National Cancer Institute®
Last Modified: March 1, 2002
UI - 11733225
AU - Singletary SE
TI - New approaches to surgery for breast cancer.
SO - Endocr Relat Cancer 2001 Dec;8(4):265-86
AD - The University of Texas M D Anderson Cancer Center, Department of Surgical Oncology, Houston, Texas 77030, USA.
The surgical management of breast cancer is rapidly evolving towards less invasive procedures. Alternative biopsy techniques, including fine-needle aspiration and core needle biopsy, are replacing excisional biopsy as the treatment standard. Breast conservation therapy is now widely used in place of mastectomy, both for small tumors and for larger tumors that have been downstaged through induction chemotherapy. Less invasive procedures for axillary treatment such as lymphatic mapping and sentinel lymph-node biopsy are being explored in an effort to avoid the morbidity associated with axillary lymph-node dissection. For women who still prefer or need to receive a mastectomy, immediate breast reconstruction with autologous tissue provides an excellent cosmetic outcome that is oncologically sound. This is especially appealing to high-risk women who opt to have a prophylactic mastectomy. High-risk women are also being offered the option of receiving chemopreventive treatment that may reduce their lifetime risk of cancer by almost 50%. These new, less invasive approaches require the close cooperation of a team of physicians,including surgeons, pathologists, radiologists, and medical and radiation oncologists.
UI - 11544837
AU - Istagilov AKh; Sigal EI; Khamidullin RG; Nagumanov EV; Gubaidullin KhM
TI - [Diagnosis and treatment of breast cancer with central and medial localization using video-assisted thoracoscopic parasternal lymphadenectomy]
SO - Vopr Onkol 2001;47(3):348-55
AD - Clinical Oncological Center, Ministry of Health of the Republic of Tatarstan, Kazan.
Since extended mastectomy after Urban involves an unjustifiably high level of trauma, this method has limited application. We have evolved a procedure of video-assisted thoracoscopic parasternal lymphadenectomy (VATPL). On completion of the experimental part using cadavers to work out the rationale for extent of surgery, clinical trials started. A total of 120 operations in patients aged 27-73 were performed (left-sided--64, right-sided--56), with the number of lymph nodes removed in each case ranging 1-10. Metastases were detected in 23 (19.2%), isolated lesions (metastases to parasternal lymph nodes alone)--6 (5.0%). With volume of removed tissue being identical, the findings on level of pain, amount of narcotic analgetics, hospital stay duration, intra- and postoperative complication incidence and cardiointervalography and pneumotachometry for VATPL patients were significantly better than for those treated by traditional (open-chest) procedure. It is concluded that VATPL is a highly effective and low-traumatizing diagnostic method. It may be recommended as an operation of choice for parasternal lymph collector involvement of central or medial localization.
UI - 11821832
AU - Kitamura K; Ishida M; Inoue H; Kinoshita J; Hashizume M; Sugimachi K
TI - Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer.
SO - Surgery 2002 Jan;131(1 Suppl):S324-9
AD - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
BACKGROUND: Subcutaneous mastectomy and reconstruction (SMR) is well established; however, most incisions are made directly on the breast, and the majority of patients care about visible scars even if they are breast cancer underwent SMR using a saline-filled prosthesis by lateral axillary incision. There were 25 patients who received previous SMR without endoscopic assistance (group A) and 21 patients who underwent an endoscope-assisted SMR (E-SMR) (group B). These 2 groups were compared for curability, morbidity, and cosmesis. RESULTS: The median follow-up period was 19.2 + 9.8 months (range, 5.8 - 35.2 months). No significant difference was found in clinicopathologic data between the 2 groups. The operation time was 176 minutes in group A and 237 minutes in group B, and the estimated blood loss was 189 mL vs 356 mL, respectively. No critical complications were seen in either group. The average length of incision was 10 cm in group A and 5.7 cm in group B. As for the patients' satisfaction, the incidence of "excellent" plus "good" ratings was 76% in group A and 90.4% in group B. CONCLUSIONS: E-SMR is a new option that can provide an improved operative view and better cosmetic results for the treatment of breast cancer than with SMR. The operation time is longer than for SMR, but the incision is drastically shorter, resulting in better cosmesis and increased patient satisfaction.
UI - 11750836
AU - Petit JY; Greco M; EUSOMA
TI - Quality control in prophylactic mastectomy for women at high risk of breast cancer.
SO - Eur J Cancer 2002 Jan;38(1):23-6
AD - Division of Plastic Surgery, European Institute of Oncology, via Ripamonti 435, Milan, Italy. firstname.lastname@example.org
UI - 11856156
AU - Chua B; Ung O; Boyages J
TI - Competing considerations in regional nodal treatment for early breast cancer.
SO - Breast J 2002 Jan-Feb;8(1):15-22
AD - Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia.
The purpose of this article was to review the patterns and morbidity of regional recurrence (RR) in patients with early breast cancer, efficacy of salvage therapy for RR, and complications of regional nodal treatment. A retrospective evaluation of 1,158 patients with stage I or stage II breast cancer treated with conservative surgery and radiotherapy (RT) between 1979 and 1994 was performed. Seven hundred fifty patients underwent axillary surgery, and 229 patients received RT as their only treatment of the regional lymphatics. Regional nodal RT was given to 168 patients who also had axillary surgery. The regional lymphatics of 11 patients were not treated. The patterns and morbidity of RR, relapse management, and complications related to regional nodal treatment were reviewed from the patients' records. With a median follow-up of 88 months, a total of 31 patients (2.7%) developed a RR. Nine of 31 patients (29%) with an RR experienced significant morbidity, including pain, fungating tumor, dysphagia, dyspnoea, and/or sensory motor changes at diagnosis. Nineteen patients (61%) had symptomatic residual or progressive regional disease after salvage therapy at last follow-up or death. Six of nine patients (67%) who developed an isolated axillary recurrence and underwent salvage surgery had no further axillary recurrence. The addition of regional nodal RT to breast irradiation significantly increased the incidence of symptomatic pneumonitis (1% without regional nodal RT and 4% with regional nodal RT, p < 0.001). Combined axillary dissection and nodal irradiation resulted in a significantly higher incidence of arm edema compared with either alone (9.5% with axillary dissection, 6.1% with RT to the axilla and supraclavicular fossa, and 31% with combined modality therapy, p < 0.001). Five of 380 patients (1%) who received RT to the axilla and/or supraclavicular fossa developed a transient brachial plexus neuropathy. Although RR was uncommon in patients treated with axillary surgery and/or regional nodal irradiation, salvage therapy failed to eradicate the recurrence in approximately two thirds of the patients with a RR. Ongoing research is essential to optimize regional control with an acceptable level of risk of treatment complications. Sentinel lymph node biopsy, if validated as an accurate method of staging the axilla in patients with breast cancer, would allow selective avoidance of regional nodal treatment and hence the associated morbidity.
UI - 11856158
AU - Lash TL; Silliman RA
TI - Long-term follow-up of upper-body function among breast cancer survivors.
SO - Breast J 2002 Jan-Feb;8(1):28-33
AD - Department of Epidemiology and Biostatistics, Boston University School of Public Health, Geriatrics Section, Boston Medical Center, Boston, Massachusetts, USA.
We enrolled a cohort of 303 stage I or stage II breast cancer patients followed the patients by interview and medical record abstract for 5 years (a) to characterize the incidence and predictors of upper-body function decline and (b) to characterize the incidence and predictors of recovery of upper-body function. The incidence of decline in the first year after therapy (17.7/100 person years) was substantially higher than in the subsequent 4 years of follow-up (11.0/100 person-years, p value for test of homogeneity equal 0.028). With only one exception, no patient characteristic, therapy component, or disease trait was associated with decline over the full follow-up period. Women with less than a high school education had an adjusted relative hazard of decline of 2.3 (95% CI, 1.4-3.7) compared with women with a high school education or more, possibly reflecting occupational or environmental insults that predispose to functional impairment. Women who had reported a decline in upper-body function and who subsequently saw their breast cancer specialist were 4.8-fold more likely to report that they had recovered their upper-body function at their next interview (95% CI, 2.0, 12). This finding suggests that attention to upper-body function during follow-up visits may facilitate recovery.
UI - 11856161
AU - Naraynsingh V; Maharaj D; Rampaul R
TI - "Swiss-roll" operation for giant fibroadenomas.
SO - Breast J 2002 Jan-Feb;8(1):45-6
AD - Department of Surgery, University of the West Indies, General Hospital, Port-of-Spain, Trinidad, West Indies.
Giant fibroadenomas can produce breast deformity and should be excised. Several techniques have been discussed, including a sub-mammary incision, which often leave a disfiguring scar. We describe a new technique for removal of such large masses via a small cosmetic circumareolar incision.
UI - 11856167
AU - Carcoforo P; Basaglia E; Corcione S; Bergossi L; Soliani G; Feggi L
TI - The main problem in treating nonpalpable breast lesion is the need for accurate localization during surgery.
SO - Breast J 2002 Jan-Feb;8(1):66-7
UI - 11872286
AU - Galper S; Gelman R; Recht A; Silver B; Kohli A; Wong JS; Van Buren T;
TI - Baldini EH; Harris JR Second nonbreast malignancies after conservative surgery and radiation therapy for early-stage breast cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):406-14
AD - Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, USA. email@example.com
PURPOSE: Breast cancer patients treated with conservative surgery and radiation therapy are at risk of developing second nonbreast malignancies (SNBMs). The purpose of this study was to determine the incidence of all SNBMs and SNBMs by specific location among long-term survivors and to compare the risk of these events to the age-specific incidence of malignancies as first cancers in the Surveillance Epidemiology and End-Results Program (SEER) population. METHODS AND MATERIALS: We analyzed the likelihood of SNBM development for 1884 patients with clinical Stage I or II breast cancer treated with gross excision and > or = 60 Gy (median 63) to the breast between 1970 and 1987. Fifty-seven percent received supraclavicular/axillary radiation (median dose 45 Gy, range 20-60) and 28% received systemic therapy. The median age at diagnosis was 52 years. The median clinical tumor size was 2 cm. Patients were considered at risk of an SNBM until the development of the first of distant metastases or contralateral breast cancer or death or, if alive and disease-free, until the last follow-up visit. The expected numbers of cancers were obtained from the SEER database, using the age-specific incidence for white women within 5-year age groups and 5-year calendar intervals. The median time at risk for an SNBM was 10.9 years (range 0.2-27.9). RESULTS: By 8 years of follow-up, 432 patients (23%) had developed distant metastases, 295 patients (16%) a local/regional recurrence, and 159 (8%) a contralateral primary. Of the 1884 patients in our cohort, 147 (8%) developed an SNBM compared with the 127.7 expected from SEER. This corresponds to an absolute excess of 1% of the study population and a relative increase of 15% greater than that expected from SEER (p = 0.05). Within the first 5 years, the observed and expected rates of SNBMs were identical (47 vs. 46.9). After 5 years, 24% more SNBMs were observed than expected (100 vs. 80.8, p = 0.02). Among patients <50 years old at breast cancer diagnosis, 43% more observed SNBMs occurred than expected (40 vs. 28, p = 0.02). For patients > or = 50 years, 7% more SNBMs were observed than expected (107 vs. 99.7, p = 0.25). Lung SNBMs were observed in 33 women, 52% more than the 21.67 predicted by SEER (p = 0.01). Most of the lung SNBMs occurred >5 years after treatment (n = 23) and in women who were >50 years at the time of their breast cancer diagnosis (n = 27). The observed incidence of ovarian cancer was significantly greater than expected among patients <50 years (7 vs. 1.96, p = 0.004) but was not different than expected for patients > or = 50 years (5 vs. 5.3, p = 0.61). Among the 7 sarcomas, 3 developed in the radiation field. CONCLUSIONS: SNBMs occur in a substantial minority (8%) of patients treated with conservative surgery and radiotherapy. However, the absolute excess risk compared with the general population is very small (1%). This excess risk is only evident after 5 years. In particular, a slightly increased incidence of lung SNBMs and a somewhat larger increase in ovarian cancer among younger patients was found. Our data suggest that preventive strategies to reduce the incidence of certain cancers (e.g., smoking cessation and prophylactic oophorectomy) and/or continued monitoring for SNBMs to increase the likelihood of early detection and treatment may be prudent in this population.
UI - 11856696
AU - Liberman L; Goodstine SL; Dershaw DD; Morris EA; LaTrenta LR; Abramson
TI - AF; Van Zee KJ One operation after percutaneous diagnosis of nonpalpable breast cancer: frequency and associated factors.
SO - AJR Am J Roentgenol 2002 Mar;178(3):673-9
AD - Department of Radiology, Breast Imaging Section, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA.
OBJECTIVE: The purpose of this study was to determine the frequency of and factors associated with performing one therapeutic operation after percutaneous diagnosis of nonpalpable breast cancer. MATERIALS AND METHODS: Retrospective review was performed of records of 350 consecutive women who had therapeutic surgery after percutaneous imaging-guided core biopsy diagnosis of nonpalpable breast cancer. Records were reviewed to determine the frequency of performing one operation and associated factors. Statistical analysis was performed. RESULTS: One operation was performed in 283 (80.9%) of 350 women, including 106 (95.5%) of 111 women who had mastectomy and 177 (74.1%) of 239 women who had breast conserving surgery. At bivariate analysis, one operation was significantly more likely in women who had no underestimation (p < 0.001), mastectomy rather than breast conservation (p < 0.001), axillary dissection during the first operation (p < 0.001), percutaneous diagnosis of infiltrating carcinoma (p = 0.001), or mammographic mass (p = 0.006). At multivariate analysis, one operation was significantly more likely if underestimation was absent (odds ratio [OR] = 10.1, 95% confidence interval [CI] = 4.2-24.7) or if mastectomy was performed (OR = 8.7, 95% CI = 3.2-23.5); for women who had breast-conserving surgery, one operation was significantly more likely if underestimation was absent (OR = 11.4, 95% CI = 3.9-33.2) or if a mammographic mass was present (OR = 2.4, 95% CI = 1.3-4.6). CONCLUSION: One operation was performed in 80.9% of women with percutaneously proven nonpalpable breast cancer, including 74.1% of women who had breast-conserving surgery and 95.5% of women who had mastectomy. Among women who had breast conservation, one operation was significantly more likely if histologic underestimation was absent or if a mammographic mass was present.
UI - 10856100
AU - Obedian E; Fischer DB; Haffty BG
TI - Second malignancies after treatment of early-stage breast cancer: lumpectomy and radiation therapy versus mastectomy.
SO - J Clin Oncol 2000 Jun;18(12):2406-12
AD - Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520-8040, USA.
PURPOSE: To determine the risk of second malignancies after lumpectomy and radiation therapy (LRT), and to compare it with that in a similar cohort of early-stage breast cancer patients undergoing mastectomy LRT. A cohort of 1,387 breast cancer patients who underwent surgical treatment by mastectomy (MAST), and who did not receive postoperative radiation during the same time period, served as a comparison group. Second malignancies were categorized as contralateral breast versus nonbreast. In the cohort of patients undergoing LRT, a detailed analysis was carried out with respect to age, disease stage, smoking history, radiation therapy technique, dose, the use of chemotherapy or hormone therapy, and other clinical and/or pathologic characteristics. RESULTS: and 16 years for the MAST group. The 15-year risk of any second malignancy was nearly identical for both cohorts (17.5% v 19%, respectively). The second breast malignancy rate at 15 years was 10% for both the MAST and LRT groups. The 15-year risk of a second nonbreast malignancy was 11% for the LRT and 10% for the MAST group. In the subset of patients 45 years of age or younger at the time of treatment, the second breast and nonbreast malignancy rates at 15 years were 10% and 5% for patients undergoing LRT versus 7% and 4% for patients undergoing mastectomy (P, not statistically significant). In the detailed analysis of LRT patients, second lung malignancies were associated with a history of tobacco use. There were fewer contralateral breast tumors in patients undergoing adjuvant hormone therapy, although this did not reach statistical significance. The adjuvant use of chemotherapy did not significantly affect the risk of second malignancies. CONCLUSION: There seems to be no increased risk of second malignancies in patients undergoing LRT using modern techniques, compared with MAST. Continued monitoring of these patient cohorts will be required in order to document that these findings are maintained with even longer follow-up periods. With nearly 15 years median follow-up periods, however, these data should be reassuring to women who are considering LRT as a treatment option.
UI - 11550486
AU - Fodor J; Sulyok Z; Polgar C; Major T; Toth J; Nemeth G
TI - [Breast-conserving treatment for early invasive lobular breast cancer: 15 years results]
SO - Magy Seb 2001 Aug;54(4):209-14
AD - Orszagos Onkologiai Intezet Sugarterapias Osztaly, 1122 Budapest, Rath Gyorgy u. 7-9. firstname.lastname@example.org
BACKGROUND: Infiltrating lobular cancer is biologically different from invasive ductal cancer and there is disagreement regarding appropriate local management of this disease. PURPOSE: To examine treatment outcomes after breast-saving surgery for patients with invasive lobular breast cancer. MATERIAL AND METHODS: Between 1983 and 1987, 77 women with early, stage I-II invasive lobular breast cancer were treated with complete gross excision of the tumour and axillary dissection. Fifty-eight of these patients were treated with 50 Gy ipsilateral breast irradiation, and 19 did not receive radiotherapy. During 176 month median follow-up local-regional recurrences, distant metastases, contralateral breast cancers, breast cancer deaths and deaths caused by other disease were scored. The probability of survival was estimated by Kaplan-Meier method. In uni- and multivariate analysis the Cox-model was used. Relative risk (RR) and associated confidence intervals (CI) were calculated from the regression coefficients. Statistical differences in proportions and means were assessed by log rank and Fisher exact-tests. RESULTS: In the saved breast, the actual rate of local recurrence at 15 years was 13% for irradiated and 53% for non-irradiated patients (RR: 0.1; 95% CI: 0.03-0.31; p: < 0.0001). The incidence of total breast cancer relapses (local-regional recurrences and distant metastases) was also higher for non-irradiated than for irradiated patients (74% vs. 40%; p: 0.0168). In multivariate analysis irradiation (no vs. yes) showed a significant effect on local tumour control (RR: 0.08: 95% CI: 0.02-0.28; p: 0.0001), but menopausal (pre vs. post), T-(T1 vs. T2) and N-(N0 vs. N1) status did not. The breast cancer specific survival at 15 years was 74% without and 62% with local recurrence (RR: 1.45; 95% CI: 0.53-3.96; p: 0.4697). The majority of local recurrences (9 of 14) were curable by salvage surgery. For all patients the rate of contralateral breast cancer was 6.5%. CONCLUSION: Results of long-term follow-up confirmed that breast-conserving surgery and radiotherapy is a reasonable treatment for patients with early invasive lobular breast cancer. The majority of local recurrences are curable by salvage surgery.
UI - 11727963
AU - Coster S; Poole K; Fallowfield LJ
TI - The validation of a quality of life scale to assess the impact of arm morbidity in breast cancer patients post-operatively.
SO - Breast Cancer Res Treat 2001 Aug;68(3):273-82
AD - Department of Oncology, University of Sussex, Brighton, UK.
This paper documents the validation of a quality of life scale (QOL) designed to assess the impact of arm morbidity on patients following breast cancer surgery. A four item arm subscale was developed to supplement a multi-dimensional, validated breast cancer QOL tool, the functional assessment of cancer therapy (FACT-B.) The new questionnaire, the FACT-B + 4, was validated on 279 women participating in a trial of sentinel node guided axillary therapy and 29 women attending a lymphoedema clinic. The subscale demonstrated good internal consistency (alpha co-efficient = 0.62 to 0.88) and stability (test-retest reliability = 0.97). Lymphoedema patients reported significantly greater arm problems than a matched sample of pre-operative trial participants. The lymphoedema group also scored lower than trial patients on the FACT-B + 4 indicating a poorer quality of life (p < 0.05). A subset of 66 trial patients who had completed three consecutive assessments was used to evaluate the sensitivity of the questionnaire to change over time. Scores on the FACT-B + 4 were found to decline significantly between the pre-operative assessment and post-operative assessment at 1 month. Arm problems significantly increased during this period. FACT-B + 4 score increased again from 1 month to 12 weeks post-surgery and symptoms reduced, as the extent of arm morbidity resolved. The FACT-B + 4 appears to be psychometrically robust and sensitive to patient rehabilitation, making it suitable for use in longitudinal surgical trials. Given the dearth of existing scales available to measure arm morbidity, we hope this new tool will prove useful to researchers.
UI - 11833331
AU - Driuk MF; Galych SP; Driuk MM; Lytvynenko OO
TI - [Technical aspects of one stage reconstruction of mammary glands using autologous tissue after mastectomy for the mammary gland cancer]
SO - Klin Khir 2001 Oct;(10):61-4
In 36 patients the first experience of performance of one-stage mammarial glands reconstruction is presented, using tissues of their own after conduction of mastectomy for the mammarial gland cancer. In 27 women patients the transposition or free microvascular transplantation of lower musculocutaneous flap basing on m. Rectus abdominis (transverse rectus abdominis musculocutaneous TRAM-flap) was performed, in 9--transposition of m. Latissimus dorsi flap.
UI - 11847506
AU - Miyashita T; Tateno A; Kumazaki T; Furukawa K; Minobe K; Shimizu K
TI - Breast-conserving therapy in the management of early stage breast cancer: Our experience in 103 cases.
SO - J Nippon Med Sch 2002 Feb;69(1):24-30
AD - Department of Radiology, Nippon Medical School, Tokyo, Japan. email@example.com
PURPOSE: The aim of this study is to determine whether our results in breastconserving therapy of 103 patients with earlystage breast cancer are comparable to those of other facilities or not. MATERIALS AND breast cancer were treated by breastconserving surgery and whole breast irradiation. All patients were of Stages I or II, and the greatest dimensions of primary tumor were less than 3 cm. The median followup time was 47 months from the completion of postoperative radiotherapy. Local, regional and distant failure rates, and survival rate were presumed using the KaplanMeyer method. RESULTS: One patient suffered from local recurrence 30 months later. She was followed by simple mastectomy and kept from further recurrence. No regional relapse occurred. Distant metastases were seen in three patients:two patients in bones, and one patient in a bone and the liver after 19, 35, and 32 months, respectively. One patient died from disseminated cancer in 41 months. Only one patient died due to intercurrent disease. Both 5year and 10year diseasefree survival rates were 94.2%, and both 5year and 10year causespecific survival rates were 98.3%. CONCLUSION: Our results were comparable to previously reported data. In this stage although the followup time was too short to define the longterm outcome, it suggested that breast conserving therapy was acceptable and effective in the management of earlystage breast cancer.
UI - 11822858
AU - Tamaki Y; Sakita I; Miyoshi Y; Sekimoto M; Takiguchi S; Monden M;
TI - Noguchi S Transareolar endoscopy-assisted partial mastectomy: a preliminary report of six cases.
SO - Surg Laparosc Endosc Percutan Tech 2001 Dec;11(6):356-62
AD - Department of Surgical Oncology, Osaka University, Graduate School of Medicine, Yamadaoka, Suita, Japan. firstname.lastname@example.org
Six patients with breast cancer in the upper inner quadrant underwent endoscopy-assisted partial mastectomy. The tumor was removed with a 2-cm-wide surgical margin through a periareolar semicircular incision using a special retractor and endoscope system for plastic surgery. Another small incision was made in the axilla for total lymph node dissection or sentinel lymph node biopsy. The average of total operation time in five patients who underwent partial mastectomy was 241 minutes (range, 190-315 minutes), and the average time for the procedure of partial mastectomy in six cases was 84 minutes (range, 69-113 minutes). The cosmetic outcome was excellent. Transareolar endoscopic partial mastectomy can be considered as an alternative surgery option and can offer great cosmetic advantage for patients with small cancers in the inner quadrants of the breast.
UI - 11822859
AU - Klimberg VS
TI - Just because you can?
SO - Surg Laparosc Endosc Percutan Tech 2001 Dec;11(6):363
UI - 11847034
AU - Rouanet P; Duchene M; Quenet F
TI - [Cancer update on breast reconstruction]
SO - Bull Cancer 2002 Jan;89(1):125-9
AD - CRLC Val-d'Aurelle, 326, rue des Apothicaires, parc Euromedecine, 34298 Montpellier Cedex 5.
Breast reconstruction is evolving towards immediate reconstruction (IBR). Adjuvant radiotherapy remains an esthetical contraindication to classical techniques due to complication rate (capsular contracture, flap necrosis and contracture). Tissue expansion combined with radiotherapy must be evaluated. IBR quality of life raises the issue of its evaluation. IBR current limits seem to be psychological. The quality of preoperative information will determine IBR real life experience.
UI - 11870664
AU - Ernst MF; Voogd AC; Balder W; Klinkenbijl JH; Roukema JA
TI - Early and late morbidity associated with axillary levels I-III dissection in breast cancer.
SO - J Surg Oncol 2002 Mar;79(3):151-5; discussion 156
AD - Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
BACKGROUND AND OBJECTIVES: Axillary dissection may cause substantial morbidity in breast cancer patients. The purpose of this study was to investigate the value of a registration method of morbidity of the arm and shoulder, which is frequently used by surgeons and which includes the measurement of range of movement, strength, and pain. METHODS: We surveyed 148 patients who had received an axillary dissection as part of breast cancer surgery. Of these patients, 77 had undergone axillary dissection 6-12 months ago and 71 patients more than 5 years ago. In all patients, an objective measurement of shoulder movement and a subjective measurement of pain and arm strength was performed. RESULTS: A difference of more than 20 degrees in abduction, ventral elevation, or dorsal elevation occurred in 12% of the patients. Pain or loss of strength were measured in half of the patients. Shoulder movement, pain, and arm strength were not significantly different between the patients who underwent mastectomy or breast conserving surgery. Also, no significant difference could be found in shoulder movement, pain, and arm strength between the patients who underwent axillary dissection 6-12 months ago and those who underwent it more than 5 years ago. CONCLUSIONS: Pain, loss of arm strength, and limitation of shoulder movement are frequent complaints after axillary dissection for breast cancer and appear to be independent of the length of follow-up and the type of surgery (i.e., breast-conservation or mastectomy). Copyright 2002 Wiley--Liss, Inc.
UI - 11869698
AU - Burak WE; Hollenbeck ST; Zervos EE; Hock KL; Kemp LC; Young DC
TI - Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer.
SO - Am J Surg 2002 Jan;183(1):23-7
AD - Division of Surgical Oncology, Department of Surgery, Ohio State University, N914 Doan Hall, 410 W. 10th Ave., Columbus, OH 43210, USA. Burak.email@example.com
BACKGROUND: This study was designed to compare the postoperative morbidity and socioeconomic impact of sentinel lymph node biopsy (SLNB) with axillary lymph node dissection (ALND) in patients with early stage breast cancer. METHODS: A prospective, nonrandomized, controlled study was designed to include patients who underwent breast conservation surgery and SLNB +/- ALND. Group A consisted of patients who had a negative SLNB and did not go on to completion ALND. Group B consisted of patients who underwent a SLNB followed by a completion ALND because either (1) their sentinel node contained cancer or (2) they were within the validation phase of our institution's sentinel lymph node protocol. Patients were evaluated with a questionnaire and underwent a standardized physical examination to determine arm circumference. RESULTS: Data were obtained from 96 patients with a mean follow-up period of 15 months (range 8 to 29). Significant differences were seen in subjective measurements of arm complaints and arm numbness (P <0.001), with fewer complaints reported in group A. The difference in mid-bicep and antecubital fossa circumferences was significant when comparing the ratio of the procedure arm with the nonprocedure arm and when subtracting the nonprocedure arm from the procedure arm (P <0.003 and P <0.016, respectively) in favor of group A. Axillary surgery was performed as an outpatient procedure in 88% of group A patients, compared with 15% in group B (P <0.001). Furthermore, 71% of group A patients returned to "normal activity" in less than 4 days, in comparison with 7% of group B (P <0.001). CONCLUSIONS: SLNB results in less postoperative morbidity in terms of subjective arm complaints and mid-arm swelling. Expeditious return to work or normal activity after SLNB has potentially significant socioeconomic consequences.
UI - 11579955
AU - Hashida H; Honda T; Morimoto H; Sasaki T; Aibara Y; Yamanaka M
TI - Breast cancer presenting with the syndrome of inappropriate secretion of antidiuretic hormone after simple mastectomy.
SO - Intern Med 2001 Sep;40(9):911-4
AD - Department of Internal Medicine, Ehime Prefectural Iyomishima Hospital.
A 71-year-old woman showed disorientation 7 days after simple mastectomy for right breast cancer. Computed tomography of the brain was normal. The level of serum sodium was very low (110 mEq/l), while the urine sodium level was normal. The osmolality of urine was higher (342 mosmol/kg) than that of serum (220 mosmol/kg). These data suggested a syndrome of inappropriate secretion of antidiuretic hormone. A fluid restriction, infusion of hypertonic saline and administration of diuretics gradually increased the level of serum sodium. Subsequently, disorientation disappeared. This is a rare case of the syndrome of inappropriate secretion of antidiuretic hormone caused by simple mastectomy, a relatively minor surgical procedure.
UI - 11750976
AU - Polgar C; Fodor J; Major T; Nemeth G
TI - Is boost irradiation with interstitial brachytherapy less favourable than with teletherapy after breast conserving surgery?
SO - Eur J Obstet Gynecol Reprod Biol 2002 Jan 10;100(2):255-6
UI - 11880791
AU - Ann Gilligan M; Kneusel RT; Hoffmann RG; Greer AL; Nattinger AB
TI - Persistent differences in sociodemographic determinants of breast conserving treatment despite overall increased adoption.
SO - Med Care 2002 Mar;40(3):181-9
AD - Department of Medicine, Medical College of Wisconsin, Milwaukee 53226, USA. firstname.lastname@example.org
BACKGROUND: Use of breast-conserving treatment (BCT) has previously demonstrated variability by sociodemographic factors. OBJECTIVE: To determine whether variation in use of BCT by age, race, county income, county education, and population density declined between 1983 and 1996. DESIGN: Trends in use of BCT over time were modeled with logistic regression. SETTING: Surveillance, Epidemiology, and End Results national tumor registry data. PATIENTS: Population-based cohort of 158,496 women with local or regional stage breast cancer. MAIN OUTCOME MEASURE: Receipt of BCT. RESULTS: Use of BCT increased overall, and among all subgroups of age, county income, county education, population density, and race. There was no decline in age-related variation in use of BCT over time. However, older women were less likely to undergo BCT including radiotherapy (RT) and lymph node dissection (LND), and were more likely to undergo BCT omitting RT and/or LND. Variation in use of BCT by county income persisted, with women residing in poorer counties less likely to undergo BCT, whether accompanied by RT and LND. Variation in overall use of BCT by county education also persisted. Although women residing in better-educated counties were more likely to undergo BCT accompanied by RT and LND, they were not more likely to undergo BCT omitting RT, LND, or both. No decline in variation by population density occurred, with women residing in urban areas more likely to use BCT whether accompanied by RT and LND. CONCLUSIONS: Sociodemographic differences in BCT use have persisted over time. The increased overall adoption of BCT has not led to consistency in use of this treatment.
UI - 11692927
AU - Marinova L
TI - [Local treatment of axillae and its impact on survival in patients with early breast cancer (EBC) after breast conservative surgery (BCS)]
SO - Khirurgiia (Sofiia) 2000;56(5-6):21-4
Following a shut survey showing the influence of the local therapeutic approaches (operative and radiation) for axillaries region on the distant survival, dissemination and lethality in patients with early BC after BCS, the author presents her treatment results. It is pointed out that BC is a systemic disease in some criteria taking in a consideration. In this aspect no significant influence of the local therapeutic methods is found. Furthermore a long-term follow up is still met to prove that a less extensive local treatment methods lead to irreversible consequences: increasing the local recurrences, distant dissemination and lethality.
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