Monica Morrow

Memorial Sloan-Kettering Cancer Center, New York City, New York, United States

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Publications (225)1812.11 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Triple-negative breast cancer (TNBC) is an operational term that refers to a heterogeneous collection of breast cancers lacking expression of estrogen receptor (ER), progesterone receptor, and HER2. These tumors account for 12–17 % of all breast cancers, preferentially affect young women, are more frequent in women of African and Hispanic descent, and are enriched in the population of patients diagnosed with “interval cancers.” TNBCs account for the majority of breast cancers arising in BRCA1 germline mutation carriers (approximately 80 %), and approximately 11–16 % of all TNBCs harbor BRCA1 or BRCA2 germline mutations. Well-known risk factors for ER-positive cancers, such as reproductive history and hormonal factors, do not appear to have the same correlations for TNBC, and histologic risk factors for TNBC have not been identified. Patients with TNBC have a higher risk of both local and distant recurrence, but this is not mitigated by bigger surgery, and standard criteria should be used to select the approach to local therapy in these patients. Although platinum drugs have shown promise in the treatment of TNBC, standard chemotherapy remains the standard of care outside of a clinical trial.
    Annals of Surgical Oncology 12/2014; · 4.12 Impact Factor
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    ABSTRACT: National Comprehensive Cancer Network guidelines consider (18)F-FDG PET/CT for only clinical stage III breast cancer patients. However, there is debate whether TNM staging should be the only factor in considering if PET/CT is warranted. Patient age may be an additional consideration, because young breast cancer patients often have more aggressive tumors with potential for earlier metastases. This study assessed PET/CT for staging of asymptomatic breast cancer patients younger than 40 y.
    Journal of Nuclear Medicine 09/2014; · 5.77 Impact Factor
  • Archives of pathology & laboratory medicine 08/2014; · 2.78 Impact Factor
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    ABSTRACT: Most women undergoing mastectomy for breast cancer do not undergo breast reconstruction.
    JAMA surgery. 08/2014;
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    ABSTRACT: Ductal carcinoma in situ with microinvasion (DCISM) is a rare diagnosis with a good prognosis. Although nodal metastases are uncommon, sentinel lymph node biopsy (SLNB) remains standard care. Volume of disease in invasive breast cancer is associated with SLNB positivity, and, thus we hypothesized that in a large cohort of patients with DCISM, multiple foci of microinvasion might be associated with a higher risk of positive SLNB.
    Annals of Surgical Oncology 08/2014; · 4.12 Impact Factor
  • International journal of radiation oncology, biology, physics 08/2014; 89(5):1139–1141. · 4.59 Impact Factor
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    ABSTRACT: The ACOSOG Z0011 trial demonstrated that axillary dissection (ALND) is not necessary for local control or survival in women with T1/2cN0 cancer undergoing breast-conserving therapy. There is concern about applying these results to triple-negative (TN) cancers secondary to their high local-recurrence (LR) rate. We examined the frequency of lymphovascular invasion (LVI) and nodal metastases in TN cancers to determine whether ALND can be safely avoided in this subtype.
    Annals of Surgical Oncology 06/2014; · 4.12 Impact Factor
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    ABSTRACT: IMPORTANCE The growing rate of contralateral prophylactic mastectomy (CPM) among women diagnosed as having breast cancer has raised concerns about potential for overtreatment. Yet, there are few large survey studies of factors that affect women's decisions for this surgical treatment option. OBJECTIVE To determine factors associated with the use of CPM in a population-based sample of patients with breast cancer. DESIGN, SETTING, AND PARTICIPANTS A longitudinal survey of 2290 women newly diagnosed as having breast cancer who reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries from June 1, 2005, to February 1, 2007, and again 4 years later (June 2009 to February 2010) merged with Surveillance, Epidemiology, and End Results registry data (n = 1536). Multinomial logistic regression was used to evaluate factors associated with type of surgery. Primary independent variables included clinical indications for CPM (genetic mutation and/or strong family history), diagnostic magnetic resonance imaging, and patient extent of worry about recurrence at the time of treatment decision making. MAIN OUTCOMES AND MEASURES Type of surgery received from patient self-report, categorized as CPM, unilateral mastectomy, or breast conservation surgery. RESULTS Of the 1447 women in the analytic sample, 18.9% strongly considered CPM and 7.6% received it. Of those who strongly considered CPM, 32.2% received CPM, while 45.8% received unilateral mastectomy and 22.8% received breast conservation surgery (BCS). The majority of patients (68.9%) who received CPM had no major genetic or familial risk factors for contralateral disease. Multivariate regression showed that receipt of CPM (vs either unilateral mastectomy or breast conservation surgery) was significantly associated with genetic testing (positive or negative) (vs UM, relative risk ratio [RRR]: 10.48; 95% CI, 3.61-3.48 and vs BCS, RRR: 19.10; 95% CI, 5.67-56.41; P < .001), a strong family history of breast or ovarian cancer (vs UM, RRR: 5.19; 95% CI, 2.34-11.56 and vs BCS, RRR: 4.24; 95% CI, 1.80-9.88; P = .001), receipt of magnetic resonance imaging (vs UM RRR: 2.07; 95% CI, 1.21-3.52 and vs BCS, RRR: 2.14; 95% CI, 1.28-3.58; P = .001), higher education (vs UM, RRR: 5.04; 95% CI, 2.37-10.71 and vs BCS, RRR: 4.38; 95% CI, 2.07-9.29; P < .001), and greater worry about recurrence (vs UM, RRR: 2.81; 95% CI, 1.14-6.88 and vs BCS, RRR: 4.24; 95% CI, 1.80-9.98; P = .001). CONCLUSIONS AND RELEVANCE Many women considered CPM and a substantial number received it, although few had a clinically significant risk of contralateral breast cancer. Receipt of magnetic resonance imaging at diagnosis contributed to receipt of CPM. Worry about recurrence appeared to drive decisions for CPM although the procedure has not been shown to reduce recurrence risk. More research is needed about the underlying factors driving the use of CPM.
    JAMA surgery. 05/2014;
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    ABSTRACT: Purpose To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.
    International journal of radiation oncology, biology, physics 05/2014; 88(3):553–564. · 4.59 Impact Factor
  • Melissa L Pilewskie, Monica Morrow
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    ABSTRACT: Sentinel lymph node biopsy (SLNB) has revolutionized the surgical management of the axilla for patients with early breast cancer. SLNB initially became standard regional therapy for women who were both clinically and pathologically node-negative. Subsequently, SLNB has been established as appropriate management in patients with very low axillary tumor burden, defined as isolated tumor cells or micrometastatic disease (< 2 mm); it provides accurate staging information with no detriment to regional control. More recently, the treatment of the axilla has evolved for women with macrometastatic axillary disease. Three randomized controlled trials have compared different regional treatment strategies for patients with > 2 mm of axillary tumor burden. Here we review the evolution of SLNB for the management of clinically node-negative breast cancer, and we address the current controversies and management issues.
    Oncology (Williston Park, N.Y.) 05/2014; 28(5):371-8. · 3.19 Impact Factor
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    ABSTRACT: Whether extracapsular extension (ECE) of tumor in the sentinel lymph node (SLN) is an indication for axillary lymph node dissection (ALND) in patients managed by American College of Surgeons Oncology Group Z0011 criteria is controversial. Here we examine the correlation between ECE in the SLN and disease burden in the axilla. Patients meeting Z0011 clinicopathologic criteria (pT1-2, cN0 with <3 positive SLNs) were selected from a prospectively maintained database (2006-2013). Chart review documented the presence and extent of ECE. Neoadjuvant chemotherapy patients were excluded. Comparisons were made by presence and extent (≤2 vs. >2 mm) of ECE. Of 11,730 patients, 778 were pT1-2, cN0 with <3 positive SLNs without ECE, and 331 (2.8 %) had ECE. Of these, 180 had ≤2 mm and 151 had >2 mm of ECE. Patients with ECE were older (57 vs. 54 years; p = 0.001) and had larger (2.0 vs. 1.7 cm; p < 0.0001), multifocal (p = 0.006), hormone receptor-positive tumors (p = 0.0164) with lymphovascular invasion (p < 0.0001). Presence and extent of ECE were associated with greater axillary disease burden; 20 and 3 % of patients with and without ECE, respectively, had ≥4 additional positive nodes at completion ALND (p < 0.0001), and 33 % of patients with >2 mm ECE had ≥4 additional positive nodes at completion ALND, compared with 9 % in the <2 mm group (p < 0.0001). On multivariate analysis, >2 mm of ECE was the strongest predictor of ≥4 positive nodes at completion ALND (odds ratio 14.2). Presence and extent of ECE were significantly correlated with nodal tumor burden at completion ALND, thus suggesting that >2 mm of ECE may be an indication for ALND or radiotherapy when applying Z0011 criteria to patients with metastases in <3 SLNs. ECE reporting should be standardized to facilitate future studies.
    Annals of Surgical Oncology 04/2014; · 4.12 Impact Factor
  • Nehmat Houssami, Monica Morrow
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    ABSTRACT: The optimal margin in breast-conserving surgery is controversial, and re-excision is common. Pathologic margin assessment is not standardized, and tumor biology and the use of systemic therapy have a major impact on local control. A study-level meta-analysis found no difference in local recurrence for margin widths of 1, 2, and 5 mm, leading a multidisciplinary panel to recommend adoption of no ink on tumor as the standard definition of a negative margin. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 04/2014; · 2.64 Impact Factor
  • Source
    Monica Morrow
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    ABSTRACT: In September 2011, the Society of Surgical Oncology (SSO) Executive Council voted to transition to self-management. The transition was successfully completed in October 2012. This article summarizes the infrastructure changes that have occurred to facilitate the transition, the SSO goals, selected results from the 2012 Membership Survey, and future directions for the SSO.
    Annals of Surgical Oncology 03/2014; · 4.12 Impact Factor
  • Melissa Pilewskie, Monica Morrow
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    ABSTRACT: Data addressing margin width and the risk of local recurrence (LR) for women undergoing breast-conserving therapy have not revealed improved recurrence rates with larger negative margins. However, incidence of LR has been revealed to vary between breast cancer subtypes, with the incidence of LR higher for triple negative (TN) breast cancer than for non-TN cancers, raising the question of whether the same margin width is appropriate for all breast cancer subtypes. This paper reviews the literature addressing margin status in breast-conserving therapy within the TN subtype. Current evidence does not support a wider surgical margin for TN breast cancer. Recent studies reveal similar LR for TN breast cancer treated with breast conservation and with mastectomy, suggesting that cancer biology, and not the negative margin width, determines the risk of LR.
    Current Breast Cancer Reports 03/2014;
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    ABSTRACT: There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We systematically review the evidence on surgical margins in BCT for invasive breast cancer to support the development of clinical guidelines. Study-level meta-analysis of studies reporting local recurrence (LR) data relative to final microscopic margin status and the threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression. Based on 33 studies (LR in 1,506 of 28,162), the odds of LR were associated with margin status [model 1: odds ratio (OR) 1.96 for positive/close vs negative; model 2: OR 1.74 for close vs. negative, 2.44 for positive vs. negative; (P < 0.001 both models)] but not with margin distance [model 1: >0 mm vs. 1 mm (referent) vs. 2 mm vs. 5 mm (P = 0.12); and model 2: 1 mm (referent) vs. 2 mm vs. 5 mm (P = 0.90)], adjusting for study median follow-up time. There was little to no statistical evidence that the odds of LR decreased as the distance for declaring negative margins increased, adjusting for follow-up time [model 1: 1 mm (OR 1.0, referent), 2 mm (OR 0.95), 5 mm (OR 0.65), P = 0.21 for trend; and model 2: 1 mm (OR 1.0, referent), 2 mm (OR 0.91), 5 mm (OR 0.77), P = 0.58 for trend]. Adjustment for covariates, such as use of endocrine therapy or median-year of recruitment, did not change the findings. Meta-analysis confirms that negative margins reduce the odds of LR; however, increasing the distance for defining negative margins is not significantly associated with reduced odds of LR, allowing for follow-up time. Adoption of wider relative to narrower margin widths to declare negative margins is unlikely to have a substantial additional benefit for long-term local control in BCT.
    Annals of Surgical Oncology 01/2014; · 4.12 Impact Factor
  • Julie O'Brien, Monica Morrow
    Journal of Surgical Oncology 01/2014; · 2.64 Impact Factor
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    ABSTRACT: For women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery (BCS), the benefit of magnetic resonance imaging (MRI) remains unknown. Here we examine the relationship of MRI and locoregional recurrence (LRR) and contralateral breast cancer (CBC) for DCIS treated with BCS, with and without radiotherapy (RT). A total of 2,321 women underwent BCS for DCIS from 1997 to 2010. All underwent mammography, and 596 (26 %) also underwent perioperative MRI; 904 women (39 %) did not receive RT, and 1,391 (61 %) did. Median follow-up was 59 months, and 548 women were followed for ≥8 years. The relationship between MRI and LRR was examined using multivariable analysis. There were 184 LRR events; 5- and 8-year LRR rates were 8.5 and 14.6 % (MRI), respectively, and 7.2 and 10.2 % (no-MRI), respectively (p = 0.52). LRR was significantly associated with age, menopausal status, margin status, RT, and endocrine therapy. After controlling for these variables and family history, presentation, number of excisions, and time period of surgery, there remained no trend toward association of MRI and lower LRR [hazard ratio (HR) 1.18, 95 % confidence interval (CI) 0.79-1.78, p = 0.42]. Restriction of analysis to the no-RT subgroup showed no association of MRI with lower LRR rates (HR 1.36, 95 % CI 0.78-2.39, p = 0.28). No difference in 5- or 8-year rates of CBC was seen between the MRI (3.5 and 3.5 %) and no-MRI (3.5 and 5.1 %) groups (p = 0.86). We observed no association between perioperative MRI and lower LRR or CBC rates in patients with DCIS, with or without RT. In the absence of evidence that MRI improves outcomes, the routine perioperative use of MRI for DCIS should be questioned.
    Annals of Surgical Oncology 01/2014; · 4.12 Impact Factor
  • Melissa Pilewskie, Monica Morrow
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    ABSTRACT: This article reviews the relevant data on breast magnetic resonance imaging (MRI) use in screening, the short-term surgical outcomes and long-term cancer outcomes associated with the use of MRI in breast cancer staging, the use of MRI in occult primary breast cancer, as well as MRI to assess eligibility for accelerated partial breast irradiation and to evaluate tumor response after neoadjuvant chemotherapy. MRI for screening is supported in specific high-risk populations, namely, women with BRCA1 or BRCA2 mutations, a family history suggesting a hereditary breast cancer syndrome, or a history of chest wall radiation.
    Surgical Oncology Clinics of North America 01/2014; · 1.22 Impact Factor
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    ABSTRACT: The effect of increasing negative margin width after breast-conserving therapy (BCT) on local recurrence (LR) is controversial. LR rates vary by subtype, with the highest rates seen in triple-negative breast cancer (TNBC). This study examined LR rates in relationship to margin width in TNBC treated with BCT. Women with TNBC who underwent BCT between 1999 and 2009 were identified. Margins were defined as positive (ink on tumor), 0.1-2.0, and 2 mm. Patients with positive margins were excluded. Statistical comparisons were by t test, Fisher's exact test, and Wilcoxon rank sum test. Cumulative incidence of LR was compared by competing-risks methodology. Of 535 cancers, 71 had margins ≤2 mm and 464 had margins >2 mm. At a median follow-up of 84 months (range 8-165 months), there were 37 local, 18 regional, and 77 distant recurrences or deaths as first events. Ten patients had a locoregional recurrence before planned radiotherapy and were excluded from cumulative incidence analyses. The cumulative incidence of LR at 60 months for margins ≤2 mm was 4.7 % (95 % confidence interval 0-10.0) and for >2 mm was 3.7 % (1.8, 5.5) (p = 0.11). After controlling for chemotherapy and tumor size, there was no difference in LR between the two margin groups (p = 0.06). A difference in the risk of distant recurrence or death was not observed (p = 0.53). Margin width of >2 mm was not associated with reduced LR rates. These data support a negative margin definition of no ink on tumor, even in this high-risk TNBC cohort.
    Annals of Surgical Oncology 12/2013; · 4.12 Impact Factor
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    ABSTRACT: PURPOSE Oncotype Dx® breast cancer 21-gene assay recurrence score (RS) is used clinically in early stage estrogen receptor (ER) positive breast cancer to quantify (range 0-100) the likelihood (increased with score) of recurrence and magnitude of chemotherapy benefit. The purpose of this study was to assess ER positive, HER2 negative early breast cancer pre-operative magnetic resonance imaging (MRI) features and their ability to predict the Oncotype Dx® RS. METHOD AND MATERIALS This retrospective study received institutional review board approval and need for informed consent waived. Pre-operative MRIs were reviewed of 50 women (mean age 51; range 32-76) with ER positive, HER2 negative early invasive ductal carcinoma (IDC) and an Oncotype Dx® (Genomic Health) RS (mean score 23; range 0-78). MRI features included mass shape, margin, internal enhancement, T2 signal, diameter (mean 1.4 cm, range 0.5-2.8 cm), volume (mean 1.4 cc, range 0.1-8.0 cc) and dynamic time-intensity contrast enhancement kinetics. Clinical and pathologic data was collected. Exclusion criteria included prior history of cancer and BRCA genetic carriers. RESULTS All 50 women had stage 1 or 2A ER positive, HER 2 negative IDC. Increased Oncotype Dx® recurrence score was significantly associated with increased tumor volume (Spearman correlation=0.35; p=0.01) and an increased percent of the tumor having plateau dynamic kinetics upon segmentation (Spearman correlation=0.32; p=0.03). Increased Oncotype Dx® recurrence score was significantly associated with irregular tumor shape (p=0.03) and increased tumor (hyperintense and heterogeneous) T2 signal (p=0.002). CONCLUSION Several IDC MRI features are significantly associated with an increased Oncotype Dx® RS, which has prognostic and predictive significance. CLINICAL RELEVANCE/APPLICATION MRI IDC phenotype is significantly associated with their genotype supporting the advent of radiogenomics and possible role in directing targeted therapy.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013

Publication Stats

5k Citations
1,812.11 Total Impact Points

Institutions

  • 2008–2014
    • Memorial Sloan-Kettering Cancer Center
      • • Breast Service
      • • Department of Surgery
      New York City, New York, United States
  • 2013
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2005–2013
    • University of Michigan
      • • Department of Internal Medicine
      • • Department of Radiation Oncology
      Ann Arbor, Michigan, United States
    • Fox Chase Cancer Center
      • Department of Surgery
      Philadelphia, PA, United States
    • Karmanos Cancer Institute
      Detroit, Michigan, United States
    • Ann & Robert H. Lurie Children's Hospital of Chicago
      Chicago, Illinois, United States
    • Duke University Medical Center
      • Department of Surgery
      Durham, NC, United States
  • 2012
    • University of Texas MD Anderson Cancer Center
      • Department of Surgical Oncology
      Houston, TX, United States
  • 2007–2011
    • John Wayne Cancer Institute
      Santa Monica, California, United States
  • 2010
    • Treatment Research Institute, Philadelphia PA
      Philadelphia, Pennsylvania, United States
    • Mater Misericordiae University Hospital
      Dublin, Leinster, Ireland
    • Goethe-Universität Frankfurt am Main
      • Klinik für Frauenheilkunde und Geburtshilfe
      Frankfurt am Main, Hesse, Germany
  • 2007–2010
    • Dana-Farber Cancer Institute
      • Department of Radiation Oncology
      Boston, MA, United States
  • 2003–2005
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 2002–2005
    • Northwestern Memorial Hospital
      Chicago, Illinois, United States
    • Northwestern University
      • Department of Surgery
      Evanston, IL, United States
    • American College of Surgeons
      Chicago, Illinois, United States