A study presented at the San Antonio Breast Cancer Symposium (SABCS) virtual meeting this week found that people who had undergone mastectomy and breast reconstruction were at increased risk of developing addiction to pain and sedatives.
The study showed that 13.1 percent of patients who were not previous opioid users became new persistent opioid users after surgery. Researchers found that 6.6 percent of patients who were not previously sedative-hypnotic users became persistent users after surgery.
“It is striking how many patients this is an issue. It’s more than we might have thought before we ran the study, ”said lead author, Jacob Cogan, MD, a hematology-oncology fellow at Irving Medical Center at New York-Presbyterian Columbia University in New York City.
The drug addiction risk study was born out of concerns about the epidemic of opioid drug abuse across the country over the past decade. Research shows that even short-term use of opioids for pain relief can lead to long-term addiction.
“As the opioid epidemic continues in the US, the rate of opioid dependence in the cancer population continues to rise,” said Dr. Cogan.
Previous research shows that about 10 percent of patients become persistent opioid users after breast cancer surgery, Cogan said. However, the addiction rates after mastectomy and reconstructive surgery are unknown. In addition to opioid pain relievers, women undergoing mastectomy and breast reconstruction surgery may also receive tranquilizers to relieve anxiety or insomnia, and these drugs can also lead to dependence.
The study included an analysis of the data from the MarketScan database on health claims of women who underwent mastectomy and breast reconstruction between 2008 and 2017 after surgery) and the postoperative period (90 to 365 days after surgery). They also identified women who were not previous opioid users and those who were not previous users of sedative-hypnotics.
In addition to the risk of addiction, analysis of the data showed that the risk of becoming permanent users of a controlled substance was much higher in women under 60 years of age diagnosed with breast cancer (as opposed to women who had a prophylactic mastectomy ). and patients treated with chemotherapy. The higher the number of risk factors, the higher the risk of developing persistent drug use, according to the study.
While both opioids and sedative hypnotics are important tools to help patients with symptom relief through surgery and recovery, the study points to the need to be aware of the risk factors for developing addiction.
In addition, the study suggests that doctors need to address ways to prevent drug addiction. For example, Cogan said research should address the idea of patients asking for a prescription when needed, rather than doctors automatically sending patients home with a prescription. Follow-up visits should ask patients whether they have stopped taking the medication and, if so, whether they have disposed of the medication properly, he added.
“The problem is when they don’t [need the medications]Don’t just leave her at home, ”said Cogan. “Studies show that people become addicted to these drugs.”
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Pregnancy after breast cancer: difficult, but not impossible
Another study presented at the conference found that premenopausal breast cancer survivors are less likely to conceive, but tend to have healthy babies when they do. The study is important because women tend to have children much later in life today, and breast cancer is more common among older maternity patients.
The study was an analysis of previous research on pregnancy after breast cancer. The researchers compiled data from 39 studies that identified women who were pregnant after being diagnosed with breast cancer. They evaluated pregnancy outcomes, including fetal and obstetric outcomes.
Compared to women in the general population, breast cancer survivors had a 60 percent lower chance of conceiving – although that number includes women who may not have tried conceiving after breast cancer treatment.
An under-analysis of studies reporting the number of women who tried to conceive after breast cancer found that about half were successful, said the study’s correspondent author Matteo Lambertini, MD, PhD, associate professor of medical oncology at the University of Genoa. IRCCS Policlinico San Martino Hospital in Genoa, Italy.
Some studies also found that some patients who did not try to get pregnant after breast cancer treatment became pregnant.
Researchers found that compared to women in the general population, breast cancer survivors had a 50 percent higher risk of having a baby of low birth weight, a 16 percent higher risk of having a baby that was small for gestational age, a 45 percent higher risk of premature labor and a 14 percent higher risk of a caesarean section.
However, there was no increased risk of congenital defects or other pregnancy complications in breast cancer survivors. In addition, pregnancy did not lead to bad results for the mother’s health. Women who became pregnant had a 48 percent lower risk of death and a 26 percent lower risk of the disease recurring compared to breast cancer survivors who did not get pregnant.
The study shows that pregnant breast cancer survivors should be closely monitored for complications, but pregnancy should not be advised against. In addition, breast cancer survivors who do not want to become pregnant may need contraception advice.
“These findings are of paramount importance in raising awareness of the need to consider patient pregnancy as a critical part of their plan for survivor care,” said Dr. Lambertini. “This starts with all newly diagnosed young breast cancer patients offering oncofertility counseling.”
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Circulating DNA tests help monitor breast cancer
The early detection of circulating tumor cells, called CTCs or circulating DNA, in women with metastatic breast cancer can help predict response to treatment, according to a study by German researchers.
The study looked at the use of CTC tests, which are simple blood tests, to monitor patient response to treatment. CTC tests can give a quicker insight into a possible relapse than the traditional type of surveillance that consists of imaging tests, noted the study’s lead author, Wolfgang Janni, MD, PhD, professor and director of the Ulm University Hospital’s Women’s Clinic in Ulm, Germany .
The meta-analysis included 4,097 patients with metastatic breast cancer who received CTC follow-up tests at the start of treatment. The study found that the median survival rates were highest in women with a negative CTC test at the start of treatment and 29 days later, while the rates were lowest in those who had an initial positive CTC test and remained positive after 29 days . The tests reliably predicted results for all breast cancer subtypes.
CTC test data can help a doctor know whether initial treatment should be stopped. The advantage of the test is that it can be carried out much earlier after the start of treatment. “It has to be early enough to add value to imaging,” says Dr. Janni.
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