National Cancer Institute®
Last Modified: April 1, 2002
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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.
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.
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. firstname.lastname@example.org
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.
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.
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.
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
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.
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
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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
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.
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. email@example.com
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.
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.
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.
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.
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.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.
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.
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. firstname.lastname@example.org
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