non-TBI exposed were not at increased risk
(SIR�0.9, p�0.9). Multivariate analysis (adjusted for age at HCT, follow-up
and primary diagnosis) revealed a 4.7-fold (p�0.068) increased
risk of s-BC among TBI-exposed. Conclusions: Risk of s-BC after TBI as the
sole source of radiation to breast is increased. Nearly 9% of those exposed
to TBI will develop s-BC by age 65y. Identification of vulnerable subpopulations
among the TBI-exposed patients is underway to create targeted
screening strategies for early detection of s-BC.
1594 General Poster Session (Board #8D), Sat, 1:15 PM-5:15 PM
Association of a history of autoimmunity or hypersensitivity with overall
survival in breast cancer. Presenting Author: Hakan Lars Olsson, Departments
of Oncology and Cancer Epidemiology, Lund University, Lund,
Sweden
Background: Antibody therapy of malignant melanoma with ipilimumab is
associated with the development of an autoimmune disease. The aim was
to investigate if preexisting autoimmune disorders or hypersensitivities,
similar to the side effects of immunotherapy in malignant melanoma, gave
a better overall survival for breast cancer (BC) patients, compared with
patients without these disorders. Methods: A consecutive clinical material
consisting of 1,705 breast cancer patients diagnosed between 1980 and
2010 was used. The patients were grouped according to preexisting
autoimmune disease or hypersensitivities. The remaining BC patients were
used as a reference group. All analyses were adjusted for age at diagnosis,
T, N, M-status of the tumor, and ever-use of HRT simultaneously. A p value
of less than 0.05 was considered significant. Results: One hundred and
twenty-five (7.3%) patients had a history of autoimmunity and 72 (4.2%)
patients had a history of hypersensitivity prior to BC diagnosis. Our main
finding was that BC patients with a preexisting autoimmune disease or
hypersensitivities with ER-negative tumors had a longer overall survival
compared to patients without, HR 0.55, 95% CI 0.31-0.97. The risk was
specifically low in BC patients with hypersensitivity and ER-negative
tumors, HR 0.39, 95% CI 0.16-0.96. The risk was nonsignificantly lower
in the autoimmune group, HR 0.78, 95% CI 0.37-1.61. Stratifying both on
ER-status and menopausal status, similar results were seen in premenopausal
BC patients with hypersensitivity. Postmenopausal BC patients with
an ER-negative tumor and an autoimmune disease had a longer nonsignificant
overall survival, HR 0.3, 95% CI 0.07-1.26. Conclusions: BC patients
with an ER-negative tumor and/or diagnosed before menopause had a
longer overall survival when previously diagnosed with hypersensitivity. For
BC patients with an autoimmune disease, the prognostic benefit was seen
when diagnosed postmenopausally with an ER-negative BC. Preexisting or
induced autoimmunity or hypersensitivity may prolong life in breast cancer
especially in young patients and those with ER-negative tumors.
1593 General Poster Session (Board #8C), Sat, 1:15 PM-5:15 PM
Effect of sunlight exposure on survival in patients with lymphoma: Results
from the prospective Singapore Lymphoma Study. Presenting Author: Yin
Leng Lee, National Cancer Center, Singapore
Background: Recently, several studies evaluating the effect of ultraviolet
light exposure on the risk of developing lymphoma have yielded conflicting
results, in part due to seasonal and latitude variation. Further, most of
these studies also lack long term follow up and could not systemically
address the influence of sunlight exposure on survival. In this prospective,
epidemiological study, we explored the relationship between past sunlight
exposure and survival in lymphoma patients in tropical Singapore, where
sunlight exposure is constant throughout the year. Methods: Singapore
Lymphoma Study was established in 2005. A total of 384 patients with
histologically confirmed lymphoma were followed from date of diagnosis
through November 2011. Interviewers were trained to conduct in-person
interviews to collect detailed information, including every occupational
period that lasted at least 1 year and number of hours worked outdoor from
9am to 5pm using a structured questionnaire. Descriptive, multivariate and
survival analysis (Kaplan Meier; age, gender, race and education level
adjusted) were performed. Results: Among all lymphoma subtypes, the
most prevalent was diffuse large B cell lymphoma, 47.7%, followed by
Hodgkin lymphoma, 14.6%, follicular lymphoma, 12.2% and T cell
lymphoma, 6.5%. 97.1% had black or brown eye color and 49.6% had fair
skin. Overall survival of lymphoma and NHL subtype decreased significantly
with increasing lifetime occupational hours (ptrend�0.01 and
0.03). Chinese was associated with longer survival with increasing daily
sunlight exposure during childhood and adolescent years, whether at
school or outdoor leisure (ptrend�0.04) and there were no evidence for
non-Chinese (Malays or Indians). Patients with lighter eye color results in
shorter survival (HR�2.91, 95% CI: 1.15-7.34, p�0.02). Conclusions: We
found leisure sunlight exposure during childhood and adolescent years to
be beneficial to the survival of Chinese lymphoma patients and increasing
lifetime cumulative occupational exposure is associated with increasing
risk of death. This data contributes to the growing research on the effects of
sunlight exposure on lymphoma patients.
1595 General Poster Session (Board #8E), Sat, 1:15 PM-5:15 PM
The evolution of breast cancer screening in the Medicare population:
Clinical and economic implications. Presenting Author: Brigid K. Killelea,
Yale University School of Medicine, Yale Comprehensive Cancer Center,
New Haven, CT
Background: Breast screening has evolved as newer approaches to mammography,
ultrasound, and MRI have diffused into clinical practice. The use of
these technologies and their impact on screening-related costs and
outcomes remain undefined, particularly among older women. Methods:
Using the Surveillance Epidemiology and End Results – Medicare linked
database, we identified women aged 66 and older without a diagnosis of
breast cancer. We constructed two cohorts (2001 vs. 2006) and followed
each for two years. We assessed changes in imaging technology, screeningrelated
costs (defined as costs for screening and subsequent imaging and
testing, adjusted to 2009 USD), and stage at diagnosis between the two
cohorts. Results: There were 136,845 women in the 2001-2002 (earlier)
cohort and 137,733 in the 2006-2007 (later) cohort. The mean age was
76.9 and 77.2 respectively, (p�.001). The proportion of women receiving
any screening mammogram was 42.5% in the earlier cohort and 43.4% in
the later cohort, (p�.001). The use of digital mammography for screening
increased from 2.2% to 15.0%, (p�.001). The use of any computer aided
detection (CAD) increased from 3.2% to 29.3% (p�.001). MRI use
increased from 0.03% to 0.2%, and ultrasound use from 4.0% to 4.5% (p
�.001 for both). Average screening-related cost increased 31%, from
$101 to $132 (p�.001). There was no significant difference in early stage
at diagnosis over time (58.1% of women were in situ/stage I in early period
vs. 57.2% in later period, p�.65). Conclusions: The use of digital
mammography and CAD increased substantially between 2001 and 2007,
contributing to a 31% increase in screening-related costs for women in the
Medicare program. The increased cost of screening and downstream testing
must be evaluated in context of an absence of benefit in terms of stage at
diagnosis.
Visit abstract.asco.org and search by abstract for the full list of abstract authors and their disclosure information.