ABSTRACT Thyroid function has been suggested to be associated with breast cancer risk, but not much is known about thyroid hormones as a potential prognostic factor for breast cancer. This study investigated the relation between thyroid hormones in breast cancer patients and mortality. A total of 2000 breast cancer patients from the Swedish SCAN‐B cohort were followed for 9 years. Blood samples were collected at the time of diagnosis, before surgery, and analysed for free and total T3 and T4. All‐cause mortality and recurrent disease were compared between quartiles (Q) using Cox proportional hazard analysis adjusted for prognostic factors, yielding hazard ratios (HR) with 95% confidence intervals (CIs). During follow‐up, 310 deaths and 167 recurrences occurred. Free T3 was associated with a lower mortality; the combined group Q2 to Q4 had an adjusted HR of 0.73 (0.58–0.93) as compared to Q1. Moreover, a high ratio of free T3/T4 was associated with a low mortality in Q2, Q3 and Q4, respectively. High levels of free and total T4 were associated with a high risk of all‐cause mortality; the crude HR for free T4 Q4 vs. Q1 was 1.53 (1.14–2.07) and the corresponding HR for total T4 was 1.63 (1.20–2.22). These results did not remain in the adjusted analysis. No clear associations were found regarding recurrent disease. We conclude that high levels of free T3, and a high free T3/T4 ratio were associated with a lower risk of all‐cause mortality and may be a marker of a favourable prognosis.
Annie Brange, Ylva Heyman, Kamil Demircan et al.· Cancer Medicine· 0 citations
Background: Population-scale molecular profiling integrated into routine healthcare could accelerate biomarker discovery, validation, and implementation, but the feasibility and sustainability of such an approach have rarely been demonstrated prospectively. The Sweden Cancerome Analysis Network - Breast (SCAN-B) Initiative was established to integrate prospective molecular profiling with population-based breast cancer care and create an infrastructure for translating molecular discoveries into clinical practice (ClinicalTrials.gov identifier NCT02306096). Methods: We evaluated the first 10 full calendar years of SCAN-B, encompassing patients with primary invasive breast cancer enrolled between August 30, 2010 and December 31, 2020. Enrollment and biospecimen collection were compared with all eligible breast cancer diagnoses in participating hospitals to assess population coverage and representativeness. Clinicopathological characteristics, treatments, recurrence-free survival, overall survival, RNA-sequencing-based molecular subtypes and risk-of-recurrence, and somatic mutations were evaluated. We additionally report the translation of SCAN-B molecular profiling from the research setting into routine clinical diagnostics. Results: Among 16,381 estimated eligible breast cancer diagnoses, 13,940 patients (85.1%) were prospectively enrolled across participating Swedish hospitals. Baseline blood samples were obtained from 98.4% of enrolled patients and tumor specimens from 71.1%; 9,323 tumors (94.0% of submitted tumor specimens) underwent RNA-sequencing. The enrolled cohort was broadly representative of the underlying breast cancer population across major clinicopathological characteristics. Integration of longitudinal clinical data with molecular profiling enabled characterization of real-world treatment patterns, long-term outcomes, molecular subtypes, risk-of-recurrence, and the somatic mutational landscape in this population-based cohort. Building on prospective real-time RNA-sequencing and subsequent development and validation of single-sample molecular subtype and risk-of-recurrence predictors, the SCAN-B workflow was transferred into routine clinical molecular diagnostics in Sk[a]ne and Blekinge in 2021. Through January 2026, more than 3,000 patients had received clinical RNA-sequencing-based molecular subtype and risk-of-recurrence reports, while prospective SCAN-B enrollment and transfer of samples and molecular data into the research infrastructure continued. Patient enrollment continues prospectively, with over 23,000 patients accrued as of January 2026. Conclusions: A prospective, population-based molecular profiling program can be integrated into routine breast cancer care at scale while maintaining high population coverage and representativeness. Over more than a decade, SCAN-B progressed from prospective biosampling and molecular profiling through biomarker development and validation to implementation of RNA sequencing-based testing in routine healthcare. This model establishes a continuous framework linking population-based molecular research, biomarker discovery and validation, and clinical implementation, and provides a strategy for integrating precision oncology research with routine cancer care.
L. Saal, H. Dalal, P. Meng et al.· medRxiv· 0 citations
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