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Davide Mauri, Antonis Valachis, Nikolaos P. Polyzos, Lamprini Tsali, Dimitris Mavroudis, Vassilis Georgoulias, and Giovanni Casazza

status of patients with early breast cancer is still unclear and controversial. 10 – 12 Considering the notable accumulation of randomized trials, the authors performed a meta-analysis of these to address whether the use of bisphosphonates in the

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Samuel Martel, Matteo Lambertini, Dominique Agbor-Tarh, Noam F. Ponde, Andrea Gombos, Vicki Paterson, Florentine Hilbers, Larissa Korde, Anna Manukyants, Amylou Dueck, Christian Maurer, Martine Piccart, Alvaro Moreno-Aspitia, Christine Desmedt, Serena Di Cosimo, and Evandro de Azambuja

BMI and outcomes in HER2-positive breast cancer. Our exploratory analysis of the ALTTO trial aimed to determine the impact of BMI and weight change in patients with HER2-positive early breast cancer treated with chemotherapy + trastuzumab and

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Jill A. Foster, Maziar Abdolrasulnia, Hamidreza Doroodchi, Joan McClure, and Linda Casebeer

Background

Studies of adherence to breast cancer guidelines have often focused on primary therapies, but concordance with other guideline recommendations has not been examined as extensively. This study assesses the knowledge and practice patterns of medical oncologists in the United States to inform education and quality improvement initiatives that can improve breast cancer care.

Methods

A survey containing case vignettes and related questions was developed to examine oncologists' clinical decision-making in evaluating and treating women with early breast cancer. The instrument was distributed to a random sample of 742 oncologists in the United States and yielded 205 responses (27.6% response rate). Responses from 184 practicing medical oncologists were analyzed relative to the 2007 NCCN Clinical Practice Guidelines in Oncology: Breast Cancer.

Results

Most oncologists made guideline-consistent choices in clarifying indeterminate human epidermal growth factor 2 (HER2) status (85%), initial treatment for early breast cancer (95%), and postsurgical management of locally advanced breast cancer (82%). Guideline-discordant choices were seen in the lack of clip placement before neoadjuvant chemotherapy (36%), unnecessary use of PET scanning for initial assessment (34%), inappropriate assessment of menopausal status (33%), inappropriate use of tumor markers (22%), and use of chest imaging (16%) during posttherapeutic surveillance.

Conclusions

Oncologists often make guideline-consistent choices, but discordant clinical decisions may occur in important aspects of care for early breast cancer. Broadening the diffusion and adoption of guideline recommendations is an important mechanism for addressing these gaps and may substantially improve the quality of breast cancer care.

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Kathleen Harnden and Kimberly Blackwell

women. Abbreviations: Bisph, bisphosphonates; E, expected; O, observed; V, variance. Adapted from Coleman R, Gnant M, Paterson A, et al. Effects of bisphosphonate treatment on recurrence and cause-specific mortality in women with early breast cancer

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Robert W. Carlson, Clifford A. Hudis, and Kathy I. Pritchard

early breast cancer . Oncology (Williston Park) 2005 ; 19 : 1425 – 1428 , 1433 . 2. Osborne CK . Tamoxifen in the treatment of breast cancer . N Engl J Med 1998 ; 339 : 1609 – 1618 . 3. Field MJ Lohr KN , eds. Clinical

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Lee S. Schwartzberg

-positive disease. An analysis by the Early Breast Cancer Trialists' Collaborative Group confirmed that, to 20 years, recurrence rates after tamoxifen exposure have not plateaued. 8 Analysis of each of the genomic classifiers shows, coupled with clinical factors

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Jennifer A. Ligibel and Eric P. Winer

References 1 Group EBTC . Tamoxifen for early breast cancer: an overview of the randomized trials . Lancet 1998 ; 351 : 1451 – 1467 . 2 Report from the Breast Cancer Trials Committee SCTO, Edinburgh . Adjuvant tamoxifen

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Melinda L. Telli, William J. Gradishar, and John H. Ward

predictive of chemotherapy benefit. “Given the widespread use of adjuvant therapy, predictive factors are probably of greater importance in early breast cancer,” Dr. Ward explained. For patients with HR-positive, node-negative, HER2-negative disease and

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Janice S. Kwon, Gary Pansegrau, Melica Nourmoussavi, Geoffrey L. Hammond, and Mark S. Carey

of the SOFT trial, use of OA/AI as a primary endocrine strategy did not improve OS over tamoxifen alone, although follow-up is still limited. 5 Nonetheless, most premenopausal women with ER-positive early breast cancer have the potential to live long

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Charles L. Loprinzi and Peter M. Ravdin

instrument . J Clin Oncol 1995 ; 13 : 847 – 853 . 4 Cole BF Gelber RD Gelber S . Polychemotherapy for early breast cancer: An overview of the randomized clinical trials with quality-adjusted survival analysis . Lancet 2001 ; 358 : 277 – 286