Metastatic Presentations of Previously Treated Early-Stage Breast Cancer Patients and Association With Survival

Najla Itani; Nicole Grogan; Sarah Mott; Sneha Phadke

doi:10.1016/j.clbc.2019.11.004

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Metastatic Presentations of Previously Treated Early-Stage Breast Cancer Patients and Association With Survival

Journal article

Open access

Peer reviewed

Metastatic Presentations of Previously Treated Early-Stage Breast Cancer Patients and Association With Survival

Najla Itani, Nicole Grogan, Sarah Mott and Sneha Phadke

Clinical breast cancer, Vol.20(3), pp.209-214

11/21/2019

DOI: 10.1016/j.clbc.2019.11.004

PMID: 32007466

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Abstract

Breast cancer (BC) patients undergoing surveillance often fear recurrence. Given that routine imaging is not recommended, recognizing metastatic disease early requires a knowledge of recurrence patterns. The aim of this study was to analyze the most common presentations of metastatic disease. A retrospective review was conducted of patients who were initially diagnosed with early-stage BC and who later developed metastatic disease. Data collected included method of metastatic disease diagnosis, types of symptoms at diagnosis, and survival. Chi-square tests as well as logistic and Cox regression models were used. Metastatic diagnoses were made from reported symptoms in 77.6% of patients, clinical examination in 3.2%, and 7.8% incidentally on imaging. Among those with symptoms, musculoskeletal pain was the most common (33.7%) and was more frequently noted at scheduled (48.9%) compared to acute-care visits (26.0%, P < .01). Receptor status was associated with nervous system symptoms at metastasis (P = .01), with higher odds of nervous system symptoms in triple-negative (odds ratio = 3.02) compared to estrogen receptor/progesterone receptor-positive, HER2 cases. On multivariable analysis, initial stage (P = .03), receptor status (P < .01), age (P < .01), and time to recurrence (P < .01) were significantly associated with 10-year survival after diagnosis of metastasis, whereas the presence of symptoms was not (P = .27). Providers of BC patients undergoing surveillance should modify their threshold of suspicion for recurrence depending on the characteristics of the initial diagnosis and the symptoms subsequently reported. In this retrospective study, patients who presented with symptoms did not have shorter survival compared to those who were diagnosed in other ways.

Recurrence

Breast cancer

Metastasis

Survival

Symptoms

Details

Title: Subtitle: Metastatic Presentations of Previously Treated Early-Stage Breast Cancer Patients and Association With Survival
Creators: Najla Itani - Conway School of Landscape Design
Nicole Grogan - University of Michigan
Sarah Mott - Holden
Sneha Phadke - University of Iowa Hospitals and Clinics
Resource Type: Journal article
Publication Details: Clinical breast cancer, Vol.20(3), pp.209-214
DOI: 10.1016/j.clbc.2019.11.004
PMID: 32007466
NLM abbreviation: Clin Breast Cancer
ISSN: 1526-8209
eISSN: 1938-0666
Grant note: name: Holden Comprehensive Cancer Center Population Research and Biostatistics Cores, award: P30 CA086862
Language: English
Date published: 11/21/2019
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
Record Identifier: 9984359821802771

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