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Abstract #702 HER2 status is established as a poor prognostic marker for survival in breast cancer and has been validated as a predictive marker for response to trastuzumab following chemotherapy.We determined the number of patients both eligible for and actually receiving trastuzumab therapy for early breast cancer (EBC) in 2006 in a tertiary breast oncology unit. We also performed a retrospective analysis of the impact of HER2 status on survival in a large cohort of low grade, node negative patients who would currently be deemed ineligible for trastuzumab treatment. Methods 1. Data for all patients diagnosed with EBC in 2006 was recorded prospectively in a database. Case notes were consulted where the HER2positive patients had not received trastuzumab, to ascertain the reasons. 2. A retrospective cohort of 367, grade 1 or 2, node negative patients diagnosed between 1980-2002 (median followup 6.2yrs) was analysed to assess the impact of HER2 status (Herceptest 3+/FISHpos) on survival. Results 1. A total of 951 patients were diagnosed with Breast Cancer in 2006. 417(43.9%) of these were screen-detected. 123(12.9%) were HER2positive (117 were EBC) and 59 (50.4%) of the HER2 positive EBCs received trastuzumab therapy. Of the 58 (49.6%) patients who did not receive trastuzumab, 25 (43%) were patients considered low risk due to small, node negative, low grade tumours. 2. Retrospective cohort. The overall hazard ratio for HER2 positivity was 6.78 with 5yr breast cancer specific survival rates of 96% (HER2 neg) and 68% (HER2 pos). The reduction in survival in HER2 positive cases persisted when patients were split into subgroups by ER status, tumour size and age. Conclusions Only 50% of our HER2 positive EBC patients received trastuzumab therapy in 2006. The commonest reason for not receiving trastuzumab was low risk status precluding chemotherapy. However, the substantial reduction in survival shown in our retrospective cohort provides support for the use of trastuzumab in these 'low risk' HER2 positive patients who typically are classified as very good prognosis, are not routinely offered standard chemotherapy, and as such do not fit current prescribing guidelines for trastuzumab. A clinical trial to assess the benefit of adjuvant trastuzumab alone in this group of patients is suggested. Our results are in keeping with the HERA trial where the best prognosis tumours (node negative and size 1-2cm) had benefit similar to the overall cohort. The persistence of poor outcomes in our ER positive subgroup despite endocrine therapy confirms the recent trans-ATAC analysis based on HER2 status and suggests that we cannot not rely solely on adjuvant endocrine therapy in these largely ER positive patients. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 702.

Abstract #5090 Background: Over the past 10 years, surgical management of Breast Cancer has undergone a huge change. More patients are now treated by breast conserving surgery (BCS) and lesser axillary surgery. Therefore, great potential exists to carry out Breast Cancer surgery in day surgery (DS) setting. However, at present few centres in the United Kingdom are practicing this. The objectives of the present study were: (i) to review the evidence in literature, (ii) analyse current practice and (iii) conduct a pilot randomised controlled trial (RCT) comparing DS and inpatient surgery (IS) for patients undergoing BCS for Breast Cancer. Methods: (i) A systematic review of literature searching DS for breast cancer was performed using standard search tools. (ii) Age, treatment and length of stay information about all breast patients admitted at a tertiary centre from March, 07 to Jan, 08 was prospectively collected. (iii) Newly diagnosed breast cancer patients undergoing BCS with axillary sampling who had passed the DS preassessment were randomised to DS or IS. Physical and psychosocial outcomes were assessed using a Surgical Site Infection Form (Day 7 and Day30), FACT-B questionnaire (Baseline, Day7 and Day30) and a Patient Diary for the first post-operative week. Results: (i) No RCTs were found in the literature. Ten observational studies describing DS for breast cancer were included. Seven of these found DS to be safe with equivalent complications to IS and 3 highlighted its economic benefits. Only 1 study used a validated psychological distress scoring system and found results in favour of DS. (ii) Over the 10-month period there were 288 breast cancer operations. Of these, only 112 (38.9%) stayed in the hospital for > 23 hours. Hence, it would be ideal to consider breast cancer for DS. ((iii) There were 18 patients in the pilot RCT; 11 in the DS arm and 7 in the IS arm. Physical outcomes: There were no significant differences in pain, nausea or vomiting scores and infection rates. Patients in the DS group mobilised and stepped out of their house earlier (Day2 vs. Day4) after surgery and also more frequently (4 days vs. 3 days) in the first week than the IS group. FACT-B: Longitudinal differences in overall FACT B scores obtained on Day 7 and Day 30 compared to Baseline scores are detailed in Table1. A difference of > 5% was considered significant. Conclusions: Systematic review of literature showed DS to be safe for the patient but there is lack of evidence in the form of RCTs. This pilot RCT shows that DS patients mobilise earlier and have equivalent results for the other physical outcomes. FACT-B scores suggest better quality of life a week after surgery in the DS group.Larger RCTs are needed to support these results. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5090.

Abstract #3159 Background: Various trials have shown substantial benefits of addition of Trastuzumab (Herceptin®) to adjuvant chemotherapy in Early Breast Cancer (EBC). We analysed our breast cancer population to determine the incidence of HER2 positive Early Breast Cancers, the tumour demographics and the number of patients eligible for and receiving trastuzumab therapy in this group. Methods: Data for all patients diagnosed with EBC in 2006 was recorded prospectively in a database. Case notes were consulted where the HER2 positive patients, determined by a combination of IHC and FISH, had not received trastuzumab, to ascertain the reasons. Results: A total of 951 patients were diagnosed with Breast Cancer in 2006. 417 (43.9%) of these were screen-detected cancers. There were 123 (12.9%) HER2 positive newly diagnosed Breast Cancers of whom 117 were EBCs. The HER2 positivity rate in the screen detected cancers (n=417) was 9% and 17% in the symptomatic cancers (n=433). 1. Demographics of the HER2 positive Early Breast Cancer Population: The median age at diagnosis was 61 yrs (range: 30-92). 2. Fifty nine (50.4%) of the HER2 positive EBCs received trastuzumab therapy. Conclusions: The HER2 positivity rate is lower than that previously reported suggestive of changing demographics secondary to a high screen detected cancer population. A third of the HER2 positive tumours are screen detected. The percentage of ER positive, node negative and low grade tumours was higher than anticipated. Only 50% of HER 2 positive EBC patients received trastuzumab therapy. Of those who did not receive trastuzumab, the commonest reason was low risk status or age and co-morbidities precluded chemotherapy. HER 2 positivity alone confers high risk irrespective of pathological stage. Further trials are required to evaluate whether the substantial number of patients who are at present not eligible for trastuzumab therapy might also benefit. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3159.

We report the arm morbidity in 131 patients with small breast cancers up to IO mm in size and who had an identical level 2 axillary clearance between 12 and 132 months previously. 19 patients (15%) were node positive. None had radiotherapy to the axilla. 71 had non palpable tumours which were localised preoperatively. 23 had a mastectomy and 108 had breast conserving surgery. 83 had radiotherapy to the breast. Sequential circumferential measurements were made and arm volumes calculated on both the operated and the normal side. Shoulder movements were measured and subjective symptoms recorded by questionnaire. 9 (7%) women had objective swelling of the arm. 24 (18%) had some restricted arm movement. There was no association between objective morbidity and possible causative factors including time since surgery, the operating surgeon, the handedness of the patient, smoking, number of nodes removed or involved, age, body mass index. Although objective morbidity is low, most women reported feeling swelling, stiffness, discomfort or numbness. 30 patients said symptoms restricted norrnal activity in some way. There was no association between objective and subjective swelling and joint mobility. The morbidity in this study is more likely to be due to surgery rather than axillary disease. Objective morbidity is low but subjective symptoms require further study.

Background Over the last decade, breast cancer surgery has become less invasive and potentially suitable for day surgery. The aim of this systematic review was to establish the benefits and disadvantages of day surgery for breast cancer. Methods A systematic search of the Cochrane Library, Medline, British Nursing Index, CINAHL, EMBASE and PsycINFO was carried out. All relevant papers were assessed for their methodological quality using a checklist designed to assess both randomised and non-randomised studies with specific questions added to address outcome measures. Results No randomised controlled trials were found in literature. Eleven observational studies were included. The rate of discharge after day surgery was universally high with very low acute readmission rates. Intractable vomiting, patient anxiety and pain control were the main reasons for failing discharge. Patient satisfaction with day surgery was high and psychological recovery was quicker, however, majority of the studies did not use validated questionnaires. The hospital costs were lower for day surgery. Conclusions Day surgery for breast cancer is safe, with equivalent complication rates, but there is lack of evidence from randomised controlled trials. Patient satisfaction and psychological well-being is high. Further trials with validated questionnaires are required to confirm this.