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Wärnberg, Fredrik
Alternative names
Publications (10 of 54) Show all publications
Bremer, T., Whitworth, P. W., Patel, R., Savala, J., Barry, T., Lyle, S., . . . Wärnberg, F. (2018). A Biological Signature for Breast Ductal Carcinoma In Situ to Predict Radiotherapy Benefit and Assess Recurrence Risk. Clinical Cancer Research, 24(23), 5895-5901
Open this publication in new window or tab >>A Biological Signature for Breast Ductal Carcinoma In Situ to Predict Radiotherapy Benefit and Assess Recurrence Risk
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2018 (English)In: Clinical Cancer Research, ISSN 1078-0432, E-ISSN 1557-3265, Vol. 24, no 23, p. 5895-5901Article in journal (Refereed) Published
Abstract [en]

Purpose: Ductal carcinoma in situ (DCIS) patients and their physicians currently face challenging treatment decisions with limited information about the individual's subsequent breast cancer risk or treatment benefit. The DCI-SionRT biological signature developed in this study provides recurrence risk and predicts radiotherapy (RT) benefit for DCIS patients following breast-conserving surgery (BCS). Experimental Design: A biological signature that calculates an individualized Decision Score (DS) was developed and cross-validated in 526 DCIS patients treated with BCS = RT. The relationship was assessed between DS and 10-year risk of invasive breast cancer (IBC) or any ipsilateral breast event (IBE), including IBC or DCIS. RT benefit was evaluated by risk group and as a function of DS. Results: The DS was significantly associated with IBC and IBE risk, HR (per 5 units) of 4.2 and 3.1, respectively. For patients treated without RT, DS identified a Low Group with 10-year IBC risk of 4% (7% IBE) and an Elevated Risk Group with IBC risk of 15% (23% IBE). In analysis of DS and RT by group, the Elevated Risk Group received significant RT benefit, HR of 0.3 for IBC and IBE. In a clinicopathologically low-risk subset, DS reclassified 42% of patients into the Elevated Risk Group. In an interaction analysis of DS and RT, patients with elevated DS had significant RT benefit over baseline. Conclusions: The DS was prognostic for risk and predicted RT benefit for DCIS patients. DS identified a clinically meaningful low-risk group and a group with elevated 10-year risks that received substantial RT benefit over baseline.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-372771 (URN)10.1158/1078-0432.CCR-18-0842 (DOI)000452374700013 ()30054280 (PubMedID)
Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2019-01-14Bibliographically approved
Wärnberg, F., Garmo, H., Folkvaljon, Y., Holmberg, L., Karlsson, P., Sandelin, K., . . . Bremer, T. (2018). Abstract GS5-08: A validation of DCIS biological risk profile in a randomised study for radiation therapy with 20 year follow-up (SweDCIS). Paper presented at San Antonio Breast Cancer Symposium, DEC 05-09, 2017, San Antonio, TX. Cancer Research, 78(4)
Open this publication in new window or tab >>Abstract GS5-08: A validation of DCIS biological risk profile in a randomised study for radiation therapy with 20 year follow-up (SweDCIS)
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2018 (English)In: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 78, no 4Article in journal, Meeting abstract (Other academic) Published
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-351602 (URN)10.1158/1538-7445.SABCS17-GS5-08 (DOI)000425489400036 ()
Conference
San Antonio Breast Cancer Symposium, DEC 05-09, 2017, San Antonio, TX
Note

Wos title: A validation of DCIS biological risk profile in a randomised study for radiation therapy with 20 year follow-up (SweDCIS)

Supplement: S

Meeting Abstract: GS5-08

Available from: 2018-05-29 Created: 2018-05-29 Last updated: 2018-09-12Bibliographically approved
Wärnberg, M., Karakatsanis, A., Abdsaleh, S. & Wärnberg, F. (2018). Abstract P3-01-11: Discoloration after injection of super paramagnetic iron oxide (SPIO) for sentinel node biopsy. A long term qualitative follow-up study. Paper presented at San Antonio Breast Cancer Symposium, DEC 05-09, 2017, San Antonio, TX. Cancer Research, 78(4)
Open this publication in new window or tab >>Abstract P3-01-11: Discoloration after injection of super paramagnetic iron oxide (SPIO) for sentinel node biopsy. A long term qualitative follow-up study
2018 (English)In: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 78, no 4Article in journal, Meeting abstract (Other academic) Published
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-351603 (URN)10.1158/1538-7445.SABCS17-P3-01-11 (DOI)000425489400340 ()
Conference
San Antonio Breast Cancer Symposium, DEC 05-09, 2017, San Antonio, TX
Note

Wos title: Discoloration after injection of super paramagnetic iron oxide (SPIO) for sentinel node biopsy. A long term qualitative follow-up study

Available from: 2018-05-29 Created: 2018-05-29 Last updated: 2018-05-29Bibliographically approved
Wadsten, C., Wärnberg, F., Tolockiene, E., Hartman, J., Fredriksson, I., Garmo, H. & Sund, M. (2018). Biomarkers in DCIS associated with breast cancer death. Paper presented at 11th European Breast Cancer Conference (EBCC), MAR 21-23, 2018, Barcelona, SPAIN. European Journal of Cancer, 92, S67-S68
Open this publication in new window or tab >>Biomarkers in DCIS associated with breast cancer death
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2018 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 92, p. S67-S68Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2018
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-357180 (URN)000429103100169 ()
Conference
11th European Breast Cancer Conference (EBCC), MAR 21-23, 2018, Barcelona, SPAIN
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2018-08-14Bibliographically approved
Plate, S., Emilsson, L., Söderberg, M., Brandberg, Y. & Wärnberg, F. (2018). High experienced continuity in breast cancer care is associated with high health related quality of life. BMC Health Services Research, 18, Article ID 127.
Open this publication in new window or tab >>High experienced continuity in breast cancer care is associated with high health related quality of life
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2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 127Article in journal (Refereed) Published
Abstract [en]

Background: High experienced continuity is known to be associated with lower needs for supportive care and most likely higher quality of life. On this background, the aim of this study was to investigate if patient-experienced continuity of care was associated with health-related quality of life (HRQoL) in breast cancer patients treated at two different-sized breast cancer units.

Methods: In 2016, two questionnaires, "Statements on experienced continuity of care" and "The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30)", were sent out to patients diagnosed between 2011 and 2014 at two different-sized breast cancer units in Sweden. Lead times and other data reflecting medical quality were collected from the patients' medical records and from the National Swedish Breast Cancer Quality Register.

Results: Of 356 eligible patients, 231 (65%) answered the questionnaires, of whom 218 patients were included in the analyses. A statistically significant association was found between high experienced continuity and high global HRQoL (p = 0.03). Continuity was higher at the smaller unit, while no major differences between the units were found regarding medical quality or lead times.

Conclusion: The study found that high experienced continuity and HRQoL was strongly associated. A statistically significant higher continuity of care was found at the smaller unit, in line with what was expected. The absence of clinically relevant differences in lead times and medical quality may indicate that continuity could be achieved without loss of quality.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2018
Keywords
Continuity of care, Health-related quality of life, HRQoL, Breast cancer, Patient reported outcome
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-349349 (URN)10.1186/s12913-018-2925-0 (DOI)000425530200003 ()29458376 (PubMedID)
Available from: 2018-04-27 Created: 2018-04-27 Last updated: 2018-04-27Bibliographically approved
Sjöström, M., Staaf, J., Eden, P., Wärnberg, F., Bergh, J., Malmström, P., . . . Fredriksson, I. (2018). Identification and validation of single-sample breast cancer radiosensitivity gene expression predictors. Breast Cancer Research, 20, Article ID 64.
Open this publication in new window or tab >>Identification and validation of single-sample breast cancer radiosensitivity gene expression predictors
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2018 (English)In: Breast Cancer Research, ISSN 1465-5411, E-ISSN 1465-542X, Vol. 20, article id 64Article in journal (Refereed) Published
Abstract [en]

Background: Adjuvant radiotherapy is the standard of care after breast-conserving surgery for primary breast cancer, despite a majority of patients being over-or under-treated. In contrast to adjuvant endocrine therapy and chemotherapy, no diagnostic tests are in clinical use that can stratify patients for adjuvant radiotherapy. This study presents the development and validation of a targeted gene expression assay to predict the risk of ipsilateral breast tumor recurrence and response to adjuvant radiotherapy after breast-conserving surgery in primary breast cancer.

Methods: Fresh-frozen primary tumors from 336 patients radically (clear margins) operated on with breast-conserving surgery with or without radiotherapy were collected. Patients were split into a discovery cohort (N = 172) and a validation cohort (N = 164). Genes predicting ipsilateral breast tumor recurrence in an Illumina HT12 v4 whole transcriptome analysis were combined with genes identified in the literature (248 genes in total) to develop a targeted radiosensitivity assay on the Nanostring nCounter platform. Single-sample predictors for ipsilateral breast tumor recurrence based on a k-top scoring pairs algorithm were trained, stratified for estrogen receptor (ER) status and radiotherapy. Two previously published profiles, the radiosensitivity signature of Speers et al., and the 10-gene signature of Eschrich et al., were also included in the targeted panel.

Results: Derived single-sample predictors were prognostic for ipsilateral breast tumor recurrence in radiotherapy-treated ER+ patients (AUC 0.67, p = 0.01), ER+ patients without radiotherapy (AUC = 0.89, p = 0.02), and radiotherapy-treated ER-patients (AUC = 0.78, p < 0.001). Among ER+ patients, radiotherapy had an excellent effect on tumors classified as radiosensitive (p < 0.001), while radiotherapy had no effect on tumors classified as radioresistant (p=0.36) and there was a high risk of ipsilateral breast tumor recurrence (55% at 10 years). Our single-sample predictors developed in ER+ tumors and the radiosensitivity signature correlated with proliferation, while single-sample predictors developed in ER-tumors correlated with immune response. The 10-gene signature negatively correlated with both proliferation and immune response.

Conclusions: Our targeted single-sample predictors were prognostic for ipsilateral breast tumor recurrence and have the potential to stratify patients for adjuvant radiotherapy. The correlation of models with biology may explain the different performance in subgroups of breast cancer.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Breast cancer, Gene expression, Radiotherapy, Radiosensitivity, Radioresistance, Ipsilateral breast tumor recurrence, Local recurrence, Nanostring, nCounter
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-360186 (URN)10.1186/s13058-018-0978-y (DOI)000437333200001 ()29973242 (PubMedID)
Funder
The Breast Cancer FoundationSwedish Cancer SocietyRegion SkåneMagnus Bergvall FoundationGunnar Nilsson Cancer FoundationCancer and Allergy FoundationKing Gustaf V Jubilee FundThe Cancer Society in StockholmMarianne and Marcus Wallenberg Foundation
Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2018-09-13Bibliographically approved
Karakatsanis, A., Tasoulis, M. K., Wärnberg, F., Nilsson, G. & MacNeill, F. (2018). Meta-analysis of neoadjuvant therapy and its impact in facilitating breast conservation in operable breast cancer. Paper presented at Annual Meeting of the Swedish-Surgical-Society, AUG, 2017, Jonkoping, SWEDEN. British Journal of Surgery, 105(5), 469-481
Open this publication in new window or tab >>Meta-analysis of neoadjuvant therapy and its impact in facilitating breast conservation in operable breast cancer
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 5, p. 469-481Article in journal (Refereed) Published
Abstract [en]

Background

Neoadjuvant therapy (NAT) for operable breast cancer may facilitate more breast-conserving surgery (BCS). It seems, however, that this benefit is not being realized fully.

Methods

A systematic review of the literature was performed. RCTs were included. The criteria for inclusion were: documentation of surgical assessment before and after NAT, surgery performed (BCS or mastectomy), and clinical and pathological responses.

Results

A total of 1452 patients from seven RCTs met the inclusion criteria. After NAT, the feasibilityof BCS increased from 43⋅3to60⋅4 per cent (P < 0⋅001), but BCS was performed in only 51⋅8percent(P = 0⋅04). Only 31 per cent of patients who became eligible for BCS (assessed on clinical response)underwent BCS (pooled rate ratio 0⋅31, 95 per cent c.i. 0⋅22 to 0⋅44; P < 0⋅001). Of the mastectomycandidates who achieved a pathological complete response after NAT, only 41 per cent underwent BCS(pooled rate ratio 0⋅41, 0⋅23 to 0⋅74; P = 0⋅003). The main factors that influenced the decision not to shiftto BCS, even though it was feasible, were clinical assessment before NAT, multicentricity and tumoursize at presentation.

Conclusion

Breast surgery performed after NAT does not reflect tumour response, resulting in potentially unnecessary radical surgery, especially mastectomy. The barriers to maximizing the surgical benefits of NAT need to be better understood and explored. Still unnecessary mastectomies

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-354236 (URN)10.1002/bjs.10807 (DOI)000428846100003 ()29603132 (PubMedID)
Conference
Annual Meeting of the Swedish-Surgical-Society, AUG, 2017, Jonkoping, SWEDEN
Available from: 2018-06-29 Created: 2018-06-29 Last updated: 2018-06-29Bibliographically approved
Karakatsanis, A., Obondo, C., Abdsaleh, S., Hersi, A.-F., Eriksson, S. & Wärnberg, F. (2018). Optimisation of breast MRI compatibility after sentinel node biopsy with paramagnetic tracers [Letter to the editor]. European Journal of Surgical Oncology, 44(5), 731-732
Open this publication in new window or tab >>Optimisation of breast MRI compatibility after sentinel node biopsy with paramagnetic tracers
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2018 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 44, no 5, p. 731-732Article in journal, Letter (Other academic) Published
Keywords
Breast cancer, Sentinel node biopsy, Superparamagnetic iron oxide nanoparticles, MRI, Breast conservation
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-361433 (URN)10.1016/j.ejso.2018.01.241 (DOI)000433399800027 ()29478740 (PubMedID)
Available from: 2018-11-26 Created: 2018-11-26 Last updated: 2018-11-26Bibliographically approved
Wadsten, C., Wennstig, A.-K., Garmo, H., Nilsson, G., Blomqvist, C., Holmberg, L., . . . Sund, M. (2018). Risk of ischemic heart disease after radiotherapy for ductal carcinoma in situ. Breast Cancer Research and Treatment, 171(1), 95-101
Open this publication in new window or tab >>Risk of ischemic heart disease after radiotherapy for ductal carcinoma in situ
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2018 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 171, no 1, p. 95-101Article in journal (Refereed) Published
Abstract [en]

The use of adjuvant radiotherapy (RT) in the management of ductal carcinoma in situ (DCIS) is increasing. Left-sided breast irradiation may involve exposure of the heart to ionising radiation, increasing the risk of ischemic heart disease (IHD). We examined the incidence of IHD in a population-based cohort of women with DCIS. The Breast Cancer DataBase Sweden (BCBase) cohort includes women registered with invasive and in situ breast cancers 1992-2012 and age-matched women without a history of breast cancer. In this analysis, 6270 women with DCIS and a comparison cohort of 31,257 women were included. Through linkage with population-based registers, data on comorbidity, socioeconomic status and incidence of IHD was obtained. Hazard ratios (HR) for IHD with 95% confidence intervals (CI) were analysed. Median follow-up time was 8.8 years. The risk of IHD was not increased for women with DCIS versus women in the comparison cohort (HR 0.93; 95% CI 0.82-1.06), after treatment with radiotherapy versus surgery alone (HR 0.77; 95% CI 0.60-0.98) or when analysing RT by laterality (HR 0.85; 95% CI 0.53-1.37 for left-sided versus right-sided RT). The risk of IHD was lower for women with DCIS allocated to RT compared to non-irradiated women and to the comparison cohort, probably due to patient selection. Comparison of RT by laterality did not show any over-risk for irradiation of the left breast.

Place, publisher, year, edition, pages
SPRINGER, 2018
Keywords
Ductal carcinoma in situ, Radiotherapy, Ischemic heart disease
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-361504 (URN)10.1007/s10549-018-4803-1 (DOI)000438656200010 ()29730730 (PubMedID)
Funder
The Breast Cancer FoundationVästerbotten County Council
Available from: 2018-09-25 Created: 2018-09-25 Last updated: 2018-09-25Bibliographically approved
Obondo, C., Karakatsanis, A., Eriksson, S., Hersi, A. F., Pistiolis, L., Abdsaleh, S., . . . Wärnberg, F. (2018). SentiDose - A dose optimizing study with SiennaXP, a superparamagnetic iron oxide for sentinel node detection. Paper presented at 11th European Breast Cancer Conference (EBCC), MAR 21-23, 2018, Barcelona, SPAIN. European Journal of Cancer, 92, S79-S79
Open this publication in new window or tab >>SentiDose - A dose optimizing study with SiennaXP, a superparamagnetic iron oxide for sentinel node detection
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2018 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 92, p. S79-S79Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2018
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-357179 (URN)000429103100206 ()
Conference
11th European Breast Cancer Conference (EBCC), MAR 21-23, 2018, Barcelona, SPAIN
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2018-08-14Bibliographically approved
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