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Abramson Cancer CenterNCI CANCERLIT® Search: Surgery for Breast Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
UI - 21426169
AU - Le Bouedec G; Cure H; de Latour M; Dauplat J
TI -
[Stewart-Treves syndrome following mastectomy for breast cancer: a case
report]
SO - Rev Med Interne 2001 Aug;22(8):753-7
AD - Service de chirurgie, centre Jean-Perrin, centre de lutte contre le
cancer, 58, rue Montalembert, B.P. 392, 63011 Clermont-Ferrand, France.
Recherche@cjp.u-clermont1.fr
INTRODUCTION: Stewart-Treves syndrome has been defined by the eponymous
authors as a lymphangiosarcoma in a setting of postmastectomy upper
extremity lymphoedema. EXEGESIS: The clinical record of one patient with
Stewart-Treves syndrome is analyzed. The primary angiosarcoma of the
skin represented by a purple nodule occurred on a chronic
lymphoedematous arm following radical mastectomy and axillary lymph node
dissection for breast carcinoma performed 9 years earlier.
Immunohistochemistry tests formally eliminated epithelial cutaneous
metastasis and produced evidence in favour of conjunctive vascular
tissue origin of the tumor. CONCLUSION: Conservative surgery for breast
cancer, application of axillary sentinel node biopsy in the lymphatic
staging and prevention of arm lymphoedema should reduce the incidence of
this syndrome.
2
UI - 21455258
AU - Arora NK; Gustafson DH; Hawkins RP; McTavish F; Cella DF; Pingree S;
TI -
Mendenhall JH; Mahvi DM
Impact of surgery and chemotherapy on the quality of life of younger
women with breast carcinoma: a prospective study.
SO - Cancer 2001 Sep 1;92(5):1288-98
AD - Center for Health Systems Research and Analysis, University of
Wisconsin, Madison, USA. aroran@mail.nih.gov
BACKGROUND: Studies that prospectively and simultaneously evaluate,
within the first year of diagnosis, the impact of surgery and
chemotherapy on quality of life (QOL) of younger women (60 years or
younger) with early stage breast carcinoma are limited. METHODS: Quality
of life of 103 women who had surgery (lumpectomy, 49; mastectomy, 54)
approximately 1 month before the start of the study was evaluated at
baseline and again after 5 months. Thirty-two women received
chemotherapy during the study. RESULTS: Over time, subjects reported
improvement in body image and physical, emotional, and functional
well-being (P < 0.001). They were less bothered by swollen/tender arms
and worried less about risk of cancer to family members (P < 0.001).
However, satisfaction with sex life, social support, and social/family
well-being declined (P < 0.001). In the period closer to surgery, women
with mastectomy reported poorer body image (P = 0.001) and worse
functional (P = 0.08) and physical well-being (P = 0.10). Women with
lumpectomy worried more about the effects of stress on their illness (P
< 0.01) and had lower emotional well-being (P = 0.06). By 6 months after
surgery, the two groups reported similar QOL scores. Chemotherapy had a
negative impact on women's sexual functioning (P = 0.01) and their
physical well-being (P = 0.09). Women who received chemotherapy also
reported more shortness of breath (P = 0.07). Post hoc analysis showed
that women with breast reconstruction had higher emotional well-being at
baseline than those with lumpectomy (P = 0.001) and mastectomy alone (P
< 0.01). CONCLUSIONS: Younger women with breast carcinoma could
experience a range of adjustment problems at various points in the
treatment cycle. Interventions that would help reduce the negative
impact of treatment on QOL need to be designed and integrated into
routine clinical practice. Copyright 2001 American Cancer Society.
3
UI - 21423011
AU - Kricker A; Haskill J; Armstrong BK
TI -
Breast conservation, mastectomy and axillary surgery in New South Wales
women in 1992 and 1995.
SO - Br J Cancer 2001 Sep 1;85(5):668-73
AD - National Breast Cancer Centre, NSW Cancer Council, Sydney, Australia.
To measure the increase in uptake of BCT in NSW and its determinants, we
examined Cancer Registry records of 2020 women with breast cancer in
1992 and 2883 in 1995 linked to records of their surgical treatment in
the NSW Inpatient Statistics' Collection. In parallel, we examined
trends and determinants in axillary surgery for breast cancer. Breast
conservation increased from 39% of breast cancer in 1992 to 45% in 1995,
mainly in women with the smallest cancers. In 1995, mastectomy was still
most common in women with larger cancers (OR for breast cancers 3+ cm
relative to <1 cm = 5.6, 95% CI 2.9-10.7) and cancers that had spread
beyond the breast (OR = 2.0, 95% CI 1.4-2.7 relative to localized to the
breast). Urban women had fewer mastectomies than rural women. Axillary
surgery, common in 1992 (78%) and 1995 (82%), fell steeply with
increasing age and more often accompanied mastectomy (93% in 1995) than
BCT (67% in 1995). In 1995 the odds for axillary surgery were some
two-fold or more higher for all cancers 1 cm or more in diameter
compared with those <1.0 cm and highest for 2.0-2.9 cm cancers (OR = 3.3
95% CI 1.7-6.7 relative to <1.0 cm). Regional spread of the cancer at
diagnosis was not a strong predictor. In the absence of collection of
treatment data by cancer registries, linkage of cancer registry records
with hospital inpatient data is an effective alternative for monitoring
breast cancer treatment trends. Copyright 2001 Cancer Research Campaign.
4
UI - 21426106
AU - Flierl D; Hanker JP
TI -
[Oncoplastic techniques for immediate reconstruction with nipple-areolar
preservation following radical resection of a centrally located breast
cancer]
SO - Zentralbl Gynakol 2001 Jul;123(7):399-402
AD - Geburtshilflich-gynakologische Abteilung, Krankenanstalt Mutterhaus der
Borromaerinnen in Trier, Lehrkrankenhaus der Universitat Mainz.
There are few breast-conserving therapies (BCT) for centrally located
breast cancer. The present paper describes a BCT for breast cancers in
such a location, which permits conservation of the nipple-areola complex
(NAC), provided this has not been infiltrated. After histological
detection of the breast cancer by punch biopsy, a central segmental
mastectomy and an axillary dissection are performed. An immediate
reconstruction of the subareolar defect is carried out by means of a
local flap technique, thus conserving the NAC.
5
UI - 21426107
AU - Peters J; Jacobi V; Kirchner J
TI -
[Optimization of the indications for breast biopsy by preoperative
conference]
SO - Zentralbl Gynakol 2001 Jul;123(7):403-10
AD - Rontgenabteilung des Bethanienkrankenhauses Frankfurt, Zentrum der
Radiologie der Universitatsklinik Frankfurt.
j.peters@em.uni-frankfurt.de
In connection with a series of second reviews of mammographies as part
of a preoperative conference, criteria are presented that allow a
correct diagnosis, thus avoiding unnecessary breast surgery. In
addition, it is shown that preoperatively all diagnostic findings must
be reviewed as a whole, in order to make the appropriate decision for
the patient. A total of 145 patients was admitted for breast surgery
between 1994 and 1997. Group 1: The mammographies of 133 patients were
re-evaluated and additional exams were performed. In only 17% (23 cases)
could the first diagnosis be confirmed and the patients went to surgery.
In 110 cases a single mammographic view sufficed to show that there was
no suspicious finding in the breast. Instead there was a pseudolesion,
not visible after an image had been taken with appropriate technique.
Group 2: For 12 additional patients, a synopsis of different findings
was presented and analysed at a preoperative conference. Even although
imaging may have been performed correctly, a conference can still
contribute to the optimization of indocations. Unnecessary breast
surgery can can thus be avoided.
6
UI - 21427140
AU - Stefanek M; Hartmann L; Nelson W
TI -
Risk-reduction mastectomy: clinical issues and research needs.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1297-306
AD - Behavioral Research Program, Division of Cancer Control and Population
Sciences, National Cancer Institute, Bethesda, MD, USA. ms496r@nih.gov
Risk-reduction mastectomy (RRM), also known as bilateral prophylactic
mastectomy, is a controversial clinical option for women who are at
increased risk of breast cancer. High-risk women, including women with a
strong family history of breast cancer and BRCA1/2 mutation carriers,
have several clinical options: risk-reduction surgery (bilateral
mastectomy and bilateral oophorectomy), surveillance (mammography,
clinical breast examination, and breast self-examination), and
chemoprevention (tamoxifen). We review research in a number of areas
central to our understanding of RRM, including recent data on 1) the
effectiveness of RRM in reducing breast cancer risk, 2) the perception
of RRM among women at increased risk and health-care providers, 3) the
decision-making process for follow-up care of women at high risk, and 4)
satisfaction and psychological status after surgery. We suggest areas of
future research to better guide high-risk women and their health-care
providers in the decision-making process.
7
UI - 21445117
AU - Wickerham DL
TI -
Ductal carcinoma-in-situ.
SO - J Clin Oncol 2001 Sep 15;19(18 Suppl):98S-100S
AD - National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
15212, USA.
8
UI - 21463149
AU - McDonnell SK; Schaid DJ; Myers JL; Grant CS; Donohue JH; Woods JE; Frost
TI -
MH; Johnson JL; Sitta DL; Slezak JM; Crotty TB; Jenkins RB; Sellers TA;
Hartmann LC
Efficacy of contralateral prophylactic mastectomy in women with a
personal and family history of breast cancer.
SO - J Clin Oncol 2001 Oct 1;19(19):3938-43
AD - Division of Medical Oncology, Mayo Clinic Cancer Center, Mayo Clinic and
Mayo Foundation, Rochester, MN 55905, USA.
PURPOSE: To estimate the efficacy of contralateral prophylactic
mastectomy in women with a personal and family history of breast cancer.
PATIENTS AND METHODS: We followed the course of 745 women with a first
breast cancer and a family history of breast and/or ovarian cancer who
underwent contralateral prophylactic mastectomy at the Mayo Clinic
between 1960 and 1993. Family history information and cancer follow-up
information were obtained from the medical record, a study-specific
questionnaire, and telephone follow-up. Life-tables for contralateral
breast cancers, which consider age at first breast cancer, current age,
and type of family history, were used to calculate the number of breast
cancers expected in our cohort had they not had a prophylactic
mastectomy. RESULTS: Of the 745 women in our cohort, 388 were
premenopausal (age < 50 years) and 357 were post- menopausal. Eight
women developed a contralateral breast cancer. Six events were observed
among the premenopausal women, compared with 106.2 predicted, resulting
in a risk reduction of 94.4% (95% confidence interval [CI], 87.7% to
97.9%). For the 357 postmenopausal women, 50.3 contralateral breast
cancers were predicted, whereas only two were observed, representing a
96.0% risk reduction (95% CI, 85.6% to 99.5%). CONCLUSION: The incidence
of contralateral breast cancer seems to be reduced significantly after
contralateral prophylactic mastectomy in women with a personal and
family history of breast cancer.
9
UI - 21215901
AU - Gordon AB; Nasiri N; Gui GP; Sacks NP
TI -
Nipple excised and areola retained after total mastectomy (NEAT).
SO - J R Soc Med 2001 Apr;94(4):185-6
AD - Academic Surgery (Breast Unit), Royal Marsden NHS Trust, Fulham Road,
London SW3 6JJ, UK.
10
UI - 21330625
AU - Sato K; Hiraide H; Mochizuki H
TI -
[Sentinel lymph node (SLN) in breast cancer: prediction of axillary
metastasis confined to the SLN spares patients further axillary
dissection]
SO - Nippon Geka Gakkai Zasshi 2001 Jun;102(6):445-8
AD - Department of Surgery I, National Defense Medical College, Tokorazowa,
Japan.
Although regional control of the axilla in patients with breast cancer
is important, axillary lymph node dissection (ALND) is performed mainly
for staging purposes. The sentinel lymph node (SLN) that first receives
lymphatic drainage from the tumor was investigated. After SLN
identification, ALND or radiation therapy is performed in patients with
SLN metastasis who are also likely to have non-SLN metastasis. However,
it is important to select patients with SLN metastasis who may benefit
from further axillary treatment. The size of the primary tumor and the
size of its SLN metastasis are reported to be associated with the
presence of non-SLN metastases. Patients in whom the SLN indicates less
than 20% of nodes are involved have a low probability of non-SLN
involvement and therefore can avoid further axillary treatment. Although
large clinical trials are necessary for confirmation, it appear, that
patients with axillary involvement confined to the SLN can be spread
further ALND.
11
UI - 21330629
AU - Masuda N; Tamaki Y; Noguchi S
TI -
[Management of axillary and internal mammary lymph nodes in primary
breast cancer]
SO - Nippon Geka Gakkai Zasshi 2001 Jun;102(6):465-72
AD - Department of Surgery and Clinical Oncology, Graduate School of
Medicine, Osaka University, Suita, Japan.
Axillary lymph node dissection (ALND) is an effective staging procedure
and is essential for local control of breast cancer. The regimen of the
adjuvant systemic therapy is largely based on the number of nodes
involved. There is as yet no evidence of survival benefit from axillary
treatment by either surgery or radiotherapy, but this issue remains
controversial. In general, the standard treatment of the axilla is
surgical clearance of nodes from level I and II (partial ALND). If these
nodes are involved, the clearance of level III nodes (complete ALND) is
indispensable from the viewpoint of local control. Because a high rate
of adverse events is observed, the extent of ALND should be determined
by considering the balance between side effects and therapeutic benefit
on a case-by-case basis. For the management of internal mammary nodes,
most reports on randomized trials indicate that neither surgical
treatment nor radiotherapy influences survival. However, the prognostic
significance of internal mammary node status is high and a selected
biopsy of lymph nodes with adenopathy should be considered for staging
purposes. The significance of local control in this region is still
controversial at present. About 30% to 40% of all invasive breast
cancers are node positive. Thus, in most cases, the potential morbidity
of ALND could be avoided if the status of the axillary nodes was
ascertained with a less invasive procedure. The technique of sentinel
lymph node biopsy may eventually prove to decrease the need for standard
ALND. The randomized trial NSABP-B32 is ongoing and the results should
indicate the clinical need for ALND.
12
UI - 21348299
AU - Cady B
TI -
Sentinel lymph node biopsy as an alternative to routine axillary lymph
node dissection in breast cancer patients.
SO - J Surg Oncol 2001 Jul;77(3):149-52
13
UI - 21438121
AU - Canizares F; Sola J; Perez M; Tovar I; De Las Heras M; Salinas J;
TI -
Penafiel R; Martinez P
Preoperative values of CA 15-3 and CEA as prognostic factors in breast
cancer: a multivariate analysis.
SO - Tumour Biol 2001 Sep-Oct;22(5):273-81
AD - Department of Clinical Chemistry, University Hospital Virgen de la
Arrixaca, Murcia, Spain. fcanizares@hvax.insalud.es
The role of circulating tumor markers in providing prognostic
information has not been widely studied. In the current study, serum
levels of the carbohydrate antigen 15-3 (CA 15-3) and carcinoembryonic
antigen (CEA) were determined preoperatively in 364 breast cancer
patients with no clinical signs of metastasis. The prognostic relevance
of these markers for recurrence (175/364) and death of disease (104/175)
was determined by Cox multivariate analysis, including the comparison
with classical prognostic factors. High levels of both tumor markers
were associated with aneuploid tumors with high S-phase fraction and
high ornithine decarboxylase activity. CA 15-3 was highly associated
with the number of positive lymph nodes and peritumoral lymphatic or
blood vessel invasion. No significant associations were found between
CEA or CA 15-3 levels and histologic grade, necrosis and steroid
receptor status. In univariate analysis, preoperative values, using
optimum cutoff values of CA 15-3 (40 U/ml) and CEA (6 ng/ml), were
statistically significant for relapse-free survival and overall
survival. In multivariate analysis, only node status, DNA ploidy and
ornithine decarboxylase activity were independent predictors for
relapse-free survival; the estrogen receptor status was a predictor of
overall survival. In node-negative patients, ornithine decarboxylase
activity was the only factor selected for relapse-free survival. In
node-positive patients, the number of lymph nodes and DNA ploidy were
the only variables selected for relapse-free survival or overall
survival. Estrogen receptor and ornithine decarboxylase activity were
excluded for relapse-free survival, but were significant prognostic
factors for overall survival. Copyright 2001 S. Karger AG, Basel
14
UI - 21438130
AU - Montero S; Guzman C; Vargas C; Ballestin C; Cortes-Funes H; Colomer R
TI -
Prognostic value of cytosolic p53 protein in breast cancer.
SO - Tumour Biol 2001 Sep-Oct;22(5):337-44
AD - Division of Medical Oncology, Hospital Universitario 12 de Octubre,
Madrid, Spain. sagrariomontero@hotmail.com
The prognostic value of cytosolic p53 protein was evaluated in 458
operable breast carcinomas by immunoblotting using the monoclonal
antibody PAb 1801. Two hundred and five carcinomas (45%) showed positive
p53 accumulation and 55% were p53 negative. When comparing p53
positivity and other clinicopathological parameters, significant
differences were found with younger age (p = 0.017), premenopausal
status (p = 0.003), increasing tumor size (p = 0.026), negative estrogen
receptor (p = 0.003) and negative progesterone receptor (p = 0.047), but
not with histologic grade, axillary lymph node status, stage or erbB-2
expression. With a median follow-up of 34 months (range 3-70), relapse
has occurred in 73 patients. Disease-free survival curves showed that
patients with p53-positive tumors had a significantly shorter
disease-free survival than patients with p53-negative carcinomas
(log-rank test, p = 0.027). A multivariate analysis of disease-free
survival showed that p53, tumor size, histologic grade and progesterone
receptor had significant independent prognostic value. The
immunoblotting technique was controlled with p53 immunohistochemistry in
94 paired samples. We obtained a statistically significant correlation
(p = 0.0004) between the two methods. Our results show that the
immunoblotting technique offers an alternative approach in evaluating
the p53 status of breast biopsy material using cytosolic extracts, and
confirm that p53 accumulation is a significant independent indicator of
a poor prognosis in operable breast carcinoma. Copyright 2001 S. Karger
AG, Basel
15
UI - 21414320
AU - Henry-Tillman R; Johnson AT; Smith LF; Klimberg VS
TI -
Intraoperative ultrasound and other techniques to achieve negative
margins.
SO - Semin Surg Oncol 2001 Apr-May;20(3):206-13
AD - Department of Surgery, Division of Breast Surgical Oncology, University
of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR
72205, USA.
Over the past few decades new procedures and technologies have been
introduced into clinical practice for the evaluation and management of
breast disease. Ultrasound is rapidly becoming a valued tool in the
armamentarium of the breast surgeon. The use of ultrasound by
radiologists and breast surgeons to evaluate nonpalpalable detected
breast lesions has increased dramatically. With its easy portability and
improvements in the technology, the use of ultrasound has now expanded
into the operating room. In this work we review the value of
intraoperative ultrasound and other techniques in obtaining and
assessing margin status. Copyright 2001 Wiley-Liss, Inc.
16
UI - 21414321
AU - Rubio IT; Klimberg VS
TI -
Techniques of sentinel lymph node biopsy.
SO - Semin Surg Oncol 2001 Apr-May;20(3):214-23
AD - Division of Breast Surgery, Hospital Santisima Trinidad, Salamanca,
Spain.
Axillary node status is the single most important prognostic factor for
patients with primary breast carcinoma. During the last decade, one of
the major advances in breast cancer has been the development of
techniques that make axillary staging less morbid and more conservative.
The sentinel lymph node (SLN) biopsy technique has received much
attention as a possible alternative to axillary lymph node dissection
(ALND). The SLN is defined as the first node in the regional lymphatic
basin that receives drainage of the primary tumor. We will review the
different techniques of lymphatic mapping for breast carcinoma,
including radioactive and/or blue dye indicators, timing and site of
injection, and preoperative lymphoscintigraphy. The SLN technique
involves a multidisciplinary team. It is therefore important that each
surgeon validate the technique in his or her own institution to ensure
the successful and accurate assessment of the axilla. The SLN technique
has modified the surgical management of breast cancer patients, although
questions as to its safety have yet to be answered. Copyright 2001
Wiley-Liss, Inc.
17
UI - 21414322
AU - Harlow SP; Krag DN
TI -
Sentinel lymph node--why study it: implications of the B-32 study.
SO - Semin Surg Oncol 2001 Apr-May;20(3):224-9
AD - Department of Surgery, University of Vermont College of Medicine,
Burlington, VT 05405-0068, USA.
Surgical removal of the regional lymph nodes by a level I and level II
axillary dissection remains the standard of care for patients with
surgically resectable breast cancer. Axillary dissection provides
accurate pathologic staging and excellent regional disease control, and
likely provides a small benefit in patient survival. Axillary
dissection, however, is associated with significant patient morbidity.
Sentinel lymph node (SLN) biopsy procedures have been found to provide
very accurate pathologic staging when compared to axillary dissection;
however, their effect on regional disease control and patient survival
is not yet known. The National Cancer Institute (NCI) has sponsored a
Phase III prospective, randomized clinical trial (the B-32 trial)
through the National Adjuvant Breast and Bowel Project (NSABP), to
compare results of patients treated with SLN biopsy alone vs. SLN biopsy
with completion axillary node dissection in patients with clinically
node-negative breast cancer. Results of this trial will provide evidence
of the safety of SLN biopsy procedures in the management of patients
with breast cancer. Copyright 2001 Wiley-Liss, Inc.
18
UI - 21414323
AU - Grube BJ; Giuliano AE
TI -
Observation of the breast cancer patient with a tumor-positive sentinel
node: implications of the ACOSOG Z0011 trial.
SO - Semin Surg Oncol 2001 Apr-May;20(3):230-7
AD - Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute at
Saint John's Health Center, 2200 Santa Monica Boulevard, Santa Monica,
CA 90404, USA.
Axillary lymph node status has been the most important prognostic factor
for breast cancer throughout the past century. During the past decade,
intraoperative lymphatic mapping with sentinel lymph node dissection
(SLND) has been investigated as an alternative staging modality. This
technique may be as accurate as ALND, and certainly is less invasive.
Adjuvant treatment recommendations, which historically were made on the
basis of lymph node status alone, now take into account primary tumor
features, molecular markers, and patient characteristics. This evolution
of current treatment patterns is driven in part by the diminishing size
of tumors, the simultaneous decrease in the presence of axillary
metastases, and a better understanding of tumor-specific risk factors.
How do these trends affect the interpretation of a tumor-positive
sentinel node (SN)? Can an axilla with a positive SN be observed? Should
it be observed? This review examines the implications of a positive SN
in the context of smaller tumor size, decreased nodal disease, and
increased reliance on alternative prognostic factors for treatment
decisions. The historical data comparing ALND to no ALND in clinically
node-negative patients is reviewed and discussed in the context of
observation for a positive SN. These are the issues underlying the
ACOSOG Z0010 and Z0011 trials. Copyright 2001 Wiley-Liss, Inc.
19
UI - 21414325
AU - Singletary SE
TI -
Minimally invasive techniques in breast cancer treatment.
SO - Semin Surg Oncol 2001 Apr-May;20(3):246-50
AD - Department of Surgical Oncology, University of Texas M. D. Anderson
Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
esinglet@mdanderson.org
Breast conservation therapy has largely replaced mastectomy as the
surgical treatment of choice for early-stage breast cancer. As the
sentinel lymph node mapping procedure, rather than routine axillary node
dissection, becomes the standard of care, the next challenge is how to
treat the primary tumor without surgery. Minimally invasive ablation of
the primary tumor is possible with a variety of approaches; the goal is
to either excise the tumor percutaneously or cool it (with cryotherapy)
or heat it (with radiofrequency ablation (RFA), focused ultrasound, or
laser interstitial therapy) sufficiently to cause complete cell death.
These developing technologies may provide treatment options that are
psychologically and cosmetically more acceptable to the patient than
traditional therapies, but they need further investigation to prove that
they are oncologically sound. This new frontier of surgery without
scalpels will require surgeons to develop radiologic expertise and to
acquire a basic understanding of molecular biology. Copyright 2001
Wiley-Liss, Inc.
20
UI - 21457413
AU - Lanzafame RJ
TI -
Surgical evolution: clinical practice catching up to tumor biology in
breast and colon cancer.
SO - J Clin Laser Med Surg 2000 Aug;18(4):171-2
21
UI - 21451040
AU - Jonkman JN; Normand SL; Wolf R; Borbas C; Guadagnoli E
TI -
Identifying a cohort of patients with early-stage breast cancer: a
comparison of hospital discharge and primary data.
SO - Med Care 2001 Oct;39(10):1105-17
AD - Department of Mathematics and Statistics, Mississippi State University,
Mississippi State, MS, USA.
BACKGROUND: Hospital discharge data are a potential source of
information for quality of care; however, they lack detailed clinical
data. OBJECTIVES: To assess the usefulness of hospital discharge data
for describing patterns of care. RESEARCH DESIGN: Cohort study comparing
hospital discharge data with data collected from medical records and
patients. PATIENTS: Women diagnosed with early-stage breast cancer in
Massachusetts and Minnesota (1993-1995). MEASURES: The percentage of
patients in the primary data set who did not match a record in the
discharge data set, and the percentage of patients in the discharge data
set who did not match a record in the primary data set. Odds ratios for
appearing in one data set, but not the other according to patient and
hospital characteristics. RESULTS: For patients in the primary data set,
26.9% from Massachusetts and 13.2% from Minnesota did not match a record
in the discharge data set. In both states, factors associated with
failure to match to the discharge data included receipt of breast
conserving surgery, shorter length of stay, and treatment hospital. For
patients in the discharge data set, 43.4% in Massachusetts and 30.3% in
Minnesota did not match a patient in the primary data set. In both
states, factors associated with failure to match to the primary data
included treatment hospital and the presence of positive lymph nodes.
CONCLUSIONS: Hospital discharge data were fairly sensitive when linked
to patients with early-stage breast cancer who were identified through
hospital records. The discharge data lacked specificity, however. If
discharge data are used to characterize patterns care for inpatients
with early stage disease, estimates are likely to be inaccurate due to
the inclusion of unsuitable patients in the denominator used to
calculate procedure rates.
22
UI - 21300168
AU - Vlastos G; Jean ME; Mirza AN; Mirza NQ; Kuerer HM; Ames FC; Hunt KK;
TI -
Ross MI; Buchholz TA; Buzdar AU; Singletary SE
Feasibility of breast preservation in the treatment of occult primary
carcinoma presenting with axillary metastases.
SO - Ann Surg Oncol 2001 Jun;8(5):425-31
AD - Department of Surgical Oncology, The University of Texas M.D. Anderson
Cancer Center, Houston 77030, USA.
BACKGROUND: The objective of the study was to compare the treatment
outcomes in patients with occult primary carcinoma with axillary lymph
node metastasis who were treated with mastectomy or with intent to
preserve the breast. METHODS: From 1951 to 1998, 479 female patients
were registered with axillary lymph node metastasis from an unknown
primary. After clinical workup, including mammography, 45 patients
retained this diagnosis and received treatment for T0 N1-2 M0 carcinoma
of the breast. Clinical and pathological data were collected
retrospectively, and survival was calculated from the date of initial
diagnosis using the Kaplan-Meier method. Median follow-up time was 7
years. RESULTS: Median age was 54 years (range, 32-79). Clinical nodal
status was N1 in 71% and N2 in 29% of the patients. Surgical treatment
was mastectomy in 29% and an intent to preserve the breast in 71% of the
patients. Locoregional radiotherapy was used in 71% and systemic
chemoendocrine therapy was used in 73% of the patients. Of the 13
mastectomy patients, only one had a primary tumor discovered in the
specimen. Two patients (4%) were ultimately diagnosed with lung cancer
and neuroendocrine tumor. No significant difference was detected between
mastectomy and breast preservation in locoregional recurrence (15%
versus 13%), distant metastases (31% versus 22%), or 5-year survival
(75% vs. 79%). Regardless of surgical therapy, the most important
determinant of survival was the number of positive nodes. Five-year
overall survival was 87% with 1-3 positive nodes compared with 42% with
> or =4 positive nodes (P < .0001). CONCLUSIONS: Occult primary
carcinoma with axillary metastases can be treated with preservation of
the breast without a negative impact on local control or survival.
23
UI - 21342878
AU - Spillane AJ; Kennedy CW; Gillett DJ; Carmalt HL; Janu NC; Rickard MT;
TI -
Donnellan MJ
Screen-detected breast cancer compared to symptomatic presentation: an
analysis of surgical treatment and end-points of effective mammographic
screening.
SO - ANZ J Surg 2001 Jul;71(7):398-402
AD - Sydney Cancer Centre, Camperdown, New South Wales, Australia.
BACKGROUND: Mammographic screening has been shown to reduce mortality
from breast cancer and to offer more opportunity for breast conservation
surgery (BCS). The minimum standards (or surrogate end-points) that need
to be achieved by a screening programme if it is to reduce mortality
have been derived from the Two County Study. Three surrogate end-points
that can be used to gauge the quality of the screening service are that
50% of the identified infiltrating cancers should be < 15 mm; at least
30% of grade 3 cancers should be < 15 mm; and 70% of screen-detected
cancers should have a negative axillary dissection. The present study
assesses these end-points of effective screening in an urban population
referred to The Strathfield Breast Centre (TSBC). The screening
end-points and surgical treatment of one group of women referred with a
BreastScreen New South Wales (NSW)-detected breast cancer (screen group)
were compared to all the other, mostly symptomatic, breast cancer
referrals (symptom group). The problems with the current pattern of
acceptance of mammographic screening in TSBC's referral area are
discussed. METHODS: A prospective non-randomized study was done via
analysis of the prospective database at The Strathfield Breast Centre
(TSBC). RESULTS: There were 224 women in the screen group and 657 women
in the symptom group. The mean tumour size was 18.1 mm in the screen
group and 22.1 mm in the symptom group. There were significantly more
small invasive cancers (< 15 mm) in the screen group (58%) compared with
the symptom group (33%; P < 0.001). In the screen group there were more
low-grade tumours but 30% of grade 3 tumours were < 15 mm compared with
16% in the symptom group (P = 0.009). In patients with invasive cancers
who underwent axillary dissection, there was a significant difference in
axillary node negativity, being 72% in the screen group and 59% in the
symptom group (P = 0.003). In the screen group 64% of women had BCS
compared with 51% in the symptom group (P = 0.002). CONCLUSIONS: These
end-points of effective mammographic screening were met in the
BreastScreen NSW group of women who were referred to TSBC despite the
biases involved which could lessen the effectiveness of the screening
programme. This crudely translated into a significant reduction in
breast cancer mortality but selection and lead time bias has to be taken
into account in evaluation of these data. There was a significantly
greater chance of BCS in the screen group.
24
UI - 21385557
AU - Harms SE
TI -
MR-guided minimally invasive procedures.
SO - Magn Reson Imaging Clin N Am 2001 May;9(2):381-92, vii
AD - Department of Radiology, University of Arkansas for Medical Sciences,
Little Rock, Arkansas 72205, USA. steven.harms@med.va.gov
This article outlines the integration of breast MR imaging minimally
invasive therapy for breast tumors. Technical obstacles discussed
include accurate determination of margins, DCIS, and localization
methods. Treatment methods such as cryotherapy, interstitial
hyperthermia, and focused ultrasound are discussed. Other subjects
include the amount of minimally-invasive therapy performed to date and
the ethical dilemma of clinical trials.
25
UI - 21468706
AU - Bold RJ; Fahy BN
TI -
Practice patterns in sentinel lymph node biopsy.
SO - J Am Coll Surg 2001 Oct;193(4):466-7
26
UI - 20468681
AU - Sufi PA; Gittos M; Collier DS
TI -
Circum-areolar mastectomy with immediate reconstruction (CAMIR).
SO - Eur J Surg Oncol 2000 Aug;26(5):461-3
AD - The Breast Unit, Basildon and Thurrock NHS Trust, Basildon Hospital,
Nethermayne, UK.
AIMS: To develop an oncologically safe and aesthetically acceptable
technique for mastectomy using a myocutaneous flap and tissue expander
for patients with neoplastic involvement of the nipple. METHODS:
Fourteen consecutive patients (mean age 40 years) underwent a
circum-areolar mastectomy with immediate reconstruction using a
latissimus dorsi myocutaneous flap and tissue expander. Assessment of
cosmesis was by review of pre- and post-operative photographs by an
independent observer. RESULTS: During a mean follow-up of 11.4 months
there have been no local recurrences. There were two deaths: pulmonary
embolus (one) and distant metastatic disease (one). Assessment of
cosmesis gave a score of 47 out of 56 (84%). CONCLUSIONS: In patients
with tumours involving the nipple, mastectomy with immediate
reconstruction may be used to achieve a good cosmetic result. The
replacement nipple is fashioned from a circle of skin attached to the
latissimus dorsi myocutaneous harvest.
27
UI - 21060732
AU - MacKenzie D; Moiemen N; Frame JD
TI -
Pyoderma gangrenosum following breast reconstruction.
SO - Br J Plast Surg 2000 Jul;53(5):441-3
AD - St Andrews Centre, Broomfield Hospital, Chelmsford, UK.
Pyoderma gangrenosum is an unusual cause of skin necrosis following
surgery, particularly in those without an associated systemic condition.
There have been reports of the condition in this context but not in
relation to breast reconstruction. We present a case of pyoderma
gangrenosum following latissimus dorsi flap reconstruction of a breast.
Copyright 2000 The British Association of Plastic Surgeons.
28
UI - 21266919
AU - Gendy RK
TI -
Re. Sufi A, Gittos M, Collier DS. Circum-arealar mastectomy with
immediate reconstruction (CAMIR). Eur J Surg Oncol 2000; 26: 461-463.
SO - Eur J Surg Oncol 2001 Apr;27(3):333-4
29
UI - 80181732
AU - Annas GJ
TI -
Breast cancer: the treatment of choice.
SO - Hastings Cent Rep 1980 Apr;10(2):27-9
30
UI - 85276849
AU - Perr IN
TI -
Right to refuse treatment and delayed medical care for psychiatric
patients.
SO - Am J Psychiatry 1985 Sep;142(9):1127
31
UI - 83095743
AU - Harrison EC; Stovall-Hurdle L
TI -
"A woman has an inherent right.".
SO - Va Med 1982 Nov;109(11):748-9
32
UI - 80189872
AU - Annas GJ
TI -
Radical faith: the right stuff?
SO - Nurs Law Ethics 1980 Apr;1(4):3, 7
33
UI - 85011721
AU - Lucas MG; Mitchell A; Lee EC
TI -
Failure to enter patients to randomised study of surgery for breast
cancer.
SO - Lancet 1984 Oct 20;2(8408):921-2
34
UI - 90359997
AU - Jack WJ; Chetty U; Rodger A
TI -
Recruitment to a prospective breast conservation trial: why are so few
patients randomised?
SO - BMJ 1990 Jul 14;301(6743):83-5
AD - Scottish Cancer Trials Office (MRC), Medical School, University of
Edinburgh.
OBJECTIVE--To investigate the rate of recruitment to early breast cancer
trials and elucidate the reasons for ineligibility and refusal to
participate among patients otherwise suitable for these trials.
DESIGN--Prospective study of one year's cohort of patients referred to a
breast unit with special reference to the subgroup suitable for
conservation management and to the proportion eligible for and (after
informed consent) ultimately randomised within the Scottish early breast
cancer trials. SETTING--The breast unit, Longmore Hospital, Edinburgh,
during 1988. PATIENTS--All 3054 patients referred to the breast unit
during the year. 324 Found to have invasive breast cancer and 147
initially thought suitable for conservation management. RESULTS--63
Patients were treated by mastectomy, 19 of whom requested mastectomy
rather than conservation management. 84 Patients were excluded from
trials, and of the 63 eligible patients, 40 gave informed consent. Most
of the 23 patients who refused the trials requested a specific adjuvant
treatment after discussion of their management and the trials.
CONCLUSIONS--Recruitment to prospective trials in which informed consent
is required before randomisation may be slower than predicted because of
a high proportion of exclusions and also refusal by patients. Trials may
therefore take longer to complete and give distorted results by virtue
of the unpredictable nature of the selection of patients.
35
UI - 94083114
AU - Morris J
TI -
Surgical treatment for early breast cancer: should the patient decide?
SO - Eur J Cancer 1993;29A(13):1801-3
AD - York Health Economics Consortium, University of York, Heslington, U.K.
Conservative surgery followed by a course of radiotherapy has been shown
to be as effective as mastectomy in terms of survival and disease-free
interval. This has led to an increase in the number of surgeons who
undertake conservative surgery for early breast cancer. However, some
studies have shown that, when offered a choice of surgery, some women
elect mastectomy. Such results highlight the need for patients to be
fully involved in the decision made about surgery, especially in the
circumstances where there is more than one surgical option and a choice
of surgery can be offered.
36
UI - 94202416
AU - Rennie D
TI -
Breast cancer: how to mishandle misconduct.
SO - JAMA 1994 Apr 20;271(15):1205-7
37
UI - 94260778
AU - Anonymous
TI -
What is truth?
SO - Lancet 1994 Jun 11;343(8911):1443-4
38
UI - 95018916
AU - Lerner HJ
TI -
Mishandling misconduct: the NSABP lumpectomy trial. National Surgical
Adjuvant Breast and Bowel Project.
SO - JAMA 1994 Oct 19;272(15):1167-8
39
UI - 94182127
AU - Anderson C
TI -
Breast cancer. How not to publicize a misconduct finding.
SO - Science 1994 Mar 25;263(5154):1679
40
UI - 96369591
AU - Nattinger AB; Hoffman RG; Shapiro R; Gottlieb MS; Goodwin JS
TI -
The effect of legislative requirements on the use of breast-conserving
surgery.
SO - N Engl J Med 1996 Oct 3;335(14):1035-40
AD - Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
53226, USA.
BACKGROUND: We studied the effect of state legislation requiring the
disclosure of options for the treatment of breast cancer on the use of
breast-conserving surgery in clinical practice. METHODS: The National
Cancer Institute's Surveillance, Epidemiology, and End Results registry
provided data on women from 30 through 79 years of age who underwent
breast-conserving surgery or mastectomy for local or regional breast
cancer from 1983 through 1990. We examined the trend over time in use of
breast-conserving surgery among patients in four sites (Connecticut,
Iowa, Seattle, and Utah) where there were no state laws specifically
requiring the disclosure of options for the treatment of breast cancer
by physicians. For four additional sites (Detroit, Atlanta, New Mexico,
and Hawaii) that had such legislation, we determined whether the rate of
breast-conserving surgery after the legislation was different from the
expected rate. RESULTS: An attorney rated the legislation as giving most
direction to physicians in Michigan, followed by Hawaii, Georgia, and
New Mexico. The rate of breast-conserving surgery was up to 8.7 percent
higher than expected in Detroit for six months after the passage of the
Michigan law (P<0.01). The rate was up to 13.2 percent higher than
expected in Hawaii for 12 months after that state's law was passed
(P<0.05) and up to 6.0 percent higher than expected in Atlanta for 3
months after the passage of the Georgia law (P<0.01). After these
transient increases, the surgery rates reverted to the expected levels.
No significant effect was detected in New Mexico, where only a
resolution without legal force was passed. CONCLUSION: Legislation
requiring physicians to disclose options for the treatment of breast
cancer appeared to have only a slight and transient effect on the rate
of use of breast-conserving surgery.
41
UI - 21296758
AU - Barillari P; Leuzzi R; Bassiri-Gharb A; D'Angelo F; Aurello P;
TI -
Naticchioni E
[Ambulatory surgical treatment for breast carcinoma]
SO - Minerva Chir 2001 Feb;56(1):55-9
AD - Universita degli Studi di Roma, La Sapienza, Roma.
BACKGROUND: The aim of the study is to demonstrate the feasibility and
the oncologic effectiveness of quadrantectomy plus sentinel node biopsy
performed under local anesthesia, and to demonstrate the economic and
patients affected with clinical T1 N0 breast cancer, underwent
quadrantectomy or tumor resection plus sentinel node biopsy and
clinically suspicion axillary nodes biopsy, under local anesthesia at
the Casa di Cura "Villa Mafalda" in Rome. RESULTS: Twenty tumors were
T1a, 26 T1b e 25 T1c. A mean of 2 sentinel nodes (range 1-4) and a mean
of 8 axillary nodes were removed during the procedure. In 2 cases
sentinel nodes were not identified. Intraoperative histologic
examination showed metastatic sentinel nodes in 11 cases. An axillary
node dissection was performed in all cases (>12 nodes) and no other
metastatic nodes were found. In all patients clinically suspected nodes
were removed. In two cases no evidence of metastasis was found in
sentinel nodes, while histologic examination revealed in a patient
micrometastasis in one node, and in another patient two metastatic
nodes. CONCLUSIONS: Fifty-three patients rated the overall surgical,
anesthetic and recovery experience as "very satisfactory", 13
"satisfactory" and 5 "unsatisfact
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