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INSIGHTS INTO THE NATURAL HISTORY OF SUBCLINICAL BREAST CANCER: A BIOLOGICAL FALL OUT FROM THE TARGIT-A TRIAL

Baum, M; Vaidya, JS; Bulsara, M; Wenz, F; Tobias, JS; Eiermann, W; Joseph, D; (2012) INSIGHTS INTO THE NATURAL HISTORY OF SUBCLINICAL BREAST CANCER: A BIOLOGICAL FALL OUT FROM THE TARGIT-A TRIAL. Annals of Oncology , 23 (Suppl. 9) ixe 1-ixe 30. 10.1093/annonc/mds499.

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Abstract

Introduction The TARGIT-A trial (n = 3451) has completed recruitment and the fresh analysis confirms that the risk-adjusted approach using targeted intra-operative radiotherapy (TARGIT) achieves local control that is non-inferior to conventional whole breast radiotherapy (EBRT). Method Patients could be randomised and receive TARGIT either at the time of the lumpectomy (pre-pathology stratum), or afterwards as a second procedure (post-pathology stratum). In the pre-pathology stratum, if protocol-defined adverse pathological features were found post operatively, the whole breast was irradiated (avoiding boost) in addition to intra-operative radiotherapy. This analysis looks at the pattern of local recurrence (LR) in the pre-pathology stratum, 64% of whom were screen detected. Results The 5-year KM estimate of local recurrence outside the index quadrants was similar in the two randomised groups (TARGIT: 0.8% vs. EBRT 0.4%, p = 0.709). Subsequently we were able to derive a group of 498 patients who received no treatment to the ipsilateral breast beyond the index quadrant, only 2 of whom experienced a LR that was outside the index quadrant. If we assume that approximately 60% of these patients had occult disease outside the index quadrant [1], then we have 296 women with locally untreated occult foci of breast cancer that failed to progress following1923 woman-years exposure to risk. Conclusion These data illustrate the danger of over-diagnosis and overtreatment of subclinical breast cancer and together add further fuel to the debate on the harms versus benefits of mammographic screening. References: 1. Vaidya JS, Vyas JJ, Chinoy RF, Merchant N, Sharma OP, Mittra I. Multicentricity of breast cancer: whole-organ analysis and clinical implications. Br J Cancer 1996;74(5):820-4.

Type: Article
Title: INSIGHTS INTO THE NATURAL HISTORY OF SUBCLINICAL BREAST CANCER: A BIOLOGICAL FALL OUT FROM THE TARGIT-A TRIAL
DOI: 10.1093/annonc/mds499
Publisher version: http://annonc.oxfordjournals.org/content/23/suppl_...
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: http://discovery.ucl.ac.uk/id/eprint/1376912
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