National Cancer Institute®
Last Modified: January 1, 2002
UI - 11074688
AU - King AG
TI - Re: Progression of idiopathic thoracolumbar scoliosis after breast reconstruction with a latissimus dorsi flap: a case report (Spine 2000; 25: 622-5).
SO - Spine 2000 Nov 15;25(22):2968
UI - 11148554
AU - Chan KC; Knox WF; Sinha G; Gandhi A; Barr L; Baildam AD; Bundred NJ
TI - Extent of excision margin width required in breast conserving surgery for ductal carcinoma in situ.
SO - Cancer 2001 Jan 1;91(1):9-16
AD - Department of Surgery, University Hospital of South Manchester, Manchester, United Kingdom.
BACKGROUND: Breast conserving surgery (BCS) is common practice for unifocal ductal carcinoma in situ (DCIS) less than 4 cm in size, but the extent of tumor free margin width around DCIS necessary to minimize recurrence is unclear. METHODS: Clinical and pathologic details were recorded from all patients with pure DCIS < 4 cm in size, treated with BCS between 1978 and 1997. Histologic margins were measured by using an ocular micrometer. Patients with clear margins (> 1 mm) were divided up into 3 groups for analysis based on margin of normal tissue excised: 1.1-5 mm, 5.1-10 mm, and 10.1-40 mm. RESULTS: There were 66 patients with close margins (< or = 1 mm), of which 25 cases (37.9%) recurred. The recurrence rates for the 3 clear margin groups ranged from 4.5-7.1%. Median followup was 47 months (range 12-197 mos). Risk of recurrence in the group with close margins was greater than the subgroups with clear margins (P < 0.001); no differences in recurrence was seen between the individual subgroups with clear margins. Nuclear Grade 3 was predictive of recurrence (P = 0.03). Following excision alone, the recurrence rate was 18.6%, compared with 11.1% when radiotherapy was given as adjuvant therapy. Women with clear margins following excision had a recurrence rate of only 8.1%. CONCLUSION: After BCS for DCIS, close margins were associated with a high risk of local recurrence. Radiotherapy did not compensate for inadequate surgical clearance. Copyright 2001 American Cancer Society.
UI - 11369255
AU - Zurrida S; Galimberti V; Gibelli B; Luini A; Gianoglio S; Sandri MT;
TI - Passerini R; Maisonneuve P; Zucali P; Jeronesi G; Pigatto F; Veronesi U Timing of breast cancer surgery in relation to the menstrual cycle: an update of developments.
SO - Crit Rev Oncol Hematol 2001 Jun;38(3):223-30
AD - Senology Department, European Institute of Oncology, Milan, Italy. firstname.lastname@example.org
It is well-established that hormones have multiple effects on breast cancer. Some, but not all studies indicate that the phase of the menstrual cycle (and hence hormonal status) at the time of breast surgery may influence survival. In this paper we review the literature in this area, explore how it is possible that such an association may occur, and note that randomised studies which unambiguously determined the phase of the cycle at the time of the operation are lacking. We go on to describe an ongoing self-randomised trial designed to address this problem and present preliminary results which show that only about 75% of the women ovulated during the cycle in which the operation took place, and that the established prognostic factor Ki-67 varied with the phase of the cycle in women who ovulated. It is too early to assess the significance of this finding.
UI - 11369256
AU - Petit J; Rietjens M; Garusi C
TI - Breast reconstructive techniques in cancer patients: which ones, when to apply, which immediate and long term risks?
SO - Crit Rev Oncol Hematol 2001 Jun;38(3):231-9
AD - European Institute of Oncology-EIO, Plastic and Reconstructive Surgery Unit, Via Ripamonti, 435, 20.141, Milan, Italy. email@example.com
Breast reconstruction is considered as part of the breast cancer treatment when a mastectomy is required. The techniques available today, allow reconstruction of the breast even in almost all the cases even in poor local conditions. In 60-70% of the cases, the reconstruction can be performed with an implant inserted behind the pectoralis muscle. Special implants called expanders, are inflatable progressively in the postoperative course thanks to a reservoir located subcutaneously. They provide a progressive distention of the teguments and a more natural shape after substitution of the expander with a definitive implant. The symmetry is usually obtained thanks to a contralateral plastic surgery, which allows at the same time histological check up of the glandular tissue of the opposite breast. The nipple areolar complex is usually reconstructed in a second stage under local anesthesia, using local flaps for the nipple and a tattoo for the colour of the areola. In 30% of the cases, especially after radiotherapy when a salvage mastectomy is required, a flap reconstruction is preferred. The autologous tissue reconstruction with the rectus myocutaneous flap gives excellent cosmetic results and the most natural shape for the breast. But it is a more demanding technique requiring a good experience. In some occasions, the reconstruction with the latissimus flap can also be autologous but usually requires the addition of prosthesis. In most cases, the reconstruction can be performed immediately. The delayed reconstruction is usually preferred when the adjuvant chemotherapy should be delivered as soon as possible after the mastectomy. Complications of the reconstruction such as local necrosis or infections, leading to implant removal or revision of the flap could be detrimental to the patient in delaying the start of the chemotherapy. It is not recommended to reconstruct the breast immediately in case of locally advanced breast cancer. Partial breast reconstruction using plastic surgery procedures can also be performed in case of quadrantectomy in order to obtain a better cosmetic result. Local glandular flaps, as well as specific incisions according to the location of the tumor in the breast allow the reshaping of the breast even in case of large resection and, therefore, provide an opportunity to increase the number of conservative treatment indications, especially in case of in-situ carcinomas.
UI - 11450122
AU - Cattelani L; Galimberti A; Piccolo P; Del Rio P; Palli D; Boselli A
TI - [Biopsy of sentinel lymph nodes in the treatment of breast carcinoma: experience of the Surgery Department of the Hospital of Parma]
SO - Acta Biomed Ateneo Parmense 2000;71(5):187-92
Radical axillary nodes dissection in breast cancer is a standard for a correct staging, unfortunately this approach can cause several unpleasant sequelae and complications. Sentinel node biopsy applied to breast tumors could be a good option for predicting axillary nodes status avoiding complete dissection. The aim of this work is to report our experience with sentinel node biopsy during a period of 18 months. One hundred and nine patients with an infiltrating breast tumor T1 had been studied. There wasn't clinical and ultrasonographic evidence of axillary infiltration. Tumors had been injected on the day before surgery with a mixture of colloidal human albumin particles marked with 99m Technetium. In 108 out of 109 patients (99%) sentinel node had been identified using a gamma probe and biopsied during surgical intervention performed under local anesthesia. Sentinel node has been examined both with conventional histology and immunohistochemistry. In 26 cases the node was positive for metastases. Radical axillary dissection in this subgroup of patients showed that in 85% of them sentinel node was the only positive. We conclude that sentinel node biopsy can be a good alternative to traditional axillary dissection but there are still important questions about the best method of analysis and, before the technique become a routine procedure in breast cancer management, we should know the results of prospective clinical trials comparing survival of patients staged by sentinel node biopsy versus traditional axillary dissection.
UI - 11432635
AU - Zgajnar J; Gatzemeier W; Costa A
TI - Will the sentinel lymph node (SLN) stand a second time--SLN biopsy in breast cancer patients with isolated local recurrence following breast conserving therapy and previous SLN procedure.
SO - Ann Oncol 2001 May;12(5):723
UI - 11449180
AU - Tocchi A; Mazzoni G; Bettelli E; Miccini M; Giuliani A; Cassini D
TI - Impact of axillary level I and II lymphnode dissection on the therapy of stage I and II breast cancer.
SO - Panminerva Med 2001 Jun;43(2):103-7
AD - 1st Department of Surgery, University of Rome La Sapienza, Rome, Italy.
BACKGROUND: Routine performance of axillary node dissection (AND) in the treatment of stage I and II breast cancer has become controversial because of pretended morbidity of this procedure and progressing consent for sentinel lymphadenectomy. METHODS: Ninety-four consecutive patients who underwent AND for clinical stage I and II breast cancer were evaluated for a range of 48.3 months after surgery for movement and sensory alterations and arm swelling. Arm circumference was measured in all patients at the same four sites on both the operated and non operated sides preoperatively and in the immediate and late postoperative course. Capacity for movement was assessed pre- and postoperatively as active ranging at the shoulder joint. Postoperative numbness and paresthesias were assessed by standard questions. RESULTS: No patient had axillary recurrence. None of the detected differences between the preoperative and postoperative arm circumferences reached statistical significance. No persistent motion limitation was observed. Pain, numbness, paresthesia were detected in almost all patients in the immediate postoperative period but resolved spontaneously in all cases within 6 months. The obese body habit was detected on multivariate analysis as the only significant predictor of edema. CONCLUSIONS: No significant morbidity and no axillary recurrence were observed in current experience to follow AND. These findings suggest that axillary level I and II dissection remains an effective and safe tool for diagnostic, as well therapeutic, purposes in the treatment of stage I and II breast cancer. Further studies are necessary before it can safely be reported that axillary node dissection is an optional part of the treatment of stage I and II breast cancer.
UI - 11456055
AU - Janni W; Rjosk D; Dimpfl TH; Haertl K; Strobl B; Hepp F; Hanke A;
TI - Bergauer F; Sommer H Quality of life influenced by primary surgical treatment for stage I-III breast cancer-long-term follow-up of a matched-pair analysis.
SO - Ann Surg Oncol 2001 Jul;8(6):542-8
AD - Department of Gynecology and Obstetrics, Women's Clinic at Ludwig-Maximilians-University, Munich, Germany. firstname.lastname@example.org
BACKGROUND: Breast-conserving therapy has been demonstrated to be just as safe and a less disruptive experience compared with mastectomy for surgically manageable breast cancer. There is, however, no agreement in the literature about the impact of these procedures on several important aspects of quality of life (QOL). The purpose of the present study is to compare the long-term impact of these two surgical approaches on QOL in patients with identical tumor stages and to suggest possible shortcomings of the standard QOL questionnaires. METHOD: Between August patients at the I. Frauenklinik, Ludwig-Maximilians University Munich, as part of routine follow-up examinations. The pairs of patients, each consisting of one patient after mastectomy and one after breast conservation, were selected according to the highest degree of equivalence in tumor stage. All patients had been initially treated for stage I-III breast cancer without evidence of distant metastases. The QOL was evaluated by using the QLQ-C30 questionnaire version 2.0 of the EORTC Study Group on Quality of Life. We formulated seven additional questions about the patients' satisfaction with the primary surgical treatment modality as viewed from their current perspective. The QOL questionnaires were answered after a median interval of 46 months following primary treatment. RESULTS: Tumor stage, prognostic factors, and adjuvant systemic treatment were well balanced between the two groups. No differences between the two groups were observed in terms of all QOL items measured by the QLQ-C30. Our additional questions, however, revealed that patients in the mastectomy group were less satisfied with the cosmetic result of their primary operation (P < .0001), were more likely to feel basic changes in their appearance (P < .0001), and were more likely to be emotionally stressed by these facts (P < .0001). From their perspective at the time of completing the questionnaires, 11 patients in the mastectomy group (15%) would decide differently about the surgical treatment modality, compared with only 3 patients (4%) in the breast conservation group (P = .025). CONCLUSION: While the primary surgical treatment modality seems to have no long-term impact on general QOL, certain body-image-related problems may be caused by mastectomy. Standard measuring instruments for QOL may fail to detect differences in satisfaction and adaptation with the primary surgical treatment modality.
UI - 11478545
AU - Deadman JM; Leinster SJ; Owens RG; Dewey ME; Slade PD
TI - Taking responsibility for cancer treatment.
SO - Soc Sci Med 2001 Sep;53(5):669-77
AD - Department of Clinical Psychology, Sutton General Hospital, Surrey, UK.
One hundred and fourteen consecutive patients with early breast cancer were entered into a study on the psychological effects of involvement in treatment choice. All women were offered counselling throughout. One group of women (n = 34), were advised to undergo mastectomy, due to the nature or position of the tumour. These women fared less well psychologically when compared on a battery of measures, before and after surgery, with women who were involved in choosing their own treatment (n = 80). The latter group itself was randomly allocated into two groups for taking explicit responsibility for treatment choice, using a double-blind procedure. These were a Patient Decision Group (n = 41) and a Surgeon Decision Group (n = 39). Results support the hypothesis that over and above the benefits of receiving their preferred treatment, women can further benefit from taking explicit responsibility for their treatment choice.
UI - 11482066
AU - Stanislawek A; Kurylcio L; Janikiewicz A
TI - Arm lymphoedema after surgical treatment for the cancer of the breast.
SO - Ann Univ Mariae Curie Sklodowska [Med] 2000;55():155-60
AD - Katedra Onkologii Akademii Medycznej w Lublinie.
UI - 11482067
AU - Stanislawek A; Kurylcio L
TI - Complications of axillary node dissection for breast carcinoma as perceived by patients.
SO - Ann Univ Mariae Curie Sklodowska [Med] 2000;55():161-7
AD - Katedra Onkologii Akademii Medycznej w Lublinie.
UI - 11527290
AU - Dodwell D; Horgan K
TI - Breast cancer: locoregional control and survival.
SO - Clin Oncol (R Coll Radiol) 2001;13(3):172-3
AD - Breast Unit, Leeds Cancer Centre, Leeds General Infirmary, UK.
UI - 11520082
AU - Cense HA; Rutgers EJ; Lopes Cardozo M; Van Lanschot JJ
TI - Nipple-sparing mastectomy in breast cancer: a viable option?
SO - Eur J Surg Oncol 2001 Sep;27(6):521-6
AD - Department of Surgery, Isala Clinics location Weezenlanden, Zwolle, The Netherlands. email@example.com
BACKGROUND: In women with breast cancer for whom breast-conserving therapy (BCT) is not the best option, a nipple and areola complex-(NAC) sparing mastectomy with immediate reconstruction has been proposed as a good and safe alternative to conventional, more radical mastectomy. Surgeons hesitate to perform this operation for fear of recurrence of tumour in the NAC due to undetected nipple involvement (NI) of the tumour. In order to determine whether a NAC-sparing mastectomy is a viable option, the frequency and predictive factors of NI by the tumour were studied in the literature. METHODS: A literature survey was performed by searching the Medline database. Other references were derived from the material perused. RESULTS AND CONCLUSIONS: NI is found in up to 58% of mastectomy specimens and correlates with tumour size, tumour-areola or tumour-nipple distance, positive lymph nodes and clinical suspicion. Best candidates for NAC-sparing mastectomy are patients with a small tumour (T1) at a large distance (>4-5 cm) from the nipple. However, in these patients BCT has excellent results with low complications and recurrence rates. Considering the incidence of NI in larger tumours (T2 average 33%, T3 average >50%) a NAC-sparing mastectomy may carry an unacceptable high risk for local relapse and should therefore not be advocated. Copyright 2001 Harcourt Publishers Limited.
UI - 11520085
AU - Shrotria S
TI - Breast mass removal made easy by the lump extractor: introducing a new instrument in breast surgery.
SO - Eur J Surg Oncol 2001 Sep;27(6):539-40
AD - Ashford Breast Unit, Ashford Hospital, Ashford, Middlesex, TW15 3AA, UK.
The difficulty encountered in the removal of breast lumps has been addressed by the use of a new instrument. The lump extractor described in this paper allows minimal scar surgery and prevents crushing of the breast mass. Copyright 2001 Harcourt Publishers Limited.
UI - 11520096
AU - Shrotria S
TI - The peri-areolar incision--gateway to the breast!
SO - Eur J Surg Oncol 2001 Sep;27(6):601-3
AD - Ashford Breast Unit, Ashford Hospital, Ashford, Middlesex, TW15 3AA, UK.
BACKGROUND: In breast surgery the challenge for good cosmesis needs to be met in the management of benign or malignant disease. With tumours this must be balanced against good clearance with safe and adequate margins. For excision of benign lesions obvious deforming scars are unacceptable while with breast preserving cancer surgery a badly placed scar reduces reconstructive choices. The peri-areolar incision has a role in skin sparing mastectomy (SSM) and in breast conserving surgery. This paper describes the application of this incision in breast surgery. METHODS: Patients undergoing breast surgery for benign and malignant disease have undergone operations using a peri-areolar incision. Examples of use of this incision are shown. CONCLUSION: The peri-areolar incision provides good cosmesis while allowing for future or immediate reconstruction and without reducing the range of options. Copyright Harcourt Publishers Limited.
UI - 11520097
AU - Ball S; Arolker M; Purushotham AD
TI - Breast cancer, Cowden disease and PTEN-MATCHS syndrome.
SO - Eur J Surg Oncol 2001 Sep;27(6):604-6
AD - Cambridge Breast Unit, Addenbrookes Hospital, Hills Road, Cambridge, UK.
UI - 11574205
AU - Lampl L
TI - Chestwall resection: a new and simple method for stabilization of extended defects.
SO - Eur J Cardiothorac Surg 2001 Oct;20(4):669-73
AD - I. Chirurgische Klinik, Zentralklinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany. firstname.lastname@example.org
OBJECTIVE: Postresectional chestwall defects can usually be stabilized by reconstructions under tension. Only few extended defects require combined stabilizing methods. The one used mostly is Marlex-Sandwich, despite some disadvantages. An alternative method using alloplastic material/metal bar is presented. MATERIAL AND METHODS: Between 1986 and 1999, 189 chestwall resections were performed either for infiltrating bronchogenic carcinoma (Type I, n=67), tumors originating from chestwall or bony metastases (Type II, n=88), or local recurrences and infiltration by breast cancer or sequelae of its treatment (Type III, n=34).The standard reconstruction is performed with non-absorbable alloplastic meshes or patches under some degree of tension. For defects exceeding 250 cm(2), usually Type-II cases, a reconstruction under tension is no longer appropriate. Therefore we developed a procedure which we used in six cases. Alloplastic mesh or patch gets sutured in the same way as is done in smaller defects. Then a metal bar (Grob-Stab, Ulrich, Herrlingen/Blaustein, Germany) is threaded through the alloplastic material and is fixed at the adjacent ribs by Parham steel bands (Ethicon, Sommerville, KY, USA). RESULTS: In all cases we achieved excellent stability. All of the patients were extubated on the operating table. There was no morbidity or mortality. In three cases the metal bars were removed after 3, 6 and 16 months postoperatively (dynamization). CONCLUSION: The new procedure is safe, simple and quickly performed. The additional costs are low (160 euro). The patient's comfort is excellent; borderline problems as described for Marlex-Sandwich can be avoided, so that this procedure can be considered as an alternative to Marlex-Sandwich.
UI - 11587678
AU - Ashkanani F; Sarkar T; Needham G; Coldwells A; Ah-See AK; Gilbert FJ;
TI - Hutcheon AW; Eremin O; Heys SD What is achieved by mammographic surveillance after breast conservation treatment for breast cancer?
SO - Am J Surg 2001 Sep;182(3):207-10
AD - Department of Surgery, University of Aberdeen, Aberdeen, UK.
BACKGROUND: After breast conservation surgery for breast cancer, patients are followed up by regular clinical examination and mammography, at intervals which vary according to local practice. However, the optimum interval remains unclear with current guidelines suggesting mammography should be carried out every 1 to 2 years. This study has investigated this aspect and, in particular, whether mammography or clinical examination or both allowed an early detection of recurrence of the disease in the conserved breast. METHODS: A total of 695 patients who had undergone breast conservation surgery were identified from a database of prospectively recorded data during the period 1990 to 1995. Clinical examination and annual mammography were performed in accordance with local protocol. The results of clinical examination, mammography, and local recurrence rates were evaluated. RESULTS: A total of 2,181 mammograms were undertaken in the 695 patients studied. Local recurrence of disease in the conserved breast occurred in 21 patients (3%), at a mean follow-up of 3.5 years. The first identification of tumor recurrence was by clinical examination in 11 patients with local recurrence, and by the surveillance mammography in the other 10 patients with local recurrence. Overall, mammography detected the local recurrence in 13 of 20 (65%) patients who underwent this examination. In the other patients, the recurrence was detected on clinical examination only. In addition, in 52 patients, mammography was falsely positive, giving a false positive rate of 2.3%. Contralateral cancers in the opposite breast were detected in 2 patients. CONCLUSIONS: The detection of local disease after breast conservation surgery requires both clinical examination and mammography. In the context of our follow-up policy, in 52% of patients with local recurrence, this was first identified by clinical examination. Disease recurrence was identified in the other 48% of patients by mammographic surveillance. Overall, mammography will identify or confirm local recurrence in two thirds of women. However, in a small number of cases (2.3% in our series) mammography will give false positive results. New imaging modalities to assist in the diagnosis of local recurrence of disease after breast conservation surgery are required.
UI - 11596017
AU - Izzo F; Thomas R; Delrio P; Rinaldo M; Vallone P; DeChiara A; Botti G;
TI - D'Aiuto G; Cortino P; Curley SA Radiofrequency ablation in patients with primary breast carcinoma: a pilot study in 26 patients.
SO - Cancer 2001 Oct 15;92(8):2036-44
AD - Division of Surgical Oncology, The G. Pascale National Cancer Institute, Naples, Italy.
BACKGROUND: The authors performed a pilot trial of ultrasound-guided percutaneous radiofrequency ablation (RFA) in patients with T1 and T2 breast tumors 1) to confirm complete coagulative necrosis of tumor tissue and 2) to determine the safety and complications related to this treatment. METHODS: Twenty-six patients with biopsy-proven, invasive breast carcinoma underwent RFA of their breast tumors followed by immediate resection. Treatment was planned to ablate the tumor and a 5 mm margin of surrounding breast tissue. Tumor viability after RFA was assessed by hematoxylin and eosin and nicotinamide adenine dinucleotide vital staining. RESULTS: Twenty patients (77%) had T1 tumors, and six patients (23%) had T2 tumors. The mean greatest dimension of tumors that were treated with RFA was 1.8 cm (range, 0.7-3.0 cm). The mean treatment time for two-phase RFA treatment was 15 minutes and 23 seconds (range, from 6 minutes and 25 seconds to 24 minutes and 54 seconds). Coagulation necrosis of the tumor was complete in 25 of 26 patients (96%): One patient had a microscopic focus of viable tissue adjacent to the needle shaft site. A single patient (1 of 26 patients; 4%) had a complication related to RFA: a full thickness burn of the skin overlying a tumor that was immediately beneath the skin. CONCLUSIONS: This pilot experience with RFA in the treatment of patients with early-stage, primary breast carcinoma revealed that 1) coagulative necrosis of the entire tumor occurred in 96% of the patients, and 2) the treatment was safe, with only a 4% complication rate. The authors have initiated a trial of RFA alone (no resection) for patients with T1 and T2 breast tumors that will include sentinel lymph node mapping and postablation irradiation. Copyright 2001 American Cancer Society.
UI - 11595118
AU - Sartor CI
TI - Postmastectomy radiotherapy in women with breast cancer metastatic to one to three axillary lymph nodes.
SO - Curr Oncol Rep 2001 Nov;3(6):497-505
AD - Department of Radiation Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA. email@example.com
The influence of postmastectomy radiotherapy on survival has long been debated. Early randomized trials established a clear role for adjuvant postmastectomy chest wall radiotherapy (PMCWRT) in reducing locoregional recurrence (LRR), and PMCWRT became standard therapy for patients at high risk of LRR: those with T3 or T4 tumors and four or more involved lymph nodes. However, without effective systemic therapy, distant metastases limited any effect of improved local control on overall outcome, and radiotherapy showed no benefit in survival. In fact, early meta-analyses showed a negative impact of radiotherapy on survival. As data and techniques matured, a favorable influence of PMCWRT on breast cancer-specific mortality emerged but was offset by a radiotherapy-related increase in vascular mortality. Improvements in radiotherapy delivery to increase efficacy and reduce toxicity, restriction of PMCWRT to patients at intermediate or high risk of LRR after mastectomy, and improved distant control of disease with systemic therapy are expected to bring the greatest likelihood of a survival advantage from locoregional control. Three randomized trials with sufficient follow-up meet these criteria. All demonstrate significant improvement in overall survival with PMCWRT. However, the trials were not designed to specifically address the benefit of PMCWRT in patients at intermediate risk of LRR (those with T1 or T2 tumors and one to three involved lymph nodes). These findings have been discussed in a host of publications and conferences in light of historical negative results. This review focuses on the recent data on PMCWRT in patients with one to three involved nodes.
UI - 11597809
AU - Fowble B; Hanlon A; Freedman G; Nicolaou N; Anderson P
TI - Second cancers after conservative surgery and radiation for stages I-II breast cancer: identifying a subset of women at increased risk.
SO - Int J Radiat Oncol Biol Phys 2001 Nov 1;51(3):679-90
AD - Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
PURPOSE: To assess the risk and patterns of second malignancy in a group of women treated with conservative surgery and radiation in a relatively contemporary manner for early-stage invasive breast cancer, and to identify a subgroup of these women at increased risk for a second cancer. METHODS AND MATERIALS: From 1978 to 1994, 1,253 women with unilateral Stage I-II breast cancer underwent wide excision, axillary dissection, and radiation. The median follow-up was 8.9 years, with 446 patients followed for >or= 10 years. The median age was 55 years. Sixty-eight percent had T1 tumors and 74% were axillary-node negative. Radiation was directed to the breast only in 78%. Adjuvant therapy consisted of chemotherapy in 19%, tamoxifen in 19%, and both in 8%. Factors analyzed for their association with the cumulative incidence of all second malignancies, contralateral breast cancer, and non-breast cancer malignancy were: age, menopausal status, race, family history, obesity, smoking, tumor size, location, histology, pathologic nodal status, region(s) treated with radiation, and the use and type of adjuvant therapy. RESULTS: One hundred seventy-six women developed a second malignancy (87 contralateral breast cancers at a median interval of 5.8 years, and 98 non-breast cancer malignancies at a median interval of 7.2 years). Nine women had both a contralateral breast cancer and non-breast cancer second malignancy. The 5- and 10-year cumulative incidences of a second malignancy were 5% and 16% for all cancers, 3% and 7% for contralateral breast cancer, 3% and 8%, for all second non-breast cancer malignancies, and 1% and 5%, respectively, for second non-breast cancer malignancies, excluding skin cancers. Patient age was a significant factor for contralateral breast cancer and non-breast cancer second malignancy. Young age was associated with an increased risk of contralateral breast cancer, while older age was associated with an increased the risk of a second non-breast cancer second malignancy. A positive family history increased the risk of contralateral breast cancer, but not non-breast cancer malignancies. The risk of a contralateral breast cancer increased as the number of affected relatives increased. Tamoxifen resulted in a nonsignificant decrease in contralateral breast cancer and an increase in non-breast cancer second malignancies. The 5-and 10-year cumulative incidences for leukemia and lung cancer were 0.08% and 0.2%, and 0.8% and 1%, respectively. There was no significant effect of chemotherapy or the regions treated with radiation on contralateral breast cancer or non-breast cancer second malignancy. The most common types of second non-breast cancer malignancies were skin cancers, followed by gynecologic malignancies (endometrial), and gastrointestinal malignancies (colorectal and pancreas). CONCLUSION: The 10-years cumulative incidence of a second cancer in this study was 16%. Young age and family history predicted for an increased risk of contralateral breast cancer, and older age predicted for an increased risk of non-breast cancer malignancy. The majority of patients treated with conservative surgery and radiation with or without adjuvant systemic therapy will not develop a second cancer. Long-term follow-up is important to document the risk and patterns of second cancer, and knowledge of this risk and the patterns will influence surveillance and prevention strategies.
UI - 11603561
AU - Answini GA; Woodard WL; Norton HJ; White RL Jr
TI - Breast conservation: trends in a major southern metropolitan area compared with surrounding rural counties.
SO - Am Surg 2001 Oct;67(10):994-8
AD - Department of General Surgery and Blumenthal Cancer Center, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
Despite randomized prospective studies and National Institutes of Health recommendations, surgeons especially in the southern United States have been slow to adopt breast conservation surgery (BCS). Data were analyzed regarding 3,349 cases of stage 0, I, and II breast cancer (1991-1998) from Charlotte-Mecklenburg County, NC; 1057 cases from six surrounding rural counties (1995-1997); and 90,398 cases (1995) from the National Cancer Data Base. During 1995 through 1997 Charlotte-Mecklenburg County had statistically significantly higher rates of BCS compared with six surrounding rural counties for stage I (59% and 42% respectively, P = 0.001) and stage II (37% and 19%, respectively, P = 0.001) breast cancer. The BCS rates in Charlotte-Mecklenburg County (1991-1998) showed the following: Stage 0 rate increased from 17 per cent in 1991 to 78 per cent in 1998 (P = 0.001), stage I rate increased from 31 per cent in 1991 to 65 per cent in 1998 (P = 0.001), and stage II rate increased from 18 per cent in 1991 to 42 per cent in 1998 (P = 0.001). BCS rates for early-stage breast cancer in Charlotte-Mecklenburg County have increased over the last 8 years and now equal national rates; however, patients in surrounding rural counties are not receiving BCS as frequently. There is a need for more widespread education of surgeons, other health care providers, and the general public to increase the use of BCS.
UI - 11606869
AU - Given C; Bradley C; Luca A; Given B; Osuch JR
TI - Observation interval for evaluating the costs of surgical interventions for older women with a new diagnosis of breast cancer.
SO - Med Care 2001 Nov;39(11):1146-57
AD - Department of Family Practice, Michigan State University, East Lansing 48824, USA. firstname.lastname@example.org
OBJECTIVE: To estimate the episodic costs of surgical treatments for breast cancer. METHODS: The surgical treatment period as the 6 weeks following diagnosis is defined. Using a sample of 205 women aged 65 and older and their Medicare claim files, the cost of treatment is estimated and the progression from first to subsequent surgical procedures during the 6-week interval is demonstrated with a decision tree. Two equations are then estimated: the probability of mastectomy versus breast conserving surgery (BCS) as first surgery using Probit regression and the log of total charges using a generalized linear regression model. RESULTS: It was found that only stage predicts the probability of mastectomy versus BCS and that 54% of women receiving BCS undergo a second surgery. Once all treatments in the initial surgical period are accounted, the difference between the adjusted cost of mastectomy alone and BCS followed by a second surgery was not statistically significant. Only a successful first BCS is statistically significantly (P <0.05) less costly than a mastectomy alone ($4,955 vs. $9,049). CONCLUSIONS: By defining a 6-week surgical treatment episode it is shown that BCS followed by subsequent surgeries is the more costly option for initial treatment. Given the high prevalence of second surgeries, previous work may have underestimated the costs of surgical interventions for breast cancer.
UI - 11641092
AU - Bourez RL; Rutgers EJ
TI - The European Organization for Research and Treatment of Cancer (EORTC) Breast Cancer Group: quality control of surgical trials.
SO - Surg Oncol Clin N Am 2001 Oct;10(4):807-19, ix
AD - Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
This article discusses the impact of surgery-related factors on the outcome of breast cancer patients and the experience of the EORTC in assessing the quality of breast cancer surgery. Furthermore an overview is given of the surgical quality control in the EORTC-AMAROS trial NR 10981.
UI - 11669588
AU - Cutress RI; Gupta R; Parakh A; Rutter D; Spencer L; Royle GT
TI - Might patients benefit from oral iron therapy following operative treatment of breast carcinoma?
SO - Eur J Surg Oncol 2001 Nov;27(7):621-5
AD - Southampton Breast Unit, Royal South Hants Hospital, Brintons Terrace, Southampton SO14 0YG, UK.
AIMS: To assess the changes in blood haemoglobin concentration and serum iron indices as a consequence of breast operations for cancer in our unit. METHODS: Haematological parameters were measured in 109 patients undergoing definitive operative treatment for breast carcinoma. RESULTS: A mean fall in haemoglobin of 2.1 g (P=0.001) occurred in patients undergoing mastectomy and axillary clearance and of 1.3 g (P<0.001) in patients undergoing wide local excision and axillary clearance. The transferrin saturation (serum iron/total iron binding capacity) in both sets of patients after surgery fell on average to levels that would be expected to impair subsequent red cell production. CONCLUSION: The changes in iron indices that occurred were unrelated to the degree of blood loss consistent with a possible inflammatory effect of the operation. Oral iron therapy is unlikely to be of benefit to operative breast patients if they have normal pre-operative iron stores. Copyright 2001 Harcourt Publishers Limited.
UI - 11680071
AU - van der Loo EM; Sastrowijoto SH; Bril H; van Krimpen C; de Graaf PW;
TI - Eulderink F [Less operations required due to perioperative frozen section examination of sentinel nodes in 275 breast cancer patients]
SO - Ned Tijdschr Geneeskd 2001 Oct 13;145(41):1986-91
AD - mw.dr.E.M.van der Loo
OBJECTIVE: To determine the reliability of a peroperative frozen section examinations of sentinel lymph nodes in mammary carcinoma. DESIGN: Retrospective. METHOD: In the Reinier de Graaf Hospital and Diagnostic Centre SSDZ Delft, the Netherlands, the results of frozen section from sentinel lymph node investigations of mammary carcinomas from 1997-2000 were compared with the final pathological results. If axillary dissection had been performed on these patients, the histopathological findings of the dissected lymph nodes were also studied. RESULTS: Frozen sections were made of 287 sentinel lymph nodes from 275 patients. A tumour was found in the sentinel lymph nodes of 64 patients and these patients immediately underwent a complete axillary lymph node dissection. For 31 of these patients a tumour was also found in the other lymph nodes. In 29 of these 31 patients, histological examination had shown extranodal extension. The frozen sections from the sentinel nodes of the remaining 211 patients were considered negative. However, in 13 of these patients, the paraffin sections of the sentinel node nevertheless showed a tumour and the remaining axillary lymph nodes were removed in a second operation. In the last 89 patients studied, the sentinel lymph nodes were cut at four levels and stained immunohistochemically at one level for cytokeratins. Accordingly micrometastases were found in the sentinel lymph nodes of 4 of the 13 patients with (false-)negative frozen sections. False-positive results did not occur. CONCLUSION: The major advantage of the sentinel node method in breast cancer is that for women without metastasis present in the sentinel node, axillary dissection is avoided. By means of a peroperative examination of frozen sections, 83% of the patients with a metastasis in the sentinel lymph node (or about one quarter of all patients) were spared from having a second operation for axillary dissection at a later stage.
UI - 11693834
AU - Scuderi N; Ribuffo D; Onesti MG; Cigna E
TI - Reconstructive options: implants versus autologous tissue.
SO - Tumori 2001 Jul-Aug;87(4):S8-9
AD - Department of Plastic Surgery, Policlinico Umberto I, University of Rome La Sapienza, Italy.
UI - 11699375
AU - Lundgren S; Jorgensen S; Karesen R
TI - [Breast cancer surgery in Norway 1990-95 illustrated by data from SINTEF United]
SO - Tidsskr Nor Laegeforen 2001 Sep 30;121(23):2688-93
AD - SINTEF Unimed NIS 7465 Trondheim. email@example.com
BACKGROUND: Breast-conserving therapy has been shown to be as effective as mastectomy in many cases; hence in many countries more breast cancer patients are offered this type of treatment. This study focuses on the amount and type of surgery used in Norway for breast cancer patients and the possible use of hospital discharge data to evaluate the diffusion of this surgical practice. MATERIAL AND METHODS: Data from the nationwide Register of Hospital Discharges in Norway at SINTEF Unimed for patients operated for breast cancer from 1990 to 1995 were used. RESULTS: 11,041 patients were registered with 11,727 hospital admissions for breast cancer operations from a total of 64 hospitals. The discrepancy in the number of breast cancer patients with the National Cancer Registry was 7%. Breast-conserving surgery was performed in 19.7%. An increase from 17% in 1990 to 21% in 1995 was f