Missouri has a high breast cancer mortality rate, as well as high rates of type 2 diabetes, cardiovascular disease (CVD), and hypertension, which present more often in individuals who are poor, those living in rural areas, African Americans, and older adults. Women with comorbidities at the time of breast cancer diagnosis may have a worse prognosis, so researchers assessed survival disparities among these patient populations. According to the findings presented at the San Antonio Breast Cancer Symposium on December 5, 2018, comorbidities can negatively impact overall breast cancer survival.

Chemotherapy-induced nausea and vomiting (CINV) can negatively affect nutritional intake, ability to work, and treatment adherence. Research suggests that younger age and female gender are the strongest predictors of CINV, but those may not be the only factors, particularly for delayed nausea, according to research findings presented at the San Antonio Breast Cancer Symposium on December 5, 2018.

Circulating tumor cells (CTCs) are identified in 20%–25% of patients with nonmetastatic breast cancer, and recent research suggests that detection of CTCs at five-year follow-up may predict late recurrence for nonmetastatic, estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2–) breast cancer. In a study presented at the San Antonio Breast Cancer Symposium on December 6, 2018, researchers from the University of Texas MD Anderson Cancer Center found that the presence of CTCs in patients with nonmetastatic breast cancer was associated with shortened relapse-free survival (RFS), regardless of the subtype.

Patient education can improve interactions with their healthcare team and provide coping mechanisms for the psychosocial effects of metastatic breast cancer, according to study findings presented at the San Antonio Breast Cancer Symposium on December 8, 2018.

Throughout the course of treatment, patients with breast cancer receive a significant amounts of information from their healthcare team. Researchers at the University of Colorado School of Medicine assessed and revamped the educational materials from the facility’s Memorial Radiation Oncology Department to achieve a patient comprehension of key treatment-related concepts of 75%. They found that although some educational concepts remained unmemorable or improperly emphasized, overall trends in comprehension indicated that a patient-tailored approach led to better satisfaction and outcomes, according to the findings presented at the San Antonio Breast Cancer Symposium on December 8, 2018.

Trastuzumab can improve disease-free survival (DFS) and overall survival (OS) in patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Although some studies suggest that short-term treatment (less than one year) may reduce cardiac toxicity and cost without compromising outcomes, the results of a new study presented at the San Antonio Breast Cancer Symposium on December 8, 2018, disagree.

Researchers from the University of Colorado Denver Young Women Breast Cancer Translational Program in Aurora identified a potential triplet combination for the treatment of hormone receptor-positive (HR+) human epidermal growth factor receptor 2-positive (HER2+) breast cancer: HER2-targeted small molecule inhibitor tucatinib, CDK4/6 inhibitor palbociclib, and selective estrogen receptor blocker fulvestrant. They presented the findings at the San Antonio Breast Cancer Symposium on December 7, 2018.

The Centers for Medicare and Medicaid Services (CMS) implemented an oncology outcome measure to assess the quality of care and determine outpatient hospital payment (OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy). The measure assesses 30-day postchemotherapy rates of inpatient or emergency department (ED) events deemed “potentially avoidable” because of an association with any of the 10 CMS-defined toxicities: anemia, dehydration, diarrhea, fever, nausea, emesis, neutropenia, pain, pneumonia, or sepsis. Researchers sought to assess those events when linked to highly emetogenic chemotherapy (HEC) in patients treated with anthracycline plus cyclophosphamide (AC), carboplatin, or cisplatin. They presented the findings at the San Antonio Breast Cancer Symposium on December 7, 2018.

Many women discontinue adjuvant endocrine therapy (AET) because of adverse events (AEs), and only half remain adherent at five years. Researchers from the University of Southern California, Los Angeles, found that continued social support for those women may improve AET adherence. They presented the findings at the San Antonio Breast Cancer Symposium on December 7, 2018.

Racial and regional disparities impact the incidence of, mortality from, and survival from breast cancer, but the role of other socioeconomic factors is unclear. Researchers from Fudan University in Shanghai, China, conducted a large study and found that marital status, insurance status, median household income, and residence also contribute to survival from nonmetastatic breast cancer. They presented the findings at the San Antonio Breast Cancer Symposium on December 7, 2018.

Magnetic resonance imaging (MRI) can help diagnose breast cancer, but it is costly. Leadership at the University of Washington in Bellingham developed a protocol to improve the timeliness of care, moving the time of MRI prior to surgeon evaluation, and found that it led to enhanced patient care, eliminated delays in treatment, avoided unnecessary tests, shifted appropriate care to primary-care providers, and provided all necessary data prior to initial surgical consultation. They presented the findings at the San Antonio Breast Cancer Symposium on December 7, 2018.

Patient-reported outcomes (PROs) can improve patient satisfaction and potentially impact survival. However, PRO data are not well-collected outside of the research setting. Researchers at the Yale School of Medicine in New Haven, CT, conducting qualitative study assessed the most personally relevant PROs in women with metastatic breast cancer and observed substantial variation in patient preferences. They presented the findings at the San Antonio Breast Cancer Symposium on December 7, 2018.

Current treatment guidelines recommend sequential hormone therapy for patients with hormone receptor-positive (HR+) metastatic breast cancer who are not in visceral crisis and whose disease is not refractory to endocrine treatment. Second-line fulvestrant monotherapy is a treatment option for patients in whom disease progresses after first-line palbociclib. Researchers used real-world data to evaluate the time to treatment discontinuation (TTD) of second-line fulvestrant in patients with HR+ human epidermal growth factor receptor 2-negative (HER2–) metastatic breast cancer who did (n = 88) and did not (n = 100) receive first-line palbociclib and found it was shorter in patients who received palbociclib. They presented the findings at the San Antonio Breast Cancer Symposium on December 7, 2018.

Triple-negative breast cancer tumors are thought to be more immunogenic than other breast cancer subtypes, such as luminal A/B or human epidermal growth factor receptor 2-positive (HER2+) tumors. Among all breast cancers, tumors appear more commonly in the upper outer quadrant. However, it is not clear whether expression of immune response genes vary with tumor location among the different subtypes. Researchers assessed gene expression associated with immune response pathways to identify potential treatment targets and presented the findings at the San Antonio Breast Cancer Symposium on December 6, 2018.

Intratumor heterogeneity can lead to cancer progression, and tumors with the highest levels of heterogeneity may be more likely to progress. Researchers compared mutational loads from separate areas of pure ductal carcinoma in situ (DCIS) to genetic heterogeneity in DCIS lesions that coexist with invasive cancer and presented the findings at the San Antonio Breast Cancer Symposium on December 6, 2018.

Genetic testing during treatment can improve accuracy of response and outcome prediction compared to other prognostic tests, according to results from a study assessing on-treatment changes in gene expression in patients receiving chemotherapy. Researchers from Oikonomidou O Institute of Genetics and Molecular Medicine in Edinburgh, United Kingdom, presented the findings at the San Antonio Breast Cancer Symposium on December 6, 2018.

Few women with metastatic breast cancer live five years or longer, and predictors of long-term survival are not well understood. Researchers from the University of Pittsburgh Medical Center (UPMC) in Pennsylvania identified demographic- and disease-specific factors related to survival and presented their findings at the San Antonio Breast Cancer Symposium on December 6, 2018.

Current guidelines recommend asymptomatic surveillance of breast cancer only for the detection of locoregional recurrences. Researchers from the Asan Medical Center in Seoul, Republic of Korea, conducted a retrospective 10-year survival analysis of a large cohort of patients with recurrent breast cancer to identify the impact of early detection on survival outcomes and presented the findings at the San Antonio Breast Cancer Symposium on December 5, 2018.

Access to quality breast cancer screening and treatment may contribute to racial disparities outcomes. In 2016, researchers at the urban safety net Cook County Health and Hospitals System in Chicago, IL, implemented changes in mammography practices, which included installing digital machines at one of four sites, centralizing reading of images at a single site with radiologists specialized in mammography, and increasing care coordination such as enhanced patient outreach efforts. The efforts improved screening volume and cancer detection, according to the results presented at the San Antonio Breast Cancer Symposium on December 5, 2018.

An estimated 266,120 new cases of invasive breast cancer and 40,920 related deaths will occur in the United States in 2018. Patients with distant disease have a poorer five-year relative survival rate (26.9%) compared with localized (98.9%) and regional (85.2%) disease. HER2+ breast cancer accounts for approximately 20%–25% of all breast cancer diagnoses, and this type of breast cancer is more common in younger women, decreasing in frequency with age across all stages.