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Volume 2, Issue 3 (Suppl)
Breast Can Curr Res, an open access journal
ISSN: 2572-4118
Breast Cancer 2017
June 15-17, 2017
June 15-17, 2017 London, UK
5
th
World Congress on
Breast Cancer
Breast Can Curr Res 2017, 2:3(Suppl)
DOI: 10.4172/2572-4118-C1-006
Contralateral prophylactic mastectomy with reconstruction increases health care utilization and cost
Judy C Boughey, Stephanie R Schilz, Lin Zhu, Elizabeth B Habermann
and
Valerie Lemaine
Mayo Clinic, USA
Background:
Rates of contralateral prophylactic mastectomy in women with unilateral breast cancer continue to rise, especially
in women undergoing immediate breast reconstruction (IBR).
Methods:
We utilized administrative claims data from a large U.S. commercial insurance database (OptumLabs) to identify
women age 18+ years who underwent IBR 1/2004-12/2013. We compared 2-year total costs of care and unadjusted utilization
rates between unilateral mastectomy (UM) and bilateral mastectomy (BM) for implant-based and autologous reconstruction.
Comparisons were tested using t-test and differences in cost were estimated with Wilcoxon rank sum test.
Results:
11,728 women undergoing mastectomy with IBR were identified; 7,693 with implant reconstruction (2,090, 27% UM
and 5,603, 73% BM) and 4,035 with autologous reconstruction (1,754, 43% UM and 2,281, 57% BM). Mean hospital length of
stay at initial surgery and overall rate of office visits was similar between BM+IBR and UM+IBR, however rate of A&E visits
was higher for BM+IBR (34.2 per 100 women vs. 30.2, p<0.0001). For implant reconstruction total 2-year cost of care was
higher for BM+IBR than UM+IBR for commercial insurance ($106,469 vs. $96,689, p<0.001) however it was not significantly
different for medicare advantage. For autologous reconstruction, total medicare advantage 2-year cost of care was higher for
BM+IBR ($57,602 vs $37,713, p=0.027) with even greater differences seen in commercial insurance.
Conclusion:
BM+IBR (autologous or implant) was associated with increased A and E visits and higher total cost of care
over 2-years compared to UM+IBR. Patients considering contralateral prophylactic mastectomy should be counseled on the
additional risks and costs associated with BM+IBR.
Boughey.Judy@mayo.eduGT198
and Her2 double positivity as an improved therapeutic marker for herceptin treatment in
human breast cancer
Lan Ko
1
, Christopher Harlow
2
and
Alistair Williams
2
1
Augusta University Cancer Center, USA
2
University of Edinburgh, UK
B
reast cancer is a lethal cancer inwomen. It is urgent to identify new therapeutic biomarkers to facilitate the treatment.Therapeutic
drug Herceptin (trastuzumab) is effective inHer2-positive breast cancer treatment, however, there is inconsistency to distinguish
responders versus non-responders using Her2 as a sole biomarker. The human GT198 gene is a breast and ovarian cancer gene at
chromosome 17q12, 2.9 Mb proximal from the ERBB2 gene encoding Her2. Both germline mutations and high frequency somatic
mutations in
GT198
are present in breast and ovarian cancer. In breast and ovarian tumors, somatic mutations are present in tumor
stromal stem cells. Gene copy number increase of
GT198
has also been found in breast cancer. Here we find that Her2 and
GT198
proteins are co-expressed in breast tumor stromal cells carrying
GT198
mutations, suggesting that Herceptin may in fact also target
GT198
-positive tumor stromal cells. Her2 gene amplicons generally encompass large genomic regions, thus the two adjacent genes
may co-amplify and result in coexpression. Our finding suggests that
GT198
/Her2 double positivity is potentially a more specific
therapeutic marker for Herceptin. In particular, positive tumor stroma, in addition to tumor, deserves more attention in clinical
decisions. Since herceptin is extensively used in the treatment of breast cancer and
GT198
is a causative breast cancer gene, this study
provides insights into novel mechanisms associated with herceptin efficacy and reveals new biomarker using
GT198
for improved
targeted therapy.
LKO@augusta.edu