A new population study supports the consideration to evaluate brain screening for breast cancer patients with high risk of brain metastases.
Brain metastases are cancer cells that have spread to the brain from primary tumors in other organs. Unfortunately, this frequently occurs amongst breast cancer patients. In autopsy, 15-35% of breast cancer patients are found to have brain metastases. Currently, screening for brain metastases by brain imaging is not commonly practiced for breast cancer patients. Unfortunately, most brain metastases are diagnosed when the patients present neurological symptoms, which means it has progressed to a later stage.
The risk of brain metastases is dependent on subtypes of breast cancers. For instance, patients with luminal A breast cancer (hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative) had fewer metastases compared to patients with triple-negative (HR-negative and HER2-negative) breast cancer and HR-negative breast cancer. Thus, screens for metastases are warranted in some types of breast cancer.
A new study published in JAMA Oncology examined incidence and survival of patients with breast cancer and brain metastases. They used the Surveillance, Epidemiology, and End Results (SEER) database which included information on cancer incidence, treatment, and survival for approximately 30% of the US population. Out of the survey, there were 968 patients with brain metastases at the time of diagnosis, and age ranged from 18 to over 80 years. The researchers found that HR-negative HER-positive patients had the highest incidence of brain metastases (11.5%). The second highest rate occurred in patients with triple-negative breast cancer (11.4%). Also, examining survival rate showed that patients with the triple-negative subtype and brain metastases had the shortest survival rate (6 months).
The findings of the study support the practice of screening for brain metastases in patients with HER2-positive breast cancer and triple-negative breast cancer. It should be noted that the survey may have missed patients with asymptomatic brain metastases since the patients included were only diagnosed when they had neurological symptoms. It is important to identify metastases at an early stage to increase the likelihood of eradication via less toxic approaches. Brain screening for breast cancer patients may lead to better therapeutic approaches and more cost-effective care.
Written By: Boram Ham, PhD