Menopausal symptoms in breast cancer survivors nearly 6 years after diagnosis.

OBJECTIVE: We investigated the prevalence and severity of menopausal symptoms, nearly 6 years from diagnosis, in women who had not experienced recurrent breast cancer or a new primary breast cancer (active disease) and were no longer taking oral adjuvant endocrine therapy (OAET). METHODS: A total of 1,683 women recruited within 12 months of diagnosis with invasive breast cancer completed an enrollment questionnaire and five annual follow-up questionnaires. Only women who had never reported active disease and were not taking OAET at their fifth follow-up were included in the analysis. Women previously recruited to a study of sex steroid levels provided community control data. Menopausal symptoms were assessed with the Menopause-Specific Quality of Life Questionnaire (MenQOL). RESULTS: Eight hundred forty-three women without active disease and not taking OAET completed the fifth follow-up questionnaire, on average, 5.8 years after diagnosis. Most had stage I (59.5%) and hormone receptor-positive disease (77.9%) at diagnosis and were postmenopausal (92.8%). Those aged 50 to 59 years were more likely to report any symptoms (P = 0.01) and more severe symptoms (P < 0.001) than older and younger women. There was no independent impact of chemotherapy on MenQOL vasomotor and sexual domain scores. Women with breast cancer had significantly higher vasomotor domain (P ≤ 0.002) and sexual domain (P ≤ 0.004) scores than community controls. CONCLUSIONS: Vasomotor and sexual symptoms are highly prevalent in breast cancer survivors and are not simply a function of OAET or chemotherapy. Given the adverse impact of these symptoms, effective interventions are needed to alleviate them in women who have completed their breast cancer treatment.

Persistent breast pain 5 years after treatment of invasive breast cancer is largely unexplained by factors associated with treatment.

PURPOSE: The aim of our study was to establish the prevalence of breast pain persisting 5 years after the initial treatment of breast cancer (BC) and the relationship between those persistent symptoms and general well-being. METHODS: The study involved women from Victoria, Australia, who had survived at least 5 years from diagnosis, remained free from recurrence or new BC and completed the fifth annual follow-up questionnaire. Analysis involved both multivariable logistic and linear regression. RESULTS: Of 1,205 women, 45 % reported breast pain which persisted for at least 3 months following initial treatment, and of these, 80 % reported pain persisting for at least 5 years. The factor contributing most to the likelihood of persistent breast pain was current lymphedema; however, a full multivariable model explained <10 % of the likelihood of breast pain persisting for 5 years. The presence of breast pain at 5 years was associated with only a modest reduction in general well-being. CONCLUSIONS: Breast pain persisting for at least 5 years after treatment for BC is common. As the pain is largely unexplained by factors associated with the characteristics of the cancer or its treatment, the contribution of patient expectations to persistent breast pain may be considerable. IMPLICATIONS FOR CANCER SURVIVORS: Where persistent pain occurs, referral for the management of pain and, where appropriate, lymphedema is warranted.

Pregnancy-associated breast cancer and pregnancy following treatment for breast cancer, in a cohort of women from Victoria, Australia, with a first diagnosis of invasive breast cancer.

BACKGROUND: This study examined pregnancy-associated breast cancer (PABC) and pregnancy following treatment for breast cancer. METHODS: We analysed data from a questionnaire-based, prospective study of women diagnosed with breast cancer. Timing of diagnosis in relation to pregnancy was self-reported in the enrolment questionnaire. Women reported subsequent pregnancies in annual follow-up questionnaires, up to at least 5 years from diagnosis. RESULTS: Women with PABC made up 3.3% of women <48 years at diagnosis and 14.3% of women aged <35 years at diagnosis. Nine of 46 (19.6%) women who were aged <40 years at diagnosis, and had either no children, or only one child, became pregnant subsequent to their diagnosis, and 8 experienced a live birth. DISCUSSION: As the number of women with PABC was small, conclusions from this study are limited. However, young women should be alert to PABC, especially in the post-partum period. Some women, with incomplete families at diagnosis, are choosing to have one or more pregnancies following treatment.

Patterns of use of oral adjuvant endocrine therapy in Australian breast cancer survivors 5 years from diagnosis.

OBJECTIVE: Oral adjuvant endocrine therapy (OAET) substantially improves the survival of women with hormone receptor-positive (HR) breast cancer. However, we reported previously that at 3 to 4 years after diagnosis, 18% of affected women are not using OAET primarily because of estrogen deficiency symptoms. The aim of this study was to determine the use of OAET in women with HR breast cancer 5 to 6 years from diagnosis. METHODS: Analysis was carried out using data from the Bupa Health Foundation's Health and Wellbeing After Breast Cancer Study, a cohort study of 1,683 women with breast cancer who were recruited in Victoria, Australia between 2004 and 2006. All women completed an enrollment questionnaire within 12 months of diagnosis and an annual follow-up questionnaire (FQ) for 5 years. The fifth FQ was completed 5.7 years from the time of diagnosis. Use of OAET was self-reported in response to a series of questions. RESULTS: A minimal exposure to OAET of at least 5 years (OAET in all six FQs) was reported by 19.7% of the women (n = 212), and another 46.7% (n = 503) received a minimal exposure of at least 4 years (OAET in five questionnaires). In total, 82.1% (n = 883) of the women would have received at least 3 years of treatment (OAET in at least four questionnaires). Only 7.8% (n = 84) reported never using OAET. CONCLUSIONS: Most women with HR breast cancer who survive at least 5 years have persisted with OAET despite the adverse effects of estrogen depletion.

Lymphedema: experience of a cohort of women with breast cancer followed for 4 years after diagnosis in Victoria, Australia.

PURPOSE: The aim of this work was to study the incidence and prevalence of self-reported lymphedema in breast cancer survivors between 2 and 4 years following diagnosis, the factors associated with the development of lymphedema and the impact of lymphedema on psychological well-being. METHODS: We assessed self-reported lymphedema in the BUPA Health Foundation Health and Wellbeing After Breast Cancer Study, a questionnaire-based study of 1,683 women newly diagnosed with their first episode of invasive breast cancer in Victoria, Australia. Psychological well-being was assessed using the Psychological General Well-being Index. RESULTS: Two years after diagnosis, nearly 20 % of women reported lymphedema and this proportion remained above 18 % 2 years later. However, self-reported lymphedema was a dynamic phenomenon, with the condition resolving in some women and others reporting onset for the first time up to 4 years from diagnosis. Lymphedema 2 years from diagnosis was positively associated with the number of nodes removed at initial surgery, although this variable only explained a small proportion of the likelihood of reporting lymphedema. The presence of lymphedema was associated with lower psychological general well-being. CONCLUSIONS: Lymphedema after breast cancer treatment frequently has a dynamic pattern and may emerge as an issue for women several years after their initial treatment. It is associated with a lower level of general well-being.

Use of imaging in surveillance of women with early stage breast cancer.

BACKGROUND: There is no evidence of benefit in terms of survival or quality of life for intensive surveillance of women with early breast cancer (BC) and current guidelines reflect this. We have examined whether Victorian women, nearly 4 years from a diagnosis of localized BC, were being managed according to these guidelines. METHODS: Participants are women in the BUPA Health Foundation Health and Wellbeing after Breast Cancer prospective cohort study. All participants completed an enrolment questionnaire within 12 months of diagnosis and then completed follow-up questionnaires every 12 months thereafter. In the third follow-up questionnaire, completed nearly 4 years from the time of diagnosis, women were asked about imaging tests they had in the previous 12 months. RESULTS: The analysis was completed on 673 women who were stage 1 at the time of diagnosis and had not reported evidence of recurrence or a new BC since diagnosis. Of the 673, 603 (89.5%) reported having had a mammogram in the previous 12 months and 319 (52.9% of those having a mammogram) reported a breast ultrasound. Seventy-one per cent of women reported no other imaging investigations in the previous 12 months. CONCLUSIONS: Our study shows that, nearly 4 years from diagnosis, Australian practitioners are generally adhering to guidelines about imaging surveillance of BC survivors. Practitioners could use the guidelines for the education of BC survivors about appropriate health surveillance.

Understanding discontinuation of oral adjuvant endocrine therapy by women with hormone receptor-positive invasive breast cancer nearly 4 years from diagnosis.

OBJECTIVE: The aim of this study was to investigate the extent of discontinuation of oral adjuvant endocrine therapy (OAET) in women nearly 4 years from the diagnosis of their first episode of invasive breast cancer and the reasons for such discontinuation. METHODS: We used a large, prospective cohort study of women who had been diagnosed with their first episode of invasive breast cancer between 2004 and 2006, recruited through a state-based cancer registry. All participants completed an enrollment questionnaire (EQ) within 12 months of diagnosis and annual follow-up questionnaires (FQs) thereafter. The data in this report were obtained from the EQ and the first three FQs. RESULTS: A total of 1,370 women with hormone receptor-positive disease completed the EQ. At the completion of the third FQ nearly 4 years from diagnosis, 1,193 women remained in the study. Use of OAET peaked by 2 years postdiagnosis. At nearly 4 years from diagnosis, 18% of the 1,193 women remaining in the study were not taking OAET. Of these women, just more than half had ceased therapy mainly owing to a range of adverse effects, predominantly estrogen deficiency symptoms, but the remainder (8% of women remaining in the study) had never used OAET. CONCLUSIONS: Our study confirms that early discontinuation of OAET due to estrogen deficiency symptoms remains an important issue despite calls for strategies to address this problem. The number of women potentially suitable for OAET but not receiving it was almost as great as the number of those who have discontinued therapy.

Changes in patterns of use of cigarettes and alcohol in women after a first diagnosis of invasive breast cancer: a cohort study of women from Victoria, Australia.

PURPOSE: Smoking and alcohol consumption after breast cancer diagnosis have received little attention. The aim of this study was to describe the change in smoking and alcohol consumption of women in the BUPA Health Foundation Health and Wellbeing After Breast Cancer Study in the first 2 years after diagnosis. METHODS: We documented cigarette and alcohol use at diagnosis in a prospective cohort study of 1,588 Australian women with invasive breast cancer in an enrolment questionnaire and again 2 years later (follow-up questionnaire, FQ1). RESULTS: Twelve percent of participants smoked at diagnosis. Nearly one third of these had quit by FQ1 and of those continuing, 1 in 4 were smoking fewer cigarettes per day. Smoking more at diagnosis was significantly associated with smoking at FQ1.Over 70% of women reported consuming alcohol in each questionnaire. The proportion of women consuming more than four alcoholic drinks per occasion at least weekly dropped between the time of diagnosis and FQ1, although by FQ1, 1 in 12 women still reported this drinking pattern. CONCLUSIONS: Smoking and alcohol consumption are important health issues for women with breast cancer. Health care providers should consider using evidence-based interventions to reduce smoking and drinking in this group.

Breast cancer survivors' beliefs about the causes of breast cancer.

OBJECTIVE: To explore the beliefs held by breast cancer (BC) survivors about the factors that contribute to the development of their BC. METHODS: The BUPA Health Foundation Health and Well-being after Breast Cancer Study is a prospective cohort study of 1684 women recruited within 12 months of their first diagnosis with invasive BC. Participants completed an enrollment questionnaire (EQ), first follow-up questionnaire (FQ1) and a second follow-up questionnaire (FQ2), 12 months and 24 months post-EQ, respectively. In the FQ2, women were asked whether they believed anything contributed to the development of their BC and whether they had made lifestyle changes since the FQ1. Well-being was assessed at the FQ2 using the psychological general well-being index (PGWB). RESULTS: In total, 1496/1684 women completed the FQ2 and 43.5% reported belief in a factor that may have contributed to their developing BC. These women were more likely to be younger (p<0.0001) and educated beyond high school (p<0.0001). Stress (58.1%) was the most common reason given, followed by previous use of hormone therapy (17.0%) and a family history of any cancer (9.8%). Women who believed stress contributed to their BC had lower PGWB scores than other study participants (70.9 ± 16.1, n = 361 versus 77.3 ± 14.9, n = 1071, mean difference = 6.4, 95% CI: 4.6-8.2 p<0.0001) and were more likely to have made lifestyle changes since their BC diagnosis. CONCLUSIONS: Many women with BC believe that stress has contributed to their condition. Women who held this belief were more likely to adopt strategies to reduce stress than those who did not.

The relationship between hormone therapy use at the time of diagnosis of breast cancer and tumor characteristics.

Exposure to postmenopausal hormone therapy (HT) may affect the stage, histological type, and hormone receptor (HR) status of invasive breast cancer at the time of diagnosis. One thousand six hundred eighty-four women with newly diagnosed first invasive breast cancer were recruited to the "MBF Foundation Health and Wellbeing after Breast Cancer Study." Women using systemic HT estrogen (E) or E combined with progesterone (P) at the time of diagnosis of breast cancer were compared with those not using HT. Breast cancer tumor data were obtained from the Victorian Cancer Registry. Regression analysis was used to determine the associations between HT use or not at the time of diagnosis and tumor histology (ductal vs lobular), stage (I vs II, III, IV), HR status (ER+ or PR+ or both vs ER- or PR-). Of 1,377 women included in the analysis, 226 (16%) were using HT at the time of diagnosis. Of HT users, 20.4% had lobular breast cancer, 50% were stage I, and 85.8% had HR-positive tumors. Of non-users, 13.6% had lobular breast cancer, 48.2% were stage I, and 82.4% had HR-positive tumors. Use of systemic HT was associated with increased odds of having lobular compared with ductal breast cancer (OR = 1.75, 95% CI = 1.14-2.69, p = 0.01). There were no associations between HT use and either breast cancer stage or HR status. Women using systemic HT at the time of diagnosis were more likely to have lobular rather than ductal breast cancer compared with women not on HT.

Psychological well-being in a cohort of women with invasive breast cancer nearly 2 years after diagnosis.

PURPOSE: The aim of this study was to document the psychological well-being of a group of women with invasive breast cancer (BC) on an average of nearly 2 years after their diagnosis. METHODS: Participants were women in the Medical Benefits Fund Australia Limited Foundation Health and Wellbeing after Breast Cancer Study, a cohort study of 1,684 women recruited within 12 months of their diagnosis with invasive BC, who completed their first annual follow-up questionnaire. Psychological well-being was measured using the Psychological General Well Being Index questionnaire (PGWB) in women with BC. RESULTS: The PGWB questionnaire was completed by 1,589 women on an average of 92 weeks after their BC diagnosis, of whom 46 had evidence of active disease. PGWB total scores for all age groups of the BC cohort were lower than community-based norms (p < 0.001 for age groups > or =70, 60-<70, 50-60; p = 0.002 for age group 40-<50 and p = 0.05 for age group <40). PGWB total scores for the BC cohort were positively associated with age (p < 0.001) and living with others (p < 0.01) and inversely associated with active disease (p < 0.001) and education beyond secondary school (p = 0.03). For the domain of anxiety, there was no statistically significant association with living with others but an inverse association with education beyond school. CONCLUSION: A higher level of education may be associated with increased anxiety and lower well-being. Social support is particularly important for women with BC who are known to live alone.