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Abramson Cancer CenterNCI CANCERLIT® Search: Surgery for Breast Cancer - April 2002
National Cancer Institute®
Last Modified: April 1, 2002
Table of Contents
1
UI - 11759819
AU - Richardson LC; Schulman J; Sever LE; Lee NC; Coate RJ
TI -
Early-stage breast cancer treatment among medically underserved women
diagnosed in a national screening program, 1992-1995.
SO - Breast Cancer Res Treat 2001 Sep;69(2):133-42
AD - Division of Cancer Prevention and Control, Centers for Disease Control
and Prevention, Atlanta, GA 30333, USA. lfr8@cdc.gov
BACKGROUND: Little research has been conducted on the breast cancer
treatment of low income, underserved women. This study was designed to
describe initial treatment of breast cancer among low-income women
diagnosed through federally funded screening programs in Detroit,
Michigan, and the states of New Mexico and California; and to compare
the treatment received by program women with early-stage breast cancer
with that of all women diagnosed in those regions. METHODS: Data from
the three screening programs were linked with cancer registry data from
the corresponding geographic areas. All women diagnosed between 1992 and
1995 through the state-based screening programs and all women
contemporaneously diagnosed with breast cancer in the three regions were
studied. Descriptive analyses were done of the proportion of women with
breast cancer receiving treatment; the proportion of early-stage breast
cancer (stage I or II) cases treated with breast-conserving surgery, and
the proportion treated with mastectomy; and among women with
breast-conserving surgery, the proportion receiving radiation therapy.
Logistic regression models controlled for age and stage at diagnosis,
race or ethnicity and geographic region. RESULTS: Less than 2% of
program women diagnosed with breast cancer received no treatment. More
than two of five women with early-stage breast cancer underwent
breast-conserving surgery, with 72% of these women receiving radiation
therapy. Multivariate regression analysis revealed that women with stage
IIA or IIB breast cancer had lower odds of undergoing breast-conserving
surgery than women with stage I (0.51 [95% CI = 0.30-0.87] and 0.36 [95%
CI = 0.19-0.70], respectively). Women over age 65 and those with
incompletely staged cancer had the lowest odds for receiving radiation
therapy after breast-conserving surgery (0.29 [95% CI = 0.09-0.99] and
0.14 [95% CI = 0.03-0.72], respectively). Women diagnosed through the
screening programs had odds of undergoing breast-conserving surgery
similar to those of all women in the regions (1.11 [95% CI= 0.89-1.39]).
CONCLUSIONS: Treatment patterns for women diagnosed with early-stage
breast cancer through three state-based screening programs appear to
have been similar to those reported in the literature. In addition,
their treatment appears to have been similar to that of other women
during the same time period.
2
UI - 11740672
AU - Wersebe A; Xydeas T; Clauss T; Dietz K; Belka C; Fersis N; Claussen CD;
TI -
Muller-Schimpfle M
[Quantitative assessment of therapy related effects after breast
conserving therapy with dynamic MRI of the breast]
SO - Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2001
Dec;173(12):1109-17
AD - Abteilung fur Radiologische Diagnostik, Universitatsklinikum Tubingen,
Germany. annika.wersebe@med.uni-tuebingen.de
PURPOSE: To quantify therapy related effects after breast conservation
therapy (BCT) with dynamic MRI of the breast. METHODS: Twenty patients
(median age 51 years) with breast conserving tumor excision were
included. Contrast enhanced dynamic MRI was performed before and 3, 6
and 12 months after adjuvant radiation therapy (RT) with a total dose of
50.0 to 50.4 Gy. The following sequences were applied: axial
fat-suppressed T(2)-weighted; coronal contrast enhanced 3D spoiled
gradient-echo (first measurement prior to the administration of 0.16
mmol/kg Gd-DTPA, six repetitive measurements); sagittal T(1)-weighted
Flash3D. Enhancement data were obtained using a computer software with
automated segmentation of regions of interest (ROIs). After defining
ROIs for skin, parenchyma and pectoral muscle of each breast the early
enhancement after the first post contrast measurement (E(1)) and the
slope of enhancement between the second and last postcontrast
measurement (SE(2-L)) were calculated. The edema was quantified by
assessing the signal intensities (SI) in the T(2)-weighted images. The
thickness of the skin was measured in the sagittal T(1)-weighted images.
RESULTS: Three months after RT statistically significant increases
between 51 and 179 % of the SI and E(1) quotients were detected for all
tissues compared to the examinations prior to RT. Six months after RT
the skin still presented a by 102 % significantly higher E(1) quotient,
and a by 140 % significantly increased SI quotient. No significant
differences for SI and E(1) quotients could be observed 12 months after
RT compared to the examinations prior to RT. A significant increase of
the SE(2-L) difference for the skin from 0.0225 to 0.0691 and 0.0665 was
found 3 and 6 months after RT, respectively. No significant differences
between the initial MR examination and the follow-up examinations 3, 6
and 12 months could be detected for the SE(2-L) differences of the
parenchyma. CONCLUSION: Early therapy related effects after BCT can be
exactly quantified with dynamic MRI using an automated ROI-segmentation
and whole breast analysis software. Both edema formation and early
enhancement show peaks 3 months after RT, and after 12 months there is
no statistically significant difference compared with baseline.
3
UI - 11776501
AU - Gregorio DI; Kulldorff M; Barry L; Samocuik H; Zarfos K
TI -
Geographical differences in primary therapy for early-stage breast
cancer.
SO - Ann Surg Oncol 2001 Dec;8(10):844-9
AD - Department of Community Medicine, University of Connecticut School of
Medicine, Farmington 06030-6205, USA. gregorio@nso.uchc.edu
BACKGROUND: Breast-conserving surgery may not be uniformly available to
all women. We evaluated geographical differences across Connecticut in
the proportions of cases with early stage breast cancer treated by
partial mastectomy (PM). We also looked at geographical variation in PM
with axillary lymph node dissection (AND) and PM with adjuvant
radiotherapy (RAD). METHODS: The Connecticut Tumor Registry identified
9106 cases of early disease for 1991 to 1995. Latitude-longitude
coordinates for place of residence at diagnosis and initial form of
therapy were available for 8795 records. A spatial scan statistic was
used to detect geographical differences in treatment rates across the
state. RESULTS: A total of 57.7% of early breast cancer cases were
treated by PM. Women living around New Haven were less likely than
others to be treated in that manner (relative risk [RR] = .86; P =
.0001), whereas those living around Norwalk were more likely (RR = 1.26;
P = .0001). PM with AND, relative to PM alone, was reported less often
for cases from a large area of southwestern Connecticut (RR = .89; P =
.0001), but more often for those in north central Connecticut (RR =
1.13; P = .0001). PM with RAD, relative to PM alone, was less common for
cases around Danbury (RR = .40; P = .0001) but more common among cases
around Hartford (RR = 1.14; P = .0001). CONCLUSIONS: Geographical
analysis is a way for physicians and health officials to identify groups
of women who may not yet benefit from preferred surgical procedures.
4
UI - 11776502
AU - Tanis PJ; Deurloo EE; Valdes Olmos RA; Rutgers EJ; Nieweg OE; Besnard
TI -
AP; Kroon BB
Single intralesional tracer dose for radio-guided excision of clinically
occult breast cancer and sentinel node.
SO - Ann Surg Oncol 2001 Dec;8(10):850-5
AD - Department of Surgery, The Netherlands Cancer Institute, Amsterdam.
ptanis@nki.nl
BACKGROUND: The purpose of this study was to determine the feasibility
of both lymphatic mapping and probe-guided primary tumor excision by use
of intralesional tracer administration in clinically occult breast
cancer. METHODS: Sixty patients with a clinically occult breast lesion
were prospectively included. Lymphoscintigraphy was performed after
intratumoral injection of 99mTc-labeled nanocolloid guided by ultrasound
or stereotaxis. A catheter over a localization wire was inserted for
intraoperative blue dye administration by using the same imaging
techniques. After sentinel node identification, the gamma-ray detection
probe was used for radio-guided wide local excision in patients who
underwent breast-conserving therapy. RESULTS: A sentinel node was
visualized on the scintigrams in 56 patients (93%) and could be
identified intraoperatively in 58 patients (97%). A sentinel node
contained tumor in 10 (17%) of these patients. Extra-axillary sentinel
nodes were visualized in 43%, were collected in 38%, and contained
metastasis in 7% of the patients. Complete excision of the primary tumor
could be accomplished in 39 (87%) of 45 patients. CONCLUSIONS: Both
sentinel node biopsy and probe-guided excision of a nonpalpable breast
cancer is feasible with the aid of intralesional tracer administration.
Sentinel node metastasis was found in 17% of the patients. A remarkably
high percentage of extra-axillary drainage (43%) was observed.
5
UI - 11801876
AU - Cody HS 3rd
TI -
Current surgical management of breast cancer.
SO - Curr Opin Obstet Gynecol 2002 Feb;14(1):45-52
AD - The Breast Service, Department of Surgery, Memorial Sloan Kettering
Cancer Center, and Cornell University Medical College, New York 10021,
USA. codyh@mskcc.org
Breast cancer surgery continues to become more conservative. Supporting
this conservatism are (1) earlier diagnosis through mammographic
screening, (2) an increasing role for diagnostic ultrasound and magnetic
resonance imaging, (3) the further development of image-guided
core-needle biopsy, and (4) the advent of sentinel lymph node biopsy as
an alternative to conventional axillary dissection. For patients with
duct carcinoma in situ, the addition of radiotherapy and tamoxifen to
surgical excision reduces local recurrence but has not yet improved
survival over the rate observed with excision alone. There may be
low-risk subgroups of duct carcinoma in situ patients for whom
conservative surgery alone is adequate treatment. For patients with
invasive cancer, breast conservation remains underutilized. A small
survival benefit from post-mastectomy adjuvant radiotherapy is offset by
an increased incidence of cardiovascular mortality, a phenomenon which
has not yet been demonstrated for radiotherapy following breast
conservation. Sentinel lymph node biopsy represents a new standard of
care for axillary lymph node staging in the large majority of breast
cancer patients with high-risk duct carcinoma in situ and stage I-II
invasive cancers. The procedure is feasible, accurate, and works best
with a combination of blue dye and radioisotope mapping. After proper
validation studies, patients with negative sentinel lymph nodes do not
require axillary dissection. The prognostic significance of sentinel
lymph node micrometastases identified by enhanced pathologic techniques
remains a matter of debate. Prophylactic mastectomy reduces breast
cancer incidence and mortality among those with a high-risk family
history, and mutations of BRCA1-2, but has significant adverse
psychosocial sequelae for a small and unpredictable fraction of patients
and should not be undertaken lightly. Prophylactic oophorectomy should
be offered to all women with BRCA1-2 mutations, especially those beyond
the years of childbearing.
6
UI - 11247064
AU - Marinova L; Todorov Y; Bildirev N; Koleva I; Zakhariev Z; Dimitrova V
TI -
[Factors influencing the cosmetic outcome in early breast cancer
patients following salvage surgery and radioisotope teletherapy]
SO - Khirurgiia (Sofiia) 1998;53(6):23-6
AD - University Hospital "Queen Joanna," Radiological Clinic, Sofia,
Bulgaria.
It is the purpose of the report to analyze the factors exerting effect
on the cosmetic outcome in breast cancer patients (I-II clinical stage),
following organ-salvaging operation in conjunction with
telegammatherapy. Assessment of the cosmetic results in 100 female
patients with early mammary gland cancer is done 5 years after complex
treatment (conservative surgery, postoperative radiotherapy, and chemo-
and/or hormonotherapy when indicated). The influence of eight factors on
the cosmetic outcome attained is evaluated through correlative
statistical analysis, namely: breast size, scope of the surgical
intervention, number of lymph nodes dissected, type of operative
cicatrix, dose exposure of the entire mamma, homogeneity of radiation
dose distribution in tre entire mammary gland, dose exposure of the
tumor bed and adjuvant therapy. The analysis performed points to the
important practical implications of three of the factors: size of
operative intervention (axillary dissection range), breast volume and
homogeneity of the irradiation dose in the entire breast.
7
UI - 11247065
AU - P'rvanova V
TI -
[Salvage therapy in early stage breast carcinoma. II. Radiotherapy - an
essential and necessary component in a new therapeutic approach]
SO - Khirurgiia (Sofiia) 1998;53(6):27-32
AD - National Oncological Center, Sofia, Bulgaria.
A concerving surgery in the treatment of early breast carcinoma
definitely need to be followed by radiotherapy to control local
recurrence of disease. However, the rate of local recurrence is lowest
with quadrantectomy versus tumotectomy, while the reverse is true as
regards cosmetic results. Progressive integration of the different
therapeutic approaches is expected to characterise the coming years, to
combine safety with good esthetic results.
8
UI - 11868452
AU - Lazar G; Ormandi K; Hajnal PR; Zollei I; Szentpali K; Paszt A; Kallai A;
TI -
Kahan Z; Balogh A
[Surgical treatment of non-palpable breast tumors]
SO - Orv Hetil 2002 Jan 13;143(2):77-81
AD - Szegedi Tudomanyegyetem, Szent-Gyorgyi Albert Orvos- es
Gyogyszeresztudomanyi Centrum, Altalanos Orvostudomanyi Kar, Sebeszeti
Klinika. lg@surg.szote.n-szeged.hu
METHOD: Between 1997 and 2000 the authors performed 110 fine-wire
localized breast biopsies in patients with nonpalpable suspicious
lesions. RESULTS: 108 target lesions (98.1%) were accurately excised
during the initial surgery. Overall, 56 lesions were malignant, among
these cases 50 invasive carcinomas and 6 DCIS were found. Breast
conservation was achieved in 48 patients (88.5%), simple mastectomy with
axillary lymph node sampling was performed in 8 cases. 86% of the
invasive malignant lesions belonged to the good prognostic subgroup of
the Nottingham Prognostic Index. CONCLUSION: There in an importance of
the close cooperation between radiologist, surgeon, pathologist and
oncologist in the treatment of nonpalpable preclinical breast
carcinomas.
9
UI - 11899394
AU - Hokanson P; Seshadri R; Miller KD
TI -
Underutilization of breast-conserving therapy in a predominantly rural
population: need for improved surgeon and public education.
SO - Clin Breast Cancer 2000 Apr;1(1):72-6
AD - MeritCare Roger Maris Cancer Center, Fargo, North Dakota, USA.
Though breast-conserving therapy (BCT) was first recommended as the
preferred treatment for women with early-stage breast cancer in 1990,
little is known about the factors influencing or limiting the use of BCT
in rural women. We retrospectively surveyed all surviving patients (227)
referred to the Roger Maris Cancer Center over a 2-year period. Disease
characteristics were verified by the tumor registry and random chart
review. Responses were obtained from 171 patients (75%), a median of 26
months from diagnosis. The majority of patients were from rural areas;
only 32% resided in towns with a population greater than or equal to
15,000. Thirty-five percent of those patients meeting published criteria
had BCT. Patients who underwent BCT were younger (mean age 56.8 vs.
62.5, P = 0.01), more likely to have benign axillary lymph nodes (82%
vs. 64%, P = 0.008), and more likely to be employed away from the home
(66% vs. 44%, P = 0.01) than patients who underwent mastectomy (MRM).
Distance from the nearest radiation facility did not affect treatment
decisions (mean: 59.5 miles BCT vs. 52.6 miles MRM). Most patients (83%)
ranked their surgeon as the most important source of information about
treatment options. Perceived surgical recommendations were generally
followed. Only three patients who felt their surgeon recommended MRM
underwent BCT; eleven patients chose MRM though they believed their
surgeon recommended BCT. The choice of local therapy is predominantly a
surgeon-driven process; logistical barriers unique to a rural population
had little impact. Unfortunately, many surgeons continue to apply much
more stringent criteria when recommending BCT than those in published
guidelines.
10
UI - 11870168
AU - Scheuer L; Kauff N; Robson M; Kelly B; Barakat R; Satagopan J; Ellis N;
TI -
Hensley M; Boyd J; Borgen P; Norton L; Offit K
Outcome of preventive surgery and screening for breast and ovarian
cancer in BRCA mutation carriers.
SO - J Clin Oncol 2002 Mar 1;20(5):1260-8
AD - Clinical Genetics, Breast Cancer Medicine, and Developmental
Chemotherapy Services, Department of Medicine, Memorial Sloan-Kettering
Cancer Center, New york, NY 10021, USA.
PURPOSE: To prospectively determine the impact of genetic counseling and
testing on risk-reduction strategies and cancer incidence in a cohort of
individuals at hereditary risk for breast and ovarian cancer. PATIENTS
AND METHODS: Two hundred fifty-one individuals with BRCA mutations were
identified at a single comprehensive cancer center from May 1, 1995,
through October 31, 2000. Uniform recommendations regarding screening
and preventive surgery were provided in the context of genetic
counseling. Patients were followed for a mean of 24.8 months (range, 1.6
to 66.0 months) using standardized questionnaires, chart reviews, and
contact with primary physicians. RESULTS: Frequency of cancer
surveillance by physical examinations and imaging studies increased
after genetic counseling and testing. Twenty-one breast, ovarian,
primary peritoneal, or fallopian tube cancers were detected after
receipt of genetic test results. Among 29 individuals choosing
risk-reducing mastectomy after testing, two were found to have occult
intraductal breast cancers. Among 90 individuals who underwent
risk-reducing salpingo-oophorectomy, one early-stage ovarian neoplasm
and one early-stage fallopian tube neoplasm were found. Radiographic or
tumor marker-based screening detected six breast cancers, five of which
were stage 0/I, one early-stage primary peritoneal cancer, and three
stage I or II ovarian cancers. Six additional breast cancers were
detected by physical examination between radiographic screening
intervals; four of these six tumors were stage I. No stage III or stage
IV malignancies were detected after genetic testing. CONCLUSION: This
study provides prospective evidence that genetic counseling and testing
increased surveillance and led to risk-reducing operations, which
resulted in diagnosis of early-stage tumors in patients with BRCA1 and
BRCA2 mutations.
11
UI - 11875706
AU - Millis RR; Springall R; Lee AH; Ryder K; Rytina ER; Fentiman IS
TI -
Occult axillary lymph node metastases are of no prognostic significance
in breast cancer.
SO - Br J Cancer 2002 Feb 1;86(3):396-401
AD - Hedley Atkins ICRF Breast Pathology Laboratory, Guy's Hospital, London
SE1 9RT, UK.
The significance of occult metastases in axillary lymph nodes in
patients with carcinoma of the breast is controversial. Additional
sections were cut from the axillary lymph nodes of 477 women with
invasive carcinoma of the breast, in whom no metastases were seen on
initial assessment of haematoxylin and eosin stained sections of the
nodes. One section was stained with haematoxylin and eosin, and one
using immunohistochemistry with two anti-epithelial antibodies (CAM5.2
and HMFG2). Occult metastases were found in 60 patients (13%). The
median follow-up was 18.9 years with 153 breast cancer related deaths.
There was no difference in survival between those with and those without
occult metastases. Multivariate analysis, however, showed that survival
was related to tumour size and histological grade. This node-negative
group was compared with a second group of 202 patients who had one
involved axillary node found on initial assessment of the haematoxylin
and eosin sections; survival was worse in the patients in whom a nodal
metastasis was found at the time of surgery. Survival was not related to
the size of nodal metastases in the occult metastases and single node
positive groups. Some previous studies have found a worse prognosis
associated with occult metastases on univariate analysis, but the
evidence that it is an independent prognostic factor on multivariate
analysis is weak. We believe that the current evidence does not support
the routine use of serial sections or immunohistochemistry for the
detection of occult metastases in the management of lymph node negative
patients, but that the traditional factors of histological grade and
tumour size are useful. Copyright 2002 The Cancer Research Campaign
12
UI - 11859495
AU - von Smitten K; Asko-Seljavaara S
TI -
[Surgical treatment of breast cancer being renewed]
SO - Duodecim 1999;115(6):617-8
13
UI - 11899651
AU - Blanchard DK; Hartmann LC
TI -
Prophylactic surgery for women at high risk for breast cancer.
SO - Clin Breast Cancer 2000 Jul;1(2):127-34; discussion 135
AD - Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Women at high risk for the development of breast cancer have several
options open to them including increased cancer surveillance,
prophylactic mastectomy and/or oophorectomy, and chemoprevention. We
consider high-risk women to be those with known BRCA mutations or a
strong family history characterized by multiple relatives with breast
cancer, early age at diagnosis, and in some families, ovarian cancer. We
present existing data regarding prophylactic surgery for these women.
Essentially, a woman at high risk for breast cancer may choose to
undergo bilateral prophylactic mastectomy, with or without
reconstruction. For patients who have a known breast cancer,
contralateral mastectomy is also an option. Finally, for women in
families with a strong incidence of ovarian cancer, prophylactic
oophorectomy can be considered.
14
UI - 11888866
AU - Wong JS; Harris JR
TI -
Can specific axillary radiotherapy be omitted in undissected, clinically
node-negative patients who undergo breast-conserving therapy?
SO - Ann Surg Oncol 2002 Mar;9(2):117-9
15
UI - 11888872
AU - Zurrida S; Orecchia R; Galimberti V; Luini A; Giannetti I; Ballardini B;
TI -
Amadori A; Veronesi G; Veronesi U
Axillary radiotherapy instead of axillary dissection: a randomized
trial. Italian Oncological Senology Group.
SO - Ann Surg Oncol 2002 Mar;9(2):156-60
AD - Department of Senology, European Institute of Oncology, Milan, Italy.
francesca.morelli@ieo.it
BACKGROUND: Surgical dissection of the axilla is a standard part of the
treatment of breast cancer but, by itself, does not improve prognosis;
furthermore, most patients with small-sized breast cancer and a
clinically uninvolved axilla never develop axillary metastases. We
evaluated disease-free and overall survival in patients with early
breast cancer treated by breast-conservation surgery without dissection
of axillary lymph nodes, receiving or not receiving axillary
radiotherapy (RT). METHODS: From 1995 to 1998, 435 patients older than
45 years with breast cancer up to 1.2 cm were randomized, 214 to breast
conservation without axillary treatment and 221 to breast conservation
plus axillary RT. RESULTS: After a follow-up of 28 to 68 months (median,
42 months), two women (1%) in the no axillary treatment group and one
(.5%) in the axillary RT group developed axillary metastases. Rates of
distant metastases and local treatment failure were also very low, and
5-year overall survival was 99%. CONCLUSIONS: After a mean of 46 months
of follow-up, our results indicate that axillary dissection can be
safely avoided in patients with very small invasive carcinomas and a
clinically negative axilla. Whether axillary RT should be added can be
assessed only by longer follow-up.
16
UI - 11920520
AU - Beer GM; Varga Z; Budi S; Seifert B; Meyer VE
TI -
Incidence of the superficial fascia and its relevance in skin-sparing
mastectomy.
SO - Cancer 2002 Mar 15;94(6):1619-25
AD - Clinic for Hand, Plastic, and Reconstructive Surgery, University
Hospital, Zurich, Switzerland. gertrude.beer@chi.usz.ch
BACKGROUND: With the move away from classical radical mastectomy to ever
more skin-sparing procedures, there has been an ongoing discussion about
how much skin and subcutaneous tissue should be resected to perform an
adequate mastectomy while leaving viable skin flaps. One of the common
recommendations is to dissect just superficial to the superficial layer
(SL) of the superficial fascia of the breast. This, in turn, has revived
the old, unsolved controversy about the existence or absence of the SL,
a fascia that reportedly encloses the mammary gland ventrally. In
skin-sparing mastectomies (SSM), which combine tumor resection with
immediate breast reconstruction, the ideal would be to create skin flaps
that are thin enough to remove all breast tissue but at the same time
are thick enough to preserve flap circulation. The feasibility of
meeting these two goals simultaneously and the possible role and
relevance of the SL as a guide to dissection in SSM was examined in this
study. METHODS: Sixty-two breast resection specimens from 31 women who
underwent breast reduction were examined histologically to determine
whether the SL was present, whether breast tissue could be detected
within or beyond this SL, the measured distance between the caudal
border of the dermis and the SL or the breast tissue, and whether the
thickness of the subcutaneous fat layer was correlated with the
patients' physical data, such as body weight or body mass index (BMI).
RESULTS: The SL was absent in 44% of resection specimens. When the SL
was present, 42% of specimens contained several islands of breast tissue
within the SL. No breast tissue was found beyond the SL. The minimal
distance between the SL and the dermis varied from 0.2 mm to 4.0 mm; the
minimal distance between the breast tissue and the dermis was 0.4 mm. In
50% of specimens, the minimal distance between the dermis and the SL or
breast tissue was < 1.1 mm. A distance of > or = 5 mm was encountered in
only 17% of specimens, and a distance of > or = 10 mm was encountered in
only 5% of specimens. No significant correlation between the right and
left breast was found with any of the parameters examined. A weak
negative correlation was seen between the BMI and the mean thickness of
the subcutaneous fat (P = 0.049; correlation coefficient [r] = -0.39;
Spearman rank correlation). CONCLUSIONS: Histologic evaluation revealed
that the SL is not present in all breasts and, thus, cannot serve as a
reliable plane of dissection. Furthermore, if the SL is present
microscopically, then it often is too thin and delicate to be detectable
macroscopically. Finally, even if the SL is present and visible
macroscopically, the distance to the overlying skin is so small in the
majority of patients that a dissection superficial to the SL would not
leave viable skin flaps in skin-sparing mastectomies. Copyright 2002
American Cancer Society.
17
UI - 11920556
AU - Polgar C; Orosz Z; Kovacs T; Fodor J
TI -
Breast-conserving therapy for Paget disease of the nipple: a prospective
European Organization for Research and Treatment of Cancer study of 61
patients.
SO - Cancer 2002 Mar 15;94(6):1904-5
18
UI - 11920493
AU - Caban ME; Nosek MA; Graves D; Esteva FJ; McNeese M
TI -
Breast carcinoma treatment received by women with disabilities compared
with women without disabilities.
SO - Cancer 2002 Mar 1;94(5):1391-6
AD - Department of Physical Medicine and Rehabilitation, Baylor College of
Medicine, Houston, Texas 77046, USA.
BACKGROUND: Disability may make it difficult to lie flat or abduct the
arm to deliver radiation therapy, imposing a high risk for
radiation-induced side effects or difficulty in positioning patients for
mammography. The goal of the current study was to determine the
differences in treatment options experienced by women with physical
disabilities compared with those without disabilities. METHODS: Chart
review of 234 women who underwent surgery for breast carcinoma between
conducted. Thirty-nine of the women had physical disabilities; the
remaining 195 women were without disabilities. Hierarchical logistic
regression was used to determine whether women with disabilities were
less likely than women without disabilities to be treated with
breast-conservation surgery (BCS) or neoadjuvant chemotherapy. RESULTS:
Women with disabilities underwent BCS 38% of the time, whereas women
without disabilities underwent BCS 49% of the time. Neither the presence
nor absence of disability (P = 0.146) nor patient age (P = 0.747) were
found to be significant predictors of BCS. However, the disease stage at
the time of the surgery was reported to be a significant predictor of
BCS (P = 0.007). The group of patients with disabilities received
neoadjuvant chemotherapy 13% of the time, whereas women without
disabilities received it 29% of the time. Disability was not found to be
a significant predictor of whether a patient received neoadjuvant
chemotherapy. Using hierarchical logistic regression, patient age was
found to be a significant predictor of neoadjuvant chemotherapy before
the disease stage was entered into the regression equation. There were
no data to support the hypothesis that breast carcinoma is at an
advanced stage when diagnosed in women with disabilities. CONCLUSIONS:
These findings are clinically significant in that they indicate that
women with disabilities are less likely to undergo BCS and are less
likely to receive neoadjuvant chemotherapy compared with women without
disabilities, but the difference did not reach statistical significance.
To the authors' knowledge, there are no data to support the hypothesis
that disabled women are diagnosed at a more advanced stage of disease
compared with women without disabilities. Copyright 2002 American Cancer
Society.
19
UI - 11919236
AU - Weir L; Speers C; D'yachkova Y; Olivotto IA
TI -
Prognostic significance of the number of axillary lymph nodes removed in
patients with node-negative breast cancer.
SO - J Clin Oncol 2002 Apr 1;20(7):1793-9
AD - Radiation Therapy Program, Breast Cancer Outcomes Unit, University of
British Columbia, Vancouver, British Columbia, Canada.
lweir@bccancer.bc.ca
PURPOSE: The objective of the study was to evaluate the association
between the number of lymph nodes removed at axillary dissection and
recurrence and survival for patients with node-negative invasive breast
cancer. PATIENTS AND METHODS: Subjects were 2,278 women with
pathologically node-negative invasive breast cancer, diagnosed from 1989
to 1993 in British Columbia, Canada. Women aged > or = 90 years, with
pure in-situ, bilateral invasive breast cancer or T4, N1, N2, or M1
stage, or who had axillary radiation were excluded. Two groups were
defined for analysis: node-negative with no systemic therapy (n = 1,468)
and node-negative with systemic therapy (n = 810). Median follow-up was
7.5 years. Prognostic variables assessed were age at diagnosis, tumor
size, tumor grade, invasion of lymphatics, veins, or nerves, estrogen
receptor status, and number of nodes removed. RESULTS: For patients not
receiving systemic therapy, regional relapse was significantly increased
with smaller numbers of nodes removed (P =.03). There was a trend toward
shorter overall survival with fewer nodes removed (P =.06).
Node-negative patients who received systemic therapy did not have a
higher regional relapse rate or shorter overall survival when fewer
nodes were recovered. CONCLUSION: Recovery of a small number of negative
lymph nodes at axillary dissection likely understages patients and leads
to undertreatment, resulting in an increased regional relapse rate and
poorer survival. The use of systemic therapy may overcome this effect.
The number of nodes removed, in conjunction with other prognostic
factors, may be useful in selecting node-negative patients for systemic
therapy.
20
UI - 11680099
AU - Fodor J; Polgar C; Peley G; Nemeth G
TI -
[Management of the axilla in breast cancer: evidences and unresolved
issues]
SO - Orv Hetil 2001 Sep 9;142(36):1941-50
AD - Sugarterapias Osztaly, Orszagos Onkologiai Intezet, Budapest.
In this study the evidences governing the management of the axilla were
examined and on the base of these evidences, the optimal clinical
practice was outlined. Computerized searches for publications, debating
specific treatment of axilla, were done of MEDLINE data. Level of
evidence was determined using standard criteria: 1. metaanalysis of
randomized trials, 2. randomized trial, 3. prospective and retrospective
studies, 4. reports and opinion of expert committees and working teams.
The probability of lymph node involvement is related directly to the
size of the primary tumour, and even with small tumour (up to 10 mm),
the risk of nodal metastases is in the order of 10-20%. To date, the
best strategy for determining complete lymph node status (qualitative
and quantitative information) is through axillary dissection. For an
accurate staging, at least ten nodes have to be obtained. Formal
axillary sampling does not provide total quantitative data in patients
with involved axilla. Sentinel node biopsy is a promising alternative to
axillary dissection for staging but it is still under way. Axillary
dissection should be omitted in patients with ductal carcinoma in situ
since the probability of nodal involvement is less than 1%. In invasive
breast cancer, the risk of axillary recurrence in the untreated axilla
varies from about 10% to 40%. For women with stage I-II breast cancer at
least level I and II axillary node dissection should be offered as the
standard procedure to reduce the risk of regional recurrence. Women at
high risk of axillary recurrence (> or = 4 involved nodes, < 6 nodes
were obtained from a positive axilla) will require axillary irradiation
after axillary dissection. However, there is a lack of higher level
evidence to support the benefit of post-dissection axillary irradiation.
Evidences suggest that axillary irradiation is as effective as axillary
dissection in preventing regional recurrence. The following factors have
to be considered for decisions regarding dissection or irradiation:
patient wishes, general condition, age, the necessity of pathological
nodal status for systemic therapy and the risk of post-treatment
morbidity. At this time, there is no well defined subgroup of patients
in whom axillary intervention can be safely omitted. In selected
patients with clinically negative axilla, the decision to observe the
axilla rather than use surgery or irradiation should be made jointly
between the women and her specialists (surgeon, radiation and medical
oncologist). The benefits of axillary treatment in prolonging survival
are unclear. Studies have reported different effects on survival. Until
evidences remain insufficient, the risk of axillary recurrence has to be
minimized, and more and more patients have to be provide to get
treatments in randomized clinical trials. Patient should be fully
informed about the benefits and the potential side effects of
treatments. A combination of radiotherapy and axillary dissection
results an increased morbidity rate compared with either alone.
21
UI - 11780698
AU - Lawrence GA; Crawford J
TI -
Maximizing radiation benefit in breast cancer.
SO - Oncology (Huntingt) 2001 Dec;15(12):1545-6
22
UI - 11783592
AU - Balzarini A; Milella M; Civelli E; Sigari C; De Conno F
TI -
Ultrasonography of arm edema after axillary dissection for breast
cancer: a preliminary study.
SO - Lymphology 2001 Dec;34(4):152-5
AD - Department of Rehabilitation and Palliative Care, National Cancer
Institute, Milan, Italy.
This work examined whether ultrasonography (US) provides detailed
information about physical characteristics of lymphedema and whether
there is agreement between imaging and clinical data. The study
population included 46 women with chronic arm edema after axillary
dissection for breast cancer. US showed in each patient an increase of
subcutaneous tissue thickness compared with the contralateral arm. Fluid
accumulation was seen in 16 patients (34.7%), fibrosis in 12 (26.0%),
and a mixed picture (fibrosis and fluid) in 18 (39.1%). Correlation with
clinical information ("soft," "medium," "hard, "and "pitting" edema)
demonstrated that US documented interstitial fluid in 68.4% of soft
edema, mixed fluid and fibrosis in 64.2% of medium edema, and fibrosis
in 76.9% of hard edema. Ultrasonography also showed that in soft and
medium edema, fibrosis may already have formed. US is useful to follow
progression, composition, and management of arm lymphedema after
axillary dissection.
23
UI - 11898259
AU - Sener SF
TI -
Sentinel lymphadenectomy for breast cancer. A standard of surgical care?
SO - Cancer Pract 2000 Jul-Aug;8(4):195-6
AD - Northwestern University Medical School, Chicago, Illinois, USA.
24
UI - 11898233
AU - Baron RH; Kelvin JF; Bookbinder M; Cramer L; Borgen PI; Thaler HT
TI -
Patients' sensations after breast cancer surgery. A pilot study.
SO - Cancer Pract 2000 Sep-Oct;8(5):215-22
AD - Breast Surgical Oncology Department, Memorial Sloan-Kettering Cancer
Center, New York, New York, USA.
PURPOSE: The purpose of this study was to obtain information about the
prevalence and characteristics of breast sensations after breast cancer
surgery, the impact they had on patients, and aggravating and relieving
factors. DESCRIPTION OF STUDY: Within 1 month after the date of their
surgery, 132 patients with breast cancer completed an instrument rating
the prevalence, severity, and level of distress of breast sensations.
Information also was obtained on the impact that those sensations had on
activities of daily living and factors that triggered and provided
relief from sensations. RESULTS: Certain sensations remain prevalent
(numb, tender), severe (burning, sharp), and distressing (cramping,
painful). Overall these sensations significantly interfered with
patients' activities of daily living. Certain activities (movement,
position change) triggered sensations, while others (position change,
medication) provided relief. CLINICAL IMPLICATIONS: Healthcare
professionals can use the information learned from this pilot study to
educate patients both preoperatively and postoperatively about prevalent
breast sensations after surgery for breast cancer and about the types of
activities that may aggravate or relieve these sensations. As patient
educators and advocates, oncology professionals must continue to explore
the long-term effects and treatment options to provide optimal care and
support to patients who have or are likely to have post-surgical breast
sensations. More studies are needed to explore long-term effects and
treatment options.
25
UI - 11872051
AU - Purushotham AD; McLatchie E; Young D; George WD; Stallard S; Doughty J;
TI -
Brown DC; Farish C; Walker A; Millar K; Murray G
Randomized clinical trial of no wound drains and early discharge in the
treatment of women with breast cancer.
SO - Br J Surg 2002 Mar;89(3):286-92
AD - Department of Surgery, Western Infirmary, University of Edinburgh,
Edinburgh, UK. amy.byrtus@addenbrookes.nhs.uk
BACKGROUND: Women undergoing surgery for primary breast cancer routinely
have suction drains inserted deep to the wounds, which are removed
approximately 6-8 days after operation, requiring a period of stay of
that duration in hospital. The aim of this study was to perform a
prospective randomized clinical trial to evaluate a new surgical
technique of suturing flaps without wound drainage, combined with early
discharge, in women undergoing surgery for breast cancer. METHODS: A
total of 375 patients undergoing surgery for breast cancer were
randomized to conventional surgery or suturing of flaps with no drain.
The main outcome measures were length of hospital stay, surgical
morbidity, psychological morbidity and health economics. RESULTS:
Suturing of flaps and avoiding wound drainage in women undergoing
surgery for breast cancer resulted in a significantly shorter hospital
stay. Adopting this surgical technique with early discharge did not lead
to any difference in surgical or psychological morbidity. Health
economic benefits to the National Health Service resulted from saved bed
days with no impact on community costs. CONCLUSION: Wound drainage
following surgery for breast cancer can be avoided, thereby facilitating
early discharge with no associated increase in surgical or psychological
morbidity.
26
UI - 11872059
AU - Callaghan CJ; Couto E; Kerin MJ; Rainsbury RM; George WD; Purushotham AD
TI -
Breast reconstruction in the United Kingdom and Ireland.
SO - Br J Surg 2002 Mar;89(3):335-40
AD - Cambridge Breast Unit, Addenbrooke's Hospital and Medical Research
Council Biostatistics Unit, Institute of Public Health, Cambridge, UK.
BACKGROUND: Although it is becoming more common, previous surveys have
identified concerns regarding the safety of immediate reconstruction
following mastectomy. The aims of this study were to define current
practice of breast reconstruction in the UK and Ireland, and to identify
the characteristics of surgeons who use immediate breast reconstruction.
METHODS: : A postal questionnaire survey of 498 consultant breast
There were 376 responses (response rate 76 per cent). Eighty-eight per
cent of surgeons 'always' or 'usually' discuss reconstruction with
patients due to undergo mastectomy; clinicians with a heavy caseload
were significantly more likely to discuss it (odds ratio (OR) 18.45 (95
per cent confidence interval 1.99 to 171.07)). The majority of
respondents (57 per cent) preferred delayed to immediate breast
reconstruction; 70 per cent believed that immediate reconstruction has
disadvantages, most commonly that it interferes with adjuvant therapy
(56 per cent). Older surgeons were significantly less likely to perform
immediate reconstruction (OR 5.18 (2.21 to 12.11)), and were
significantly more likely to believe that immediate breast
reconstruction has disadvantages (OR 2.02 (1.01 to 4.05)). Surgeons from
Ireland were less likely to discuss and perform breast reconstruction
(OR 0.20 (0.10 to 0.43) and 0.27 (0.12 to 0.60) respectively), or to
have access to a plastic surgeon (OR 0.22 (0.11 to 0.44)). CONCLUSION: :
Significant variation exists in the delivery of breast reconstruction
after mastectomy in the UK and Ireland. The age, workload and personal
characteristics of the surgeon are important in determining
reconstructive practice.
27
UI - 11872060
AU - Burke M; Burke KI; Boyle S; Shah K; Price AB; Zammit C
TI -
Late results of selective axillary surgery based on contact cytology in
women with operable breast cancer.
SO - Br J Surg 2002 Mar;89(3):341-3
AD - Departments of Surgery and Cellular Pathology, Northwick Park Hospital,
Harrow, UK. crooklets@msn.com
BACKGROUND: Interest in the possibility of intraoperative analysis of
sentinel lymph nodes to select patients with operable breast cancer for
immediate axillary clearance encouraged this review of a long-term
experience of selective axillary surgery based on intraoperative contact
cytology of conventionally sampled nodes. Survival was assessed as a
potential marker for understaging. METHODS: Records of 437 patients who
had surgery between 1991 and 1994 were reviewed to compare rates of
axillary recurrence in patients who had contact cytology only with those
who had contact cytology and axillary clearance. RESULTS: Axillary
recurrence occurred in seven (3 per cent) of 219 patients who had
negative contact cytology, three (4 per cent) of 75 patients who had
positive contact cytology with axillary clearance and one (1 per cent)
of 93 who had axillary clearance alone. In patients with positive
contact cytology, 131 (78 per cent) of 168 positive nodes were in the
sample specimen, which included all positive nodes on 19 occasions.
Survival probability at 36, 72 and 96 months was 92, 87 and 84 per cent
respectively for patients with negative contact cytology, and 85, 73 and
71 per cent for patients with positive cytology and axillary clearance.
CONCLUSION: A selective approach to axillary surgery based on
intraoperative contact cytology of sampled lymph nodes gave good
long-term control of axillary disease.
28
UI - 11887990
AU - Cataliotti L; Calabrese C; Orzalesi L
TI -
The response of the surgeon to changing patterns in breast cancer
diagnosis.
SO - Eur J Cancer 2001 Oct;37 Suppl 7():S19-31
AD - Department of Medical and Surgical Critical Care, University of
Florence, Italy.
29
UI - 11896094
AU - Keating NL; Guadagnoli E; Landrum MB; Borbas C; Weeks JC
TI -
Treatment decision making in early-stage breast cancer: should surgeons
match patients' desired level of involvement?
SO - J Clin Oncol 2002 Mar 15;20(6):1473-9
AD - Division of General Internal Medicine, Section on Health Services and
Policy Research, Department of Medicine, Brigham and Women's Hospital,
Boston, MA, USA. keating@hcp.med.harvard.edu
PURPOSE: To describe desired and actual roles in treatment decision
making among patients with early-stage breast cancer, identify how often
patients' actual roles matched their desired roles, and examine whether
matching of actual and desired roles was associated with type of
treatment received and satisfaction. PATIENTS AND METHODS: We surveyed
1,081 women (response, 70%) diagnosed with early-stage breast cancer in
Massachusetts or Minnesota about their desired and actual roles in
treatment decision making with their surgeon and used logistic
regression to assess whether matching of actual to desired roles was
associated with type of surgery and satisfaction. RESULTS: Most patients
(64%) desired a collaborative role in decision making, but only 33%
reported actually having such a collaborative role when they discussed
treatments with their surgeons. Overall, 49% of women reported an actual
role that matched the desired role they reported, 25% had a less active
role than desired, and 26% had a more active role than desired. In
adjusted analyses, patients whose reported actual role matched
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