Jennifer Plichta

Positions:

Assistant Professor of Surgery

Surgical Oncology
School of Medicine

Assistant Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 2002

Depauw University

M.D. 2008

Indiana University, School of Medicine

M.S. 2012

Loyola University Medical Center

General Surgery Resident, Surgery

Loyola University Medical Center

Breast Surgery Fellowship, Surgery

Brigham and Women's Hospital

Breast Surgery Fellowship, Surgery

Dana-Farber Cancer Institute

Breast Surgery Fellowship, Surgery

Massachusetts General Hospital

Grants:

Genetic testing for women with high-risk breast lesions

Awarded By
The Color Foundation
Role
Principal Investigator
Start Date
End Date

Publications:

Surgery for Men with Breast Cancer: Do the Same Data Still Apply?

BACKGROUND: Men represent a small proportion of breast cancer diagnoses, and they are often excluded from clinical trials. Current treatments are largely extrapolated from evidence in women. We compare practice patterns between men and women with breast cancer following the publication of several landmark clinical trials in surgery. PATIENTS AND METHODS: Patients with invasive breast cancer (2004-2015) from the National Cancer Data Base were identified; subcohorts were created based on eligibility for NSABP-B06, CALGB 9343, and ACOSOG Z0011. Practice patterns were stratified by gender and compared. Cox proportional hazards regression analyses were utilized to estimate the association between OS and gender. RESULTS: Of the 1,664,746 patients identified, 99% were women and 1% were men. Among NSABP-B06 eligible men, mastectomy rates did not change (consistently ~ 80%), and their adjusted OS was minimally worse compared with women (HR 1.19, 95% CI 1.11-1.28). Following publication of CALGB 9343, omission of radiation after lumpectomy was less likely in men and lagged behind that of women, despite similar OS (male HR 0.92, 95% CI 0.59-1.44). Application of ACOSOG Z0011 findings resulted in deescalation of axillary surgery for men and women with comparable OS (male HR 0.69, 95% CI 0.33-1.45). CONCLUSIONS: Uptake of clinical trial results for men with breast cancer often mirrors that for women, despite exclusion from these studies. Furthermore, when study findings were applied to eligible patients, men and women demonstrated similar survival. Observational studies can help inform the potential application of study findings to this unique population and improve patient enrollment in clinical trials.
Authors
MLA Citation
Plichta, Jennifer K., et al. “Surgery for Men with Breast Cancer: Do the Same Data Still Apply?Ann Surg Oncol, July 2020. Pubmed, doi:10.1245/s10434-020-08901-z.
URI
https://scholars.duke.edu/individual/pub1452159
PMID
32705510
Source
pubmed
Published In
Annals of Surgical Oncology
Published Date
DOI
10.1245/s10434-020-08901-z

A Novel Staging System for De Novo Metastatic Breast Cancer Refines Prognostic Estimates.

OBJECTIVE: We aim to identify prognostic groups within a de novo metastatic cohort, incorporating both anatomic and biologic factors. BACKGROUND: Staging for breast cancer now includes anatomic and biologic factors, although the guidelines for stage IV disease do not account for how these factors may influence outcomes. METHODS: Adults with de novo metastatic breast cancer were selected from the National Cancer DataBase (2010-2013). Recursive partitioning analysis was used to group patients with similar overall survival (OS) based on clinical T/N stage, tumor grade, ER, PR, HER2, number of metastatic sites, and presence of bone-only metastases. Categories were created by amalgamating homogeneous groups based on 3-year OS rates (stage IVA: >50%, stage IVB: 30%-50%, stage IVC: <30%). RESULTS: 16,187 patients were identified; median follow-up was 32 months. 65.2% had 1 site of distant metastasis, and 42.9% had bone-only metastases. Recursive partitioning analysis identified the number of metastatic sites (1 vs >1) as the first stratification point, and ER status as the second stratification point for both resulting groups. Additional divisions were made based on HER2 status, PR status, cT stage, tumor grade, and presence of bone-only metastases. After bootstrapping, significant differences in 3-year OS were noted between the 3 groups [stage IVB vs IVA: HR 1.58 (95% confidence interval 1.50-1.67), stage IVC vs IVA: HR 3.54 (95% confidence interval 3.33-3.77)]. CONCLUSIONS: Both anatomic and biologic factors yielded reliable and reproducible prognostic estimates among patients with metastatic disease. These findings support formal stratification of de novo stage IV breast cancer into 3 distinct prognosis groups.
MLA Citation
Plichta, Jennifer K., et al. “A Novel Staging System for De Novo Metastatic Breast Cancer Refines Prognostic Estimates.Ann Surg, July 2020. Pubmed, doi:10.1097/SLA.0000000000004231.
URI
https://scholars.duke.edu/individual/pub1452147
PMID
32657941
Source
pubmed
Published In
Ann Surg
Published Date
DOI
10.1097/SLA.0000000000004231

Do Histopathology and Clinical Outcomes of Breast Atypia Vary by Race/Ethnicity?

BACKGROUND: The clinical behavior of breast cancer varies by racial and ethnic makeup (REM), but the impact of REM on the clinical outcomes of breast atypia remains understudied. We examined the impact of REM on risk of underlying or subsequent carcinoma following a diagnosis of breast atypia. METHODS: In this retrospective, single-institution chart review, adult women diagnosed with breast atypia (atypical ductal hyperplasia, atypical lobular hyperplasia, or lobular carcinoma in situ) were stratified by REM. Regression modeling was used to estimate risk of underlying or subsequent carcinoma. RESULTS: We identified 539 patients with breast atypia, including 15 Hispanic (2.8%), 127 non-Hispanic black (23.6%), and 397 non-Hispanic white women (73.7%). Diagnoses included 75.1% atypical ductal hyperplasia (n = 405), 4.6% atypical lobular hyperplasia (n = 25), and 20.2% lobular carcinoma in situ (n = 109). Rates for each type of atypia did not vary by REM (P = 0.33). Of those with atypia on needle biopsy, the rate of underlying carcinoma at excision was 17.3%. After adjustment, REM was not associated with greater risk for carcinoma at excision (P = 0.41). Of those with atypia alone on surgical excision, the rate of a subsequent carcinoma diagnosis was 15.4% (median follow-up 49 mo). REM was not associated with a long-term risk for carcinoma (P = 0.37) or differences in time to subsequent carcinoma (log-rank P = 0.52). Chemoprevention uptake rates were low (10.6%), especially among Hispanic (0%) and non-Hispanic black (3.8%) patients (P = 0.01). CONCLUSIONS: Among patients with atypia, REM does not appear to influence type of histologic atypia, risk for carcinoma, or clinical outcome, despite differences in chemoprevention rates.
Authors
Sergesketter, AR; Thomas, SM; Parrilla Castellar, ER; Fayanju, OM; Menendez, C; Hwang, ES; Plichta, JK
MLA Citation
Sergesketter, Amanda R., et al. “Do Histopathology and Clinical Outcomes of Breast Atypia Vary by Race/Ethnicity?J Surg Res, vol. 255, June 2020, pp. 205–15. Pubmed, doi:10.1016/j.jss.2020.05.066.
URI
https://scholars.duke.edu/individual/pub1448058
PMID
32563761
Source
pubmed
Published In
J Surg Res
Volume
255
Published Date
Start Page
205
End Page
215
DOI
10.1016/j.jss.2020.05.066

Management of Male Breast Cancer: ASCO Guideline.

PURPOSE: To develop recommendations concerning the management of male breast cancer. METHODS: ASCO convened an Expert Panel to develop recommendations based on a systematic review and a formal consensus process. RESULTS: Twenty-six descriptive reports or observational studies met eligibility criteria and formed the evidentiary basis for the recommendations. RECOMMENDATIONS: Many of the management approaches used for men with breast cancer are like those used for women. Men with hormone receptor-positive breast cancer who are candidates for adjuvant endocrine therapy should be offered tamoxifen for an initial duration of five years; those with a contraindication to tamoxifen may be offered a gonadotropin-releasing hormone agonist/antagonist plus aromatase inhibitor. Men who have completed five years of tamoxifen, have tolerated therapy, and still have a high risk of recurrence may be offered an additional five years of therapy. Men with early-stage disease should not be treated with bone-modifying agents to prevent recurrence, but could still receive these agents to prevent or treat osteoporosis. Men with advanced or metastatic disease should be offered endocrine therapy as first-line therapy, except in cases of visceral crisis or rapidly progressive disease. Targeted systemic therapy may be used to treat advanced or metastatic cancer using the same indications and combinations offered to women. Ipsilateral annual mammogram should be offered to men with a history of breast cancer treated with lumpectomy regardless of genetic predisposition; contralateral annual mammogram may be offered to men with a history of breast cancer and a genetic predisposing mutation. Breast magnetic resonance imaging is not recommended routinely. Genetic counseling and germline genetic testing of cancer predisposition genes should be offered to all men with breast cancer.
Authors
Hassett, MJ; Somerfield, MR; Baker, ER; Cardoso, F; Kansal, KJ; Kwait, DC; Plichta, JK; Ricker, C; Roshal, A; Ruddy, KJ; Safer, JD; Van Poznak, C; Yung, RL; Giordano, SH
MLA Citation
Hassett, Michael J., et al. “Management of Male Breast Cancer: ASCO Guideline.J Clin Oncol, vol. 38, no. 16, June 2020, pp. 1849–63. Pubmed, doi:10.1200/JCO.19.03120.
URI
https://scholars.duke.edu/individual/pub1447056
PMID
32058842
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
38
Published Date
Start Page
1849
End Page
1863
DOI
10.1200/JCO.19.03120

Surgical Management of the Axilla in Elderly Women With Node-positive Breast Cancer.

BACKGROUND: Elderly women with clinically node-positive (cN+) breast cancer (BC) often have comorbidities that limit life expectancy and complicate treatment. We sought to determine whether the number of lymph nodes (LNs) retrieved among older women with node-positive BC was associated with overall survival (OS). METHODS: Using the National Cancer Database (2010-2015), women 70-90 y with cN + BC and ≥1 LNs removed were categorized by treatment sequence: upfront surgery or neoadjuvant chemotherapy (NAC). Multivariable Cox proportional hazards models with restricted cubic splines characterized the functional association of LN retrieval with OS; threshold values of LN retrieval were estimated. Cox proportional hazards models were used to estimate the association of LN retrieval groups with OS. RESULTS: In the upfront surgery cohort, a nonlinear association was identified between LNs retrieved and OS. In the NAC cohort, no association was identified. For the upfront surgery cohort, the optimal threshold value of LN retrieval was 21 LNs (90% confidence interval 18-23). Based on this estimate, LN retrieval groups were created: <6, 6-11, 12-17, 18-23, and >23 LNs. After adjustment, retrieval of <12 LNs in the upfront surgery group was associated with a worse OS. No differences were observed in the NAC group. CONCLUSIONS: For elderly women receiving upfront surgery, there is no survival benefit to removing more than 12 LNs, and for those receiving NAC, there is no association between number of LNs removed and survival. In older women who present with cN + BC, aggressive surgery to remove more than 12 LNs may not be necessary.
Authors
Marks, CE; Ren, Y; Rosenberger, LH; Thomas, SM; Greenup, RA; Fayanju, OM; McDuff, S; Kimmick, G; Shelley Hwang, E; Plichta, JK
MLA Citation
Marks, Caitlin E., et al. “Surgical Management of the Axilla in Elderly Women With Node-positive Breast Cancer.J Surg Res, vol. 254, May 2020, pp. 275–85. Pubmed, doi:10.1016/j.jss.2020.04.036.
URI
https://scholars.duke.edu/individual/pub1446657
PMID
32480072
Source
pubmed
Published In
J Surg Res
Volume
254
Published Date
Start Page
275
End Page
285
DOI
10.1016/j.jss.2020.04.036