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1

Post-mastectomy radiation in male breast cancer  

Microsoft Academic Search

Background and purpose: Previous studies of male breast cancer have suggested that due to the lack of breast tissue, post-mastectomy radiation should be routinely utilized in all stages of this disease. We propose that the pattern of local recurrence in male breast cancer is, stage for stage, similar to female breast cancer and, therefore, the indications for post-mastectomy radiation should

Anuradha Chakravarthy; Choong-Ryul Kim

2002-01-01

2

Genomic Prediction of Locoregional Recurrence After Mastectomy in Breast Cancer  

Microsoft Academic Search

Purpose This study aims to explore gene expression profiles that are associated with locoregional (LR) recurrence in breast cancer after mastectomy. Patients and Methods A total of 94 breast cancer patients who underwent mastectomy between 1990 and 2001 and had DNA microarray study on the primary tumor tissues were chosen for this study. Eligible patient should have no evidence of

Skye H. Cheng; Cheng-Fang Horng; Mike West; Erich Huang; Jennifer Pittman; Mei-Hua Tsou; Holly Dressman; Chii-Ming Chen; Stella Y. Tsai; James J. Jian; Mei-Chin Liu; Joseph R. Nevins; Andrew T. Huang

2006-01-01

3

Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer  

Microsoft Academic Search

Background: Risk factors for contralateral breast cancer (CBC) may indicate a benefit for contralateral prophylactic mastectomy (CPM) at the time of unilateral mastectomy for breast cancer. The purpose of this study is to evaluate the efficacy of CPM in preventing CBC.Methods: sixty-four patients undergoing CPM and a control group of 182 patients not undergoing CPM and matched for age, stage,

Elizabeth A Peralta; Joshua D. I Ellenhorn; Lawrence D Wagman; Andrew Dagis; James S Andersen; David Z. J Chu

2000-01-01

4

Predictors of contralateral breast cancer in patients with unilateral breast cancer undergoing contralateral prophylactic mastectomy  

Microsoft Academic Search

BACKGROUND: Although contralateral prophylactic mastectomy (CPM) reduced the risk of contralateral breast cancer in unilateral breast cancer patients, it was difficult to predict which patients were most likely to benefit from the procedure. The objective of this study was to identify the clinicopathologic factors that predict contralateral breast cancer and thereby inform decisions regarding performing CPM in unilateral breast cancer

Min Yi; Funda Meric-Bernstam; Lavinia P. Middleton; Banu K. Arun; Isabelle Bedrosian; Gildy V. Babiera; Rosa F. Hwang; Henry M. Kuerer; Wei Yang; Kelly K. Hunt

2009-01-01

5

Selective Mastectomy in the Management of Locally Advanced Breast Cancer  

SciTech Connect

Purpose: To evaluate local control for patients with locally advanced noninflammatory breast cancer (LABC) managed by selective mastectomy. Methods and Materials: Between 1979 and 1996, 176 patients with LABC were prospectively managed by chemotherapy (CT)-irradiation (RT)-CT without routine mastectomy. All surviving patients were followed for a minimum of 5 years. Results: A total of 132 patients (75%) had a T4 tumor and 22 (12.5%) supraclavicular nodal disease. The clinical complete response rate was 91% (160/176), which included 13 patients who underwent mastectomy and 2 an iridium wire implant. The first site of failure was local for 43 patients (breast {+-} axilla for 38); 27 of these patients underwent salvage mastectomy and 11 did not for an overall mastectomy rate of 23% (40/176). If all 176 patients had undergone routine mastectomy (136 extra mastectomies), 11 additional patients may have avoided an unsalvageable first local relapse. The others would have either have not had a local relapse or would have suffered local relapse after distant disease. No tumor or treatment related factor was found to predict local disease at death. Median disease-free and overall survival for all patients was 26 and 52 months, respectively. Conclusions: Selective mastectomy in LABC may not jeopardize local control or survival.

Ahern, Verity [Department of Radiation Oncology, Westmead Hospital, Sydney (Australia)]. E-mail: verity.ahern@swahs.healthnsw.gov.au; Boyages, John [Department of Radiation Oncology, Westmead Hospital, Sydney (Australia); NSW Breast Cancer Institute, Westmead Hospital, Sydney (Australia); Gebski, Val M. Stat [Department of Radiation Oncology, Westmead Hospital, Sydney (Australia); Department of Medical Oncology, Westmead Hospital, Sydney (Australia); Moon, Dominic [Department of Surgery, Westmead Hospital, Sydney (Australia); Wilcken, Nicholas [NSW Breast Cancer Institute, Westmead Hospital, Sydney (Australia); NHMRC Clinical Trials Centre, University of Sydney, Sydney (Australia)

2007-07-15

6

Breast cancer after bilateral risk-reducing mastectomy.  

PubMed

This study aims to evaluate the incidence of breast cancer after risk-reducing mastectomy (RRM) in healthy BRCA mutation carriers. This study is a long-term follow-up of 307 BRCA mutation carriers of whom 96 chose RRM. None of the study participants had a previous history of breast or ovarian cancer nor had they undergone RRM or risk-reducing bilateral salpingo-oophorectomy (BSO) prior to the time of BRCA testing. The annual incidence of post-mastectomy breast cancer was 0.8% compared with 1.7% in the non-operated group. Implications of these findings in relation to genetic counseling and future management are discussed. PMID:21199491

Skytte, A-B; Crüger, D; Gerster, M; Laenkholm, A-V; Lang, C; Brøndum-Nielsen, K; Andersen, M K; Sunde, L; Kølvraa, S; Gerdes, A-M

2011-05-01

7

The meaning of ‘reconstruction’ within the lived experience of mastectomy for breast cancer  

Microsoft Academic Search

This paper represents a heuristic study of the meaning and essence of ‘reconstruction’ within the lived experience of mastectomy for breast cancer. Open-ended interviews were conducted with a sample of eight women aged 40 to 58 years, who underwent mastectomy for breast cancer. Four participants had immediate breast reconstruction; two participants had delayed breast reconstruction, and two participants decided not

Margaret Truelsen

2003-01-01

8

Achieving autologous breast reconstruction for breast cancer patients in the setting of post-mastectomy radiotherapy  

Microsoft Academic Search

Introduction  Breast cancer is now associated with long-term disease-free and overall survival, and in the setting of mastectomy, long term\\u000a psycho-sexual health becomes an important consideration. To this end, breast reconstruction has been shown to significantly\\u000a improve quality of life for mastectomy patients. With adjuvant radiotherapy often required in the setting of breast reconstruction,\\u000a it is unclear what interaction the two

Namrata S. Anavekar; Warren M. Rozen; Cara M. Le Roux; Mark W. Ashton

2011-01-01

9

Nipple-sparing mastectomy in association with intra operative radiotherapy (ELIOT): a new type of mastectomy for breast cancer treatment  

Microsoft Academic Search

Summary\\u000a Background  Breast-conserving surgery has become the standard approach for about 80% of patients treated for primary breast cancer in\\u000a most centres. However, mastectomy is still required in case of multicentric and\\/or large tumours or where recurrences occur\\u000a after conservative treatment. When a total mastectomy is performed, the removal of the nipple areola complex (NAC) is a strongly\\u000a debated issue. In

Jean Yves Petit; Umberto Veronesi; Roberto Orecchia; Alberto Luini; Piercarlo Rey; Mattia Intra; Florence Didier; Stefano Martella; Mario Rietjens; Cristina Garusi; Francesca De Lorenzi; Giovanna Gatti; Maria Elena Leon; Chiara Casadio

2006-01-01

10

Breast reconstruction after mastectomy  

Microsoft Academic Search

The management of the woman with breast cancer who requires mastectomy should involve a multidisciplinary approach which includes close collaboration between the oncological surgeon, the medical oncologist, the radiation oncologist and the reconstructive surgeon. The reconstructive surgeon can be a useful source of information for the patient with respect to the available options for breast reconstruction as well as appropriate

M. A. Codner; J. Bostwick; F. Nahai

1995-01-01

11

Predictors and outcomes of contralateral prophylactic mastectomy among breast cancer survivors  

Microsoft Academic Search

Background  Women affected with breast cancer who carry a BRCA1 or BRCA2 (BRCA1\\/2) mutation are at risk of developing contralateral breast\\u000a cancer. To reduce the risk of contralateral breast cancer, some patients opt for prophylactic surgery of the unaffected breast\\u000a (contralateral prophylactic mastectomy, CPM) in addition to mastectomy of the affected breast.\\u000a \\u000a \\u000a \\u000a Methods  We conducted the present study to determine the predictors

Kristi D. Graves; Beth N. Peshkin; Chanita H. Halbert; Tiffani A. DeMarco; Claudine Isaacs; Marc D. Schwartz

2007-01-01

12

Invasive breast cancer following bilateral subcutaneous mastectomy in a BRCA2 mutation carrier: a case report and review of the literature  

Microsoft Academic Search

BACKGROUND: Primary prevention of breast cancer through prophylactic mastectomy can reduce the risk of malignancy in high-risk individuals. No type of mastectomy completely removes all breast tissue, but a subcutaneous mastectomy leaves more tissue in situ than does a simple mastectomy. CASE PRESENTATION: We report a case of invasive breast cancer in a BRCA2-positive woman 33 years after bilateral subcutaneous

Lidia Kasprzak; Benoit Mesurolle; Francine Tremblay; Maria Galvez; Fawaz Halwani; William D Foulkes

2005-01-01

13

Mastectomy  

MedlinePLUS

... BREAST CANCER The most common reason for a mastectomy is breast cancer. If you are diagnosed with breast cancer, talk ... may choose to have a preventive (or prophylactic) mastectomy to reduce your risk of breast cancer. You may be more likely to get breast ...

14

Researchers find that Angelina Jolie's preventive mastectomy raised awareness, but not knowledge of breast cancer risk  

Cancer.gov

Angelina Jolie heightened awareness about breast cancer when she announced in May 2013 that she had undergone a preventive double mastectomy, but a new study by the University of Maryland School of Public Health reveals that despite widespread awareness of Jolie's story, most Americans could not correctly answer questions about breast cancer risk.

15

"Does that Make Me a Woman?": Breast Cancer, Mastectomy, and Breast Reconstruction Decisions among Sexual Minority Women  

ERIC Educational Resources Information Center

Feminist scholars and activists writing about breast cancer care among women have highlighted the sexist and heterosexist assumptions often embedded in the medical management of breast cancer, and of mastectomy in particular. Despite these contributions, and some speculation that sexual minority women may be less interested in breast

Rubin, Lisa R.; Tanenbaum, Molly

2011-01-01

16

Safety and efficacy of contra-lateral breast reduction for women with mammary hypertrophy undergoing mastectomy for breast cancer  

Microsoft Academic Search

Women with mammary hypertrophy undergoing mastectomy for breast cancer suffer disability because of disproportionate asymmetry. The case notes of all women with mammary hypertrophy undergoing mastectomy and immediate contra-lateral reduction mammaplasty for primary breast cancer from February 2001 to December 2008 were reviewed. Thirty-three women were identified of whom twenty-seven underwent inferior pedicle reduction mammaplasty and six inferior dermoglandular pedicle

Michael Green; Sebastian Aspinall; James Kollias

2009-01-01

17

Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer: comparison of breast conservation and mastectomy  

Microsoft Academic Search

Women with BRCA1 and BRCA2 mutations have an elevated risk of breast cancer and ovarian cancer, but also of developing second\\u000a primary breast cancer. BRCA1\\/2 mutation carriers with breast cancer must choose between breast conservation (BCT) and mastectomy\\u000a (M) yet data on outcomes are limited. The purpose of this study is to compare long-term outcome following BCT and M in

Lori J. PierceKelly-Anne; Kelly-Anne Phillips; Kent A. Griffith; Saundra Buys; David K. Gaffney; Meena S. Moran; Bruce G. Haffty; Merav Ben-David; Bella Kaufman; Judy E. Garber; Sofia D. Merajver; Judith Balmaña; Amichay Meirovitz; Susan M. Domchek

2010-01-01

18

Comparison of recurrence and survival rates after breast-conserving therapy and mastectomy in young women with breast cancer  

PubMed Central

Multiple randomized trials have demonstrated that breast-conserving therapy with partial mastectomy and radiotherapy provides survival equivalent to that seen with mastectomy for patients with early-stage breast cancer. Breast-conserving therapy has been associated with better quality of life relative to mastectomy and has become the standard of care for patients with early-stage breast cancer. Young age has been identified as a risk factor for recurrence and death from breast cancer. Some studies have suggested that young women (less than 35 or 40 years of age) have inferior outcomes with breast-conserving therapy, implying that such women may be better served by mastectomy. On review of the available literature, there is no definitive evidence that mastectomy provides a consistent, unequivocal recurrence-free or overall survival benefit over breast-conserving therapy. However, available meta-analyses have not compared outcomes in young women specifically, and such analyses should be performed. In the interim, breast-conserving therapy is not contraindicated in young women (less than 40 years of age) and can be used cautiously; however, such women should be advised of the lack of unequivocal data proving that survival is equivalent to that with mastectomy in their age group.

Cao, J.Q.; Olson, R.A.; Tyldesley, S.K.

2013-01-01

19

Penn researchers find contralateral prophylactic mastectomy offers limited gains to life expectancy for breast cancer patients:  

Cancer.gov

Contralateral prophylactic mastectomy (CPM), a procedure that removes the unaffected breast in patients with cancer in one breast, provides only a modest increase in life expectancy, according to a new study by researchers from the Perelman School of Medicine at the University of Pennsylvania.

20

Survival Implications Associated with Variation in Mastectomy Rates for Early-Staged Breast Cancer  

PubMed Central

Despite a 20-year-old guideline from the National Institutes of Health (NIH) Consensus Development Conference recommending breast conserving surgery with radiation (BCSR) over mastectomy for woman with early-stage breast cancer (ESBC) because it preserves the breast, recent evidence shows mastectomy rates increasing and higher-staged ESBC patients are more likely to receive mastectomy. These observations suggest that some patients and their providers believe that mastectomy has advantages over BCSR and these advantages increase with stage. These beliefs may persist because the randomized controlled trials (RCTs) that served as the basis for the NIH guideline were populated mainly with lower-staged patients. Our objective is to assess the survival implications associated with mastectomy choice by patient alignment with the RCT populations. We used instrumental variable methods to estimate the relationship between surgery choice and survival for ESBC patients based on variation in local area surgery styles. We find results consistent with the RCTs for patients closely aligned to the RCT populations. However, for patients unlike those in the RCTs, our results suggest that higher mastectomy rates are associated with reduced survival. We are careful to interpret our estimates in terms of limitations of our estimation approach.

Brooks, John M.; Chrischilles, Elizabeth A.; Landrum, Mary Beth; Wright, Kara B.; Fang, Gang; Winer, Eric P.; Keating, Nancy L.

2012-01-01

21

Survival implications associated with variation in mastectomy rates for early-staged breast cancer.  

PubMed

Despite a 20-year-old guideline from the National Institutes of Health (NIH) Consensus Development Conference recommending breast conserving surgery with radiation (BCSR) over mastectomy for woman with early-stage breast cancer (ESBC) because it preserves the breast, recent evidence shows mastectomy rates increasing and higher-staged ESBC patients are more likely to receive mastectomy. These observations suggest that some patients and their providers believe that mastectomy has advantages over BCSR and these advantages increase with stage. These beliefs may persist because the randomized controlled trials (RCTs) that served as the basis for the NIH guideline were populated mainly with lower-staged patients. Our objective is to assess the survival implications associated with mastectomy choice by patient alignment with the RCT populations. We used instrumental variable methods to estimate the relationship between surgery choice and survival for ESBC patients based on variation in local area surgery styles. We find results consistent with the RCTs for patients closely aligned to the RCT populations. However, for patients unlike those in the RCTs, our results suggest that higher mastectomy rates are associated with reduced survival. We are careful to interpret our estimates in terms of limitations of our estimation approach. PMID:22928097

Brooks, John M; Chrischilles, Elizabeth A; Landrum, Mary Beth; Wright, Kara B; Fang, Gang; Winer, Eric P; Keating, Nancy L

2012-01-01

22

Increasing contralateral mastectomy use at diagnosis: Surgical prevention of contralateral breast cancer  

Microsoft Academic Search

Patients with unilateral breast cancer are at increased risk for developing contralateral breast cancer (CBC). The annual\\u000a risk of clinically detected metachronous CBC is about 0.6%. Some patients choose contralateral prophylactic mastectomy (CPM)\\u000a to prevent CBC. Recent studies reported that the CPM rates have markedly increased in recent years in the United States. The\\u000a risk of CBC is reduced by

Todd M. Tuttle; Amanda Arrington; Natasha Rueth

2009-01-01

23

Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation  

Microsoft Academic Search

BACKGROUND: Women with a BRCA1 or BRCA2 mutation have a high risk of breast cancer and may choose to undergo prophylactic bilateral total\\u000a mastectomy. We investigated the efficacy of this procedure in such women.\\u000a METHODS: We conducted a prospective study of 139 women with a pathogenic\\u000a BRCA1 or BRCA2 mutation who were enrolled in a breast-cancer surveillance\\u000a program at the

E. J. Meijers-Heijboer; M. F. Niermeijer; J. G. M. Klijn; C. T. Brekelmans; Geel van B. N; Putten van W. L. J; S. C. Henzen-Logmans; C. M. Seynaeve; M. B. E. Menke-Pluymers; L. C. Verhoog; Ouweland van den A. M. W; C. C. M. Bartels

2001-01-01

24

Depression after surgery for breast cancer. Comparison of mastectomy and lumpectomy.  

PubMed

The impact of the loss of the breast in women undergoing surgical treatment for breast cancer is subordinated to the confrontation with the diagnosis of a malignancy in causing depression. The equal distribution of depression in mastectomy and in lumpectomy patients supports the hypothesis that it is the confrontation with the potentially lethal outcome of the diagnosis which is decisive in causing depression. The grief reaction following mastectomy has two components: a depressive reaction to the loss of the breast and an anticipatory grief for anticipation of the potentially lethal outcome. Psychosocial therapeutic support in breast malignancy must give priority to coping with the diagnosis of cancer over the loss of the breast. PMID:2641560

van Heeringen, C; Van Moffaert, M; de Cuypere, G

1989-01-01

25

Male Breast Cancer: 20-Year Survival Data for Post-Mastectomy Radiotherapy  

PubMed Central

Summary Background The goal of this population-based study was to determine the impact of post-mastectomy radiation therapy on long-term overall survival (OS) of male patients with breast cancer. Patients and Methods We investigated 20-year OS rates of 664 patients diagnosed with primary stage I–III breast cancer in former East Germany between 1970 and 1989. Patients had a radical mastectomy with axillary lymph node dissection without systemic adjuvant therapy. Results Median follow-up time was 26.2 years (range 19–38 years). 52.4% of the patients had post-mastectomy radiotherapy. Radiotherapy showed different effects in each stage group after 20 years. Whereas there was an OS trend for radiotherapy to harm patients with stage I disease (hazard ratio (HR) 1.45; 95% confidence interval (CI) 0.98–2.15; p = 0.065), radiotherapy showed no benefit in patients with stage II disease (HR 0.82; 95% CI 0.62–1.1; p = 0.15). There was a significant survival benefit for patients with stage III disease receiving radiotherapy (HR 0.60; 95% CI 0.41–0.88; p = 0.008). Conclusion Post-mastectomy radiotherapy is associated with longer OS in male patients with stage III breast cancer. Male breast cancer patients at stages I and II do not seem to benefit from radiotherapy, but obsolete irradiation techniques might explain adverse long-term effects in earlier stages.

Eggemann, Holm; Ignatov, Atanas; Stabenow, Roland; von Minckwitz, Gunter; Rohl, Friedrich Wilhelm; Hass, Peter; Costa, Serban-Dan

2013-01-01

26

Genetic counselling and the intention to undergo prophylactic mastectomy: effects of a breast cancer risk assessment  

Microsoft Academic Search

Scientific reports suggest that women at risk for familial breast cancer may benefit from prophylactic mastectomy. However, few data are available about how women decide upon this clinical option, and in particular, what role an objective risk assessment plays in this. The purpose of the present study is to assess whether this objective risk information provided in genetic counselling affects

S van Dijk; W Otten; M W Zoeteweij; D R M Timmermans; C J van Asperen; M H Breuning; R A E M Tollenaar; J Kievit

2003-01-01

27

[Axillar-subclavian-subscapular area plasty after radical mastectomy for breast cancer].  

PubMed

Indexes of lymphorrhea and rates of early and late complications of the radical mastectomy were studied in 153 patients with breast cancer. Axillar-subclavian-subscapular area plasty with latissimus dorsi muscle fragment is worked out and applied to prevent complications after mastectomy. The use of the method allowed reducing the volume and duration of postoperative lymphorrhea on 45.5% and to 7 days, respectively, after Madden procedure, on 46.8% and to 11 days, respectively, after modified radical mastectomies. It also allowed reducing the wound healing complication rates from 21.8 to 5.4% after Madden procedure and from 58.1 to 16.7% after modified radical mastectomies; rates of postmastectomy oedema of I-II stage from 48 to 18.5%, rates of pain syndrome from 32.7 to 7.4%. PMID:19008814

Pak, D D; Ermoshchenkova, M V

2008-01-01

28

Breast Reconstruction After Mastectomy  

MedlinePLUS

... started. What is breast reconstruction? New choices in breast cancer surgery and reconstruction Types of breast reconstruction Nipple and ... Choosing your plastic surgeon for breast reconstruction Before breast reconstruction surgery After breast reconstruction surgery Can breast reconstruction hide ...

29

Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy.  

PubMed

Increasing numbers of women with breast cancer are electing for contralateral prophylactic mastectomy (CPM) to reduce the risk of developing contralateral breast cancer. The objective of this study was to identify factors that may affect a patient's decision to undergo CPM. We identified 2,504 women with stage 0 to III unilateral primary breast cancer who underwent breast surgery at our institution from January 2000 to August 2006 from a prospectively maintained database. We did logistic regression analyses to determine which factors were associated with undergoing CPM. Of 2,504 breast cancer patients, 1,223 (48.8%) underwent total mastectomy. Of the 1,223 patients who underwent mastectomy, 284 (23.2%) underwent immediate or delayed CPM. There were 33 patients (1.3%) who had genetic testing before the surgery, with the use of testing increasing in the latter years of the study (0.1% in 2000-2002 versus 2.0% in 2003-2006; P < 0.0001). Multivariable analysis revealed several factors that were associated with a patient undergoing CPM: age younger than 50 years, white ethnicity, family history of breast cancer, BRCA1/2 mutation testing, invasive lobular histology, clinical stage, and use of reconstruction. We identified specific patient and tumor characteristics associated with the use of CPM. Although genetic testing is increasing, most women undergoing CPM did not have a known genetic predisposition to breast cancer. Evidence-driven models are needed to better inform women of their absolute risk of contralateral breast cancer as well as their competing risk of recurrence from the primary breast cancer to empower them in their active decision making. PMID:20647335

Yi, Min; Hunt, Kelly K; Arun, Banu K; Bedrosian, Isabelle; Barrera, Angelica Gutierrez; Do, Kim-Anh; Kuerer, Henry M; Babiera, Gildy V; Mittendorf, Elizabeth A; Ready, Kaylene; Litton, Jennifer; Meric-Bernstam, Funda

2010-08-01

30

Persistence of tumor DNA in plasma of breast cancer patients after mastectomy  

Microsoft Academic Search

Background: We investigated tumor DNA changes before and after mastectomy in the plasma of breast cancer patients with no disseminated\\u000a disease and eventually investigated these changes’ relationship to specific pathological parameters of the tumors.\\u000a \\u000a \\u000a Methods: We studied 41 patients. DNA extracted from tumor and normal breast tissues, mononuclear blood cells, and plasma was used\\u000a for molecular studies. Alterations in the

Jose M. Silva; Jose M. Garcia; Gemma Dominguez; Javier Silva; Celia Miralles; Blanca Cantos; Santiago Coca; Mariano Provencio; Pilar Espafia; Felix Bonilla

2002-01-01

31

Univ. of Md. study reports young women with early-stage breast cancer have similar survival with breast-conservation therapy as mastectomy:  

Cancer.gov

Young women with early-stage breast cancer have similar survival rates with a lumpectomy and radiation treatment, known as breast-conservation therapy, as with mastectomy, a new study conducted at the University of Maryland has found.

32

Similar Survival With Breast Conservation Therapy or Mastectomy in the Management of Young Women With Early-Stage Breast Cancer  

SciTech Connect

Purpose: To evaluate survival outcomes of young women with early-stage breast cancer treated with breast conservation therapy (BCT) or mastectomy, using a large, population-based database. Methods and Materials: Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all female patients, ages 20 to 39 years old, diagnosed with T1-2 N0-1 M0 breast cancer between 1990 and 2007, who underwent either BCT (lumpectomy and radiation treatment) or mastectomy. Multivariable and matched pair analyses were performed to compare overall survival (OS) and cause-specific survival (CSS) of patients undergoing BCT and mastectomy. Results: A total of 14,764 women were identified, of whom 45% received BCT and 55% received mastectomy. Median follow-up was 5.7 years (range, 0.5-17.9 years). After we accounted for all patient and tumor characteristics, multivariable analysis found that BCT resulted in OS (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.83-1.04; p = 0.16) and CSS (HR, 0.93; CI, 0.83-1.05; p = 0.26) similar to that of mastectomy. Matched pair analysis, including 4,644 BCT and mastectomy patients, confirmed no difference in OS or CSS: the 5-, 10-, and15-year OS rates for BCT and mastectomy were 92.5%, 83.5%, and 77.0% and 91.9%, 83.6%, and 79.1%, respectively (p = 0.99), and the 5-, 10-, and 15-year CSS rates for BCT and mastectomy were 93.3%, 85.5%, and 79.9% and 92.5%, 85.5%, and 81.9%, respectively (p = 0.88). Conclusions: Our analysis of this population-based database suggests that young women with early-stage breast cancer have similar survival rates whether treated with BCT or mastectomy. These patients should be counseled appropriately regarding their treatment options and should not choose a mastectomy based on the assumption of improved survival.

Mahmood, Usama, E-mail: usama.mahmood@gmail.com [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States)] [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States); Morris, Christopher; Neuner, Geoffrey [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States)] [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States); Koshy, Matthew [Department of Cellular and Radiation Oncology, University of Chicago, Chicago, Illinois (United States)] [Department of Cellular and Radiation Oncology, University of Chicago, Chicago, Illinois (United States); Kesmodel, Susan; Buras, Robert [Department of Surgery, University of Maryland, Baltimore, Maryland (United States)] [Department of Surgery, University of Maryland, Baltimore, Maryland (United States); Chumsri, Saranya; Bao Ting; Tkaczuk, Katherine [Department of Medicine, University of Maryland, Baltimore, Maryland (United States)] [Department of Medicine, University of Maryland, Baltimore, Maryland (United States); Feigenberg, Steven [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States)] [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States)

2012-08-01

33

ADJUVANT CHEMOTHERAPY (TRIETHYLENE THIOPHOSPHORAMIDE) WITH RADICAL MASTECTOMY AND RADIOTHERAPY IN BREAST CANCER.  

PubMed

Triethylene thiophosphoramide (Thio-TEPA) as an adjuvant to radical mastectomy for the treatment of carcinoma of the breast has been shown to be effective in reducing tumour recurrences. In many centres radiotherapy is considered valuable in breast cancer treatment, and in the minds of many there has existed the question of the safety of giving triethylene thiophosphoramide, a radiomimetic drug, at the time of surgery to the patient destined to receive post-operative radiotherapy. Fears had been expressed that the additive effects of triethylene thiophosphoramide and radiotherapy would result in serious complications and preclude the use of this valuable drug.A total of 70 patients with breast cancer were treated by radical mastectomy and administration of triethylene thiophosphoramide. Most patients received postoperative radiotherapy. Results of this study showed that the benefit of adjuvant chemotherapy with triethylene thiophosphoramide need not be withheld and that the drug may be administered with safety to the patient with breast carcinoma for whom radical mastectomy and postoperative radiotherapy are planned. PMID:14101448

HANKINS, G W; MCCARTEN, A B

1963-12-28

34

Adjuvant Chemotherapy (Triethylene Thiophosphoramide) with Radical Mastectomy and Radiotherapy in Breast Cancer  

PubMed Central

Triethylene thiophosphoramide (Thio-TEPA) as an adjuvant to radical mastectomy for the treatment of carcinoma of the breast has been shown to be effective in reducing tumour recurrences. In many centres radiotherapy is considered valuable in breast cancer treatment, and in the minds of many there has existed the question of the safety of giving triethylene thiophosphoramide, a radiomimetic drug, at the time of surgery to the patient destined to receive post-operative radiotherapy. Fears had been expressed that the additive effects of triethylene thiophosphoramide and radiotherapy would result in serious complications and preclude the use of this valuable drug. A total of 70 patients with breast cancer were treated by radical mastectomy and administration of triethylene thiophosphoramide. Most patients received postoperative radiotherapy. Results of this study showed that the benefit of adjuvant chemotherapy with triethylene thiophosphoramide need not be withheld and that the drug may be administered with safety to the patient with breast carcinoma for whom radical mastectomy and postoperative radiotherapy are planned.

Hankins, G. W.; McCarten, A. B.

1963-01-01

35

Current Knowledge on Contralateral Prophylactic Mastectomy Among Women with Sporadic Breast Cancer  

PubMed Central

The use of contralateral prophylactic mastectomy (CPM) in the U.S. among patients with unilateral invasive breast cancer increased by 150% from 1993 to 2003. Although CPM has been shown to reduce the risk for developing contralateral breast cancer, there is conflicting evidence on whether or not it reduces breast cancer mortality or overall death. The increase in the CPM rate is especially concerning among women with early-stage sporadic breast cancer who have a minimal annual risk for developing contralateral breast cancer, and for many of these women the risk for distant metastatic disease outweighs the risk for contralateral breast cancer. The lack of information about the clinical value of CPM in women with sporadic breast cancer is an important public health problem. This review evaluates current data on the clinical indications for CPM and long-term patient satisfaction and psychosocial outcomes. Gaps in knowledge about the clinical value of CPM, including patient- and physician-related psychosocial factors that influence the decision-making process of CPM among women with sporadic breast cancer, are highlighted.

Parker, Patricia A.

2011-01-01

36

Skin Sparing Mastectomy and Immediate Breast Reconstruction (SSMIR) for early breast cancer: Eight years single institution experience  

PubMed Central

Background Skin Sparing Mastectomy (SSM) and immediate breast reconstruction has become increasingly popular as an effective treatment for patients with breast carcinoma. The aim of this study was to evaluate the clinical outcome of skin sparing mastectomy in early breast cancer at a single population-based institution. Methods Records of ninety-five consecutive patients with operable breast cancer who had skin-sparing mastectomy and immediate breast reconstructions between 1995 and 2003 were reviewed. Patient and tumor characteristic, type of reconstruction, postoperative complications, aesthetic results and incidence of recurrence were analyzed. Results Mean age of the patients was 51.6(range 33–72) years. The AJCC pathologic stages were 0 (n = 51, 53.7%), I (n = 20, 21.1%), and II (n = 2, 2.1%). Twenty of the patients had recurrent disease (21.1%). The immediate breast reconstructions were performed with autologus tissue including latissimus dorsi musculocutaneous flap in 63 (66.3%) patients and transverse rectus abdominis myocutaneous (TRAM) flap in 4 (4.2%) patients. Implants were used in 28 (29.4%) patients. The average hospital stay was 7.7 days. Flap complication occurred in seven (10.4%) patients resulting in four (6%) re-operations and there were no delay in accomplishing postoperative adjuvant therapy. At a median follow-up of 69 months (range 48 to 144), local recurrence was seen in one patient (1.1%) and systemic recurrence was seen in two patients (2.1%). Conclusion Skin sparing mastectomy and immediate breast reconstruction for early breast cancer is associated with low morbidity and low rate of local recurrence.

Omranipour, Ramesh; Bobin, Jean yves; Esouyeh, Mustafa

2008-01-01

37

Breast Reconstruction After Mastectomy  

MedlinePLUS

... to rebuild the shape of the removed breast. Breast reconstruction surgery can be either immediate or delayed. With immediate ... ed. Philadelphia: Lippincott Williams & Wilkins; 2009. Cordeiro PG. Breast reconstruction after surgery for breast cancer. New England Journal of Medicine ...

38

Local recurrence after mastectomy for breast cancer: analysis of clinicopathological, biological and prognostic characteristics  

Microsoft Academic Search

Background  Despite the increasing use of breast-conserving therapy, modified radical mastectomy retains an important role in primary\\u000a as well as in salvage treatment of breast cancer. Nevertheless, a significant number of patients will eventually develop a\\u000a local recurrence (LR).\\u000a \\u000a \\u000a \\u000a Aims  To identify the potential prognostic factors at the time of the first isolated LR, and to compare the expression of several\\u000a parameters

Guillermo Carreño; José M. del Casar; Ma Daniela Corte; Luis O. González; Miguel Bongera; Antonio M. Merino; Germán Juan; Raúl Obregón; Enrique Martínez; Francisco J. Vizoso

2007-01-01

39

Post-mastectomy radiotherapy in pT3N0M0 breast cancer: is it needed?  

Microsoft Academic Search

Background and purpose: It is not been established whether breast cancer patients who have a primary tumor 5 cm or larger but no axillary nodal or distant metastases at the time of the diagnosis (pT3N0M0) benefit from post-operative radiation therapy after mastectomy.Material and methods: We identified 81 patients with T3N0M0 breast cancer out of the total of 4190 breast cancer

Maaret Helintö; Carl Blomqvist; Päivi Heikkilä; Heikki Joensuu

1999-01-01

40

The Incidence of Arm Edema in Women With Breast Cancer Randomized on the National Surgical Adjuvant Breast and Bowel Project Study B-04 to Radical Mastectomy Versus Total Mastectomy and Radiotherapy Versus Total Mastectomy Alone  

SciTech Connect

Purpose: To determine the incidence and factors associated with the development of arm edema in women who participated in the National Surgical Adjuvant Breast and Bowel Project (NSABP) study B-04. Methods and Materials: Between 1971 and 1974, the NSABP protocol B-04 randomized 1,665 eligible patients with resectable breast cancer to either (1) the Halstead-type radical mastectomy; (2) total mastectomy and radiotherapy to the chest wall, axilla, supraclavicular region, and internal mammary nodes if by clinical examination axillary nodes were involved by tumor; and (3) for patients with a clinically uninvolved axilla, a third arm, total mastectomy alone. Measurements of the ipsilateral and contralateral arm circumferences were to be performed every 3 months. Results: There was at least one recorded measurement of arm circumferences for 1,457 patients (87.5% of eligible patients). There were 674 women (46.3%) who experienced arm edema at some point during the period of follow-up until February 1976. For radical mastectomy patients, total mastectomy and radiotherapy patients, and total mastectomy patients alone, arm edema was recorded at least once in 58.1%, 38.2%, and 39.1% of patients, respectively (p < .001) and at last recorded measurement in 30.7%, 14.8%, and 15.5%, respectively (p = <.001). Increasing body mass index (BMI) also showed a statistically significant correlation with arm edema at any time (p = .001) and at last assessment (p = .005). Conclusions: Patients who undergo mastectomy, including those whose treatment plans do not include axillary dissection or postoperative radiotherapy, suffer an appreciable incidence of arm edema.

Deutsch, Melvin [National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers, Pittsburgh, PA (United States); University of Pittsburgh Medical Center, Department of Radiation Oncology, Pittsburgh, PA (United States)], E-mail: deutschm@upmc.edu; Land, Stephanie; Begovic, Mirsada; Sharif, Saima [National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers, Pittsburgh, PA (United States)

2008-03-15

41

Mastectomy and breast reconstruction - what to ask your doctor  

MedlinePLUS

... of surgery I have? Will one type of breast surgery work better for my breast cancer? Will I ... more like a natural breast? Can I have breast reconstruction during the same surgery as my mastectomy? If not, how long do ...

42

Patterns and Correlates of Adjuvant Radiotherapy Receipt After Lumpectomy and After Mastectomy for Breast Cancer  

PubMed Central

Purpose To use patient self-report to provide more valid estimates of whether radiotherapy (RT) is underutilized than possible with registry data, as well as to evaluate for disparities and the influence of preferences and provider interactions. Methods We considered 2,260 survey respondents who had nonmetastatic breast cancer, were age 20 to 79 years, were diagnosed between July 2005 and February 2007 in Detroit and Los Angeles, and reported to Surveillance, Epidemiology and End Results (SEER) registries (72% response rate). Survey responses were merged with SEER data. We assessed rates and correlates of RT receipt among all patients with invasive cancer receiving breast-conserving surgery (BCS) and among patients undergoing mastectomy with indications for RT (ie, positive lymph nodes or T3-4 tumors). Results Among 904 patients undergoing BCS with strong indications for RT, 95.4% received RT, and 77.6% received RT among the 135 patients undergoing mastectomy with strong indications (P < .001). Among 114 patients undergoing BCS with weaker indications (ie, elderly) for RT, 80.0% received treatment, and 47.5% received RT among the 164 patients undergoing mastectomy with weaker indications (T1N1, T2N1, or T3N0 disease; P < .001). On multivariate analysis, surgery type (P < .001), indication strength (P < .001), age (P = .005), comorbidity (P < .001), income (P = .03), patient desire to avoid RT (P < .001), level of surgeon involvement in decision to have radiation (P < .001), and SEER site (P < .001) were significantly associated with likelihood of RT receipt. Conclusion RT receipt was consistently high across sociodemographic subgroups after BCS but was lower after mastectomy, even among patients with strong indications for treatment, in whom clinical benefit is similar. Surgeon involvement had a strong influence on RT receipt.

Jagsi, Reshma; Abrahamse, Paul; Morrow, Monica; Hawley, Sarah T.; Griggs, Jennifer J.; Graff, John J.; Hamilton, Ann S.; Katz, Steven J.

2010-01-01

43

Treatment results of breast cancer patients with locoregional recurrence after mastectomy  

PubMed Central

Purpose To analyze the results of locoregional and systemic therapy in the breast cancer patients with locoregional recurrence (LRR) after mastectomy. Materials and Methods Seventy-one patients who received radiotherapy for isolated LRR after mastectomy between January 1999 and December 2009 were retrospectively reviewed. Among the 71 patients, 59 (83.1%) underwent wide excision and radiotherapy and 12 (16.9%) received radiotherapy alone. Adjuvant hormonal therapy was given to 45 patients (63.4%). Oncologic outcomes including locoregional recurrence-free survival, disease-free survival (DFS), and overall survival (OS) and prognostic factors were analyzed. Results Median follow-up time was 49.2 months. Of the 71 patients, 5 (7%) experienced second isolated LRR, and 40 (56%) underwent distant metastasis (DM). The median DFS was 35.6 months, and the 3- and 5-year DFS were 49.1% and 28.6%, respectively. The median OS was 86.7 months, and the 5-year OS was 62.3%. Patients who received hormone therapy together showed better 5-year DFS and OS than the patients treated with locoregional therapy only (31.6% vs. 22.1%, p = 0.036; 66.5% vs. 55.2%, p = 0.022). In multivariate analysis, higher N stage at recurrence was a significant prognostic factor for DFS and OS. Disease free interval (?30 months vs. >30 months) from mastectomy to LRR was also significant for OS. The patients who received hormone therapy showed superior DFS and showed trend to better OS. Conclusion DM was a major pattern of failure after the treatment of LRR after mastectomy. The role of systemic treatment for LRR after mastectomy should be investigated at prospective trials.

Jeong, Yuri; Gong, Gyungyub; Lee, Hee Jin; Ahn, Sei Hyun; Son, Byung Ho; Lee, Jong Won; Choi, Eun Kyung; Lee, Sang-wook; Joo, Ji Hyeon; Ahn, Seung Do

2013-01-01

44

Post mastectomy radiation for large node negative breast cancer: time for a second look.  

PubMed

Patients with node negative and large primary tumors ?5cm comprise a rare entity of breast cancer patients for which clear management guidelines are not available. Data about the rates of loco-regional failures (LRF) in this patient population are scarce and reporting widely varying observations. Post Mastectomy Radiation Therapy (PMRT) for this group of patients is controversial. In this review we examined the available literature discussing the LRF rates in this clinical setting and the value of adding PMRT in their management. PMID:21115360

Boutrus, Rimoun; Taghian, Alphonse G

2012-12-01

45

Risk Factors Associated with Lymphedema among Postmenopausal Breast Cancer Survivors after Radical Mastectomy and Axillary Dissection in China  

PubMed Central

Summary Background Lymphedema is the major complication following breast cancer treatment and can persist long periods of time and affect breast cancer survivors’ quality of life. Accurate estimation of the risk factors for lymphedema is of significant importance. In this article we report the factors for secondary lymphedema among postmenopausal breast cancer patients after radical mastectomy in China. Patients and Methods A total of 126 consecutive postmenopausal breast cancer patients who received radical mastectomy were admitted to the Chongqing Breast Cancer Center between July 2009 and June 2010. Circumferential measurement was used to diagnose lymphedema. Results Among the 126 postmenopausal women with breast cancer, 54 (42.9%) had lymphedema. Body mass index (BMI), lymph nodes status, and radiotherapy were associated with lymphedema. BMI ? 25 kg/m2 (adjusted odds ratio (OR) = 7.5; 95% confidence interval (CI) 2.8–20.1) and radiotherapy (adjusted OR = 3.0; 95% CI 2.0–9.2) were independent predictors of lymphedema. Conclusion BMI, lymph nodes status, and radiotherapy were the risk factors for lymphedema among Chinese postmenopausal breast cancer patients who underwent radical mastectomy. Clinicians should provide sufficient information for patients and their caregivers to prevent this complication, especially for those who are at high risk of developing lymphedema.

Hua-Ping, Huang; Jian-Rong, Zhou; Zeng, Qing

2012-01-01

46

Influence of Surgical Technique on Mastectomy and Reexcision Rates in Breast-Conserving Therapy for Cancer  

PubMed Central

Introduction. Breast conserving surgery (BCS) requires tumor excision with negative margins. Reexcision rates of 30–50% are reported. Ultrasound localization, intraoperative margin pathology, and specimen mammography have reduced reexcisions, but require new equipment. Cavity shave margin (CSM) is a technique, utilizing existing equipment, that potentially reduces reexcision. This study evaluates CSM reexcision impact. Methods. 522 cancers treated with BCS were reviewed. Patients underwent standard partial mastectomy (SPM) or CSM. Data collected included demographics, pathology, and treatments. Results. 455 SPMs were compared to 67 CSMs. Analysis revealed no differences in pathology, intraductal component, or neoadjuvant chemotherapy. Overall reexcision rate = 43%. Most reexcisions were performed for DCIS at margin. SPMs underwent 213 reexcisions (46.8%), versus 16/67 (23.9%) CSMs (P = 0.0003). Total mastectomy as definitive procedure was performed after more SPMs (P = 0.009). Multivariate analysis revealed CSM, % DCIS, tumor size, and race to influence reexcisions. Conclusions. CSM is a technique that reduces reexcisions and mastectomy rates.

Unzeitig, Alison; Kobbermann, Anne; Xie, Xian-Jin; Yan, Jingsheng; Euhus, David; Peng, Yan; Sarode, Venetia; Moldrem, Amy; Leitch, A. Marilyn; Andrews, Valerie; Rao, Roshni

2012-01-01

47

Two Cases of Mastectomy after Paclitaxel + Bevacizumab Therapy for Locally Advanced Breast Cancer  

PubMed Central

Introduction Locally advanced breast cancer (LABC) deteriorates the quality of life (QOL) of the affected patients. Combination chemotherapy or extended chemotherapy is considered to help to shrink local lesions. Case 1 A 71-year-old female with a history of tympanitis and cystitis with methicillin-resistant Staphylococcus aureus (MRSA) visited our hospital. There was a tumor of 7 cm in diameter in her right breast with skin ulceration. Paclitaxel + bevacizumab therapy was started, and after five cycles of therapy, a mastectomy with axillary dissection was performed. Chemotherapy with anthracycline was avoided for fear of activating the MRSA. After the operation, the patient's wound opened. However, it naturally epithelialized. Case 2 A 41-year-old female visited our hospital due to a tumor of 8 cm in diameter in her right breast with skin ulceration. Four cycles of paclitaxel + bevacizumab therapy were started, and her tumor almost disappeared during the first cycle. Then, doxorubicin + cyclophosphamide therapy was performed for four cycles, and a mastectomy with axillary dissection was performed. Her postoperative course was good. Discussion Chemotherapy with bevacizumab or extended chemotherapy is generally not considered to contribute to a survival improvement. However, such therapy contributes in increasing the response to chemotherapy, and should be considered for patients with LABC to shrink the local lesions and improve the QOL.

Shinoda, Chika; Mori, Ryutaro; Nagao, Yasuko

2014-01-01

48

Local Therapy in BRCA1 and BRCA2 Mutation Carriers with Operable Breast Cancer: Comparison of Breast Conservation and Mastectomy  

PubMed Central

Purpose Women with BRCA1 and BRCA2 mutations have an elevated risk of breast cancer and ovarian cancer, but also of developing second primary breast cancer. BRCA1/2 mutation carriers with breast cancer must choose between breast conservation (BCT) and mastectomy (M) yet data on outcomes are limited. The purpose of this study is to compare BCT to M in BRCA1/2 carriers. Methods 655 women with BRCA1/2 mutations diagnosed with breast cancer and treated with BCT (n=302) or M (n=353) were identified and underwent follow up to assess local, regional and systemic recurrence. Results Local failure as first failure was significantly more likely in those treated with BCT compared to M, with a cumulative estimated risk of 23.5% vs. 5.5%, respectively, at 15 years (p<0.0001); 15-year estimates in carriers treated with BCT and chemotherapy was 11.9% (p=0.08 when compared to M). Most events appeared to be second primary cancers rather than failure to control the primary tumor. The risk of contralateral breast cancer was high in all groups, exceeding 40%, but was not statistically significantly different by use of adjuvant radiotherapy (RT) or not, suggesting no added risk from scatter RT at 10 and 15 years. There were no differences seen in regional or systemic recurrences between the BCT and M groups, and no difference in overall survival. Conclusions BRCA1/2 mutation carriers with breast cancer have similar survivals whether treated with M or BCT. However, women undergoing BCT have an elevated risk of a second in-breast event that is significantly reduced in the presence of chemotherapy. Contralateral breast cancer events are very common.

Pierce, Lori J.; Phillips, Kelly-Anne; Griffith, Kent A.; Buys, Saundra; Gaffney, David K.; Moran, Meena S.; Haffty, Bruce G.; Ben-David, Merav; Kaufman, Bella; Garber, Judy E.; Merajver, Sofia D.; Balmana, Judith; Meirovitz, Amichay; Domchek, Susan M.

2010-01-01

49

Prospective Evaluation of the Nipple Areola Complex Sparing Mastectomy for Risk Reduction and for Early-Stage Breast Cancer  

PubMed Central

Background Psychological effects of mastectomy for women with breast cancer have driven treatments that optimize cosmesis while strictly adhering to oncologic principles. Although skin-sparing mastectomy is oncologically safe, questions remain regarding the use of nipple–areola complex (NAC)-sparing mastectomy (NSM). We prospectively evaluated NSM for patients undergoing mastectomy for early-stage breast cancer or risk reduction. Methods We enrolled 33 early-stage breast cancer and high-risk patient; 54 NSMs were performed. NAC viability and surgical complications were evaluated. Intraoperative and postoperative pathologic assessments of the NAC base tissue were performed. NAC sensory, cosmetic and quality of life (QOL) outcomes were also assessed. Results Twenty-one bilateral and 12 unilateral NSMs were performed in 33 patients, 37 (68.5%) for prophylaxis and 17 (31.5%) for malignancy. Mean age was 45.4 years. Complications occurred in 16 NACs (29.6%) and 6 skin flaps (11.1%). Operative intervention for necrosis resulted in 4 NAC removals (7.4%). Two (11.8%) of the 17 breasts with cancer had ductal carcinoma-in-situ at the NAC margin, necessitating removal at mastectomy. All evaluable patients had nipple erection at 6 and 12 months postoperatively. Cosmetic outcome, evaluated by two plastic surgeons, was acceptable in 73.0% of breasts and 55.8% of NACs, but lateral displacement occurred in most cases. QOL assessment indicated patient satisfaction. Conclusions NSM is technically feasible in select patients, with a low risk for NAC removal resulting from necrosis or intraoperative detection of cancer, and preserves sensation and QOL. Thorough pathologic assessment of the NAC base is critical to ensure disease eradication.

Wagner, Jamie L.; Fearmonti, Regina; Hunt, Kelly K.; Hwang, Rosa F.; Meric-Bernstam, Funda; Kuerer, Henry M.; Bedrosian, Isabelle; Crosby, Melissa A.; Baumann, Donald P.; Ross, Merrick I.; Feig, Barry W.; Krishnamurthy, Savitri; Hernandez, Mike; Babiera, Gildy V.

2013-01-01

50

Radiation dose escalation for loco-regional recurrence of breast cancer after mastectomy  

PubMed Central

Background Radiation is a standard component of treatment for patients with locoregional recurrence (LRR) of breast cancer following mastectomy. The current study reports the results of a 10% radiation dose escalation in these patients. Methods 159 patients treated at MD Anderson Cancer Center between 1994-2006 with isolated LRR after mastectomy alone were reviewed. Patients in the standard treatment group (65 pts, 40.9%) were treated to 50 Gy comprehensively plus a boost of 10 Gy. The dose escalated group (94 pts, 59.1%) was treated to 54 Gy comprehensively and a minimum 12 Gy boost. Median dose in the standard dose and dose escalated group was 60 Gy (±1 Gy, 95% CI) and 66 Gy (±0.5 Gy, 95% CI) respectively. Median follow up for living patients was 94 months from time of recurrence. Results The actuarial five year locoregional control (LRC) rate was 77% for the entire study population. The five year overall survival and disease-free survival was 55% and 41%, respectively. On multivariate analysis, initial tumor size (p?=?0.03), time to initial LRR (p?=?0.03), absence of gross tumor at the time of radiation (p?=?0.001) and Her2 status (p?=?0.03) were associated with improved LRC. Five year LRC rates were similar in patients with a complete response to chemotherapy without surgery and patients with a complete surgical excision (77% vs 83%, p?=?NS), compared to a 63% LRC rate in patients with gross disease at the time of radiation (p?=?0.024). LRC rates were 80% in the standard dose group and 75% in the dose escalated group (p?=?NS). Conclusions While LRR following mastectomy is potentially curable, distant metastasis and local control rates remain suboptimal. Radiation dose escalation did not appear to improve LRC. Given significant local failure rates, these patients are good candidates for additional strategies to improve their outcomes.

2013-01-01

51

Concurrent adjuvant chemotherapy and immediate breast reconstruction with skin expanders after mastectomy for breast cancer  

Microsoft Academic Search

Background. Immediate breast reconstruction (IBR) by means of skin expander is currently one of the most widely used methods of breast reconstruction in mastectomized patients. However, given that many breast cancer patients usually receive adjuvant chemotherapy, the adoption of IBR raises new questions concerning possible cumulative toxicity. The present study reports our experience in the use of concurrent adjuvant chemotherapy

Orazio Caffo; Daniela Cazzolli; Alberto Scalet; Bruno Zani; Gianni Ambrosini; Maurizio Amichetti; Daniele Bernardi; Sonia Brugnara; Gianni Ciaghi; Antonio Lucenti; Ninoo Natale; Silvio Agugiaro; Claudio Eccher; Enzo Galligioni

2000-01-01

52

Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer  

Microsoft Academic Search

In 1976 the authors began a randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of State I and II breast tumors less than or equal to 4 cm in size. The operation removes only sufficient tissue to ensure that margins of resected specimens are free of tumor. Women were randomly assigned to total mastectomy, segmental

Bernard Fisher; Madeline Bauer; Richard Margolese; Roger Poisson; Yosef Pilch; Carol Redmond; Edwin Fisher; Norman Wolmark; Melvin Deutsch; Eleanor Montague; Elizabeth Saffer; Lawrence Wickerham; Harvey Lerner; Andrew Glass; Henry Shibata; Peter Deckers; Alfred Ketcham; Robert Oishi; Ian Russell

1985-01-01

53

Hypofractionation in post-mastectomy breast cancer patients: seven-year follow-up.  

PubMed

To compare three fractionation schedules in post-mastectomy patients treated with radiotherapy as regard acute and early late effects as well as local recurrence rates. One hundred and seven breast cancer patients treated with modified radical mastectomy and adjuvant radiotherapy±adjuvant systemic treatments between November 2001 and July 2004 were enrolled in this study. Patients were categorized into three groups. Group A (41 patients) received conventional fractionation 50 Gy over 25 fractions. Group B (36 patients) received other fractionation regimen 45 Gy over 17 fractions. Group C (30 patients) received 40 Gy over 15 fractions. The median follow-up period was 23 months. There has been no statistical significant difference in local control (P=0.88), pain (P=0.98), telangectasis (P=0.23), fibrosis (P=0.13), arm oedema (P=0.96) or pigmentation (P=0.80) between the three groups. GII-III Erythema was significantly higher in the two hypofractionation arms compared to the control arm (P=0.001). Although acute skin reactions were higher in the hypofractionated arms, there was no significant difference in the local recurrence rates or late radiation effects. A national randomized multicentre study is recommended to explore this further. PMID:22354766

Eldeeb, Hany; Awad, Iman; Elhanafy, Osman

2012-12-01

54

Treatment choices in breast cancer: a comparative analysis of mastectomy patients and radiation patients  

SciTech Connect

This descriptive-exploratory study identified factors that distinguished women on the basis of the treatment they chose for breast cancer. A semi-structured interview and questionnaire was administered to 30 respondents who received mastectomy and 31 who received lumpectomy with radiation. The variables investigated as potential predictors of treatment choice were (1) participation in treatment planning, (2) knowledge of illness and treatment alternatives, (3) health locus of control, (4) sex-role identification, (5) body image, (6) social support and (7) age. As perceptions of the outcome of treatment influence attitudes about treatment choice, five variables relating to perceived treatment consequences were also examined. These were (1) social support, (2) body image, (3) satisfaction with medical care, (4) satisfaction with treatment and (5) general well-being. The major findings in regard to the predictor variables included a profile of the characteristics of each group. The radiation group had more knowledge, participated in planning to a greater extent, investigated treatment options more often and typically made their own decisions about treatment. The mastectomy group was older, attributed locus of control to chance and demonstrated nonsignificant trends toward locus of control in powerful others and toward a feminine sex-role identification; 50% cited Surgeon's Advice as the basis of their choice.

Williams, J.

1985-01-01

55

Breast cancer subpopulation with high risk of internal mammary lymph nodes metastasis: analysis of 2,269 Chinese breast cancer patients treated with extended radical mastectomy  

Microsoft Academic Search

Purpose  The selective treatment of internal mammary lymph nodes (IMNs) in breast cancer is controversial. The purpose of this research\\u000a was to determine the subpopulation patients with high risk of internal mammary lymph nodes metastasis who received extended\\u000a radical mastectomy without any preoperative treatment from 1956 to 2003 in China.\\u000a \\u000a \\u000a \\u000a Patients and methods  1,679 Chinese patients were underwent extended radical mastectomy (ERM)

Ou Huang; Liping Wang; Kunwei Shen; Hong Lin; Zhen Hu; Guangyu Liu; Jiong Wu; Jinsong Lu; Zhiming Shao; Qixia Han; Zhenzhou Shen

2008-01-01

56

[Risk factors for lymphedema of the arm after mastectomy for breast cancer].  

PubMed

Postmastectomy lymphedema of the arm is frequently associated to different factors including axillary node involvement and local and regional treatment of breast cancer. Our aims was to identify risk factors of postmastectomy lymphedema. From a retrospective analysis of 735 breast cancers treated in our institute, we found 61 lymphedema of the arm. We then describe our study population and identify by univariate et multivariate analysis the factors significantly associated to the disease. The majority of the patients were young black African female found to have locally advanced breast cancers (88% of T3 et T4 UICC 1988), inflammatory diseases (46% of PEV 2 and 3 of Gustave ROUSSY Institute classification of inflammatory breast cancers). Ulceration is found in half of the patients, metastasis in 20%. The patients first underwent chemotherapy mainly with cyclophosphamide alone (56%). Only 59 patients (8%) had preoperative radiation. Surgery consisted mainly in modified radical mastectomy and lymph node dissection (95%). Residual disease is left in 50% of the cases. Only 35% had post-operative chemotherapy and 9% postoperative external beam radiation therapy. From that population, during the follow up, 61 patients were found to have postmastectomy lymphedema. The disease was asymptomatic in 60% of the cases and painful in 26%. 30% of all the patients spontaneously partially regressed. From univariate analysis we found 7 factors associated with lymphedema: The big size of the tumor (p = 0.005), clinically involved axillary lymph nodes (p = 0.001), metastatic disease (p = 0.0046), traditional or inadequate surgery out of the Institute (p = 0.001), lack of post-operative chemotherapy (p = 0.002), postoperative external beam radiations (p = 0.005), relapse (p = 0.002). From logistic regression analysis three independent factors were found: clinically involved axillary lymph nodes (p = 0.0267), metastasis (p = 0.0002) and local or regional relapse (p = 0.0405). In our practice we found that advanced disease, treated by traditional healers or surgery nurses who had relapsed after mastectomy and external beam radiations without chemotherapy have higher risks of lymphedema. PMID:10797983

Kasse, A A; Diop, M; Dieng, M; Deme, A; Ndaw, D; Fall, M G; Diop, P S; Betel, E; Dembele, B; Drabo, B; Timbely, G; Toure, P

1999-01-01

57

Importance of revealing a rare case of breast cancer in a female to male transsexual after bilateral mastectomy  

PubMed Central

The incidence of breast carcinoma following prophylactic mastectomy is probably less than 2%. We present a 43-year-old female to male transsexual who developed breast cancer 1 year after bilateral nipple- sparing subcutaneous mastectomy as part of female to male gender reassignment surgery. In addition to gender reassignment surgery, total abdominal hysterectomy with bilateral salpingo-oophorectomy (to avoid the patient from entering menopause and to eliminate any subsequent risk of iatrogenic endometrial carcinoma), colpocleisys, metoidioplasty, phalloplasty, urethroplasty together with scrotoplasty/placement of testicular prosthesis and perineoplasty were also performed. Before the sex change surgery, the following diagnostic procedures were performed: breast ultrasound and mammography (which were normal), lung radiography (also normal) together with abdominal ultrasound examination, biochemical analysis of the blood and hormonal status. According to medical literature, in the last 50 years only three papers have been published with four cases of breast cancer in transsexual female to male patients. All hormonal pathways included in this complex hormonal and surgical procedure of transgender surgery have important implications for women undergoing prophylactic mastectomy because of a high risk of possible breast cancer.

2012-01-01

58

Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer  

SciTech Connect

In 1976 the authors began a randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of State I and II breast tumors less than or equal to 4 cm in size. The operation removes only sufficient tissue to ensure that margins of resected specimens are free of tumor. Women were randomly assigned to total mastectomy, segmental mastectomy alone, or segmental mastectomy followed by breast irradiation. All patients had auxillary dissections, and patients with positive nodes received chemotherapy. Life-tables estimates based on data from 1843 women indicated that treatment by segmental mastectomy, with or without breast irradiation, resulted in disease-free, distant-disease-free, and overall survival at five years that was no worse than that after total breast removal. In fact, disease-free survival after segmental mastectomy plus radiation was better than disease-free survival after total mastectomy, and overall survival after segmental mastectomy, with or without radiation, was better than overall survival after total mastectomy. A total of 92.3% of women treated with radiation remained free of breast tumor at five years, as compared with 72.1% of those receiving no radiation. Among patients with positive nodes 97.9% of women treated with radiation and 63.8% of those receiving no radiation remained tumor-free, although both groups received chemotherapy. They conclude that segmental mastectomy, followed by breast irradiation in all patients and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for Stage I and II breast tumors less than or equal to 4 cm, provided that margins of resected specimens are free of tumor. 23 references, 4 figures, 6 tables.

Fisher, B.; Bauer, M.; Margolese, R.; Poisson, R.; Pilch, Y.; Redmond, C.; Fisher, E.; Wolmark, N.; Deutsch, M.; Montague, E.

1985-03-14

59

The Association Between Contralateral Prophylactic Mastectomy and Breast Cancer Outcomes by Hormone Receptor Status  

PubMed Central

Background The effect of contralateral prophylactic mastectomy (CPM) on the survival of patients with early-stage breast cancer remains controversial. The objective of this study was to evaluate the benefits of CPM using a propensity scoring approach that reduces selection bias from the non-random assignment of patients in observational studies. Methods We identified 3,889 female patients with stages I-III breast cancer who were treated at The University of Texas MD Anderson Cancer Center from 1997 to 2009. We assessed the association between CPM and disease-free (DFS) and overall survival (OS) using Cox proportional hazards models to estimate hazard ratios (HRs), and by matching patients in the CPM and no CPM groups using propensity scores (n = 497 pairs). Results With a median follow-up time of 4.5 years, CPM was associated with improved DFS (HR 0.75, 95% CI 0.59-0.97) and OS (HR 0.74, 95% CI 0.56-0.99), adjusted for prognostic factors. The improved DFS was seen predominately among hormone receptor-negative (HR 0.60, 95% CI 0.38-0.95) compared with hormone receptor-positive patients (HR 0.80, 95% CI 0.58-1.10). For the matched patient cohort, stratified survival analysis also showed an improvement in DFS with CPM (HR 0.48, 95% CI 0.22-1.01) in hormone receptor-negative patients that was nearly statistically significant. Conclusions CPM was associated with improved DFS for some patients with hormone receptor-negative breast cancer, after reducing selection bias. Identifying subsets of patients most likely to benefit from CPM may have important implications for a more personalized approach to treatment decisions about CPM.

Brewster, A.M.; Bedrosian, I.; Parker, P.A.; Dong, W.; Peterson, S.K.; Cantor, S.B.; Crosby, M.; Shen, Y.

2012-01-01

60

Advances in breast reconstruction after mastectomy.  

PubMed

Over the past 40 years, surgical reconstruction of the breast following mastectomy has become an important aspect of the cancer patient's rehabilitation process. While the surgical emphasis remains on a cure for the cancer, experience with breast reconstruction has not demonstrated any increased rate of cancer recurrence, even when reconstruction is performed immediately following tumor resection. Advances in surgical technique and biotechnology have made post-mastectomy reconstruction possible. The development of silicone gel and saline-filled implants as well as tissue expanders has revolutionized breast reconstruction. The elucidation of musculocutaneous flaps now provides the surgeon with the ability to transfer adequate quantities of vascularized tissue to reconstruct the surgical defects. The advent of microsurgical techniques has provided an additional reconstructive option, with free tissue transfer allowing the plastic surgeon to move musculocutaneous flaps from remote or distant sites to reconstruct the defect. The option of having the reconstruction immediately following the mastectomy procedure is now available to the patient. When reviewing the anatomy of the breast region, the surgeon must consider the mammary gland, its vascular supply, and its lymphatic system. The surgical techniques involved in reconstruction after mastectomy include the use of breast implants and tissue expansion, as well as reconstruction with autogenous tissues. Reconstruction with autogenous tissues includes the use of latissimus dorsi musculocutaneous flap, transverse rectus abdominus musculocutaneous flap, free flap transfer, as well as nipple-areola reconstruction. Breast reconstruction after mastectomy should be undertaken by a plastic and reconstructive surgeon with considerable training and experience with these diversified procedures. PMID:15777171

Edlich, Richard F; Winters, Kathryne L; Faulkner, Brent C; Bill, Timothy J; Lin, Kant Y

2005-01-01

61

The influence of patient geometry on the selection of chest wall irradiation techniques in post-mastectomy breast cancer patients  

Microsoft Academic Search

Background and purpose: To evaluate three chest wall (CW) irradiation techniques: wide tangential photon beams, direct appositional electron field and electron arc therapy with regards to target coverage and normal tissue tolerance.Materials and methods: Thirty-two post-mastectomy breast cancer patients were planned using three CW irradiation techniques. Computed tomography (CT) simulation was done on all patients and clinical target, heart and

Yee C Ung; Katharina E Sixel; Christine Bell

2000-01-01

62

The evolution of mastectomies in the oncoplastic breast surgery era  

PubMed Central

Over time, surgical techniques have advanced to the point where oncological safety and aesthetic outcomes are the pillars of contemporary breast surgery. Variations of mastectomy came up and started allowing the oncological safety and the possibility of an immediate breast reconstruction. Nowadays the association between plastic surgical techniques and mastectomy with immediate breast reconstruction is one of the best alternatives to treat breast cancer and also improved overall aesthetic outcomes and favors the achievement of contralateral breast symmetry. “Oncoplastic mastectomy” is a feasible term and can be routinely used.

Manconi, Andrea; da Costa Viera, Rene Aloisio; Michelli, Rodrigo Augusto Depieri; Matthes, Angelo do Carmo Silva

2013-01-01

63

Bilateral breast reconstruction with bipedicle transverse rectus abdominis myocutaneous (TRAM) flap for simultaneous delayed and immediate breast reconstruction after therapeutic modified radical mastectomy and prophylactic nipple sparing mastectomy  

PubMed Central

Contralateral prophylactic mastectomy (CPM) rate is increasing worldwide recently due to better understanding of genetic and hereditary breast cancer. The evolution of mastectomy technique from modified radical mastectomy to nipple sparing mastectomy with immediate or delayed breast reconstruction is also a potential cause of increasing mastectomy rate. This case report presents a young woman who had breast cancer at very young age then she decided for CPM due to her sister and mother are also breast cancer victim. We report clinical course and immediate outcome of the oncologic and reconstructive surgery in this case.

Lohsiriwat, Visnu

2014-01-01

64

Clinical Outcomes of Video-Assisted Skin-Sparing Partial Mastectomy for Breast Cancer and Immediate Reconstruction with Latissimus Dorsi Muscle Flap as Breast-Conserving Therapy  

Microsoft Academic Search

Background  Skin-sparing partial mastectomy (SSPM) has yet to be investigated as a breast-conserving therapy for early-stage breast cancer.\\u000a We report the clinical outcomes for video-assisted SSPM (VA-SSPM) with immediate breast reconstruction using autogenous tissue.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  VA-SSPM is indicated for early-stage breast cancer arising in the upper-outer or lower-outer quadrant without skin involvement.\\u000a An incision is placed along the midaxillary line, and SSPM

Hiroo Nakajima; Ikuya Fujiwara; Naruhiko Mizuta; Koichi Sakaguchi; Mahiro Ohashi; Asako Nishiyama; Yoshimi Umeda; Miho Ichida; Junji Magae

2010-01-01

65

Treatment of primary breast cancer without mastectomy. The Los Angeles community experience and review of the literature  

SciTech Connect

Between 1977 and 1983, 150 women with primary breast cancer, ranging in age from 26 to 84, were treated with a breast-sparing procedure involving lumpectomy, axillary node dissection, external beam radiotherapy, and 192-iridium implant. Median follow-up to date is 46+ months, with a range of 14 to 96+ months. All surviving patients have been followed for a minimum of 24+ months. Actuarial disease-free survival projected to 8 years is 79% for the entire group, 100% for the five noninfiltrating intraductal cancer patients, 97% for the 71 Stage I patients, and 68% for the 74 Stage II patients. Eighteen of the 150 patients (12%) have developed local recurrences thus far. Five (3%) have developed second, nonbreast, primary tumors. This community-based study, examined together with other published reports of similar procedures and compared to published results following mastectomy, helps confirm lumpectomy-radiotherapy as a legitimate approach to the management of primary breast cancer.

Not Available

1986-08-01

66

Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer.  

PubMed

The outcome of bilateral prophylactic mastectomy with breast reconstruction (BPM-IBR) in healthy BRCA1/2 mutation carriers can be potentially burdensome for body image and the intimate relationship. Therefore, in the current analysis the impact on body image, sexual and partner relationship satisfaction was prospectively investigated in women opting for BPM-IBR as well as cancer distress and general quality of life. Healthy women undergoing BPM-IBR completed questionnaires preoperatively (T0, n = 48), at 6 months (T1, n = 44) and after finishing breast reconstruction (median 21 months, range 12-35) (T2, n = 36). With multi-level regression analyses the course of outcome variables was investigated and a statistically significant change in body image and/or sexual and partner relationship satisfaction was predicted by baseline covariates. Body image significantly decreased at T1. At T2 sexual relationship satisfaction and body image tended to be lower compared to baseline. The overall partner relationship satisfaction did not significantly change. At T2, 37 % of the women reported that their breasts felt unpleasantly, 29 % was not satisfied with their breast appearance and 21 % felt embarrassed for their naked body. Most body image issues remained unchanged in 30 % of the women. A negative body image was predicted by high preoperative cancer distress. BPM-IBR was associated with adverse impact on body image in a substantial subgroup, but satisfaction with the overall sexual and partner relationship did not significantly change in time. The psychosocial impact of BPM-IBR in unaffected women should not be underestimated. Psychological support should ideally be integrated both before and after BPM-IBR. PMID:23224779

Gopie, Jessica P; Mureau, Marc A M; Seynaeve, Caroline; Ter Kuile, Moniek M; Menke-Pluymers, Marian B E; Timman, Reinier; Tibben, Aad

2013-09-01

67

Areola and Nipple-Areola-Sparing Mastectomy for Breast Cancer Treatment and Risk Reduction: Report of an Initial Experience in a Community Hospital Setting  

Microsoft Academic Search

Background  The use of areola-sparing (AS) or nipple-areola-sparing (NAS) mastectomy for the treatment or risk reduction of breast cancer\\u000a has been the subject of increasing dialogue in the surgical literature over the past decade. We report the initial experience\\u000a of a large community hospital with AS and NAS mastectomies for both breast cancer treatment and risk reduction.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective chart review

Jay K. Harness; Thomas S. Vetter; Arthur H. Salibian

2011-01-01

68

Clinical practice guidelines for the care and treatment of breast cancer: 3. Mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer (2002 update)  

Microsoft Academic Search

Objective: To assist women and their physicians in making the most clinically effective and personally acceptable decision regarding the choice of primary surgery for potentially curable breast cancer. Options: Breast-conserving surgery (BCS; also referred to as lumpectomy or wide local excision) or mastectomy. Outcomes: Local recurrence, disease-free survival, overall survival, cosmetic results. Evidence: Systematic computerized search of MEDLINE (1980 to

Hugh Scarth; Jacques Cantin; Mark Levine

2002-01-01

69

Prognostic index score and clinical prediction model of local regional recurrence after mastectomy in breast cancer patients  

SciTech Connect

Purpose: To develop clinical prediction models for local regional recurrence (Lr) of breast carcinoma after mastectomy that will be superior to the conventional measures of tumor size and nodal status. Methods and Materials: Clinical information from 1,010 invasive breast cancer patients who had primary modified radical mastectomy formed the database of the training and testing of clinical prognostic and prediction models of LRR. Cox proportional hazards analysis and Bayesian tree analysis were the core methodologies from which these models were built. To generate a prognostic index model, 15 clinical variables were examined for their impact on LRR. Patients were stratified by lymph node involvement (<4 vs. {>=}4) and local regional status (recurrent vs. control) and then, within strata, randomly split into training and test data sets of equal size. To establish prediction tree models, 255 patients were selected by the criteria of having had LRR (53 patients) or no evidence of LRR without postmastectomy radiotherapy (PMRT) (202 patients). Results: With these models, patients can be divided into low-, intermediate-, and high-risk groups on the basis of axillary nodal status, estrogen receptor status, lymphovascular invasion, and age at diagnosis. In the low-risk group, there is no influence of PMRT on either LRR or survival. For intermediate-risk patients, PMRT improves LR control but not metastases-free or overall survival. For the high-risk patients, however, PMRT improves both LR control and metastasis-free and overall survival. Conclusion: The prognostic score and predictive index are useful methods to estimate the risk of LRR in breast cancer patients after mastectomy and for estimating the potential benefits of PMRT. These models provide additional information criteria for selection of patients for PMRT, compared with the traditional selection criteria of nodal status and tumor size.

Cheng, Skye Hongiun [Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China) and Department of Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China) and Department of Radiation Oncology, Duke University, Durham, North Carolina (United States)]. E-mail: skye@mail.kfcc.org.tw; Horng, C.-F. [Department of Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Clarke, Jennifer L. [Institute of Statistics and Decision Sciences, Duke University, Durham, North Carolina (United States); Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina (United States); Tsou, M.-H. [Department of Pathology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Tsai, Stella Y. [Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Department of Radiation Oncology, Duke University, Durham, North Carolina (United States); Chen, C.-M. [Department of Surgical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Jian, James J. [Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Department of Radiation Oncology, Duke University, Durham, North Carolina (United States); Liu, M.-C. [Department of Medical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); West, Mike [Institute of Statistics and Decision Sciences, Duke University, Durham, North Carolina (United States); Huang, Andrew T. [Department of Medical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Department of Medicine, Duke University, Durham, North Carolina (United States); Prosnitz, Leonard R. [Department of Radiation Oncology, Duke University, Durham, North Carolina (United States)

2006-04-01

70

Is the use of preoperative breast MRI predictive of mastectomy?  

PubMed Central

Background Several recent studies have described increasing rates of unilateral and bilateral mastectomy among women with newly diagnosed breast cancer. The use of breast magnetic resonance imaging (MRI) has also risen rapidly, leading to speculation that the high false-positive rate and need for multiple biopsies associated with MRI may contribute to more mastectomies. The objective of this study was to determine whether newly diagnosed patients who underwent preoperative MRI were more likely to undergo mastectomy compared with those who did not have a preoperative MRI. Methods A retrospective review was performed of all newly diagnosed patients with breast cancer at our academic breast center from 2004 to 2009. Results The proportion of newly diagnosed patients with breast cancer having MRI prior to surgery increased from 6% in 2004 to 73% in 2009. Of 628 patients who underwent diagnostic MRI, 369 (59%) had abnormal results, 257 (41%) had one or more biopsies, and 73 had additional sites of cancer diagnosed. Patients with a malignant biopsy, or those with an abnormal MRI who did not undergo biopsy, had an increased mastectomy rate (P<0.01). However, patients with a normal MRI or a benign biopsy actually had a decreased mastectomy rate (P<0.05). Although there was a trend toward more bilateral mastectomies, the overall mastectomy rate did not change over this time period. Conclusions Although there is a strong relationship between the result of an MRI and the choice of surgery, the overall effect is not always to increase the mastectomy rate. Some patients who were initially considering mastectomy chose lumpectomy after an MRI.

2013-01-01

71

SERUM CA15-3 MEASUREMENT IN BREAST CANCER PATIENTS BEFORE AND AFTER MASTECTOMY  

Microsoft Academic Search

Background: Much research is being carried out to find a tumor marker for early diagnosis of breast cancer when the lesion is still small. CA15-3, a glycoprotein, is one candidate with probable use as tumor marker in breast cancer. Objective: We conducted this study to analyze the relationship between serum levels of CA15- 3 and several variables including age, clinical

Mahindocht Keyhani; Soheila Nasizadeh; Ardeshir Dehghannejad

72

Approaching the dilemma between prophylactic bilateral mastectomy or oophorectomy for breast and ovarian cancer prevention in carriers of BRCA1 or BRCA2 mutations  

Microsoft Academic Search

Despite advances in the genetics of familial breast and ovarian cancer, the clinical management of women with established mutations in BRCA1 or BRCA2 genes remains controversial. For women who decide for prophylactic surgery and not for a conservative approach, it is highly debated whether they are benefited more by a prophylactic mastectomy rather than a prophylactic oophorectomy. Although BRCA mutation

Dimitrios H. Roukos; Niki J. Agnanti; Evangelos Paraskevaidis; Angelos M. Kappas

2002-01-01

73

Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimeters or less. The experience of the Institut Gustave-Roussy  

Microsoft Academic Search

A clinical trial was conducted at the Institut Gustave Roussy between October 1972 and December 1980 to compare mastectomy with local excision plus Cobalt-irradiation, in patients with breast cancer tumors of 20 mm in diameter or less at macroscopic examination. Low-axillary dissection and extemporaneous histologic examination were carried out for all patients. If one or more positive nodes were found,

Danièle Sarrazin; M. Le; J. Roueesse; Geneviève Contesso; Jean-Yves Petit; Jean Lacour; Janine Viguier; Catherine Hill

1984-01-01

74

The Changing Face of Mastectomy (from Mutilation to Aid to Breast Reconstruction)  

PubMed Central

Breast cancer is the most common cancer in women. Primary treatment is surgery, with mastectomy as the main treatment for most of the twentieth century. However, over that time, the extent of the procedure varied, and less extensive mastectomies are employed today compared to those used in the past, as excessively mutilating procedures did not improve survival. Today, many women receive breast-conserving surgery, usually with radiotherapy to the residual breast, instead of mastectomy, as it has been shown to be as effective as mastectomy in early disease. The relatively new skin-sparing mastectomy, often with immediate breast reconstruction, improves aesthetic outcomes and is oncologically safe. Nipple-sparing mastectomy is newer and used increasingly, with better acceptance by patients, and again appears to be oncologically safe. Breast reconstruction is an important adjunct to mastectomy, as it has a positive psychological impact on the patient, contributing to improved quality of life.

Zurrida, Stefano; Bassi, Fabio; Arnone, Paolo; Martella, Stefano; Del Castillo, Andres; Ribeiro Martini, Rafael; Semenkiw, M. Eugenia; Caldarella, Pietro

2011-01-01

75

Effect of Postmastectomy Radiotherapy in Patients <35 Years Old With Stage II-III Breast Cancer Treated With Doxorubicin-Based Neoadjuvant Chemotherapy and Mastectomy  

SciTech Connect

Purpose: Postmastectomy radiotherapy (PMRT) improves locoregional control (LRC) in patients with high-risk features after mastectomy. Young age continues to evolve as a potentially important risk factor. The objective of this study was to assess the benefits of PMRT in patients <35 years old treated with doxorubicin-based neoadjuvant chemotherapy for Stage II-III breast cancer. Patients and Methods: We retrospectively analyzed 107 consecutive breast cancer patients <35 years old with Stage IIA-IIIC disease treated at our institution with doxorubicin-based neoadjuvant chemotherapy and mastectomy, with or without PMRT. The treatment groups were compared in terms of LRC and overall survival. Results: Despite more advanced disease stages, the patients who received PMRT (n = 80) had greater rates of LRC (5-year rate, 88% vs. 63%, p = 0.001) and better overall survival (5-year rate, 67% vs. 48%, p = 0.03) than patients who did not receive PMRT (n = 27). Conclusion: Among breast cancer patients <35 years old at diagnosis, the use of PMRT after doxorubicin-based neoadjuvant chemotherapy and mastectomy led to a statistically greater rate of LRC and overall survival compared with patients without PMRT. The benefit seen for PMRT in young patients provides valuable data to better tailor adjuvant, age-specific treatment decisions after mastectomy.

Garg, Amit K. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Oh, Julia L. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail: joh@mdanderson.org; Oswald, Mary Jane; Huang, Eugene; Strom, Eric A.; Perkins, George H.; Woodward, Wendy A.; Yu, T. Kuan; Tereffe, Welela [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Meric-Bernstam, Funda [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Hahn, Karin [Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

2007-12-01

76

Radiation Therapy for Breast Cancer  

MedlinePLUS

... 7852 www.astro.org • www.rtanswers.org TREATING BREAST CANCER Surgery The main curative treatment for breast cancer is ... of the lymph nodes is performed with the breast surgery of choice. Both mastectomy and breast conserving therapy ( ...

77

Clinical investigation: Regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy  

SciTech Connect

Purpose: The purpose of this study was to describe regional nodal failure patterns in patients who had undergone mastectomy with axillary dissection to define subgroups of patients who might benefit from supplemental regional nodal radiation to the axilla or supraclavicular fossa/axillary apex. Methods and Materials: The cohort consisted of 1031 patients treated with mastectomy (including a level I-II axillary dissection) and doxorubicin-based systemic therapy without radiation on five clinical trials at M.D. Anderson Cancer Center. Patient records, including pathology reports, were retrospectively reviewed. All regional recurrences (with or without distant metastasis) were recorded. Median follow-up was 116 months (range, 6-262 months). Results: Twenty-one patients recurred within the low-mid axilla (10-year actuarial rate 3%). Of these, 16 were isolated regional failures (no chest wall failure). The risk of failure in the low-mid axilla was not significantly higher for patients with increasing numbers of involved nodes, increasing percentage of involved nodes, larger nodal size or gross extranodal extension. Only 3 of 100 patients with <10 nodes examined recurred in the low-mid axilla. Seventy-seven patients had a recurrence in the supraclavicular fossa/axillary apex (10-year actuarial rate 8%). Forty-nine were isolated regional recurrences. Significant predictors of failures in this region included {>=}4 involved axillary lymph nodes, >20% involved axillary nodes, and the presence of gross extranodal extension (10-year actuarial rates 15%, 14%, and 19%, respectively, p < 0.0005). The extent of axillary dissection and the size of the largest involved node were not predictive of failure within the supraclavicular fossa/axillary apex. Conclusions: These results suggest that failure in the level I-II axilla is an uncommon occurrence after modified radical mastectomy and chemotherapy. Therefore, supplemental radiotherapy to the dissected axilla is not warranted for most patients. However, patients with {>=}4 involved axillary lymph nodes, >20% involved axillary nodes, or gross extranodal extension are at increased risk of failure in the supraclavicular fossa/axillary apex and should receive radiation to undissected regions in addition to the chest wall.

Strom, Eric A. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: estrom@mdanderson.org; Woodward, Wendy A. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Katz, Angela [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Perkins, George H. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Jhingran, Anuja [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Theriault, Richard [Department of Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Singletary, Eva [Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Sahin, Aysegul [Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); McNeese, Marsha D. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

2005-12-01

78

Radiotherapy for Stage II and Stage III Breast Cancer Patients With Negative Lymph Nodes After Preoperative Chemotherapy and Mastectomy  

SciTech Connect

Purpose: To evaluate the effect of postmastectomy radiotherapy (PMRT) in Stage II-III breast cancer patients with negative lymph nodes (pN0) after neoadjuvant chemotherapy (NAC). Patients and Materials: Of 1,054 breast cancer patients treated with NAC at our institution between 1990 and 2004, 134 had pN0 status after NAC and mastectomy. The demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The effect of PMRT on locoregional recurrence-free survival and overall survival (OS) was evaluated by multivariate analysis, including known prognostic factors. Results: Of the 134 eligible patients, 78 (58.2%) received PMRT and 56 (41.8%) did not. At a median follow-up time of 91.4 months, the 5-year locoregional recurrence-free survival and OS rate was 96.2% and 88.3% with PMRT and 92.5% and 94.3% without PMRT, respectively (p = NS). The corresponding values at 10 years were 96.2% and 77.2% with PMRT and 86.8% and 87.7% without PMRT (p = NS). On multivariate analysis, PMRT had no effect on either locoregional recurrence-free survival (hazard ratio, 0.37; 95% confidence interval, 0.09-1.61; p = .18) or OS (hazard ratio, 2.06; 95% confidence interval, 0.71-6; p = .18). This remained true in the subgroups of patients with clinical Stage II or Stage III disease at diagnosis. A trend was seen toward poorer OS among patients who had not had a pathologic complete in-breast tumor response after NAC (hazard ratio, 6.65; 95% confidence interval, 0.82-54.12; p = .076). Conclusions: The results from the present retrospective study showed no increase in the risk of distant metastasis, locoregional recurrence, or death when PMRT was omitted in breast cancer patients with pN0 status after NAC and mastectomy. Whether the omission of PMRT is acceptable for these patients should be addressed prospectively.

Le Scodan, Romuald, E-mail: lescodan@crh1.org [Department of Radiation Oncology, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Selz, Jessica [Department of Radiation Oncology, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Stevens, Denise [Department of Biostatistics, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Bollet, Marc A.; Lande, Brigitte de la; Daveau, Caroline [Department of Radiation Oncology, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Lerebours, Florence [Department of Medical Oncology, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Labib, Alain [Department of Radiation Oncology, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France); Bruant, Sarah [Department of Biostatistics, Institut Curie-Hopital Rene Huguenin, Saint-Cloud (France)

2012-01-01

79

Recurrence after skin-sparing mastectomy and immediate transverse rectus abdominis musculocutaneous flap reconstruction for invasive breast cancer  

PubMed Central

Background The aim of this study was to evaluate the recurrence pattern after skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) using transverse rectus abdominis musculocutaneous (TRAM) flap in patients with invasive breast cancer. Methods From 1995 to 2010, patients with invasive breast cancer who underwent SSM followed by IBR using TRAM flap were retrospectively reviewed. The pattern of the first recurrence event was recorded. Results We identified 249 consecutive patients with invasive breast cancer, two-thirds of whom (67.1%) were diagnosed with stage II or stage III disease. During a median follow-up period of 53 months, three (1.2%) local, 13 (5.2%) regional, 34 (13.7%) distant, and five (2.0%) concurrent locoregional and distant recurrences were observed. The median time to recurrences was 26 months (range, 2 to 70 months) for all recurrences, 23 months (range, 2 to 64 months) for locoregional recurrences, and 26 months (range, 8 to 70 months) for distant recurrences. All local recurrent lesions were detectable by careful physical examination, and detection of local recurrence suggested the presence of distant metastasis (60.0%). In contrast to distant metastasis, the risk of locoregional recurrence did not increase significantly with an increase in disease stage. The 5-year overall, locoregional relapse-free, and distant relapse-free survival rates were 89.7%, 90.8%, and 81.6%, respectively. Conclusions SSM followed by immediate reconstruction using TRAM flap is an oncologically safe procedure even in patients with advanced-stage disease. Detection of local recurrence is crucial and can be aided by a thorough physical examination.

2013-01-01

80

The impact of isolated tumor cells on loco-regional recurrence in breast cancer patients treated with breast-conserving treatment or mastectomy without post-mastectomy radiation therapy.  

PubMed

To compare the outcome of patients with invasive breast cancer, who had isolated tumor cells (ITC) in sentinel lymph nodes, pN0(i+), to patients with histologically negative nodes, pN0. We retrospectively studied 1,273 patients diagnosed with T1-T3 breast cancer from 1999 to 2009. Patients were divided into 2 populations: 807 patients treated with breast-conserving surgery (BCS) and radiotherapy (RT), 85(10.5 %) with pN0(i+) and 722(89.5 %) with pN0. And the other population had 466 patients treated with mastectomy without post-mastectomy radiation therapy (PMRT), 80(17.2 %) with pN0(i+),and 386(82.8 %)with pN0. All patients underwent sentinel node biopsy, and the presence of ITC was determined. Patients with axillary dissection only or neoadjuvant chemotherapy were excluded. Among the 1,273 patients studied; 87.3 % received adjuvant systemic therapy. Kaplan-Meier, Cox regression, and log-rank statistical tests were used. Median patient age was 55.7 years. Median follow-up was 69.5 months. The 5- and 10-year cumulative incidence of Loco-regional recurrence (LRR) for patients treated with BCS and RT was 1.6 and 3.5 % for 85 pN0(i+) patients, and 2.4 and 5 % for 722 pN0 patients, respectively. For patients treated with mastectomy without PMRT, 5- and 10-year LRR rates were 2.8 and 2.8 % for 80 pN0(i+) patients, and 1.8 and 3 % for 386 pN0 patients, respectively. There were no statistically significant differences in LRR (p = 0.9), distant recurrence (p = 0.3) ,and overall survival (p = 0.5) among all groups. On multivariate analysis, ITC were not associated with increased risk of LRR, distant recurrence and overall survival. Grade (p = 0.003) and systemic therapy (p = 0.02) were statistically significantly associated with risk of LRR. Sentinel node ITC have no significant impact on LRR, distant recurrence and overall survival in breast cancer patients. Additional treatments such as axillary dissection, chemotherapy, or regional radiation should not be given solely based on the presence of sentinel node ITC. PMID:24952906

Keruakous, Amany R; Sadek, Betro T; Shenouda, Mina N; Niemierko, Andrzej; Abi Raad, Rita F; Specht, Michelle; Smith, Barbara L; Taghian, Alphonse G

2014-07-01

81

Treating Male Breast Cancer by Stage  

MedlinePLUS

... cancer. Most often, a mastectomy is done. If breast-conserving surgery is done, it is followed by radiation therapy ... cancer. Although this is usually done by mastectomy, breast-conserving surgery such as a lumpectomy may also be an ...

82

Long-term results of post-operative radiation therapy following mastectomy with or without chemotherapy in Stage I--III breast cancer  

SciTech Connect

The purpose of this work was to determine the risk of local-regional failure following post-mastectomy radiotherapy and the incidence of complications associated with such treatment. The authors retrospectively analyzed the results in 309 patients with Stage I--III invasive breast cancer treated with post-mastectomy radiation therapy between 1975 and 1985. The median radiotherapy dose was 45 Gy in 1.8 to 2.25 Gy fractions. One hundred forty-seven (48%) of the patients received adjuvant systemic chemotherapy with 115 (78%) of these receiving a CMF-based or doxorubicin-containing regime. The median follow-up time of surviving patients was 130 months (range, 28 to 191 months) after mastectomy. Seventeen patients (6%) developed a local-regional failure at an interval of 4 to 87 months after radiotherapy. Moderate or severe complications related to radiotherapy and requiring treatment were uncommon. Symptomatic radiation pneumonitis occurred in four patients (1.3%), arm edema in 18 (5.8%), and brachial plexopathy in 2 (0.6%). The authors conclude that post-operative radiotherapy is a safe and effective means of reducing local-regional failure following mastectomy. The efficacy of post-mastectomy radiotherapy in improving survival should be addressed in new large randomized controlled studies. 33 refs., 1 fig., 3 tabs.

Uematsu, Minoru; Bornstein, B.A.; Recht, A.; Abner, A.; Silver, B. (Harvard Medical School, Boston, MA (United States)); Come, S.E. (Beth Israel Hospital, Boston, MA (United States) Harvard Medical School, Boston, MA (United States)); Shulman, L.N. (Brigham and Women's Hospital, Boston, MA (United States) Harvard Medical School, Boston, MA (United States)); Harris, J.R.

1993-04-02

83

The Impact of Post-Mastectomy Radiation Therapy on Male Breast Cancer Patients-A Case Series  

SciTech Connect

Objective: To assess the impact of radiation management on male breast cancer (MBC) at London Regional Cancer Program (LRCP). Methods and Materials: Men with a diagnosis of breast cancer referred to LRCP were reviewed. The seventh American Joint Committee on Cancer staging system was used. Patients treated with and without post-mastectomy radiation therapy (PMRT) were analyzed. Disease-free survival (DFS) was defined as time duration from diagnosis to first recurrence. Overall survival (OS) was defined as time duration from pathologic diagnosis to death or last follow-up with any death defined as an event. Survival estimates were obtained using Kaplan-Meier methodology. Results: From January 1977 to December 2006, 81 men had invasive ductal carcinoma. The median age was 65 (range, 35-87 years). There were 15 Stage I, 40 Stage II, 20 Stage III, and 6 Stage IV patients. Median follow-up time was 46 months (range, 1-225 months). Of the 75 patients treated with curative intent, 29 did not receive PMRT and 46 completed PMRT. Patients who received PMRT demonstrated no benefit in overall survival (p = 0.872) but significantly better local recurrence free survival (p < 0.001) compared with those who did not receive RT. There was trend toward improving locoregional recurrence with PMRT in patients with high-risk features (node-positive, advanced stage, and {<=}2 mm or unknown surgical margin). The median, 5-year, and 10-year disease-free survival and overall survival for the 75 patients were 77.7 months, 66.3%, 32.7%, and 91.2 months, 73.9%, and 36.6%, respectively. Conclusion: The experience at LRCP suggests that high-risk MBC patients should consider PMRT to improve their chance of local recurrence-free survival.

Yu, Edward, E-mail: edward.yu@lhsc.on.ca [Department of Radiation Oncology, London Regional Cancer Program, London Health Science Centre, University of Western Ontario, Ontario (Canada); Suzuki, Hiromichi [Department of Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka (Japan); Younus, Jawaid [Department of Medical Oncology, London Regional Cancer Program, London Health Science Centre, University of Western Ontario, Ontario (Canada); Elfiki, Tarek [Department of Medical Oncology, Windsor Regional Cancer Centre, Windsor, Ontario (Canada); Stitt, Larry [Epidemiology Biostatistics, London Regional Cancer Program, London Health Science Centre, University of Western Ontario, Ontario (Canada); Yau, Gary; Vujovic, Olga; Perera, Francisco; Lock, Michael [Department of Radiation Oncology, London Regional Cancer Program, London Health Science Centre, University of Western Ontario, Ontario (Canada); Tai, Patricia [Department of Radiation Oncology, Allan Blair Cancer Center, Regina, Saskatchewan (Canada)

2012-02-01

84

Proton Therapy for Breast Cancer After Mastectomy: Early Outcomes of a Prospective Clinical Trial  

SciTech Connect

Purpose: Dosimetric planning studies have described potential benefits for the use of proton radiation therapy (RT) for locally advanced breast cancer. We report acute toxicities and feasibility of proton delivery for 12 women treated with postmastectomy proton radiation with or without reconstruction. Methods and Materials: Twelve patients were enrolled in an institutional review board-approved prospective clinical trial. The patients were assessed for skin toxicity, fatigue, and radiation pneumonitis during treatment and at 4 and 8 weeks after the completion of therapy. All patients consented to have photographs taken for documentation of skin toxicity. Results: Eleven of 12 patients had left-sided breast cancer. One patient was treated for right-sided breast cancer with bilateral implants. Five women had permanent implants at the time of RT, and 7 did not have immediate reconstruction. All patients completed proton RT to a dose of 50.4 Gy (relative biological effectiveness [RBE]) to the chest wall and 45 to 50.4 Gy (RBE) to the regional lymphatics. No photon or electron component was used. The maximum skin toxicity during radiation was grade 2, according to the Common Terminology Criteria for Adverse Events (CTCAE). The maximum CTCAE fatigue was grade 3. There have been no cases of RT pneumonitis to date. Conclusions: Proton RT for postmastectomy RT is feasible and well tolerated. This treatment may be warranted for selected patients with unfavorable cardiac anatomy, immediate reconstruction, or both that otherwise limits optimal RT delivery using standard methods.

MacDonald, Shannon M., E-mail: smacdonald@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Patel, Sagar A.; Hickey, Shea [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)] [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Specht, Michelle [Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)] [Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Isakoff, Steven J. [Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)] [Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Gadd, Michele; Smith, Barbara L. [Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)] [Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Yeap, Beow Y. [Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)] [Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Adams, Judith; DeLaney, Thomas F.; Kooy, Hanne; Lu, Hsiao-Ming; Taghian, Alphonse G. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)] [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)

2013-07-01

85

Paget's disease in contralateral breast occuring 11 years after mastectomy for invasive ductal carcinoma.  

PubMed

Paget's disease of the breast is a rare form of breast cancer and represents only 1% to 4% of all breast cancers. It is characterized by the presence of Paget's cells in the epithelium tissue (in epidermis) and it manifests as a lesion of the nipple. In most cases, Paget's disease is associated with an underlying breast malignancy. Mastectomy has been considered the treatment of choice, but breast conservation is also being explored, in properly selected patients, depending on the underlying malignancy. We report a case of Paget's disease occurring in the contralateral breast 11 years after mastectomy for invasive ductal carcinoma but with no underlying breast malignancy. PMID:19408647

Salopek, Daniela; Murgi?, Jure; Tomas, Davor; Bolanca, Ante; Kusi?, Zvonko

2009-03-01

86

Breast forms after mastectomy--patient's issues.  

PubMed

After mastectomy restoration of body symmetry, a very important aspect of coping with daily life, may be achieved either using breast forms that are suspended in a brassière or by a new system in which breast forms are attached by adhesive strips to the thorax walls. The system promises free and easy movement, favourable effects on lymphoedema, and improvements with respect to dressing. Brassières are not necessarily needed. The influence of improved prosthetics on patients' self concept and well-being was investigated. A group of 67 patients after unilateral mastectomy tested custom breast forms and self-adhesive breast forms. Using the Frankfurter Selbstkonzeptionsskalen (Frankfurt Self-Concept Scales), plus additional questions concerning problems after mastectomy, self-concept was assessed before study and after 3 months. Analysis of variance with repeated measures revealed significant differences with respect to the scale Social Contact and Relations (FSKU). Most patients were better satisfied with epicutaneous self-adhesive breast forms. The weight and type of movement of the self-adhesive breast forms were considered natural, and adhesive strips were well tolerated. A total of 78% were able to wear more fashionable clothing. Breast reconstruction became less important for 62%. The new concept of self-adhesive breast forms is an improvement with respect to social and pyschological rehabilitation. PMID:8564350

Münstedt, K; Milch, W; Reimer, C

1995-11-01

87

Influence of health insurance, hospital factors and physician volume on receipt of immediate post-mastectomy reconstruction in women with invasive and non-invasive breast cancer  

PubMed Central

For women with breast cancer who undergo mastectomy, immediate breast reconstruction (IR) offers a cosmetic and psychological advantage. We evaluated the association between demographic, hospital, surgeon and insurance factors and receipt of IR. We conducted a retrospective hospital-based analysis with the Perspective database. Women who underwent a mastectomy for invasive breast cancer (IBC) and ductal carcinoma in situ (DCIS) from 2000 to 2010 were included. Logistic regression analysis was used to determine factors predictive of IR. Analyses were stratified by age (<50 vs. ?50) and IBC versus DCIS. Of the 108,992 women with IBC who underwent mastectomy, 30,859 (28.3 %) underwent IR, as compared to 6,501 (44.2 %) of the 14,710 women with DCIS who underwent mastectomy underwent IR. In a multivariable model for IBC, increasing age, black race, being married, rural location, and increased comorbidities were associated with decreased IR. Odds ratios (OR) of IR increased with commercial insurance (OR 3.38) and Medicare (OR 1.66) insurance (vs. self-pay), high surgeon-volume (OR 1.19), high hospital-volume (OR 2.24), and large hospital size (OR 1.20). The results were identical for DCIS, and by age category. The absolute difference between the proportion of patients who received IR with commercial insurance compared to other insurance, increased over time. Immediate in-hospital complication rates were higher for flap reconstruction compared to implant or no reconstruction (15.2, 4.0, and 6.1 %, respectively, P <.0001). IR has increased significantly over time; however, modifiable factors such as insurance status, hospital size, hospital location, and physician volume strongly predict IR. Public policy should ensure that access to reconstructive surgery is universally available.

Richards, C. A.; Kalinsky, K.; Wilde, E. T.; Lu, Y. S.; Ascherman, J. A.; Neugut, A. I.; Wright, J. D.

2013-01-01

88

Locoregional Failure in Early-Stage Breast Cancer Patients Treated With Radical Mastectomy and Adjuvant Systemic Therapy: Which Patients Benefit From Postmastectomy Irradiation?  

SciTech Connect

Purpose: To assess the locoregional failure in patients with Stage I-II breast cancer treated with radical mastectomy and to evaluate whether a subset of these patients might be at sufficiently high risk of locoregional recurrence (LRR) to benefit from postmastectomy irradiation (PMRT). Methods and Materials: Stage I-II breast cancer patients (n = 150) treated with radical mastectomy without adjuvant irradiation between 1999 and 2005 were analyzed. The pattern of LRR was reported. Kaplan-Meier analysis was used to calculate rates of LRR, and Cox proportional hazards methods were used to evaluate potential risk factors. Results: Median follow-up was 75 months. Mean patient age was 56 years. One-hundred forty-three (95%) patients received adjuvant systemic therapy: 85 (57%) hormonal therapy alone, 14 (9%) chemotherapy alone, and 44 (29%) both chemotherapy and hormonal therapy. Statistically significant factors associated with increased risk of LRR were premenopausal status (p = 0.004), estrogen receptor negative cancer (p = 0.02), pathologic grade 3 (p = 0.02), and lymphovascular invasion (p = 0.001). T and N stage were not associated with increased risk of regional recurrence. The 5-year LRR rate for patients with zero or one, two, three, and four risk factors was 1%, 10.3%, 24.2%, and 75%, respectively. Conclusions: A subset of patients with early-stage breast cancer is at high risk of LRR, and therefore PMRT might be beneficial.

Trovo, Marco, E-mail: marcotrovo33@hotmail.com [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Durofil, Elena [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Polesel, Jerry [Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Roncadin, Mario [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Perin, Tiziana [Department of Pathology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Mileto, Mario; Piccoli, Erica [Department of Surgery, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Quitadamo, Daniela [Scientific Direction, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Massarut, Samuele [Department of Surgery, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Carbone, Antonino [Department of Pathology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Trovo, Mauro G. [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy)

2012-06-01

89

Columbia study finds many women do not undergo breast reconstruction after mastectomy:  

Cancer.gov

Despite the benefits, only a small minority of women, regardless of age, are opting for immediate reconstructive breast surgery after undergoing mastectomy for treatment of breast cancer, according to data presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.

90

[Motivations for breast reconstruction after mastectomy. A comparative study].  

PubMed

The aim of this study is to define the psychosocial profile and the motivations of women who seek post-mastectomy reconstruction. A questionnaire was administered to 45 women who had breast reconstruction several months after mastectomy and 51 who did not. Statistical analysis of data shows significant differences between the two groups regarding age, education, leisure activities, sexual intercourse and fear of recurrence. A qualitative analysis shows how women feel about reconstruction. The results suggest that information concerning reconstruction must be adapted to the psychosocial profile of women. Moreover, reconstruction must be considered by the surgeon as an essential stage of breast cancer treatment. In order to help women in their choice, they must give them appropriate information on the technique of breast reconstruction, on the risk of relapse and on the possibility of reimbursement of medical expenses. PMID:8672856

Charavel, M; Bremond, A

1996-01-01

91

Local-Regional Recurrence With and Without Radiation Therapy After Neoadjuvant Chemotherapy and Mastectomy for Clinically Staged T3N0 Breast Cancer  

SciTech Connect

Purpose: The purpose of this study was to determine local-regional recurrence (LRR) risk according to whether postmastectomy radiation therapy (PMRT) was used to treat breast cancer patients with clinical T3N0 disease who received neoadjuvant chemotherapy (NAC) and mastectomy. Methodsand Materials: Clinicopathology data from 162 patients with clinical T3N0 breast cancer who received NAC and underwent mastectomy were retrospectively reviewed. A total of 119 patients received PMRT, and 43 patients did not. The median number of axillary lymph nodes (LNs) dissected was 15. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test. Results: At a median follow-up of 75 months, 15 of 162 patients developed LRR. For all patients, the 5-year LRR rate was 9% (95% confidence interval [CI], 4%-14%). The 5-year LRR rate for those who received PMRT was 4% (95% CI, 1%-9%) vs. 24% (95% CI, 10%-39%) for those who did not receive PMRT (p <0.001). A significantly higher proportion of irradiated patients had pathology involved LNs and were {<=}40 years old. Among patients who had pathology involved LNs, the LRR rate was lower in those who received PMRT (p <0.001). A similar trend was observed for those who did not have pathology involved LN disease. Among nonirradiated patients, the appearance of pathologic LN disease after NAC was the only clinicopathologic factor examined that significantly correlated with the risk of LRR. Conclusions: Breast cancer patients with clinical T3N0 disease treated with NAC and mastectomy but without PMRT had a significant risk of LRR, even when there was no pathologic evidence of LN involvement present after NAC. PMRT was effective in reducing the LRR rate. We suggest PMRT should be considered for patients with clinical T3N0 disease.

Nagar, Himanshu [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Mittendorf, Elizabeth A. [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Strom, Eric A.; Perkins, George H.; Oh, Julia L.; Tereffe, Welela; Woodward, Wendy A. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Gonzalez-Angulo, Ana M. [Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Hunt, Kelly K. [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Yu, Tse-Kuan, E-mail: tkyu@mdanderson.org [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)

2011-11-01

92

Isolated local-regional recurrence of breast cancer following mastectomy: Radiotherapeutic management  

SciTech Connect

Two hundred twenty-four patients with their first, isolated local-regional recurrence of breast cancer were irradiated with curative intent. Patients who had previous chest wall or regional lymphatic irradiation were not included in the study. With a median follow-up of 46 months (range 24 to 241 months), the 5- and 10-year survival for the entire group were 43% and 26%, respectively. Overall, 57% of the patients were projected to be loco-regionally controlled at 5 years. The 5-year local-regional tumor control was best for patients with isolated chest wall recurrences (63%), intermediate for nodal recurrences (45%), and poor for concomitant chest wall and nodal recurrences (27%). In patients with solitary chest wall recurrences, large field radiotherapy encompassing the entire chest wall resulted in a 5- and 10-year freedom from chest wall re-recurrence of 75% and 63% in contrast to 36% and 18% with small field irradiation (p = 0.0001). For the group with recurrences completely excised, tumor control was adequate at all doses ranging from 4500 to 7000 cGy. For the recurrences less than 3 cm, 100% were controlled at doses greater than or equal to 6000 cGy versus 76% at lower doses. No dose response could be demonstrated for the larger lesions. The supraclavicular failure rate was 16% without elective radiotherapy versus 6% with elective radiotherapy (p = 0.0489). Prophylactic irradiation of the uninvolved chest wall decreased the subsequent re-recurrence rate (17% versus 27%), but the difference is not statistically significant (p = .32). The incidence of chest wall re-recurrence was 12% with doses greater than or equal to 5000 cGy compared to 27% with no elective radiotherapy, but again was not statistically significant (p = .20). Axillary and internal mammary failures were infrequent, regardless of prophylactic treatment.

Halverson, K.J.; Perez, C.A.; Kuske, R.R.; Garcia, D.M.; Simpson, J.R.; Fineberg, B. (Washington Univ. School of Medicine, St. Louis, MO (USA))

1990-10-01

93

Georgetown researchers examine nipple sparing mastectomy cases and find no recurrent or new cancers:  

Cancer.gov

A new study suggests some women needing a lumpectomy or mastectomy to treat their breast cancer have another potential option that is safe and effective, say researchers at Georgetown. They say the procedure known as a nipple sparing mastectomy is also a viable surgical option for women who choose to have their breasts removed because of their increased risk of developing the disease.

94

Post-Mastectomy and Phantom Breast Pain: Risk Factors, Natural History, and Impact on Quality of Life.  

National Technical Information Service (NTIS)

Post-mastectomy pain syndrome (PMPS), phantom breast pain, and post- lumpectomy pain are poorly understood chronic pain syndromes that occur following surgical procedures for breast cancer. These pain syndromes are not well studied, but there is appreciab...

R. Dworkin

2001-01-01

95

Post-Mastectomy and Phantom Breast Pain: Risk Factors, Natural History, and Impact on Quality of Life.  

National Technical Information Service (NTIS)

Post-mastectomy pain syndrome (PMPS) and phantom breast pain are poorly understood chronic pain syndromes that occur following surgical procedures for breast cancer. Although these pain syndromes are not well studied, there is appreciable evidence that pa...

R. H. Dworkin

1999-01-01

96

Patterns and Risk Factors of Locoregional Recurrence in T1-T2 Node Negative Breast Cancer Patients Treated With Mastectomy: Implications for Postmastectomy Radiotherapy  

SciTech Connect

Purpose: Postmastectomy radiation therapy (PMRT) can reduce locoregional recurrences (LRR) in high-risk patients, but its role in the treatment of lymph node negative (LN-) breast cancer remains unclear. The aim of this study was to identify a subgroup of T1-T2 breast cancer patients with LN- who might benefit from PMRT. Methods and Materials: We retrospectively reviewed 1,136 node-negative T1-T2 breast cancer cases treated with mastectomy without PMRT at the Massachusetts General Hospital between 1980 and 2004. We estimated cumulative incidence rates for LRR overall and in specific subgroups, and used Cox proportional hazards models to identify potential risk factors. Results: Median follow-up was 9 years. The 10-year cumulative incidence of LRR was 5.2% (95% CI: 3.9-6.7%). Chest wall was the most common (73%) site of LRR. Tumor size, margin, patient age, systemic therapy, and lymphovascular invasion (LVI) were significantly associated with LRR on multivariate analysis. These five variables were subsequently used as risk factors for stratified analysis. The 10-year cumulative incidence of LRR for patients with no risk factors was 2.0% (95% CI: 0.5-5.2%), whereas the incidence for patients with three or more risk factors was 19.7% (95% CI: 12.2-28.6%). Conclusion: It has been suggested that patients with T1-T2N0 breast cancer who undergo mastectomy represent a favorable group for which PMRT renders little benefit. However, this study suggests that select patients with multiple risk factors including LVI, tumor size {>=}2 cm, close or positive margin, age {<=}50, and no systemic therapy are at higher risk of LRR and may benefit from PMRT.

Abi-Raad, Rita; Boutrus, Rimoun [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Wang Rui [Division of Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Division of Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Macdonald, Shannon [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Smith, Barbara [Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)

2011-11-01

97

PATTERNS AND RISK FACTORS OF LOCOREGIONAL RECURRENCE IN T1-T2 NODE NEGATIVE BREAST CANCER PATIENTS TREATED WITH MASTECTOMY: IMPLICATIONS FOR POSTMASTECTOMY RADIOTHERAPY  

PubMed Central

Purpose Postmastectomy radiation therapy (PMRT) can reduce locoregional recurrences (LRR) in high-risk patients, but its role in the treatment of lymph node negative (LN?) breast cancer remains unclear. The aim of this study was to identify a subgroup of T1-T2 breast cancer patients with LN? who might benefit from PMRT. Methods and Materials We retrospectively reviewed 1,136 node-negative T1-T2 breast cancer cases treated with mastectomy without PMRT at the Massachusetts General Hospital between 1980 and 2004. We estimated cumulative incidence rates for LRR overall and in specific subgroups, and used Cox proportional hazards models to identify potential risk factors. Results Median follow-up was 9 years. The 10-year cumulative incidence of LRR was 5.2% (95% CI: 3.9–6.7%). Chest wall was the most common (73%) site of LRR. Tumor size, margin, patient age, systemic therapy, and lymphovascular invasion (LVI) were significantly associated with LRR on multivariate analysis. These five variables were subsequently used as risk factors for stratified analysis. The 10-year cumulative incidence of LRR for patients with no risk factors was 2.0% (95% CI: 0.5–5.2%), whereas the incidence for patients with three or more risk factors was 19.7% (95% CI: 12.2–28.6%). Conclusion It has been suggested that patients with T1-T2N0 breast cancer who undergo mastectomy represent a favorable group for which PMRT renders little benefit. However, this study suggests that select patients with multiple risk factors including LVI, tumor size ?2 cm, close or positive margin, age ?50, and no systemic therapy are at higher risk of LRR and may benefit from PMRT.

Abi-Raad, Rita; Boutrus, Rimoun; Wang, Rui; Niemierko, Andrzej; Macdonald, Shannon; Smith, Barbara; Taghian, Alphonse G.

2013-01-01

98

Breast conservation: Is the survival better for mastectomy?  

PubMed

Breast conserving therapy with radiation is now firmly established as an effective treatment option for early stage disease, and has been thought for decades to yield equivalent survival outcomes to mastectomy. However, recently published observational studies as well as meta-analyses suggest not only a locoregional, but possibly a systemic benefit to BCT. Choice of surgery and radiation is only one of numerous factors impacting survival following surgery for early stage breast cancer; competing comorbidities and risk of treatment related side effects from radiotherapy must also be considered in order to make optimal treatment recommendations. J. Surg. Oncol. 2014 110:58-61. © 2014 Wiley Periodicals, Inc. PMID:24846595

Hwang, E Shelley

2014-07-01

99

Prophylactic Mastectomy in BRCA1/2 Mutation Carriers and Women at Risk of Hereditary Breast Cancer: Long-Term Experiences at the Rotterdam Family Cancer Clinic  

PubMed Central

Background BRCA1/2 mutation carriers and women from a hereditary breast(/ovarian) cancer family have a highly increased risk of developing breast cancer (BC). Prophylactic mastectomy (PM) results in the greatest BC risk reduction. Long-term data on the efficacy and sequels of PM are scarce. Methods From 358 high-risk women (including 236 BRCA1/2 carriers) undergoing PM between 1994 and 2004, relevant data on the occurrence of BC in relation to PM, complications in relation to breast reconstruction (BR), mutation status, age at PM and preoperative imaging examination results were extracted from the medical records, and analyzed separately for women without (unaffected, n = 177) and with a BC history (affected, n = 181). Results No primary BCs occurred after PM (median follow-up 4.5 years). In one previously unaffected woman, metastatic BC was detected almost 4 years after PM (primary BC not found). Median age at PM was younger in unaffected women (P < .001), affected women more frequently were 50% risk carriers (P < .001). Unexpected (pre)malignant changes at PM were found in 3% of the patients (in 5 affected, and 5 unaffected women, respectively). In 49.6% of the women opting for BR one or more complications were registered, totaling 215 complications, leading to 153 surgical interventions (71%). Complications were mainly related to cosmetic outcome (36%) and capsular formation (24%). Conclusions The risk of developing a primary BC after PM remains low after longer follow-up. Preoperative imaging and careful histological examination is warranted because of potential unexpected (pre)malignant findings. The high complication rate after breast reconstruction mainly concerns cosmetic issues.

Heemskerk-Gerritsen, Bernadette A. M.; Brekelmans, Cecile T. M.; Menke-Pluymers, Marian B. E.; van Geel, Albert N.; Tilanus-Linthorst, Madeleine M. A.; Bartels, Carina C. M.; Tan, Murly; Meijers-Heijboer, Hanne E. J.; Klijn, Jan G. M.

2007-01-01

100

Mastectomy With Immediate Expander-Implant Reconstruction, Adjuvant Chemotherapy, and Radiation for Stage II-III Breast Cancer: Treatment Intervals and Clinical Outcomes  

SciTech Connect

Purpose: To determine intervals between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy with immediate expander-implant reconstruction, and to evaluate locoregional and distant control and overall survival in these patients. Methods and Materials: Between May 1996 and March 2004, 104 patients with Stage II-III breast cancer were routinely treated at our institution under the following algorithm: (1) definitive mastectomy with axillary lymph node dissection and immediate tissue expander placement, (2) tissue expansion during chemotherapy, (3) exchange of tissue expander for permanent implant, (4) radiation. Patient, disease, and treatment characteristics and clinical outcomes were retrospectively evaluated. Results: Median age was 45 years. Twenty-six percent of patients were Stage II and 74% Stage III. All received adjuvant chemotherapy. Estrogen receptor staining was positive in 77%, and 78% received hormone therapy. Radiation was delivered to the chest wall with daily 0.5-cm bolus and to the supraclavicular fossa. Median dose was 5040 cGy. Median interval from surgery to chemotherapy was 5 weeks, from completion of chemotherapy to exchange 4 weeks, and from exchange to radiation 4 weeks. Median interval from completion of chemotherapy to start of radiation was 8 weeks. Median follow-up was 64 months from date of mastectomy. The 5-year rate for locoregional disease control was 100%, for distant metastasis-free survival 90%, and for overall survival 96%. Conclusions: Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation results in a median interval of 8 weeks from completion of chemotherapy to initiation of radiation and seems to be associated with acceptable 5-year locoregional control, distant metastasis-free survival, and overall survival.

Wright, Jean L. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Cordeiro, Peter G. [Department of Surgery, Plastic and Reconstructive Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Ben-Porat, Leah [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Van Zee, Kimberly J. [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Hudis, Clifford [Department of Medicine, Solid Tumor Division, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Beal, Kathryn [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); McCormick, Beryl [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)], E-mail: mccormib@mskcc.org

2008-01-01

101

Detection of estradiol-induced messenger RNA (pS2) in uninvolved breast tissue from mastectomies for breast cancer  

Microsoft Academic Search

Summary pS2 mRNA was estimated in uninvolved breast tissue and breast carcinoma from the same patients. pS2 mRNA was clearly detected in 14 of 59 uninvolved breast tissues and in 30 of 58 breast carcinomas. pS2 mRNA was found more frequently in uninvolved breast tissue of premenopausal women than in that of post-menopausal women.

Erika Hähnel; Raymond JOyce; Greg Sterrett; Jennet Harvey; Roland HfihneP

1991-01-01

102

The Impact of Skin-Sparing Mastectomy With Immediate Reconstruction in Patients With Stage III Breast Cancer Treated With Neoadjuvant Chemotherapy and Postmastectomy Radiation  

SciTech Connect

Purpose: The safety and efficacy of skin-sparing mastectomy (SSM) with immediate reconstruction (IR) in patients with locally advanced breast cancer are unclear. The purpose of this study is to compare the outcomes of women with noninflammatory Stage III SSM with IR vs. non-SSM-treated women who underwent neoadjuvant chemotherapy and adjuvant radiation therapy (XRT). Methods and Materials: Between October 1997 and March 2010, 100 consecutive patients (40 SSM with IR vs. 60 non-SSM) with Stage III breast cancer received anthracycline- and/or taxane-based neoadjuvant chemotherapy, mastectomy, and adjuvant XRT. Clinical stage (SSM with IR vs. for non-SSM) was IIIA (75% vs. 67%), IIIB (8% vs. 18%), and IIIC (8% vs. 8%). Tumors greater than 5 cm were found in 74% vs. 69%; 97% of patients in both groups were clinically node positive; and 8% vs. 18% had T4b disease. Results: The time from initial biopsy to XRT was prolonged for SSM-IR patients (274 vs. 254 days, p = 0.04), and there was a trend toward XRT delay of more than 8 weeks (52% vs. 31%, p = 0.07) after surgery. The rate of complications requiring surgical intervention was higher in the SSM-IR group (37.5% vs. 5%, p < 0.001). The 2-year actuarial locoregional control, breast cancer-specific survival, and overall survival rates for SSM with IR vs. non-SSM were 94.7% vs. 97.4%, 91.5% vs. 86.3%, and 87.4% vs. 84.8%, respectively (p = not significant). Conclusions: In our small study with limited follow-up, SSM with IR prolonged overall cancer treatment time and trended toward delaying XRT but did not impair oncologic outcomes. Complication rates were significantly higher in this group. Longer follow-up is needed.

Prabhu, Roshan; Godette, Karen [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Winship Cancer Institute, Emory University, Atlanta, GA (United States); Carlson, Grant; Losken, Albert; Gabram, Sheryl [Winship Cancer Institute, Emory University, Atlanta, GA (United States); Department of Surgery, Emory University, Atlanta, GA (United States); Fasola, Carolina [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Winship Cancer Institute, Emory University, Atlanta, GA (United States); O'Regan, Ruth; Zelnak, Amelia [Winship Cancer Institute, Emory University, Atlanta, GA (United States); Department of Hematology and Medical Oncology, Emory University, Atlanta, GA (United States); Torres, Mylin, E-mail: matorre@emory.edu [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Winship Cancer Institute, Emory University, Atlanta, GA (United States)

2012-03-15

103

Triple-Negative or HER2-Positive Status Predicts Higher Rates of Locoregional Recurrence in Node-Positive Breast Cancer Patients After Mastectomy  

SciTech Connect

Purpose: To evaluate the prognostic value of determining estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) expression in node-positive breast cancer patients treated with mastectomy. Methods and Materials: The records of 835 node-positive breast cancer patients who had undergone mastectomy between January 2000 and December 2004 were analyzed retrospectively. Of these, 764 patients (91.5%) received chemotherapy; 68 of 398 patients (20.9%) with T1-2N1 disease and 352 of 437 patients (80.5%) with T3-4 or N2-3 disease received postoperative radiotherapy. Patients were classified into four subgroups according to hormone receptor (Rec+ or Rec-) and HER2 expression profiles: Rec-/HER2- (triple negative; n = 141), Rec-/HER2+ (n = 99), Rec+/HER2+ (n = 157), and Rec+/HER2- (n = 438). The endpoints were the duration of locoregional recurrence-free survival, distant metastasis-free survival, disease-free survival, and overall survival. Results: Patients with triple-negative, Rec-/HER2+, and Rec+/HER2+ expression profiles had a significantly lower 5-year locoregional recurrence-free survival than those with Rec+/HER2- profiles (86.5% vs. 93.6%, p = 0.002). Compared with those with Rec+/HER2+ and Rec+/HER2- profiles, patients with Rec-/HER2- and Rec-/HER2+ profiles had significantly lower 5-year distant metastasis-free survival (69.1% vs. 78.5%, p = 0.000), lower disease-free survival (66.6% vs. 75.6%, p = 0.000), and lower overall survival (71.4% vs. 84.2%, p = 0.000). Triple-negative or Rec-/HER2+ breast cancers had an increased likelihood of relapse and death within the first 3 years after treatment. Conclusions: Triple-negative and HER2-positive profiles are useful markers of prognosis for locoregional recurrence and survival in node-positive breast cancer patients treated with mastectomy.

Wang Shulian [Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (China); Li Yexiong, E-mail: yexiong@yahoo.com [Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (China); Song Yongwen; Wang Weihu; Jin Jing; Liu Yueping; Liu Xinfan; Yu Zihao [Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (China)

2011-07-15

104

Evaluation of a Mouse Model for Prophylactic Mastectomy in Mice Genetically Predisposed to Breast Cancer.  

National Technical Information Service (NTIS)

Specific Aim I: To evaluate the role of mammary cell volume reduction in inducing morphologic changes in residual tissue. Muller (9) observed that the mammary tissue in these mice is initially hyperplastic and eventually becomes cancerous. Therefore any h...

Y. L. Matory

2001-01-01

105

Using the lymph nodal ratio to predict the risk of locoregional recurrence in lymph node-positive breast cancer patients treated with mastectomy without radiation therapy  

PubMed Central

Background To evaluate the prognostic value of axillary lymph node ratio (LNR) as compared to the number of involved nodes (pN stage) in patients with axillary lymph node-positive breast cancer treated with mastectomy without radiation. Methods We performed a retrospective analysis of the clinical data of patients with stage II-III node-positive breast cancer (N=1068) between 1998 and 2007. Locoregional recurrence-free survival (LRFS) and overall survival (OS) were compared based on the LNR and pN staging. Results A total of 780 cases were classified as pN1, 183 as pN2, and 105 as pN3. With respect to LNR, 690 cases had a LNR from 0.01-0.20, 269 cases a LNR from 0.21-0.65, and 109 cases a LNR > 0.65. The median follow-up time was 62 months. Univariate analysis showed that both LNR and pN stage were prognostic factors of LRFS and OS (p<0.05). Multivariate analysis indicated that LNR was an independent prognostic factor of LRFS and OS (p<0.05). pN stage had no significant effect on LRFS or OS (p>0.05). In subgroup analysis, the LNR identified groups of patients with different survival rates based on pN stage. Conclusions LNR is superior to pN staging as a prognostic factor in lymph node-positive breast cancer after mastectomy, and should be used as one of the indications for adjuvant radiation therapy.

2013-01-01

106

Post-mastectomy radiotherapy in Denmark: from 2D to 3D treatment planning guidelines of The Danish Breast Cancer Cooperative Group.  

PubMed

This paper describes the procedure of changing from 2D to 3D treatment planning guidelines for post-mastectomy radiotherapy in Denmark. The aim of introducing 3D planning for post-mastectomy radiotherapy was to optimize the target coverage and minimize the dose to the normal tissues. Initially, it was investigated whether it was possible to find a treatment technique alternative to the one recommended by the Danish Breast Cancer Cooperative Group (DBCG). A dosimetric comparison of a combined photon/electron 3-field technique (3F) and a partial wide tangent technique (PWT) was carried out on individual planning CT-scans from seven patients selected to represent a wide range of sizes and shapes of chest walls. The heart dose was lower for PWT than for 3F, however, for both techniques the dose was within the accepted constraints. The lung dose was higher but acceptable for six of the seven patients with PWT. The dose to the internal mammary nodes (IMN) was not satisfactory for five of the seven patients for 3F, whereas only two of the seven patients had a minimum dose lower than 95% of the prescribed dose with PWT. Finally, the dose to the contralateral breast was increased when using PWT compared to 3F. It was concluded that PWT was an appropriate choice of technique for future radiation treatment of post-mastectomy patients. A working group was formed and guidelines for 3D planning were developed during a series of workshops where radiation oncologists and physicists from all radiotherapy centres participated. This work also included a definition of the tissue structures needed to be outlined on the planning CT-scan. The work was initiated in 2003 and the guidelines were approved by the DBCG Radiotherapy Committee in 2006. The first of January 2007 the 3D guidelines had been fully implemented in five of the seven radiotherapy centres. PMID:18465333

Thomsen, Mette S; Berg, Martin; Nielsen, Hanne M; Pedersen, Aanders N; Overgaard, Marie; Ewertz, Marianne; Block, Thomas; Brodersen, Hans J; Caldera, Claudio; Jakobsen, Erik; Kamby, Claus; Kjaer-Kristoffersen, Flemming; Klitgaard, Dorte; Nielsen, Mette M; Stenbygaard, Lars; Zimmermann, Sune J; Grau, Cai

2008-01-01

107

Nipple-Sparing Mastectomy for Breast Cancer and Risk-Reducing Surgery: The Memorial Sloan-Kettering Cancer Center Experience  

Microsoft Academic Search

Background  Nipple-sparing mastectomy (NSM) has been gathering increased recognition as an alternative to more traditional mastectomy\\u000a approaches. Initially, questions concerning its oncologic safety limited the use of NSM. Nevertheless, mounting evidence supporting\\u000a the practice of NSM for both prophylactic and oncologic purposes is leading to its more widespread use and broadened indications.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Using a prospectively maintained database, we reviewed our experience

Paulo de Alcantara Filho; Deborah Capko; John Mitchel Barry; Monica Morrow; Andrea Pusic; Virgilio S. Sacchini

108

The Impact of the Size of Nodal Metastases on Recurrence Risk in Breast Cancer Patients With 1-3 Positive Axillary Nodes After Mastectomy  

SciTech Connect

Purpose: Use of postmastectomy radiation therapy (PMRT) in breast cancer patients with 1-3 positive nodes is controversial. The objective of this study was to determine whether the size of nodal metastases in this subset could predict who would benefit from PMRT. Methods and Materials: We analyzed 250 breast cancer patients with 1-3 positive nodes after mastectomy treated with contemporary surgery and systemic therapy at our institution. Of these patients, 204 did not receive PMRT and 46 did receive PMRT. Local and regional recurrence risks were stratified by the size of the largest nodal metastasis measured as less than or equal to 5 mm or greater than 5 mm. Results: The median follow-up was 65.6 months. In the whole group, regional recurrences occurred in 2% of patients in whom the largest nodal metastasis measured 5 mm or less vs 6% for those with metastases measuring greater than 5 mm. For non-irradiated patients only, regional recurrence rates were 2% and 9%, respectively. Those with a maximal nodal size greater than 5 mm had a significantly higher cumulative incidence of regional recurrence (P=.013). The 5-year cumulative incidence of a regional recurrence in the non-irradiated group was 2.7% (95% confidence interval [CI], 0.7%-7.2%) for maximal metastasis size of 5 mm or less, 6.9% (95% CI, 1.7%-17.3%) for metastasis size greater than 5 mm, and 16% (95% CI, 3.4%-36.8%) for metastasis size greater than 10 mm. The impact of the maximal nodal size on regional recurrences became insignificant in the multivariable model. Conclusions: In patients with 1-3 positive lymph nodes undergoing mastectomy without radiation, nodal metastasis greater than 5 mm was associated with regional recurrence after mastectomy, but its effect was modified by other factors (such as tumor stage). The size of the largest nodal metastasis may be useful to identify high-risk patients who may benefit from radiation therapy after mastectomy.

Harris, Eleanor E.R., E-mail: Eleanor.harris@moffitt.org [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Freilich, Jessica [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)] [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Lin, Hui-Yi [Biostatistics Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)] [Biostatistics Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Chuong, Michael [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)] [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Acs, Geza [Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)] [Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)

2013-03-01

109

Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol.  

PubMed

The main objective of the present study aims at comparing the long-term efficacy of breast conserving surgery (BCS) vs. mastectomy (M) based on a randomized design. The Danish Breast Cancer Cooperative Group (DBCG) conducted the trial (DBCG-82TM) from January 1983 to March 1989 recruiting 1154 patients with invasive breast carcinoma. Follow-up time ended 1(st) May 2006 with a median follow-up time of 19.6 years (time span 17.1-23.3 years). Eligibility criteria included a one-sided, unifocal, primary operable breast carcinoma, patient age below 70 years, probability of satisfactory cosmetic outcome with BCS, and no evidence of disseminated disease. The patients accrued were grouped into three subsets: correctly randomized, suspicion of randomization error, and declining randomization. The main analyses focus on the subgroup of 793 correctly randomized patients representing 70% of the complete series. 10-year recurrence free survival (RFS) and 20-year overall survival (OS) based on intent to treat did not reveal significant differences in outcome between breast conserving surgery vs. mastectomy, p=0.95 and p=0.10, respectively. Including the complete series comprising 1133 eligible patients based on treatment in fact given similarly no significant difference between surgical options could be traced in outcome of 10-year RFS and 20-year OS, p=0.94 and p=0.24, respectively. The pattern of recurrences as a first event in breast conservation vs. mastectomy did not differ significantly irrespective of site, p=0.27. Looking into the type of local relapse, viz., new primaries vs. true recurrences, it appeared that new primaries were significantly associated to BCS, while true recurrences dominated among M treated patients (p<0.001). In conclusion, long-term data indicate that BCS in eligible patients proves as effective as mastectomy both regarding local tumour control, RFS and OS. Local failures as a first event consistent with new primaries are strongly associated with BCS, whereas true recurrence predominates after mastectomy. PMID:18465335

Blichert-Toft, Mogens; Nielsen, Maja; Düring, Maria; Møller, Susanne; Rank, Fritz; Overgaard, Marie; Mouridsen, Henning T

2008-01-01

110

Findings from NSABP Protocol No. B-04: comparison of radical mastectomy with alternative treatments. II. The clinical and biologic significance of medial-central breast cancers  

SciTech Connect

Findings from 1665 women with primary breast cancer, treated at 34 NSABP institutions in Canada and the United States, have failed to demonstrate that patients with medial-central tumors had a greater probability of developing distant metastases or dying than did those with lateral tumors despite the greater incidence of internal mammary (IM) node involvement when tumors are medial-central in location. A comparison of patients with similar clinical nodal status and tumor location who were treated either by radical mastectomy (RM) or by total mastectomy plus radiation therapy (TM + RT) failed to indicate that radiation of IM nodes reduced the probability of distant treatment failure (TF) or mortality. When findings from patients having equivalent clinical nodal status and tumor location treated by TM alone or TM + RT were compared, it was found that the addition of RT failed to alter the probability of the occurrence of a distant TF or of death. This was despite the fact that in the nonradiated group two putative sources of further tumor spread, i.e., positive axillary and IM nodes, were left unremoved and untreated. The findings provide further insight into the biologic significance of the positive lymph node and confirm our prior contention that positive regional lymph nodes are indicators of a host-tumor relationship which permits the development of metastases and that they are not important investigators of distant disease.

Fisher, B.; Wolmark, N.; Redmond, C.; Deutsch, M.; Fisher, E.R.

1981-01-01

111

A breast-halving incision for subcutaneous mastectomy.  

PubMed

A new "breast-halving incision" for subcutaneous mastectomy is described. It has particular advantages in the large breast, where the incidence of complications is much higher. Its main disadvantage is the length of the incision, which runs across the equator of the breast. However, subcutaneous mastectomy is not primarily a cosmetic operation. The improved results in immediate reconstruction would seem to justify this approach. PMID:1144543

Corso, P F; Zubiri, J S

1975-07-01

112

Long-Term Outcomes in Patients With Isolated Supraclavicular Nodal Recurrence After Mastectomy and Doxorubicin-Based Chemotherapy for Breast Cancer  

SciTech Connect

Purpose: To examine the outcome of patients who developed an isolated locoregional recurrence (LRR) involving the supraclavicular fossa (SCV) after initial treatment with modified radical mastectomy and chemotherapy. Methods and Materials: Records from 140 breast cancer patients treated on five prospective trials with mastectomy and doxorubicin-based chemotherapy, with or without radiation, who developed a LRR were reviewed. Kaplan-Meier survival times were calculated using date of LRR as time zero. Results: The median follow-up after LRR was 2.9 years (N = 140; interquartile range, 1.3-6.6 years). In all, 47 of 140 patients (34%) had an SCV component to their LRR. These patients had lower 3-y distant metastasis-free survival (40% vs. 54%, p = 0.003) and overall survival (49% vs. 69%, p = 0.04) than patients without an SCV component. Multivariate analysis revealed that LRR involving an SCV component (hazard ratio, 1.96, p = 0.004) and patients with lymphovascular space invasion in their primary tumors (hazard ratio, 1.65, p = 0.029) were independently associated with a poor distant metastasis-free survival. However, among 23 patients with isolated SCV recurrence, Overall survival was not statistically significantly different between isolated chest wall recurrence and isolated SCV recurrence. Patients with isolated SCV recurrence displayed a median follow-up of 3.3 years (IR, 1.2-5.2). Only 6 LRR of 23 patients were treated with aggressive local therapy, including surgery, chemotherapy, and radiation (alone or in combination). Conclusions: Although breast cancer recurrence with SCV involvement carries a high risk of distant metastasis and death, among women with recurrence limited to the SCV alone, overall survival after isolated SCV recurrence can be long (25% >5 years).

Reddy, Jay P. [Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX (United States); Levy, Larry; Oh, Julia L.; Strom, Eric A.; Perkins, George H.; Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Woodward, Wendy A., E-mail: wwoodward@mdanderson.org [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

2011-08-01

113

Eleven-Year Follow-Up of a Randomized Study of Pectoral Fascia Preservation After Mastectomy for Early Breast Cancer  

Microsoft Academic Search

Background  The present study reports results of a randomized trial in which breast cancer patients operated with preserved pectoral fascia\\u000a compared to removal of the pectoral fascia showed a trend toward an increased risk for chest wall recurrence The aim of the\\u000a study was to assess whether the different procedural modes had any impact on survival or local control in breast

Kristina Dalberg; Kamilla Krawiec; Kerstin Sandelin

2010-01-01

114

Evaluation of expressive writing as an intervention for patients following a mastectomy for breast cancer – a feasibility study  

Microsoft Academic Search

AbstractBackgroundBreast cancer and treatment can significantly affect bodily appearance. Older women are as likely as younger women to experience body dissatisfaction that is significantly related to poorer mental health. Despite this, the needs of older women for psychological support during cancer treatment remain under-studied.AimThis feasibility study investigated the efficacy and limitations of expressive writing as an intervention for body dissatisfaction

S Pini; C Harley; D OConnor; G Velikova

2011-01-01

115

Results of salvage hormonal therapy and salvage chemotherapy in women failing adjuvant chemotherapy after mastectomy for breast cancer  

Microsoft Academic Search

Summary We have evaluated the results of salvage systemic therapy in 257 patients with breast cancer recurrent after surgical adjuvant treatment with cyclophosphamide, fluorouracil, and prednisone (CFP) with or without tamoxifen. The overall objective response rate to salvage hormonal therapy was 29% (47 responses in 161 patients) and to salvage chemotherapy was 28% (43 responses in 156 patients). Response rates

Jan C. Buckner; James N. Ingle; Lloyd K. Everson; Judith R. O'Fallon; Stephen A. Cullinan; David L. Ahmann; James E. Krook; Delano M. Pfeifle

1989-01-01

116

Prognostic Value of Molecular Subtypes, Ki67 Expression and Impact of Postmastectomy Radiation Therapy in Breast Cancer Patients With Negative Lymph Nodes After Mastectomy  

SciTech Connect

Purpose: To determine whether Ki67 expression and breast cancer subtypes could predict locoregional recurrence (LRR) and influence the postmastectomy radiotherapy (PMRT) decision in breast cancer (BC) patients with pathologic negative lymph nodes (pN0) after modified radical mastectomy (MRM). Methods and Materials: A total of 699 BC patients with pN0 status after MRM, treated between 2001 and 2008, were identified from a prospective database in a single institution. Tumors were classified by intrinsic molecular subtype as luminal A or B, HER2+, and triple-negative (TN) using estrogen, progesterone, and HER2 receptors. Multivariate Cox analysis was used to determine the risk of LRR associated with intrinsic subtypes and Ki67 expression, adjusting for known prognostic factors. Results: At a median follow-up of 56 months, 17 patients developed LRR. Five-year LRR-free survival and overall survival in the entire population were 97%, and 94.7%, respectively, with no difference between the PMRT (n=191) and no-PMRT (n=508) subgroups. No constructed subtype was associated with an increased risk of LRR. Ki67 >20% was the only independent prognostic factor associated with increased LRR (hazard ratio, 4.18; 95% CI, 1.11-15.77; P<.0215). However, PMRT was not associated with better locoregional control in patients with proliferative tumors. Conclusions: Ki67 expression but not molecular subtypes are predictors of locoregional recurrence in breast cancer patients with negative lymph nodes after MRM. The benefit of adjuvant RT in patients with proliferative tumors should be further investigated in prospective studies.

Selz, Jessica, E-mail: chaumontjessica@yahoo.fr [Department of Radiation Oncology, Institut Curie, Hopital Rene Huguenin, Saint Cloud (France)] [Department of Radiation Oncology, Institut Curie, Hopital Rene Huguenin, Saint Cloud (France); Stevens, Denise; Jouanneau, Ludivine [Department of Medical Statistics, Institut Curie, Hopital Rene Huguenin, Saint Cloud (France)] [Department of Medical Statistics, Institut Curie, Hopital Rene Huguenin, Saint Cloud (France); Labib, Alain [Department of Radiation Oncology, Institut Curie, Hopital Rene Huguenin, Saint Cloud (France)] [Department of Radiation Oncology, Institut Curie, Hopital Rene Huguenin, Saint Cloud (France); Le Scodan, Romuald [Department of Radiation Oncology, Centre Hospitalier Prive Saint Gregoire, Saint Gregoire (France)] [Department of Radiation Oncology, Centre Hospitalier Prive Saint Gregoire, Saint Gregoire (France)

2012-12-01

117

Skin-sparing mastectomy and immediate reconstruction with DIEP flap after breast-conserving therapy  

PubMed Central

Summary Background Currently about 70% of women who suffer from breast cancer undergo breast-conserving therapy (BCT) without removing the entire breast. Thus, this surgical approach is the standard therapy for primary breast cancer. If corrections are necessary, the breast surgeon is faced with irritated skin and higher risks of complications in wound healing. After radiation, an implant-based reconstruction is only recommended in selected cases. Correction of a poor BCT outcome is often only solved with an additional extended operation using autologous reconstruction. Material/Methods In our plastic surgery unit, which focuses on breast reconstruction, we offer a skin-sparing or subcutaneous mastectomy, followed by primary breast reconstruction based on free autologous tissue transfer to correct poor BCT outcomes. Between July 2004 and May 2011 we performed 1068 deep inferior epigastric artery perforator (DIEP) flaps for breast reconstruction, including 64 skin-sparing or subcutaneous mastectomies, followed by primary DIEP breast reconstruction procedures after BCT procedures. Results In all free flap-based breast reconstruction procedures, we had a total flap loss in 0.8% (9 cases). Within the group of patients after BCT, we performed 41 DIEP flaps and 23 ms-2 TRAM flaps after skin-sparing or subcutaneous mastectomies to reconstruct the breast. Among this group we had of a total flap loss in 1.6% (1 case). Conclusions In cases of large tumour sizes and/or difficult tumour locations, the initial oncologic breast surgeon should inform the patients of a possibly poor cosmetic result after BCT and radiation. In our opinion a skin-sparing mastectomy with primary breast reconstruction should be discussed as a valid alternative.

Andree, Christoph; Munder, Beatrix; Seidenstuecker, Katrin; Richrath, Philipp; Behrendt, Philipp; Koppe, Tobias; Hagouan, Mazen; Audretsch, Werner; Nestle-Kramling, Carolin; Witzel, Christian

2012-01-01

118

Comparison of quality of life, satisfaction with surgery and shoulder-arm morbidity in breast cancer survivors submitted to breast-conserving therapy or mastectomy followed by immediate breast reconstruction  

PubMed Central

OBJECTIVES: This study was designed to compare the prevalence of shoulder-arm morbidity, patient satisfaction with surgery and the quality of life of women submitted to breast-conserving therapy or modified radical mastectomy and immediate breast reconstruction. METHODS: This study was a cross-sectional study of women who underwent breast-conserving therapy (n?=?44) or modified radical mastectomy and immediate breast reconstruction (n?=?26). Quality of life was evaluated with the SF-36 Health Survey Questionnaire. RESULTS: No differences were found in the prevalence of lymphedema. The movements that were most commonly affected by these procedures were abduction, flexion and external rotation. When the two groups were compared, however, we only found a statistically significant difference for the prevalence of restricted internal rotation, which occurred in 32% of women in the breast-conserving therapy group and 12% of those in the modified radical mastectomy and immediate breast reconstruction group (OR: 7.23; p?=?0.03 following adjustment for potential confounding factors). No difference in quality of life or satisfaction with surgery was found between the two groups. CONCLUSIONS: These data suggest that the type of surgery did not affect the occurrence of lymphedema. Breast-conserving therapy, however, increased the risk of shoulder movement limitation. No differences were found between the two surgical techniques with respect to quality of life or satisfaction with surgery.

Freitas-Silva, Renata; Conde, Delio Marques; de Freitas-Junior, Ruffo; Martinez, Edson Zangiacomi

2010-01-01

119

Breast reconstruction and post-mastectomy radiation practice  

PubMed Central

Purpose The goal of this study was to explore the perspectives and practice of radiation oncologists who treat breast cancer patients who have had breast reconstruction. Methods In 2010, an original electronic survey was sent to all physician members of the American Society of Radiation Oncology, National Cancer Research Institute-Breast Cancer Studies Group in the United Kingdom, Thai Society of Therapeutic Radiology and Oncology, Swiss Society of Radiation Oncology, and Turkish Radiation Oncology Society. We identified factors associated with radiation oncologists who treat breast cancer patients with reconstruction performed prior to radiation and obtained information regarding radiation management of the breast reconstruction. Results 358 radiation oncologists responded, and 60% of the physicians were from the United States. While 64% of participants agree or strongly agree that breast image affects a woman’s quality of life during radiation, 57% feel that reconstruction challenges their ability to deliver effective breast radiation. Compared with other countries, treatment within the United States was associated with a high reconstruction rate (>/= 50% of mastectomy patients) prior to radiation (p?breast reconstruction. United States physicians were more likely than physicians from other countries to boost or bolus the reconstruction irrespective of the type of reconstruction seen in their clinic patients (p?breast cancer patients with reconstruction. Further research on the impact and delivery of radiation to a reconstructed breast may validate some of the observed practices, highlight the variability in treatment practice, and help create a treatment consensus.

2013-01-01

120

Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimeters or less. The experience of the Institut Gustave-Roussy  

SciTech Connect

A clinical trial was conducted at the Institut Gustave Roussy between October 1972 and December 1980 to compare mastectomy with local excision plus Cobalt-irradiation, in patients with breast cancer tumors of 20 mm in diameter or less at macroscopic examination. Low-axillary dissection and extemporaneous histologic examination were carried out for all patients. If one or more positive nodes were found, complete axillary dissection was performed. The study included 179 patients. No significant difference was detected in either overall or relapse-free survival between the two groups, although the conservatively treated group showed slightly better results. The results of conservative treatment were esthetically satisfactory in 92% of the cases. The trial included a second randomization for the patients with positive axillary nodes to assess the value of nodal area irradiation; 72 patients were studied in this part of the trial. No significant differences were found between the two groups after adjustment for the number of positive axillary nodes, although the no-nodal irradiation group showed better results and less complications than the nodal irradiation group.

Sarrazin, D.; Le, M.; Roueesse, J.; Contesso, G.; Petit, J.Y.; Lacour, J.; Viguier, J.; Hill, C.

1984-03-01

121

Influence of Lymphatic Invasion on Locoregional Recurrence Following Mastectomy: Indication for Postmastectomy Radiotherapy for Breast Cancer Patients With One to Three Positive Nodes  

SciTech Connect

Purpose: The indication for postmastectomy radiotherapy (PMRT) in breast cancer patients with one to three positive lymph nodes has been in discussion. The purpose of this study was to identify patient groups for whom PMRT may be indicated, focusing on varied locoregional recurrence rates depending on lymphatic invasion (ly) status. Methods and Materials: Retrospective analysis of 1,994 node-positive patients who had undergone mastectomy without postoperative radiotherapy between January 1990 and December 2000 at our hospital was performed. Patient groups for whom PMRT should be indicated were assessed using statistical tests based on the relationship between locoregional recurrence rate and ly status. Results: Multivariate analysis showed that the ly status affected the locoregional recurrence rate to as great a degree as the number of positive lymph nodes (p < 0.001). Especially for patients with one to three positive nodes, extensive ly was a more significant factor than stage T3 in the TNM staging system for locoregional recurrence (p < 0.001 vs. p = 0.295). Conclusion: Among postmastectomy patients with one to three positive lymph nodes, patients with extensive ly seem to require local therapy regimens similar to those used for patients with four or more positive nodes and also seem to require consideration of the use of PMRT.

Matsunuma, Ryoichi, E-mail: r-matsunuma@nifty.com [Department of Surgery, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo (Japan); First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka (Japan); Oguchi, Masahiko [Radiation Oncology Department, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo (Japan); Fujikane, Tomoko [Department of Surgery, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo (Japan); Matsuura, Masaaki [Bioinformatics Group, Genome Center of the Japanese Foundation for Cancer Research and Division of Cancer Genomics, Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo (Japan); Sakai, Takehiko; Kimura, Kiyomi; Morizono, Hidetomo; Iijima, Kotaro; Izumori, Ayumi; Miyagi, Yumi; Nishimura, Seiichiro; Makita, Masujiro [Department of Surgery, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo (Japan); Gomi, Naoya [Department of Diagnostic Imaging, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo (Japan); Horii, Rie [Division of Pathology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo (Japan); Akiyama, Futoshi [Division of Pathology, Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo (Japan); Iwase, Takuji [Department of Surgery, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo (Japan)

2012-07-01

122

Constructing Breast Cancer in the NewsBetty Ford and the Evolution of the Breast Cancer Patient  

Microsoft Academic Search

In this article, the author explores a key moment in breast cancer history—the publicity surrounding Betty Ford's radical mastectomy in 1974—and points to the ways in which the print news coverage of Ford's mastectomy offers an identity, or subject position, for breast cancer patients that is constrained by stereotypical gender roles, particularly the need for breast cancer patients to maintain

Tasha N. Dubriwny

2009-01-01

123

Breast Cancer  

MedlinePLUS

... Breast Cancer Overview What is breast cancer? Breast cancer begins in breast tissue. Most of the tumors that develop in breast tissue are benign (not cancerous). Some breast tumors are cancerous, but have ... body. This type of breast cancer is called "in situ," and it can almost ...

124

Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group.  

PubMed

The aim of this study was to investigate and compare the prognosis after treatment for loco-regional recurrences (LR) after (modified) radical mastectomy (MRM) or breast conserving therapy (BCT), in terms of overall survival and time to subsequent LR, in patients originally treated in two European randomised trials. In EORTC trial 10801 and DBCG trial 82-TM, 1,807 patients with stage I and II breast cancer were randomised to receive MRM or BCT from 1980 to 1989. All patients with a LR in these trials were analysed for survival and time to subsequent LR after salvage treatment. Of these, 133 patients had their LR as a first event, the majority within 5 years after initial treatment. The prognostic significance for survival and time to subsequent LR after salvage treatment was analysed in uni-, and multivariate analyses for a number of original tumour- and recurrence-related variables. After salvage treatment of LR after MRM or BCT, actuarial survival curves and the actuarial locoregional control curves were similar. The 5-year survival rates were 58% and 59% and the 5-year subsequent loco-regional control rates 62% and 63%, respectively. In a multivariate analysis, pN category (P = 0.03), pT category (P = 0.01) and vascular invasion (P = 0.02) of the primary tumour were the only independent prognostic factors for survival, whereas extensive LR (P < 0.001), interval < or = 2 years (P < 0.002) and pN+ at primary treatment (P = 0.004) were significant predictive factors for time to subsequent LR. The type of original treatment (MRM or BCT) did not have any prognostic impact. It is concluded that the survival and time to subsequent LR after treatment for an early loco-regional recurrence after MRM or BCT was similar in these two European randomised trials. This suggests that both after MRM and BCT an early LR is an indicator of a biologically aggressive tumour; early loco-regional relapse carries a poor prognosis and salvage treatment only cures a limited number of patients, whether treated by MRM or BCT originally. PMID:10211085

van Tienhoven, G; Voogd, A C; Peterse, J L; Nielsen, M; Andersen, K W; Mignolet, F; Sylvester, R; Fentiman, I S; van der Schueren, E; van Zijl, K; Blichert-Toft, M; Bartelink, H; van Dongen, J A

1999-01-01

125

Pregnancy and Breast Cancer  

MedlinePLUS

... often used after breast-conserving surgeries (lumpectomy or partial mastectomy) to help reduce the risk of the cancer coming back. The high doses of radiation used for this can harm the fetus any time during pregnancy. It may cause miscarriage, birth defects, slow fetal growth, or a higher risk of ...

126

Retrospective Comparison of Non-Skin-Sparing Mastectomy and Skin-Sparing Mastectomy with Immediate Breast Reconstruction  

PubMed Central

Background. We compared Skin-sparing mastectomy (SSM) with immediate breast reconstruction and Non-skin-sparing mastectomy (NSSM), various types of incision in SSM. Method. Records of 202 consecutive breast cancer patients were reviewed retrospectively. Also in the SSM, three types of skin incision were used. Type A was a periareolar incision with a lateral extension, type B was a periareolar incision and axillary incision, and type C included straight incisions, a small elliptical incision (base line of nipple) within areolar complex and axillary incision. Results. Seventy-three SSMs and 129 NSSMs were performed. The mean follow-up was 30.0 (SSM) and 41.1 (NSSM) months. Respective values for the two groups were: mean age 47.0 and 57; seven-year cumulative local disease-free survival 92.1% and 95.2%; post operative skin necrosis 4.1% and 3.1%. In the SSM, average areolar diameter in type A & B was 35.4?mm, 43.0?mm in type C and postoperative nipple-areolar plasty was performed 61% in type A & B, 17% in type C, respectively. Conclusion. SSM for early breast cancer is associated with low morbidity and oncological safety that are as good as those of NSSM. Also in SSM, Type C is far superior as regards cost and cosmetic outcomes.

Kinoshita, Satoki; Nojima, Kimihiro; Takeishi, Meisei; Imawari, Yoshimi; Kyoda, Shigeya; Hirano, Akio; Akiba, Tadashi; Kobayashi, Susumu; Takeyama, Hiroshi; Uchida, Ken; Morikawa, Toshiaki

2011-01-01

127

Simultaneous forequarter amputation and radical mastectomy for metastatic breast carcinoma in a male patient: a case report.  

PubMed

Although the majority of forequarter amputations are performed for high-grade bone and soft tissue sarcomas or extensive osteomyelitis of the upper extremity, this radical operation may also be indicated for the curative treatment of recurrent breast cancer and for the palliation of locally advanced breast cancer. We report a male patient with metastatic breast adenocarcinoma who underwent simultaneous mastectomy and forequarter amputation for the management of both his primary and metastatic disease. PMID:22319742

Ayvaz, Mehmet; Yilgor, Caglar; Mermerkaya, Musa Ugur; Konan, Ali; Sonmez, Erhan; Acaroglu, Rifat Emre

2011-12-01

128

Simultaneous forequarter amputation and radical mastectomy for metastatic breast carcinoma in a male patient: a case report  

PubMed Central

Although the majority of forequarter amputations are performed for high-grade bone and soft tissue sarcomas or extensive osteomyelitis of the upper extremity, this radical operation may also be indicated for the curative treatment of recurrent breast cancer and for the palliation of locally advanced breast cancer. We report a male patient with metastatic breast adenocarcinoma who underwent simultaneous mastectomy and forequarter amputation for the management of both his primary and metastatic disease.

Yilgor, Caglar; Mermerkaya, Musa Ugur; Konan, Ali; Sonmez, Erhan; Acaroglu, Rifat Emre

2011-01-01

129

Defining a place for nipple sparing mastectomy in modern breast care: an evidence based review.  

PubMed

Breast cancer is a diverse disease that requires a fully integrated multidisciplinary approach. Breast surgery has undergone a revolutionary change leading us from the conventional radical mastectomy of the Halstedian era to the current motion of nipple sparing mastectomy (NSM). Despite the lack of randomized controlled trials, the technique of NSM continues to gain popularity as a prophylactic procedure in high risk patients. The current indications for NSM, if any, in the treatment of early invasive breast cancer remains uncertain and requires rigorous scientific scrutiny. This article aims to critically review the indications and limitations of NSM, discuss evidence based intra-operative protocols and to discuss ways in which radiation therapy may be incorporated in treatment planning following NSM. A comprehensive search of the scientific literature was carried out using PubMed to access all publications related to nipple sparing mastectomy. The search focused specifically on technique, current management, safety, and complications of these procedures. Keywords searched included "Nipple sparing mastectomy,"breast conserving surgery,"Nipple areola complex preservation" and "skin sparing mastectomy." NSM offers an opportunity to preserve native breast envelope without mutilation of nipple-areola complex (NAC), and avoids multiple surgical procedures required for reconstruction. NSM may be a reasonable alternative for prophylactic and select breast cancer patients without NAC involvement; however, oncological safety of NSM has not yet been fully demonstrated. Best available evidence suggests that patients should be selected based on study of breast duct anatomy by breast Magnetic Resonance Imaging, mammographic distance between tumor and nipple and obligatory intra-operative frozen section from retro-areolar tissue. Additional factors such as tumor size, axillary lymph node status, lymphovascular invasion and degree of intraductal component are also being used to either include or exclude NSM candidates based on institutional protocols. Heterogeneity of patients selected for NSM is great and the lack of standardization of preoperative investigations, intra-operative technique and pathologic sampling of retro-areola tissues mandates a multi-institutional prospective study to define and validate a role for NSM in invasive breast cancer and DCIS. Nipple necrosis or sloughing is an important problem after NSM which can be greatly reduced using alternative skin incisions. Even if the nipple survives, an insensate nipple and lack of sexual function is common and requires preoperative counseling and discussion. Finally the relation and timing of intra-operative versus adjuvant breast radiation and tailoring of dosage and delivery methods has not been fully explored. Although NSM reduces the psychological trauma associated with nipple loss, the oncologic safety as well as functional and aesthetic outcomes needs additional investigation. PMID:22284266

Murthy, Vijayashree; Chamberlain, Ronald S

2013-01-01

130

Dosimetric evaluation of integrated IMRT treatment of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy.  

PubMed

To investigate the dosimetric characteristics of irradiation of the chest wall and supraclavicular region as an integrated volume with intensity-modulated radiation therapy (IMRT) after modified radical mastectomy. This study included 246 patients who received modified radical mastectomy. The patients were scanned with computed tomography, and the chest wall (with or without the internal mammary lymph nodes) and supraclavicular region were delineated. For 143 patients, the chest wall and supraclavicular region were combined as an integrated planning volume and treated with IMRT. For 103 patients, conventional treatments were employed with 2 tangential fields for the chest wall, abutting a mixed field of 6-MV x-rays (16Gy) and 9-MeV electrons (34Gy) for the upper supraclavicular region. The common prescription dose was 50Gy/25Fx/5W to 90% of the target volume. The dosimetric characteristics of the chest wall, the supraclavicular region, and normal organs were compared. For the chest wall target, compared with conventional treatments, the integrated IMRT plans lowered the maximum dose, increased the minimum dose, and resulted in better conformity and uniformity of the target volume. There was an increase in minimum, average, and 95% prescription dose for the integrated IMRT plans in the supraclavicular region, and conformity and uniformity were improved. The V30 of the ipsilateral lung and V10, V30, and mean dose of the heart on the integrated IMRT plans were lower than those of the conventional plans. The V5 and V10 of the ipsilateral lung and V5 of the heart were higher on the integrated IMRT plans (p < 0.05) than on conventional plans. Without an increase in the radiation dose to organs at risk, the integrated IMRT treatment plans improved the dose distribution of the supraclavicular region and showed better dose conformity and uniformity of the integrated target volume of the chest wall and supraclavicular region. PMID:24503002

Yang, Bo; Wei, Xian-Ding; Zhao, Yu-Tian; Ma, Chang-Ming

2014-01-01

131

Observation on Bilateral Mastectomy: Resource Evaluation.  

National Technical Information Service (NTIS)

This is an observational study of a cohort of patients who had undergone a modified radical mastectomy for primary breast cancer and then underwent a contralateral subcutaneous mastectomy at the time of reconstruction. The comparison of the survival and d...

K. S. McCarty

1998-01-01

132

Observations on Bilateral Mastectomy: Resource Evaluation.  

National Technical Information Service (NTIS)

This observational study involves the evaluation of a cohort of patients who had undergone a modified radical mastectomy for primary breast cancer and then underwent a contralateral subcutaneous mastectomy at the time of reconstruction. The study extends ...

K. McCarty

1997-01-01

133

Male inflammatory breast cancer.  

PubMed

A case of a 48-year-old male with an inflammatory breast cancer is used to illustrate this uncommon malignancy. The physical examination of thickening and erythema made the clinical diagnosis. Mammographic findings of increased density in the right breast with coarsened stroma and an underlying mass confirmed the clinical findings. The sonographic evaluation revealed a 2-cm ill-defined hypoechoic mass. The pathologic examination of the mastectomy specimen showed an infiltrating duct cell carcinoma with lobular features. Male breast cancer afflicts 1500 men each year. Clinically it must be differentiated from gynecomastia, a much more common and benign condition. PMID:11899787

Spigel, J J; Evans, W P; Grant, M D; Langer, T G; Krakos, P A; Wise, D K

2001-07-01

134

Oncoplastic surgery in a Japanese patient with breast cancer in the lower inner quadrant area: partial mastectomy using horizontal reduction mammoplasty.  

PubMed

We report the results of oncoplastic surgery in a Japanese patient with early breast cancer. Her breasts were ptotic, and her lesion was considered to be suitable for breast-conserving surgery. Oncoplastic surgery involving partial resection of the gland and a horizontal-type mammoplasty was performed. The technique was easy to perform, and the cosmetic outcome was excellent. PMID:21188565

Kijima, Yuko; Yoshinaka, Heiji; Hirata, Munetsugu; Mizoguchi, Tadao; Ishigami, Sumiya; Nakajo, Akihiro; Arima, Hideo; Ueno, Shinichi; Natsugoe, Shoji

2014-05-01

135

Generation of voxelized breast phantoms from surgical mastectomy specimens  

PubMed Central

Purpose: In the research and development of dedicated tomographic breast imaging systems, digital breast object models, also known as digital phantoms, are useful tools. While various digital breast phantoms do exist, the purpose of this study was to develop a realistic high-resolution model suitable for simulating three-dimensional (3D) breast imaging modalities. The primary goal was to design a model capable of producing simulations with realistic breast tissue structure. Methods: The methodology for generating an ensemble of digital breast phantoms was based on imaging surgical mastectomy specimens using a benchtop, cone-beam computed tomography system. This approach allowed low-noise, high-resolution projection views of the mastectomy specimens at each angular position. Reconstructions of these projection sets were processed using correction techniques and diffusion filtering prior to segmentation into breast tissue types in order to generate phantoms. Results: Eight compressed digital phantoms and 20 uncompressed phantoms from which an additional 96 pseudocompressed digital phantoms with voxel dimensions of 0.2 mm3 were generated. Two distinct tissue classification models were used in forming breast phantoms. The binary model classified each tissue voxel as either adipose or fibroglandular. A multivalue scaled model classified each tissue voxel as percentage of adipose tissue (range 1%–99%). Power spectral analysis was performed to compare simulated reconstructions using the breast phantoms to the original breast specimen reconstruction, and fits were observed to be similar. Conclusions: The digital breast phantoms developed herein provide a high-resolution anthropomorphic model of the 3D uncompressed and compressed breast that are suitable for use in evaluating and optimizing tomographic breast imaging modalities. The authors believe that other research groups might find the phantoms useful, and therefore they offer to make them available for wider use.

Michael O'Connor, J.; Das, Mini; Dider, Clay S.; Mahd, Mufeed; Glick, Stephen J.

2013-01-01

136

Post-Mastectomy Radiotherapy for Breast Cancer Patients with T1-T2 and 1-3 Positive Lymph Nodes: a Meta-Analysis  

PubMed Central

Background The role of post-mastectomy radiotherapy (PMRT) in patients with T1-2 and 1-3 positive lymph nodes remains controversial. The aim of this study is to investigate the possible benefits of PMRT for this subgroup. Methods Three electronic databases were systematically quarried (Cochrane Library, MEDLINE, and EMBASE) for published studies evaluating the effects of PMRT on breast cancer patients with T1-T2 tumors with 1-3 positive lymph nodes. Of the 334 studies identified, information was available for 3432 patients from 10 clinical studies. Pooled relative risk estimates (RR) and overall survival (OS) were calculated using the inverse variance weighted approach, publication bias and chi-square test were also calculated. Results From the 10 studies, the pooled RR (RRs) for locoregional recurrence (LRR) with PMRT was 0.348 (95% CI = 0.254 to 0.477), suggesting a significant benefit for PMRT to decrease the risk of LRR in patients with T1-T2 tumors and 1-3 positive nodes (p<0.05). Reporting bias ( Begg’s p = 0.152; Egger’s p = 0.107) or significant heterogeneity (Cochran’s p = 0.380; I2 = 6.7%) were not detected. For further subset analysis, the RR for T1, N1-3+ tumors was 0.330 (95% CI = 0.171 to 0.639); for T2, N1-3+ tumors the RR was 0.226 (95% CI = 0.121 to 0.424). The pooled RR for overall survival (OS) was not significantly different between PMRT and no-PMRT group (1.051, 95% CI =1.001 to 1.104). Conclusions Our pooled analysis revealed that PMRT significantly reduces the risk of LRR in patients with TI-T2 tumors with 1-3 positive nodes, and the magnitude of the LRR risk reduction is slightly greater for larger tumors. Our results suggest that PMRT should be considered for patients with T1/T2 tumors with 1-3 positive nodes to decrease the relatively high risk of LRR.

Li, Yaming; Moran, Meena S.; Huo, Qiang; Yang, Qifeng; Haffty, Bruce G.

2013-01-01

137

Intercostal nerves block for mastectomy in two patients with advanced breast malignancy.  

PubMed Central

Regional anesthesia is recognized as an alternative to general anesthesia for modern breast cancer surgery. Various techniques of block have been described. Each has its unique problems. Regional anesthesia was chosen for simple mastectomy in two patients with advanced breast malignancy, due to compromised pulmonary status resulting from widespread malignant infiltration of both lungs. We used intercostal nerves block. The block was supplemented with an infraclavicular infiltration to interrupt the branches of the superficial cervical plexus that provide sensation to the upper chest wall and subcutaneous infiltration in the midline to block the nerve supply from the contralateral side. Anesthesia was generally effective and the operations were uneventful. Both patients and surgeons expressed satisfaction. We conclude that where patients have significant comorbidities that make general anesthesia undesirable, the use of intercostal nerves block remains a safe and reliable anesthetic option that allows the patient access to surgery for simple mastectomy. Images Figure 1 Figure 2 Figure 3

Kolawole, Israel K.; Adesina, Michael D.; Olaoye, Iyiade O.

2006-01-01

138

Idiopathic granulomatous mastitis: successful treatment by mastectomy and immediate breast reconstruction.  

PubMed

We describe three women with idiopathic granulomatous mastitis (IGM), a rare, benign breast disease. It is a chronic inflammatory lesion of the breast and presents with the clinical symptoms of inflammation, breast mass and tumorous indurations and ulcerations of the skin. Clinical and radiological findings often mimic breast cancer. Histopathologic examination remains the gold standard for the diagnosis. It is a non-malignant entity but it may be both locally aggressive and recurrent. The treatment of choice is unclear, but surgical excision and adjunctive treatment with glucocorticoids or antibiotics is described most frequently. We present three patients with a long history of recurrences that was successfully treated by mastectomy and immediate breast reconstruction. PMID:21813343

Hladik, Michaela; Schoeller, Thomas; Ensat, Florian; Wechselberger, Gottfried

2011-12-01

139

[The place of skin-sparing mastectomy in oncoplastic breast surgery].  

PubMed

Despite its ever increasing popularity, there is no evidence-based confirmation so far on the results of skin-sparing mastectomy, introduced 20 years ago. However, the results of countless published retrospective, long-term trials seem to underpin the ability of the precisely implemeted procedure in early stage invasive and in situ breast cancers to yield the oncological results of modified radical mastectomy. As a result of the procedure involving special surgical techniques, the skin not affected by cancer can be preserved, which facilitates immediate reconstruction and improves cosmetic outcome. The effect of postmastectomy radiotherapy on the reconstruction needs to be considered at the time of the multidisciplinary design of the surgical procedure. The authors give a detailed description of the surgical techniques, and provide a wide review of the literature, for the first time in Hungarian language. PMID:22128308

Mátrai, Zoltán; Gulyás, Gusztáv; Tóth, László; Sávolt, Akos; Kunos, Csaba; Pesthy, Pál; Bartal, Alexandra; Kásler, Miklós

2011-11-01

140

Prophylactic bilateral mastectomy and contralateral prophylactic mastectomy.  

PubMed

With increasing public awareness of the risk for breast cancer and modern techniques of reconstruction, the option of surgical prophylaxis for risk reduction is becoming increasingly popular. Bilateral prophylactic mastectomy for women at increased risk of developing breast cancer and contralateral prophylactic mastectomy for those with unilateral breast cancer seeking symmetry, risk reduction, and ease of follow-up are acceptable options for many women. However, prophylactic surgery is not an inconsequential decision, and careful consideration should be given to the risks and benefits of such procedures. PMID:24882342

Chagpar, Anees B

2014-07-01

141

Male breast cancer  

Microsoft Academic Search

Opinion statement  Treatments for men with breast cancer are based largely on accepted regimens for women with the disease. Surgical treatment\\u000a of the primary tumor should be a mastectomy. Lymph node assessment can be done by conventional axillary node dissection or,\\u000a similar to selected women with small primary tumors, by sentinel node dissection. Decisions regarding adjuvant systemic treatment\\u000a should be made

Matthew D. Volm

2003-01-01

142

In situ breast cancer  

Microsoft Academic Search

Opinion statement  The clinical expression of in situ cancer varies widely but is usually occult. Diagnosis can be made by a variety of minimally\\u000a invasive techniques. Treatment of lobular carcinoma in situ (LCIS) is patient-directed but generally requires only close followup.\\u000a Mastectomy is the gold standard for ductal carcinoma in situ (DCIS) and is associated with low recurrence rates. Breast conservation

Ronda S. Henry-Tillman; V. Suzanne Klimberg

2000-01-01

143

Advances in breast reconstruction of mastectomy and lumpectomy defects.  

PubMed

Breast reconstruction continues to evolve along with advances in the detection and management of breast cancer. With more patients diagnosed with breast cancer earlier in life and increased identification of genetic mutations predisposing patients to breast cancer, patients' desires and expectations regarding reconstruction have become more sophisticated. Restoration of the breast to a form as close as possible to its presurgical state continues to be a primary goal. The past decade has seen many advances in implant and autologous tissue-based reconstruction. The future of reconstruction for breast cancer patients is promising with continued research in ways to improve the care provided. PMID:24882349

Ballard, Tiffany Nicole S; Momoh, Adeyiza O

2014-07-01

144

The prevention of breast cancer: an overview.  

PubMed

The role of lifestyle modifications, antioestrogens, cyclo-oxygenase-2 inhibitors and prophylactic mastectomy in reducing breast cancer is reviewed. It is concluded that avoiding postmenopausal obesity and regular physical activity are simple measures that seem to reduce breast cancer risk. There is no conclusive evidence that dietary modification and vitamin supplementation significantly reduce the risk of breast cancer. The evidence suggests that tamoxifen significantly reduces the risk of breast cancer in women at increased risk, but whether it reduces breast cancer mortality remains unknown. Ongoing clinical trials may prove that raloxifene is superior to tamoxifen in breast cancer prevention due to its anti-oestrogenic effects on the endometrium. Bilateral prophylactic mastectomy reduces the risk of breast cancer by 90% in high risk women. PMID:11268709

Leris, C; Mokbel, K

2001-01-01

145

Are patients making high-quality decisions about breast reconstruction after mastectomy?  

PubMed Central

Background Variation in rates of breast reconstruction after mastectomy has raised concerns about the quality of decisions about reconstruction. We sought to evaluate patient decision making about reconstruction, using a validated measure of knowledge and preferences related to reconstruction. Methods A cross-sectional survey of early-stage breast cancer survivors from four university medical centers was conducted. The survey included measures of knowledge about specific reconstruction facts, personal goals and concerns, and involvement in decision making. A multivariable linear regression model of characteristics associated with knowledge and a logistic regression model of factors associated with having reconstruction were developed. Results 84 patients participated (59% response rate). Participants answered 37.9% of knowledge questions correctly. Higher education (beta 15%, p=0.003) and having reconstruction (beta 21%, p<0.0001) were associated with higher knowledge. The goals “use your own tissue to make a breast” (OR 1.53, 95% CI 1.15, 2.05) and “wake up after mastectomy with reconstruction underway” (OR 1.66, 95% CI 1.30, 2.12) were associated with reconstruction. The goal “avoid putting foreign material in your body” was associated with no reconstruction (OR 0.64, 95% CI 0.48, 0.86). Most patients reported they mainly made the decision or made the decision with the doctor equally (93%, 95%CI 85-97%), and that their degree of involvement was about right (85%, 95%CI 75-91%). Conclusion Women treated with mastectomy in this study were not well-informed about breast reconstruction. Treatments were associated with patients' goals and concerns, however, and patients were highly involved in their decisions. Knowledge deficits suggest that breast cancer patients would benefit from interventions to support their decision making.

Lee, Clara N.; Belkora, Jeff; Chang, Yuchiao; Moy, Beverly; Partridge, Ann; Sepucha, Karen

2013-01-01

146

Treatment of Breast Cancer during Pregnancy  

MedlinePLUS

... recommended for pregnant women with breast cancer. Since breast-conserving surgery (BCS) needs to be followed with radiation, BCS is only an option if radiation can be delayed until after the baby is delivered. But breast biopsy procedures and even mastectomy and lymph node ...

147

Fifteen-year results of a randomized prospective trial of hyperfractionated chest wall irradiation versus once-daily chest wall irradiation after chemotherapy and mastectomy for patients with locally advanced noninflammatory breast cancer  

SciTech Connect

Purpose: To analyze the results of a Phase III clinical trial that investigated whether a hyperfractionated radiotherapy (RT) schedule could reduce the risk of locoregional recurrence in patients with locally advanced breast cancer treated with chemotherapy and mastectomy. Methods and Materials: Between 1985 and 1989, 200 patients with clinical Stage III noninflammatory breast cancer were enrolled in a prospective study investigating neoadjuvant and adjuvant chemotherapy. Of the 179 patients treated with mastectomy after neoadjuvant chemotherapy, 108 participated in a randomized component of the trial that compared a dose-escalated, hyperfractionated (twice-daily, b.i.d.) chest wall RT schedule (72 Gy in 1.2-Gy b.i.d. fractions) with a once-daily (q.d.) schedule (60 Gy in 2-Gy q.d. fractions). In both arms of the study, the supraclavicular fossa and axillary apex were treated once daily to 50 Gy. The median follow-up period was 15 years. Results: The 15-year actuarial locoregional recurrence rate was 7% for the q.d. arm and 12% for the b.i.d. arm (p = 0.36). The rates of severe acute toxicity were similar (4% for q.d. vs. 5% for b.i.d.), but moist desquamation developed in 42% of patients in the b.i.d. arm compared with 28% of the patients in the q.d. arm (p = 0.16). The 15-year actuarial rate of severe late RT complications did not differ between the two arms (6% for q.d. vs. 11% for b.i.d., p = 0.54). Conclusion: Although the sample size of this study was small, we found no evidence that this hyperfractionation schedule of postmastectomy RT offered a clinical advantage. Therefore, we have concluded that it should not be further studied in this cohort of patients.

Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: tbuchhol@mdanderson.org; Strom, Eric A. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Oswald, Mary Jane [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Perkins, George H. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Oh, Julia [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Domain, Delora [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Yu, Tse-Kuan [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Woodward, Wendy A. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Tereffe, Welela [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Singletary, S. Eva [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Thomas, Eva [Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Buzdar, Aman U. [Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Hortobagyi, Gabriel N. [Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); McNeese, Marsha D. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

2006-07-15

148

The increasing efficacy of breast cancer treatment  

Microsoft Academic Search

Breast cancer is the commonest malignancy in women and although identification of this multi-system disease has increased, the survival rates have not dramatically altered over the past four decades. Optimium treatment of patients with breast cancer is a subject of great debate and traditionally may be divided into surgery, radiotherapy, chemotherapy and hormone manipulation.Halsted's radical mastectomy, although initially superseded by

A. Gordon

1997-01-01

149

Reconstructive surgery in breast cancer treatment  

Microsoft Academic Search

A breast cancer diagnosis can be frightening, confusing experience for the women with newly diagnosed disease, not only at the prospect of having a malignant disease but also by the possibility of a radical change in their appearance after mastectomy. Even when cancer treatment does not involve removal of the entire breast, its appearance may be adversely affected. The first

Ferenc Vicko

150

Circumvertical mastectomy incision: refinement in the surgical scar of implant-based breast reconstruction.  

PubMed

Different surgical incisions have been proposed for skin-sparing mastectomy in an attempt to better disguise the remaining scar. These techniques are more hidden than the Stewart incision but can still leave scars in visible places and can restrict the natural shape of the upper pole. They can also add complexity and time to the mastectomy, requiring extensive retraction that could damage the salvaged skin flaps to perform an adequate mastectomy. We present a circumvertical mastectomy incision technique, which limits the mastectomy scar to the inferior pole, provides natural lateral contour, superior pole fullness, and contributes to a more youthful breast projection. Between November 2011 and November 2012, 51 women underwent circumvertical AlloDerm/tissue expansion reconstruction at our institution by a single surgeon. The reconstruction was bilateral in 30 patients and unilateral in 21 patients for a total of 81 breasts. Of the 81 reconstructed breasts, 5 patients went on to require a latissimus dorsi flap for definitive reconstruction and 3 failed breast reconstruction for a completion rate of 96%. The goal of creating breast reconstruction results comparable to those of cosmetic breast surgery is becoming a reality. Circumvertical incision is a technique that can prevent visible upper hemispheric breast scarring, limit upper pole constriction by scar placement, and preserves or restores breast projection. Following the principles of aesthetic breast surgery and repositioning the mastectomy scar, one can reconstruct a breast with a more disguised scar, which can be hidden from the patient's downward gaze. PMID:24691348

Chapman-Jackson, Emme D; Griner, Devan; Brzezienski, Mark A

2014-06-01

151

Psychological effects of breast conserving therapy in comparison with radical mastectomy  

SciTech Connect

Psychosocial sequelae of breast conserving therapy (BCT) and radical mastectomy (RM) have been compared. Also, in the BCT group, the cosmetic results were judged by the patients themselves and two plastic surgeons. Body image in the BCT group (n = 114) was significantly more positive than in the RM group (n = 58). Patients treated with BCT had even less fear of recurrence of the cancer and would, if necessary, choose the same treatment again. Cosmetic results were good to excellent in 75% of the cases as judged by the two plastic surgeons. Most of the patients with a bad grading by the surgeons were happy with the results.

Bartelink, H.; van Dam, F.; van Dongen, J.

1985-02-01

152

Breast Cancer  

MedlinePLUS

... ma-STEK-tuh-mee), which removes the whole breast. This surgery is done when cancer cells have spread through ... woman and her family. A woman who has breast cancer surgery or treatment may not feel well for a ...

153

[A case of recurrent breast cancer with carcinomatous pleurisy successfully treated with combined chemoendocrine-therapy of CTF (CPA, THP and 5-FU) and anastrozole following instillation therapy 12 years after radical mastectomy].  

PubMed

A 52-year-old female underwent radical mastectomy at the age of 41 for left breast cancer (n0, positive for ER). After a few years of adjuvant TAM therapy, follow-up was stopped at the age of 50 with no recurrence. She had suffered from symptoms of cold since January 2001 and came to our hospital complaining dyspnea on February 11. CXP showed pleural effusion of the entire thoracic cavity and she was admitted to the hospital immediately. Pleural exudate cytodiagnosis showed carcinomatous pleurisy; however, dyspnea and thoracic effusion were improved by continuous thoracic drainage and instillation therapy. Various examinations demonstrated that the carcinomatous pleurisy was due to recurrent breast cancer. They also showed local recurrence, left supraclavicular lymph node metastasis and multiple bone metastasis. Thus, combined chemoendocrine-therapy of CTF (CPA, THP and 5-FU) and anastrozole was administered. After 6 cycles of CTF, the carcinomatous pleurisy, local recurrence and left supraclavicular lymph node metastasis were diagnosed as CR by CXP, chest CT and US and multiple bone metastasis were diagnosed as PR by bone scintigram. The patient continues to be treated on an outpatient basis with no recurrence about one year after the beginning of the treatment (6 months after CTF 6 cycles) and she is taking anastrozole continuously. PMID:12506484

Mori, Katsuaki; Chiba, Naokazu; Yamamoto, Yutaka; Yonekawa, Hajime

2002-12-01

154

Aesthetic Design of Skin-Sparing Mastectomy Incisions for Immediate Autologous Tissue Breast Reconstruction in Asian Women  

PubMed Central

Background The advent of skin-sparing mastectomy has allowed for the reconstruction of the breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC) in Asian patients is more pigmented and scars easily. Therefore, commonly described incisions tend to result in poor aesthetic outcomes in Asian patients with breast cancer. Methods We describe an algorithmic approach to skin-sparing mastectomy incisions in Asian patients on the basis of the location of the biopsy scar and the tumor site and size. Four incision types are described: peri-areolar, a peri-areolar incision with a second distant skin paddle, "racquet handle," and peri-areolar with adjacent skin excision. Results 281 immediate breast reconstructions were performed between May 2001 and February 2012 after skin-sparing mastectomy. The mastectomy incisions used included the peri-areolar design (n=124, 44%), peri-areolar design with a second distant skin paddle (n=39, 14%), "racquet handle" (n=21, 7.5%), and peri-areolar design with adjacent skin excision (n=42, 14%). The traditional elliptical incision and other variants where the NAC outline was not preserved were performed in the remaining 55 patients. The average follow-up was 44.7 months during which there was 1 case of total flap loss and 7 cases of partial flap necrosis; all remaining flaps survived. 24% of the patients (68/281) underwent subsequent nipple reconstruction. Conclusions Our algorithm avoids breast incisions that are randomly placed or excessively long and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparing mastectomy and immediate breast reconstruction to be performed with a consistently achievable aesthetic result in Asian women without neglecting oncological safety.

Chim, Harvey; Ng, Zhi Yang; Ong, Kong Wee

2014-01-01

155

Radiation therapy of early carcinoma of the breast without mastectomy. [Linear acceleraor and iridium implants  

SciTech Connect

The results of the treatment of 176 patients with early breast cancer, using radiation therapy without mastectomy are reported. The likelihood of local recurrence was 5% for Stage I patients and 7% for Stage II patients. Local control was significantly greater in those patients receiving an iridium implant. The cumulative survival probability at five years is 96% for Stage I and 68% for Stage II. Gross tumor resection with careful reapproximation of the breast tissue and well-placed incisions facilitates the radiation therapy. Homogeneous external beam radiation to the breast and draining lymph nodes (4500 to 5000 rads) and supplemental local radiation to the sites of the primary lesion (in this series using interstitial implantation) are recommended. The frequency of normal tissue complications was low.

Hellman, S.; Harris, J.R.; Levene, M.B.

1980-08-15

156

Operable breast cancer: A clinical analysis of 6,263 cases  

Microsoft Academic Search

Objective  In Europe and America breast cancer commonly occurs in women of middle and old age, with a median age of about 57 years. Modified\\u000a radical mastectomy now called standard radical mastectomy, has taken the place of traditional radical mastectomy. Patients\\u000a with breast cancer at an early stage commonly receive BCT (breast conservative therapy). The TNM stage (especially the lymph\\u000a node

Mingtian Yang; Tiehua Rong; Zhifan Huang; Changuang Zeng; Hao Long; Jianhua Fu; Peng Lin; Xin Wang; Siyu Wang; Jun Tang

2005-01-01

157

What Is Breast Cancer?  

MedlinePLUS

... Next Topic Types of breast cancers What is breast cancer? Breast cancer is a malignant tumor that ... our document, Breast Cancer in Men . The normal breast To understand breast cancer, it helps to have ...

158

How to treat male breast cancer  

Microsoft Academic Search

The prevalence for breast cancer in males in Europe is estimated to be 1 or less per 100 000. Male breast cancer has a peak incidence at the age of 71 years.There are no randomized data giving information on the optimal therapy for male breast cancer patients, thereby limiting firmer conclusions.The preferred primary surgical therapy is modified radical\\/simple mastectomy, but

Czene Kamila; Bergqvist Jenny; Hall Per; Bergh Jonas

2007-01-01

159

Controversies in loco-regional treatment: post-mastectomy radiation for pT2-pT3N0 breast cancer arguments in favour.  

PubMed

Post-mastectomy RT decreases the rate of locoregional recurrences of about 70% in all patients irrespective of age, tumor characteristics or systemic therapy. Post-mastectomy RT has to be proposed, moreover when locoregional lymph nodes are part of the PTV, if an optimal coverage of the PTV and a satisfactory sparing of the OAR could be obtained. Due to the results of meta-analysis, consensus conferences and randomized trials the long-term efficacy of RT in decreasing the risk of LRF is well established and the vast majority of women, treated with mastectomy, will benefit from it. PMID:21134765

Valli, Maria Carla

2012-12-01

160

Radiotherapy Can Improve the Disease-Free Survival Rate in Triple-Negative Breast Cancer Patients with T1-T2 Disease and One to Three Positive Lymph Nodes After Mastectomy  

PubMed Central

Purpose. Several studies have demonstrated poor locoregional control in patients with triple-negative breast cancer (TNBC), compared with other molecular subtypes of breast cancer. We sought to evaluate whether or not postmastectomy radiotherapy (PMRT) improves locoregional recurrence-free survival (LRFS) and disease-free survival (DFS) outcomes in TNBC patients. Methods and Materials. Between January 2000 and July 2007, 553 TNBC patients treated with modified radical mastectomy from a single institution were analyzed retrospectively. Patients were categorized into three groups: low risk (stage T1–T2N0), intermediate risk (stage T1–T2N1), and high risk (stage T3–T4 and/or N2–N3). Cox proportional hazards models were used to evaluate the association between PMRT and LRFS and DFS times after adjusting for other clinicopathologic covariates. Results. With a median follow-up of 65 months (range, 1–140 months), 51 patients (9.2%) developed locoregional recurrence and 135 patients (24.4%) experienced disease recurrence. On multivariate analysis, PMRT was associated with significantly longer LRFS and DFS times in the entire cohort. In the intermediate-risk group, PMRT was associated with a longer DFS time but not with the LRFS interval. In the high-risk group, PMRT was associated with significantly longer LRFS and DFS times. Conclusion. PMRT is associated with longer LRFS and DFS times in high-risk TNBC patients and a longer DFS time in intermediate-risk TNBC patients. Prospective randomized studies are needed to investigate the best locoregional treatment approaches for patients with this molecular subtype of breast cancer.

Chen, Xingxing; Yu, Xiaoli; Chen, Jiayi; Yang, Zhaozhi; Shao, Zhimin; Zhang, Zhen; Feng, Yan

2013-01-01

161

Radiotherapy Can Decrease Locoregional Recurrence and Increase Survival in Mastectomy Patients With T1 to T2 Breast Cancer and One to Three Positive Nodes With Negative Estrogen Receptor and Positive Lymphovascular Invasion Status  

SciTech Connect

Purpose: To define a subgroup of patients at high risk of locoregional recurrence (LRR) who might be benefit from postmastectomy radiotherapy in invasive breast cancer and tumor size <5 cm with one to three involved axillary lymph nodes (T1-2 N1). Methods and Materials: Between April 1991 and December 2005, 544 patients with T1-2 N1 invasive breast cancer were treated with modified radical mastectomy. Of the 544 patients, 383 patients (70.4%) had no radiotherapy, and 161 patients (29.6%) received radiotherapy. We retrospectively compared these two patient groups. Results: With a median follow-up of 40.3 months, LRR occurred in 40 (7.4%) of 544 patients. On univariate analysis, high nuclear grade (p = 0.04), negative estrogen receptor (ER) status (p = 0.001), presence of lymphovascular invasion (LVI) (p = 0.003), and no radiotherapy (p = 0.0015) were associated with a significantly higher rate of LRR. Negative ER status (hazard ratio = 5.1) and presence of LVI (hazard ratio = 2.5) were the risk factors for LRR with statistical significance in the multivariate analysis. Radiotherapy reduced the LRR in patients with the following characteristics: age <40 years, T2 stage, high nuclear grade, negative ER status, and presence of LVI. For 41 patients with negative ER and positive LVI status, radiotherapy can reduce LRR from 10 of 25 (40%) to 2 of 16 (12.5%) and increase the 5-year overall survival from 43.7% to 87.1%. Conclusion: Radiotherapy can reduce LRR and increase survival in T1-2 N1 breast cancer patients with negative ER status and presence of LVI.

Yang, P.S., E-mail: psyang@kfsyscc.or [Department of Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Chen, C.M. [Department of Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Liu, M.C. [Department of Medical Oncology, Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Jian, J.M. [Department of Radiation Oncology, Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Horng, C.F. [Department of Research, Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Liu, M.J. [Department of Radiation Oncology, Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Yu, B.L. [Department of Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Lee, M.Y. [Department of Pathology, Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Chi, C.W. [Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan (China)

2010-06-01

162

Pilot Clinical Trial to Assess Percutaneous Segmental Mastectomy in Women with Malignant Tumors < or = 1.0 Centimeter.  

National Technical Information Service (NTIS)

The operative treatment of primary breast cancer has changed. The radical mastectomy has been replaced by the modified radical mastectomy. Increasingly breast-conserving operations are being accepted as the standard of care. The logical culmination of the...

N. Wolmark

1999-01-01

163

Quality of life in women following various surgeries of body manipulation: organ transplantation, mastectomy, and breast reconstruction.  

PubMed

This study aimed to determine biopsychosocial differences (anxious-depressive symptomatology and quality of life) among three groups of patients who underwent surgical interventions related to body manipulation, as well as to assess the clinical significance of these results versus reference values. Four groups were compared: women who underwent organ transplant (n = 26), mastectomy for breast cancer (n = 36), breast reconstruction (n = 36), and general population (n = 608). The Hospital Anxiety and Depression Scale and the EORTC QLQ-C30 were used. Women who underwent mastectomy showed the highest anxious-depressive symptomatology and quality-of-life impairment in comparison to the remaining groups, and they also displayed the most clinically significant deterioration in the majority of dimensions (large effect sizes). In contrast, the group with implantation of a healthy organ (transplantation) only showed higher biopsychosocial impairment than the group with reconstruction of an organ (breast reconstruction) in gastrointestinal dysfunctions and in the global self-perception of health. PMID:23613108

Pérez-San-Gregorio, M Angeles; Fernández-Jiménez, Eduardo; Martín-Rodríguez, Agustín; Borda-Más, Mercedes; Rincón-Fernández, M Esther

2013-09-01

164

Decision Making about Surgery for Early Stage Breast Cancer  

PubMed Central

Background Practice variation in breast cancer surgery has raised concerns about the quality of treatment decisions. We sought to evaluate the quality of decisions about surgery for early stage breast cancer by measuring patient knowledge, concordance between goals and treatments, and involvement in decisions. Study Design A mailed survey of Stage I/II breast cancer survivors was conducted at four sites. The Decision Quality Instrument measured knowledge, goals, and involvement in decisions. A multivariable logistic regression model of treatment was developed. The model-predicted probability of mastectomy was compared to treatment received for each patient. Concordance was defined as having mastectomy and predicted probability >=0.5 or partial mastectomy and predicted probability <0.5. Frequency of discussion about partial mastectomy was compared to discussion about mastectomy using chi-squared tests. Results 440 patients participated (59% response rate). Mean overall knowledge was 52.7%. 45.9% knew that local recurrence risk is higher after breast conservation. 55.7% knew that survival is equivalent for the two options. Most participants (89.0%) had treatment concordant with their goals. Participants preferring mastectomy had lower concordance (80.5%) than those preferring partial mastectomy (92.6%, p=0.001). Participants reported more frequent discussion of partial mastectomy and its advantages than of mastectomy. 48.6% reported being asked their preference. Conclusions Breast cancer survivors had major knowledge deficits, and those preferring mastectomy were less likely to have treatment concordant with goals. Patients perceived that discussions focused on partial mastectomy, and many were not asked their preference. Improvements in the quality of decisions about breast cancer surgery are needed.

Lee, Clara N; Chang, Yuchiao; Adimorah, Nesochi; Belkora, Jeff; Moy, Beverly; Partridge, Ann; Ollila, David W.; Sepucha, Karen

2011-01-01

165

Breast reconstruction after nipple/areola-sparing mastectomy using cell-enhanced fat grafting  

PubMed Central

Background: The success of fat grafting in breast reconstruction depends on fat retention. The use of stem-cells-enriched fat graft is an alternative method for graft stability. Case report: A case of nipple-areola sparing mastectomy double stage reconstruction with the use of stem cells enhanced fat graft is reported. Conclusions: Fat grafting is growing as a new and promising tool in reconstruction following nipple and areola sparing mastectomies as a way to restore a sufficient and reliable subcutaneous space in the mastectomy flap. This combined with an anatomical gel implant offers an integrated system of achieving a natural shaped breast.

Calabrese, C; Orzalesi, L; Casella, D; Cataliotti, L

2008-01-01

166

Breast reconstruction after nipple/areola-sparing mastectomy using cell-enhanced fat grafting  

PubMed Central

Background: The success of fat grafting in breast reconstruction depends on fat retention. The use of stem-cells-enriched fat graft is an alternative method for graft stability. Case report: A case of nipple-areola sparing mastectomy double stage reconstruction with the use of stem cells enhanced fat graft is reported. Conclusions: Fat grafting is growing as a new and promising tool in reconstruction following nipple and areola sparing mastectomies as a way to restore a sufficient and reliable subcutaneous space in the mastectomy flap. This combined with an anatomical gel implant offers an integrated system of achieving a natural shaped breast.

Calabrese, C; Orzalesi, L; Casella, D; Cataliotti, L

2009-01-01

167

A 30-day risk assessment of mastectomy alone compared to immediate breast reconstruction (IBR).  

PubMed

Abstract Immediate breast reconstruction (IBR) is emerging as a favourable reconstruction option for breast cancer patients. Understanding the factors associated with complications following IBR will enhance care delivery, risk counselling and management, and potentially improve patient satisfaction. Women undergoing mastectomy alone and mastectomy with IBR from 2005-2011 were identified in the ACS-NSQIP datasets. Specific complications examined included surgical (flap or prosthesis loss and unplanned reoperation), wound (superficial/deep surgical site infection and wound dehiscence), and medical complications. Bivariate and multivariate analyses were performed to identify predictors of outcomes. A total of 47,443 patients were identified. For patients who underwent IBR compared to mastectomy alone, total complications (11.2% vs 9.2%, p < 0.001) and surgical complications (7.8% vs 4.7%, p < 0.001) were more frequent. In adjusted analysis, a common predictor of complications was class III obesity (BMI ? 40 kg/m(2)) for mastectomy alone (OR = 1.79, p < 0.001) and implant-based IBR (OR = 2.20, p < 0.001), and class II obesity (BMI 35-39.9) for autologous IBR (OR = 1.62, p = 0.003). Wound complications were found to be associated with autologous reconstruction (p < 0.001 kg/m(2)), smoking (p < 0.001), bilateral procedures (p = 0.005), patient comorbidity (p = 0.006), obesity (p < 0.001), and diabetes (p < 0.001). The strongest predictors of wound complications were class II obesity (OR = 2.12), class III obesity (OR = 3.09), and smoking (OR = 1.70). Risk factors for medical morbidity included: immediate autologous (p < 0.001), recent chemotherapy (p = 0.013), ASA physical status (p < 0.001), bilateral procedure (p = 0.002), patient comorbidity (p < 0.001), and obesity (p < 0.001). The strongest predictors of medical morbidity were immediate autologous reconstruction (OR = 3.54) and comorbidity burden of ?2 comorbid conditions (OR = 2.28). In conclusion, undergoing IBR is associated with a modality-specific increased risk of morbidity relative to mastectomy alone. However, other modifiable risk factors appear to be strongly correlated with postoperative complications. Level of Evidence: prognostic/risk category, level II. PMID:24328902

Fischer, John P; Tuggle, Charles T; Au, Alex; Kovach, Stephen J

2014-06-01

168

Efficacy of sentinel lymph node biopsy in male breast cancer  

Microsoft Academic Search

Background: Sentinel lymph node biopsy (SLNB) is rapidly becoming the standard of care in the treatment of women with early stage breast cancer. Male breast cancer although relatively rare, has typically been treated with mastectomy and axillary lymph node dissection (ALND). Men who develop breast carcinoma have the same risk as their female counterparts of developing the morbidities associated with

Vincent M. Cimmino; Amy C. Degnim; Michael S. Sabel; Kathleen M. Diehl; Lisa A. Newman; Alfred E. Chang

2004-01-01

169

Changing practices in the surgical treatment of breast cancer in Japan: A nationwide survey by the Japanese Breast Cancer Society  

Microsoft Academic Search

A nationwide survey in Japan of the patients with primary breast cancer from 1989 to 1991 revealed marked changes in the surgical\\u000a treatment of the disease. During this period, there was a significant trend toward fewer instances of radical and extended\\u000a radical mastectomies, and an increase in modified radical mastectomies and breast-conserving surgery. The percentage of breast-conserving\\u000a surgery for the

Masaru Izuo; Tsunehiro Ishida

1994-01-01

170

Prognostic Significance of the Number of Positive Lymph Nodes in Women With T1-2N1 Breast Cancer Treated With Mastectomy: Should Patients With 1, 2, and 3 Positive Lymph Nodes Be Grouped Together?  

SciTech Connect

Purpose: To determine whether patients with 1, 2, or 3 positive lymph nodes (LNs) have similar survival outcomes. Methods and Materials: We analyzed the Surveillance, Epidemiology, and End Results registry of breast cancer patients diagnosed between 1990 and 2003. We identified 10,415 women with T1-2N1M0 breast cancer who were treated with mastectomy with no adjuvant radiation, with at least 10 LNs examined and 6 months of follow-up. The Kaplan-Meier method and log–rank test were used for survival analysis. Multivariate analysis was performed using the Cox proportional hazard model. Results: Median follow-up was 92 months. Ten-year overall survival (OS) and cause-specific survival (CSS) were progressively worse with increasing number of positive LNs. Survival rates were 70%, 64%, and 60% (OS), and 82%, 76%, and 72% (CSS) for 1, 2, and 3 positive LNs, respectively. Pairwise log–rank test P values were <.001 (1 vs 2 positive LNs), <.001 (1 vs 3 positive LNs), and .002 (2 vs 3 positive LNs). Multivariate analysis showed that number of positive LNs was a significant predictor of OS and CSS. Hazard ratios increased with the number of positive LNs. In addition, age, primary tumor size, grade, estrogen receptor and progesterone receptor status, race, and year of diagnosis were significant prognostic factors. Conclusions: Our study suggests that patients with 1, 2, and 3 positive LNs have distinct survival outcomes, with increasing number of positive LNs associated with worse OS and CSS. The conventional grouping of 1-3 positive LNs needs to be reconsidered.

Dai Kubicky, Charlotte, E-mail: charlottedai@gmail.com [Department of Radiation Medicine and Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon (United States); Mongoue-Tchokote, Solange [Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon (United States)] [Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon (United States)

2013-04-01

171

Indications for prophylactic mastectomy.  

PubMed

This article reviews the current state of knowledge regarding factors which put women at highest risk for developing breast cancer and identifies that population we consider as potential candidates for prophylactic mastectomy. Specifically, we focus on the concept of cumulative predisposition and the relative risk assigned to more significant factors that increase a woman's chances of developing breast cancer: family history, proliferative breast histology, and previous cancer in one breast. In addition to outlining the results of reconstruction, the article also examines the controversy surrounding the issue of whether any mastectomy can be truly prophylactic. We conclude with advice to physicians who must counsel women concerned about their breast cancer risk so they can help their patients make fully informed choices. PMID:8446090

Nemecek, J R; Young, V L; Lopez, M J

1993-03-01

172

In situ breast cancer.  

PubMed

The clinical expression of in situ cancer varies widely but is usually occult. Diagnosis can be made by a variety of minimally invasive techniques. Treatment of lobular carcinoma in situ (LCIS) is patient-directed but generally requires only close follow-up. Mastectomy is the gold standard for ductal carcinoma in situ (DCIS) and is associated with low recurrence rates. Breast conservation therapy (BCT) has become an acceptable alternative. This choice of definitive therapy for DCIS depends largely on the ability to obtain negative margins. Any attempt at BCT should be coupled with the caveat of close postoperative long-term follow-up. Patients diagnosed with LCIS or who have a history of DCIS should be given the options for the use of tamoxifen for the reduction of subsequent development of invasive breast cancer. Risk versus benefits should be clearly defined. PMID:12057162

Henry-Tillman, R S; Klimberg, V S

2000-08-01

173

Improved aesthetics in breast reconstruction: modified mastectomy incision and immediate autologous tissue reconstruction.  

PubMed

A common detraction from the aesthetic results of breast reconstruction is the presence of a transverse mastectomy scar and the patch-like effect of the paler abdominal skin contrasting with the thoracic skin. The technique described involves a modified mastectomy approach in which the breast parenchyma and nipple are first mobilized through a periareolar incision and then removed, along with the axillary lymph nodes, through an axillary counter-incision. A de-epithelialized transverse rectus abdominis musculocutaneous flap is then used to fill the empty "skin brassiere," effectively replacing the glandular defect, and a small patch of skin is exteriorized to match the areolar defect. Excellent symmetry can be attained usually without having to manipulate the opposite breast. After nipple-areolar reconstruction, the breast looks quite normal without the usual stigmas of mastectomy. In 21 breast reconstructions performed since 1991, there has been no incidence of skin flap necrosis or local recurrence. PMID:7598377

Bensimon, R H; Bergmeyer, J M

1995-03-01

174

Risk-reducing mastectomy.  

PubMed

Breast cancer is a malignant proliferation of epithelial cells lining the ducts or lobules of the breast. Excluding skin cancer, breast cancer is the most common cancer in women. Only lung cancer accounts for more cancer deaths in women. Breast cancer may exist for a long period either as an invasive or noninvasive disease, but not as a nonmetastatic disease. Consequently, timely diagnosis and appropriate management are lifesaving. Approximately 10% of human breast cancers are linked to germline mutations, such BRCA1 and BRCA2. Correct staging of breast cancer patients is critical. It permits an accurate diagnosis, as well as in many cases, therapeutic decisions based largely on the TNM classification. Staging provides the most important prognostic variable. Second opinions of the staging of breast cancer by pathologic examination of the tissue is recommended. There are some variables in which the association with disease-free survival and overall survival seem clear and include estrogen and progesterone receptor cells, S-phase analysis using flow cytometry, histologic classification, molecular changes in the tumor as well as neovasculature semi-quantitative scoring systems. There are four objectives to risk-reducing mastectomy. First, risk-reducing mastectomy should reduce the incidence of breast cancer in high-risk women, for example, BRCA1 or BRCA2 carriers. It should reduce mortality from breast cancer in high-risk women. Moreover, it should have psychological benefits in relieving anxiety about developing breast cancer. Finally, there must be a balance in the reduction in risk against cosmetic outcome, with subsequent quality of life issues. Women should be offered risk reduction mastectomy only on the basis of a strict selection and management plan, like that used in Manchester protocol. This protocol involves a minimum of two sessions with a geneticist/oncologist, a session with a psychiatrist and two sessions with a plastic and reconstructive surgeon with the support of a breast care nurse. The surgical technique should aim at removing substantially all at-risk breast tissue. However, there is an obvious balance between reduction of cancer risk and cosmetic outcome. The surgical technique involves several operations to include the risk-reducing mastectomy as well as breast reconstructive procedures. Skin-sparing mastectomy represents a new surgical approach that allows a mastectomy, whereas preserving the natural skin envelope of the breast. Breast reconstruction will involve several operations, especially if the nipple areola complex is resected and is subsequently reconstructed. The contraindications to risk-reducing mastectomy include the following. The status of the family history or Munchausen's syndrome has not been confirmed. The risk-reducing mastectomy is not the women's own choice. The patient has a current psychiatric disorder including clinical depression, cancer phobia or body dysmorphic syndrome. If the co-morbidity outweighs the clinical benefits, surgery should not be undertaken. Finally, the patient must not have unrealistic expectations of the benefits of surgery. She must understand the subsequent risk-reducing mastectomy may significantly reduce, but not eliminate the risk of subsequent breast cancer. PMID:17073572

Edlich, Richard F; Winters, Kathryne L; Faulkner, Brent C; Lin, Kant Y

2006-01-01

175

Individual and Marital Adjustment in Spouse Pairs Subsequent to Mastectomy.  

ERIC Educational Resources Information Center

Explored effects of mastectomy for breast cancer on individual and marital adjustment among 20 spouse pairs in which wife had single mastectomy. Results indicated that both husbands and wives had adapted to mastectomy and were functioning well as individuals. Measures of marital adjustment, however, indicated serious problems with extremes of…

Carter, Ross E.; Carter, Charlene A.

1993-01-01

176

Endoscopic Breast Surgery in Treating Patients With Breast Cancer  

ClinicalTrials.gov

Male Breast Cancer; Recurrent Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer

2014-02-05

177

From Radical Mastectomy to Breast-Conserving Therapy and Oncoplastic Breast Surgery: A Narrative Review Comparing Oncological Result, Cosmetic Outcome, Quality of Life, and Health Economy  

PubMed Central

Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view.

Kaviani, Ahmad; Sodagari, Nassim; Sheikhbahaei, Sara; Eslami, Vahid; Hafezi-Nejad, Nima; Safavi, Amin; Noparast, Maryam; Fitoussi, Alfred

2013-01-01

178

Influences on decision for mastectomy in patients eligible for breast conserving surgery.  

PubMed

Increasing emphasis is being placed on low mastectomy rates. Our objective was to investigate factors influencing rates of mastectomy and breast conserving surgery. A group of 171 patients (27%) who could have had breast conserving surgery (BCS) but chose mastectomy was identified as well as all patients who underwent BCS over a 6 year period. A questionnaire asking patient's attitudes to factors which could influence their choice of operation was compiled and sent to this study group. Results showed surgical advice to be the most important factor, with significantly more influence in BCS patients. No significant difference was found in distance to treatment between the groups. Shorter duration radiotherapy would have made 47% of mastectomy patients more likely to accept BCS. BCS rates are a poor measure of quality of patient care. More emphasis should be put on choices offered to patients rather than overall uptake of a specific choice. PMID:24456967

Rippy, E E; Ainsworth, R; Sathananthan, D; Kollias, J; Bochner, M; Whitfield, R

2014-06-01

179

Skin-sparing mastectomy and immediate tissue expander breast reconstruction in patients with macromastia using the passot breast reduction pattern.  

PubMed

Skin-sparing mastectomy (SSM) with immediate tissue expander reconstruction poses a challenge in the patient with macromastia or excessive ptosis. Skin reduction via the Wise pattern has been described but is associated with high rates of skin necrosis. The study group consisted of 43 women with grade 2 or 3 ptosis who underwent SSM and immediate reconstruction with tissue expanders, using the Passot (horizontal) skin reduction pattern. Age ranged from 31 to 67 years (mean, 51 years). The endpoints measured were time to final expansion, mastectomy skin flap necrosis, infectious complications, and total complications. Thirty reconstructions were bilateral and 13 were unilateral (73 breasts total). Follow-up ranged from 6 to 55 months (mean, 20). Common comorbid conditions included hypertension (n = 16), obesity (n = 22), and smoking (n = 9). The mean body mass index was 30.6 (range, 19.4-58.6). Twenty-one patients underwent chemotherapy; 12 received radiation. The mean initial fill was 196 mL (range, 0-420 mL), and the mean time to final expansion was 84 days (range, 28-225 days). Five patients did not complete the reconstruction, 2 because of cancer recurrence and 3 because of infection. There were 3 cases of mastectomy flap necrosis occurring after tissue expander placement (7%). There were 7 infectious complications (16%). The use of a horizontal breast reduction pattern at the time of expander placement produces consistently good esthetic outcomes and a low rate of skin necrosis, and it should be considered as an option in patients with macromastia or ptosis undergoing SSM and immediate reconstruction. PMID:24835873

Rinker, Brian; Thornton, Brian P

2014-06-01

180

Long term outcomes reporting the safety of breast conserving therapy compared to mastectomy: 20-year results of EORTC 10801  

PubMed Central

Large multicenter clinical trials have demonstrated the safety of breast conserving surgery and radiation (BCT) compared to modified radical mastectomy (MRM). At 20 years follow-up, the European Organization of Research and Treatment of Cancer (EORTC) 10801 trial reports the outcomes of distant metastasis (DM) and overall survival (OS) for stage 1 and 2 breast cancers treated from 1980-1986. Even though BCT had a higher 10 years local-regional recurrence (LRR) at 20% compared to MRM (12%), no significant difference was identified in long term OS (44% in the BCT group and 39% in the MRM group) or time to DM. Factors associated with increased LRR were dependent on biologic characteristics including larger tumor size, lymph node metastasis, and receptor subtype. BCT should be offered in appropriate patients when complete resection can be achieved. Continued research evaluating the heterogeneity of breast cancer subtypes will help further guide local-regional therapy for continued improvement in LRR, DM, and OS.

Black, Dalliah M.; Hunt, Kelly K.

2013-01-01

181

Breast Cancer in Men  

MedlinePLUS

... surgery removes the entire breast. Lumpectomy (also called breast conserving surgery) is rarely used because of the small size ... the fact sheets on Breast Cancer Detection and Breast Cancer Surgery. Resources While breast cancer is rare among men, ...

182

Modified radical mastectomy with immediate reconstruction for carcinoma of the breast.  

PubMed Central

Fifty patients undergoing immediate reconstruction of the breast following modified radical mastectomy for carcinoma were characterized by their clinical findings and the pathologic features of their tumors. Evidence of nipple--areolar involvement by tumor was noted in five patients. This high incidence mitigates against nipple--areolar transplantation. In ten patients the breast contained multifocal tumor or intraductal carcinoma away from the primary tumor, thus emphasizing the importance of careful evaluation of the total tissue specimens. Four patients have had recurrence of tumor. The detection of the recurrence was not hindered by the presence of the prosthesis. In these four patients immediate reconstruction of the breast did not appear to adversely affect the natural history of the breast cancer. We suggest that when appropriate and thorough surgical extirpation followed by reconstruction is undertaken as a team effort among the general and plastic surgeons, pathologist and clinical psychologist, the optimal clinical and cosmetic results may be achieved. However, conclusive statements regarding the long-term implications of immediate reconstruction awaits additional follow-up. Images Fig. 2a and b. Fig. 2c and d. Fig. 3a and b. Fig. 3c. Fig. 3d and e.

Georgiade, G S; Georgiade, N G; McCarty, K S; Ferguson, B J; Seigler, H F

1981-01-01

183

Is Mastectomy Superior to Breast-Conserving Treatment for Young Women?  

SciTech Connect

Purpose: To examine whether modified radical mastectomy (MRM) improves outcomes compared with breast-conserving treatment (BCT) in young women. Methods and Materials: Women aged 20-49 years, diagnosed with early breast cancer between 1989 and 1998, were identified. Management with BCT or MRM was compared for local (L), locoregional (LR), and distant relapse-free survival (DRFS) and breast cancer-specific survival (BCSS) by age group (20-39 years, 40-49 years). The analysis was repeated for patients considered 'ideal' candidates for BCT: tumor size {<=}2 cm, pathologically negative axillary nodes, negative margins, and no reported ductal carcinoma in situ. Results: A total of 1,597 women received BCT, and 801 had MRM. After a median follow-up of 9.0 years, the outcomes (L, LR, BCSS) were worse for the younger age group; however, the outcomes were not statistically different by type of local treatment. For women aged 20-39 years considered 'ideal' for BCT, those treated with BCT had slightly lower LRFS compared with those treated with MRM (p = 0.3), but DRFS and BCSS were similar. Conclusions: A difference in LRFS at 10 years potentially favored MRM among women aged 20-39 years considered 'ideal' BCT candidates but was not statistically significant and did not translate into a noticeable difference in DRFS or BCSS. Our data suggest that young age alone is not a contraindication to BCT.

Coulombe, Genevieve [Radiation Therapy Program, British Columbia Cancer Agency, Vancouver, BC (Canada); Tyldesley, Scott [Radiation Therapy Program, British Columbia Cancer Agency, Vancouver, BC (Canada) and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC (Canada) and University of British Columbia, Vancouver, BC (Canada)]. E-mail: styldesl@bccancer.bc.ca; Speers, Caroline B.A. [Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC (Canada); Paltiel, Chuck M.Sc. [Population and Preventive Oncology Program, British Columbia Cancer Agency (BCCA), Vancouver, BC (Canada); Aquino-Parsons, Christina [Radiation Therapy Program, British Columbia Cancer Agency, Vancouver, BC (Canada); University of British Columbia, Vancouver, BC (Canada); Bernstein, Vanessa [Systemic Therapy Program, BCCA, Vancouver Island Centre, Victoria, BC (Canada); University of British Columbia, Vancouver, BC (Canada); Truong, Pauline T. [Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC (Canada); Radiation Therapy Program, BCCA, Vancouver Island Centre, Victoria, BC (Canada); University of British Columbia, Vancouver, BC (Canada); Keyes, Mira [Radiation Therapy Program, British Columbia Cancer Agency, Vancouver, BC (Canada); University of British Columbia, Vancouver, BC (Canada); Olivotto, Ivo A. [Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC (Canada); Radiation Therapy Program, BCCA, Vancouver Island Centre, Victoria, BC (Canada); University of British Columbia, Vancouver, BC (Canada)

2007-04-01

184

Seroma formation after surgery for breast cancer  

PubMed Central

Background Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation. Patients and methods A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy (MRM) or breast preservation (BP) was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios. Results A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years (SD ± 11.9). Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy (OR = 2.83, 95% CI 1.01–7.90, P = 0.04). No other factor studied was found to significantly effect the seroma formation after breast cancer surgery. Conclusion The findings suggest that the type of surgery is a predicting factor for seroma formation in breast cancer patients.

Hashemi, Esmat; Kaviani, Ahmad; Najafi, Masoume; Ebrahimi, Mandana; Hooshmand, Homeira; Montazeri, Ali

2004-01-01

185

Surgery Choices for Women with DCIS or Breast Cancer  

Cancer.gov

For women diagnosed with DCIS or breast cancer that can be removed with surgery. This guide explains types of breast surgery, such as breast-sparing surgery and mastectomy, and helps women decide which surgery is the best choice for them.

186

Surgery Choices for Women With DCIS or Breast Cancer  

Cancer.gov

For women diagnosed with DCIS or breast cancer that can be removed with surgery. This guide explains types of breast surgery, such as breast-sparing surgery and mastectomy, and helps women decide which surgery is the best choice for them.

187

Quality of life of breast cancer patients and types of surgery for breast cancer — Current status and unresolved issues —  

Microsoft Academic Search

Since standard radical mastectomy was established by Halsted for breast cancer, surgical procedures for breast cancer have\\u000a been changed according to the results of randomized controlled trials. Breast-conserving treatment is now regarded as a standard\\u000a local treatment for early breast cancer. More recently, sentinel node biopsy is becoming popular as an alternative procedure\\u000a to axillary node dissection for nodal staging.

Shozo Ohsumi; Kojiro Shimozumai; Katsumasa Kuroi; Michikazu Ono; Hirohisa Imai

2007-01-01

188

[Precursors of breast cancer].  

PubMed

It has become apparent that estrogen receptor (ER) -?positive and -?negative breast lesions are completely distinct diseases. Precursors of low-grade breast cancer are low-grade premalignant lesions, usually ER and progesterone receptor (PR) positive and HER2 negative. On the other hand, precursors of high-grade breast cancer are high-grade premalignant lesions, usually ER and PR negative and HER2 positive. Lobular neoplasia (LN) and ductal carcinoma in situ (DCIS) are important from the clinical point of view. LN increases the risk of bilateral breast cancer. This is why the recommendation for the treatment of LN is very different -? from just following?up up to bilateral mastectomy. The complete surgical excision of the lesion with negative margins is the usual treatment of DCIS. Several big randomized clinical trials showed the benefit of adjuvant radiotherapy (RT). Some of them suppose that there is a group of patients who do not need adjuvant treatment. The benefit of adjuvant tamoxifen is clear only for patients with ER positive disease. The UK/?ANZ study showed the benefit of tamoxifen only in patients without RT. PMID:24325156

Petráková, K

2013-01-01

189

Outcomes following local therapy for early-stage breast cancer in non-trial populations  

Microsoft Academic Search

Recent studies suggest trends toward more mastectomies for primary breast cancer treatment. We assessed survival after mastectomy\\u000a and breast-conserving surgery (BCS) with radiation for early-stage breast cancer among non-selected populations of women and\\u000a among women similar to those in clinical trials. Using population-based data from Surveillance Epidemiology, and End Results\\u000a cancer registries linked with Medicare administrative data from 1992 to

Nancy L. KeatingMary; Mary Beth Landrum; John M. Brooks; Elizabeth A. Chrischilles; Eric P. Winer; Kara Wright; Rita Volya

2011-01-01

190

Comparison of Treatment Outcome Between Breast-Conservation Surgery With Radiation and Total Mastectomy Without Radiation in Patients With One to Three Positive Axillary Lymph Nodes  

Microsoft Academic Search

Purpose: To test the difference in treatment outcome between breast-conservation surgery with radiation and total mastectomy without radiation, to evaluate the benefits of adjuvant radiotherapy in patients with one to three positive axillary lymph nodes. Methods and Materials: Using the Severance Hospital Breast Cancer Registry, we divided the study population of T1, T2 and one to three axillary node-positive patients

Hyung Seok Park; Yong Bae Kim; Chang Ok Suh; Byeong-Woo Park

2011-01-01

191

Stewart-Treves syndrome after treatment for breast cancer  

Microsoft Academic Search

This study reviews 3 cases of angiosarcoma of the upper extremity after mastectomy and radiotherapy for breast cancer (Stewart-Treves syndrome). Angiosarcoma was diagnosed an average 14 years (from 6.5 to 26 years) after treatment for breast cancer. Presenting signs included a red raised lesion, a palpable mass, a blister appearance (in one case). Two of our three patients underwent surgical

Y. M. Kirova; F. Feuilhade; E. Calitchi; Y. Otmezguine; J. P. Le Bourgeois

1999-01-01

192

Electrochemotherapy of chest wall breast cancer recurrence  

Microsoft Academic Search

Chest wall breast cancer recurrence after mastectomy is a disease difficult to treat. Its incidence varies between 5% and 30% in different subset of patients. When possible, radical surgical therapy represents the main treatment approach, however when the disease progresses and\\/or treatments are not successful, ulceration, bleeding, lymphedema and psychological distress of progressive disease significantly decrease the quality of the

Gregor Sersa; Tanja Cufer; Snezna Marija Paulin; Maja Cemazar; Marko Snoj

193

Issues of Regret in Women With Contralateral Prophylactic Mastectomies  

Microsoft Academic Search

Background: Patients with a history of carcinoma of one breast have an estimated risk of 0.5% to 0.75% per year of developing a contralateral breast cancer. This risk prompts many women to consider contralateral prophylactic mastectomy (CPM) as a preventive measure. Virtually nothing is known about patient acceptance following CPM. We have developed a National Prophylactic Mastectomy Registry comprised of

Leslie L. Montgomery; Katherine N. Tran; Melissa C. Heelan; Kimberly J. Van Zee; Mary Jane Massie; David K. Payne; Patrick I. Borgen

1999-01-01

194

Operable Breast Cancer: Neoadjuvant Treatment (Methodology)  

Microsoft Academic Search

Primary operable breast cancer has been treated by neoadjuvant systemic therapy (NST) to make breast conservation possible\\u000a in some patients with operable disease who otherwise would require a mastectomy. Nowadays, the surgical defect is expected\\u000a to be as limited as possible. Neoadjuvant systemic therapy has become widely accepted as the treatment of choice for patients\\u000a with locally advanced disease, large

Manfred Kaufmann; Sibylle Loibl; Gunter von Minckwitz

195

Breast cancer.  

PubMed

Breast cancer will continue to be a major health problem for women as long as there is a lack of prevention strategies and underuse of early detection programs. The role of the nurse in health promotion must focus on educating women about the ambiguity surrounding risk factors and the importance of participating in early detection practices. PMID:1448358

Ellerhorst-Ryan, J M; Goeldner, J

1992-12-01

196

Partial breast irradiation as second conservative treatment for local breast cancer recurrence  

Microsoft Academic Search

Purpose: Mastectomy is the treatment of reference for local relapse after breast cancer (BC). The aim of this study was to document the feasibility and the results of associating lumpectomy with partial breast irradiation by interstitial brachytherapy (IB) as local treatment for an isolated ipsilateral BC local recurrence (LR). Methods and materials: Between 1975 and 1996 at Marseille and Nice

Jean-Michel. Hannoun-Levi; Gilles Houvenaeghel; Steve Ellis; Eric Teissier; Claude Alzieu; Michel Lallement; Didier Cowen

2004-01-01

197

Breast cancer presenting as an axillary mass.  

PubMed Central

Experience with breast cancer presenting as an axillary mass in 42 patients has been reviewed according to initial clinical findings, treatment and survival. In the absence of an obvious inflammatory lesion, an axillary node may prove to be the first sign of breast cancer. It has been demonstrated that such a node should be biopsied and if positive for adenocarcinoma, a radical mastectomy performed presuming other primary sites have been ruled out. The survival rate after surgery in this group of patients is better than in those who present with a palpable breast mass and have axillary metastases.

Ashikari, R; Rosen, P P; Urban, J A; Senoo, T

1976-01-01

198

Landmark Trials Affecting the Surgical Management of Invasive Breast Cancer  

PubMed Central

SYNOPSIS Significant progress has been made in the surgical management of breast cancer. Historically, women with invasive breast cancer underwent a Halsted radical mastectomy; morbid procedure removing the breast, underlying muscle and regional lymph nodes. In contemporary practice, the majority of women diagnosed with early stage invasive breast cancer can now be managed with breast conserving therapy to include a segmental mastectomy followed by radiation. Axillary lymph nodes are routinely assessed by sentinel lymph node biopsy. Axillary lymph node dissection is reserved for patients with documented nodal metastasis, however, here too progress has been made as a population of low risk patients has been identified in whom a complete dissection is not required even in the setting of a positive sentinel lymph node. This chapter details the landmark clinical trials that have guided the surgical management of breast cancer.

Black, Dalliah M.

2014-01-01

199

Breast cancer therapies weighed  

SciTech Connect

Even as the National Institutes of Health came under fire last week for giving short shrift to women in the institute's basic and clinical research programs, the report of a recent NIH consensus conference points up the need for more research on how to treat early breast cancer. Although the experts were able to agree on the best surgical treatment for women with early breast cancer, they couldn't resolve the more controversial issue of whether the patients should subsequently receive systemic treatment - chemotherapy or hormone therapy - to prevent recurrence of their disease. The panel reaffirmed that the removal of the lump and nearby lymph nodes, followed by irradiation, is just as effective as a mastectomy. But then came the contentious question: should women with early breast cancer, especially those without detectable lymph node metastases, receive drug therapy to prevent recurrence of the disease Currently, 70% of such cancers are successfully treated with surgery and radiation alone. For this reason, about 2 years ago, the National Cancer Institute issued a clinical alert saying that addition treatment with drugs or hormones is a credible therapeutic option worthy of careful attention for all early stage patients. This pronouncement engendered a storm of criticism. A consensus panel concluded that in cases where tumors are 1 centimeter or less in diameter and no lymph nodes are affected, the likelihood of recurrence is so small that the benefits of adjuvant therapy would be insignificant. But for the patients with larger tumors, the panel concluded that the decision is an individual one that depends on personal preferences and a variety of prognostic factors that can help to indicate whether a woman is at high risk of having a recurrence and should therefore have adjuvant therapy.

Holden, C.

1990-06-29

200

Evolving perspectives in contralateral breast cancer.  

PubMed

Despite extensive publications reviewing contralateral breast cancer (CBC), the role of screening and preventative measures for contralateral tumours is controversial and optimal clinical management remains undefined. This paper addresses the incidence, the predisposing factors, the prevention and the treatment of bilateral breast cancer based on a review of the literature. Risk factors for CBC include young age at primary breast cancer diagnosis, hereditary breast cancer (due to a germline mutation), familial breast cancer (one or more affected relatives), radiation exposure at a young age, lobular carcinoma in situ (LCIS), lobular invasive carcinoma and multicentricity. Retrospective studies suggest that contralateral mammographic surveillance results in the early detection of breast cancer, but no clear survival benefit has been demonstrated. Trials of adjuvant tamoxifen in breast cancer patients have shown a reduction in the incidence of CBC in both pre- and postmenopausal women. In addition, breast cancer patients treated with ovarian ablation and prednisone have significantly reduced CBC versus controls. In patients with primary breast cancer there is no evidence that contralateral breast biopsies or contralateral prophylactic mastectomy reduce mortality. Randomised, prospective trials to determine optimal surveillance, prevention and treatment strategies for the contralateral breast in breast cancer patients have not been conducted. Based on the published literature, contralateral breast surveillance in breast cancer patients reasonably includes breast self-examination, regular physical examinations and annual mammography. In women who have no evidence of distant metastasis at the time of CBC diagnosis, we recommend that the CBC be treated in the same manner as a first breast cancer, taking into account prior local and systemic therapy. PMID:10070301

Dawson, L A; Chow, E; Goss, P E

1998-12-01

201

Talking with the Doctor about Breast Surgery Options  

MedlinePLUS

Surgical options for the treatment of early-stage breast cancer include mastectomy and breast-conserving surgery (also called lumpectomy). Mastectomy ... low, but it is still higher than with mastectomy. It's very important to stress ... due to breast cancer are not higher in women who choose lumpectomy, ...

202

[Role of nipple sparing mastectomy in modern breast surgery].  

PubMed

Recently an increasing number of reports of clinical experience have been published on nipple-sparing mastectomy. By the preservation of uninvolved skin and the nipple areola complex, this surgical technique greatly facilitates immediate reconstruction and optimal aesthetic outcome. However, the procedure raises serious oncologic concerns regarding the risk of an occult or a newly formed primary tumor due to parenchyma left behind in the nipple and the retroareola. Despite the ever increasing popularity of the method, there is still no evidence based confirmation to it. According to data from scientific literature on nipple-sparing mastectomy, there is no straightforward consequence to be drawn on oncologic safety; therefore the procedure is not generally considered to be alternative to standard mastectomy. In the indication of risk reduction, justification of the intervention seems to be well supported, and is expected to foster a greater rate of acceptance of surgical prophylaxis in patients with higher risk diseases. The procedure should be carried out possibly in the framework of clinical trials, in well selected patients with suitable preoperative and postoperative examinations, applying precise techniques and adequate patient education, according to international guidelines. Further long-term results are needed to form a substantive expert opinion. Authors give a detailed description of the surgical techniques, and provide a wide review of the literature, for the first time in Hungarian language. PMID:21788206

Mátrai, Zoltán; Gulyás, Gusztáv; Tóth, László; Sávolt, Akos; Kunos, Csaba; Pesthy, Pál; Bartal, Alexandra; Kásler, Miklós

2011-07-31

203

Breast Cancer Tissue Repository.  

National Technical Information Service (NTIS)

During the preceding year, the Duke Breast Cancer Tissue Repository collected breast cancer tissue from 124 patients undergoing surgery for pflmary breast cancer at Duke Hospital. In 119 patients, tumor tissue was also embedded in gelatin for special appl...

J. D. Inglehart

1995-01-01

204

Breast Cancer Surgery  

MedlinePLUS

... AM to 10 PM EST. FACTS FOR LIFE Breast Cancer Surgery The goal of breast cancer surgery is to remove the tumor from the breast. ... therapy. This helps to increase survival. Types of breast cancer surgery There are two main types of breast cancer ...

205

Integration of Sexual Counseling and Family Therapy with Surgical Treatment of Breast Cancer.  

ERIC Educational Resources Information Center

The impact of breast cancer and mastectomy on women and their families is examined from a family systems orientation. Sexual counseling and family therapy are advocated to reduce the psychological and sexual trauma of mastectomy and enhance family adjustment. Clinical case studies provide support for therapeutic intervention. (Author)

May, Harold J.

1981-01-01

206

Outcomes following local therapy for early-stage breast cancer in non-trial populations  

PubMed Central

Recent studies suggest trends toward more mastectomies for primary breast cancer treatment. We assessed survival after mastectomy and breast-conserving surgery (BCS) with radiation for early-stage breast cancer among non-selected populations of women and among women similar to those in clinical trials. Using population-based data from Surveillance Epidemiology, and End Results cancer registries linked with Medicare administrative data from 1992 to 2005, we conducted propensity score analysis of survival following primary therapy for early-stage breast cancer, including BCS with radiation, BCS without radiation, mastectomy with radiation, and mastectomy without radiation. Adjusted survival was greatest among women who had BCS with radiation (median survival = 10.98 years). Compared with this group, mortality was higher among women who had mastectomy without radiation (median survival 10.04 years, adjusted hazard ratio (HR) = 1.19, 95% confidence interval (CI) = 1.14–1.23), mastectomy with radiation (median survival 10.02 years, HR = 1.20, 95% CI = 1.14–1.27), and BCS without radiation (median survival 7.63 years, HR = 1.81, 95% CI = 1.70–1.92). Among women representative of those eligible for clinical trials (age ?70 years, Charlson comorbidity score = 0/1, and stage 1 tumors), there were no differences in survival for women who underwent BCS with radiation or mastectomy. In conclusion, after careful adjustment for differences in patient, physician, and hospital characteristics, we found better survival for BCS with radiation versus mastectomy among older early-stage breast cancer patients, with no difference in survival for BCS with radiation versus mastectomy among women representative of those in clinical trials. These findings are reassuring in light of recent trends towards more aggressive primary breast cancer therapy.

Keating, Nancy L.; Landrum, Mary Beth; Brooks, John M.; Chrischilles, Elizabeth A.; Winer, Eric P.; Wright, Kara; Volya, Rita

2010-01-01

207

Post-Mastectomy and Phantom Pain: Risk Factors, Natural History, and Impact on Quality of Life.  

National Technical Information Service (NTIS)

Post-mastectomy pain syndrome (PMPS), phantom breast pain, and post- lumpectomy pain are poorly understood chronic pain syndromes that occur following surgical procedures for breast cancer. These pain syndromes are not well studied, but there is appreciab...

R. Dworkin

2000-01-01

208

Sexuality following breast cancer  

Microsoft Academic Search

This article provides sex and marital therapists with detailed, multifaceted descriptions of sexuality after breast cancer based on survey responses from 863 breast cancer survivors. One third of women reported that breast cancer had had a negative impact on her sex life, and most reported negative changes in at least some areas. Nonetheless, breast cancer survivors did not differ from

Beth E. Meyerowitz; Katherine A. Desmond; Julia H. Rowland; Gail E. Wyatt; Patricia A. Ganz

1999-01-01

209

Basic Information about Breast Cancer  

MedlinePLUS

... Helping Rural Counties Access Screening Cancer Home Basic Information About Breast Cancer Cancer is a disease in ... General Information About Male Breast Cancer. Share this information Previous: Breast Cancer Home Next: What Is Breast ...

210

Contralateral prophylactic mastectomy: are we overtreating patients?  

PubMed

Patients with unilateral breast cancer are at increased risk for developing cancer in the contralateral breast. As a result, some patients choose contralateral prophylactic mastectomy (CPM) to prevent cancer in the contralateral breast. Several studies have reported that the CPM rates have markedly increased in recent years in the United States. In this article, we will discuss recent CPM trends, potential reasons patients choose CPM, outcomes after CPM, and alternative strategies for managing the increased risk of contralateral breast cancer among survivors of unilateral breast cancer. In addition, we will try to determine if women undergoing CPM are adequately informed about their decision. PMID:24524287

Burke, Erin E; Portschy, Pamela R; Tuttle, Todd M

2014-05-01

211

Surgical resection for persistent seroma, following modified radical mastectomy  

Microsoft Academic Search

BACKGROUND: Seroma formation following modified radical mastectomy with axillary lymph node dissection for breast cancer is a most common wound complication. In our experience seroma occurs in approximately 50% of patients undergoing mastectomy. Postmastectomy seromas usually vanishes within a few weeks after operation. CASE PRESENTATION: In this report we present the case of a 73 year old woman who had

Marek Stanczyk; Bartlomiej Grala; Tomasz Zwierowicz; Marek Maruszynski

2007-01-01

212

'Imbricated dermal flap': a novel technique for autologous augmentation in immediate breast reconstruction after skin-sparing mastectomy.  

PubMed

This case demonstrates use of a de-epithelialised inferior pole skin flap for a more aesthetic result in immediate autologous breast reconstruction. For women with medium to large ptotic breasts, utilising the excess tissue following skin-sparing mastectomy as an auto-prosthesis, adds volume to the breast and improves inferior pole aesthetics. This 'imbricated dermal flap' offers an excellent addendum to aesthetic breast reconstruction. PMID:24685335

Haydon, N; Southwell-Keely, J; Moisidis, E

2014-06-01

213

Radiation Therapy for Locally Recurrent Breast Cancer  

PubMed Central

Approximately one-third of all breast cancer patients experience local recurrence of their tumor after initial treatment. As initial treatment often employs the use of radiation therapy (RT), the standard of care for local breast cancer recurrence after initial breast conserving therapy has traditionally been surgical intervention with mastectomy. However, recent attempts to preserve the intact breast after recurrence with local excision have revealed a potential need for RT in addition to repeat breast conserving surgery as rates of local failure with resection alone remain high. Additionally, local recurrence following initial mastectomy and chest wall RT can be treated with reirradiation to increase local control. Repeating RT, however, in a previously irradiated area, is a complex treatment strategy, as the clinician must carefully balance maximizing treatment effectiveness while minimizing treatment-related toxicity. As a result, physicians have been hesitant to treat recurrent disease with repeat RT with limited data. Results from the current literature are promising and current clinical trials are underway to explore reirradiation modalities which will provide additional information on treatment-related toxicity and outcomes. This paper will review the current literature on repeat radiation therapy for locally recurrent breast cancer.

Siglin, Joshua; Champ, Colin E.; Vakhnenko, Yelena; Anne, Pramila R.; Simone, Nicole L.

2012-01-01

214

Rates of breast cancer surgery in Canada from 2007/08 to 2009/10: retrospective cohort study  

PubMed Central

Background Surgery is a common and important component of breast cancer treatment. We assessed the rates of breast cancer surgery across Canada from 2007/08 to 2009/10. Methods We used hospital and day surgery data from the Canadian Institute for Health Information to assemble a cohort of women who had undergone breast cancer surgery. We identified the index surgical procedure and subsequent surgical procedures performed within 1 year for each woman included in the analysis. We calculated the crude mastectomy rate for each province, and we calculated the adjusted mastectomy rate for select jurisdictions using a logistic regression model fitted using age, neighbourhood income quintile and travel time. Results In total, 57 840 women underwent breast cancer surgery during the study period. Among women with unilateral invasive breast cancer, the crude mastectomy rate was 39%. Adjusted rates for mastectomy varied widely by province (26%–69%). The rate of re-excision within 1 year for women who had breast-conserving surgery as their index procedure was 23% and varied by province in terms of frequency and type (mastectomy or repeat breast-conserving surgery). Among women who underwent mastectomy for unilateral invasive breast cancer, 6% also underwent contralateral prophylactic mastectomy, and 7% had immediate breast reconstruction following surgery. Of mastectomy procedures, 20% were performed as day surgery; for breast-conserving surgery, 70% were performed as day surgery. Interpretation There is substantial interprovincial variation in surgical care for breast cancer in Canada. Further research is needed to better understand such variation, and continued monitoring should be the focus of quality initiatives.

Wagar, Brandon; Bryant, Heather; Hewitt, Maria; Wai, Elaine; Dabbs, Kelly; McFarlane, Anne; Rahal, Rami

2014-01-01

215

Response to neoadjuvant therapy with cisplatin in BRCA1-positive breast cancer patients  

Microsoft Academic Search

Background Ten patients with breast cancer and a breast cancer susceptibility gene 1 (BRCA1) mutation, who presented with stages I to\\u000a III breast cancer between December 2006 and 2007, were treated with four cycles of neoadjuvant cisplatin, followed by mastectomy\\u000a and conventional chemotherapy. Methods The excised breast tissue and lymph nodes were examined for the presence of residual disease. Results

T. Byrski; T. Huzarski; R. Dent; J. Gronwald; D. Zuziak; C. Cybulski; J. Kladny; B. Gorski; J. Lubinski; S. A. Narod

2009-01-01

216

Breast Cancer in the Older Woman: Therapeutic Controversies.  

PubMed

This article reviews several controversial issues related to treatment of in situ, localized, locally advanced, and metastatic breast cancer in the elderly. In particular we examine the management of both ductal and lobular carcinoma in situ, the benefits of breast preservation, the indications for postoperative irradiation following partial mastectomy, the role of axillary lymphadenectomy in patients with a clinically normal axilla, and the value of systemic treatment for localized breast cancer. In addition, we review the indications for and duration of adjuvant hormonal treatment with tamoxifen and adjuvant cytotoxic chemotherapy, neoadjuvant systemic therapy for locally advanced breast cancer, and approaches to the palliation of metastatic disease. PMID:10886987

Balducci; Greenberg

1994-07-01

217

Fluctuating mastectomy rates across time and geography.  

PubMed

In 2009, 2 single-institution studies from the United States reported increasing mastectomy rates during the last decade. We have recently reported unilateral mastectomy trends from a European database and demonstrated a significant trend of decreasing mastectomy rates from 38.1 % in 2005 to 13.1 % in 2010. A recent study from the SEER registry in the United States confirmed a previously reported decrease in mastectomy rates from 40.1 % in year 2000 to 35.6 % in 2005, but showed a statistically significant increase in mastectomy rates up to 38.4 % in 2008. This report provides evidence that mastectomy trends may be in opposite directions in different geographical areas. The sharpest increase in mastectomy rates across all ages in the recent SEER study occurs right after year 2005, which interestingly corresponds with the time of publication of the meta-analysis by the EBCTCG that highlighted the importance of local control in breast cancer. The coincident timing raises the question of whether this evidence may have indirectly triggered an increase in mastectomy rates in the United States that would partially explain the observed trend, and more importantly, of whether an increase would be justified on this basis. Multiple factors influence the proportion between mastectomy and breast conservation, so it may be unreasonable to think of an optimal cutoff. There is not necessarily a right or wrong direction for mastectomy trends, but aiming to determine explanations for these differences may help provide a clearer insight of the decision-making process involved in the surgical management of breast cancer. PMID:23640480

Garcia-Etienne, Carlos A; Tomatis, Mariano; Heil, Joerg; Danaei, Mahmoud; Rageth, Christoph J; Marotti, Lorenza; Rosselli Del Turco, Marco; Ponti, Antonio

2013-07-01

218

Nation-Wide Korean Breast Cancer Data from 2008 Using the Breast Cancer Registration Program  

PubMed Central

Purpose Since 1996, the Korean Breast Cancer Society has collected nation-wide breast cancer data and analyzed the data using their online registration program biannually. The purpose of this study was to evaluate the characteristics of Korean breast cancer from 2008 and examine chronological based patterns. Methods Data were collected from 38 medical schools (67 hospitals), 20 general hospitals, and 10 private clinics. The data on the total number, gender, and age distribution were collected through a questionnaire as well as other detailed data analyzed via the online registration program. Results In 2008, there were 13,908 patients who were newly diagnosed with breast cancer. The crude incidence rate of female breast cancer was 57.3 among 100,000 and the median age was 49 years. The age distribution had not changed since the initial survey; however the proportion of postmenopausal patients had increased and median age was older than the past. In staging distribution, the proportion of early breast cancer (stage 0, I) was 47.2% with, breast-conserving surgery performed in 58% and mastectomy in 39.5%. Conclusion Compared to past data, the incidence of breast cancer in Korea continues to rise. Furthermore, the proportion of those detected by screening and breast conservation surgery has increased remarkably. To understand the patterns of Korean breast cancer, the nation-wide data should continuously investigated.

Na, Kuk Young; Kim, Ku Sang; Ahn, Sei-Hyun; Lee, Soo-Joong; Park, Heung Kyu; Cho, Young Up

2011-01-01

219

Trends in the use of bilateral mastectomy in England from 2002 to 2011: retrospective analysis of hospital episode statistics  

PubMed Central

Objectives For healthy women at high risk of developing breast cancer, a bilateral mastectomy can reduce future risk. For women who already have unilateral breast cancer, removing the contralateral healthy breast is more difficult to justify. We examined trends in the number of women who had a bilateral mastectomy in England between 2002 and 2011. Design Retrospective cohort study using the Hospital Episode Statistics database. Setting NHS hospital trusts in England. Participants Women aged between 18 and 80?years who had a bilateral mastectomy (or a contralateral mastectomy within 24?months of unilateral mastectomy) with or without a diagnosis of breast cancer. Main outcome measures Number and incidence of women without breast cancer who had a bilateral mastectomy; number and proportion who had a bilateral mastectomy as their first breast cancer operation, and the proportion of those undergoing bilateral mastectomy who had immediate breast reconstruction. Results Among women without breast cancer, the number who had a bilateral mastectomy increased from 71 in 2002 to 255 in 2011 (annual incidence rate ratio 1.16, 95% CI 1.13 to 1.18). In women with breast cancer, the number rose from 529 to 931, an increase from 2% to 3.1% of first operations (OR for annual increase 1.07, 95% CI 1.05 to 1.08). Across both groups, rates of immediate breast reconstruction roughly doubled and reached 90% among women without breast cancer in 2011. Conclusions The number of women who had a bilateral mastectomy nearly doubled over the last decade, and more than tripled among women without breast cancer. This coincided with an increase in the use of immediate breast reconstruction.

Neuburger, Jenny; MacNeill, Fiona; Jeevan, Ranjeet; van der Meulen, Jan H P; Cromwell, David A

2013-01-01

220

Laser optoacoustic imaging of breast cancer in vivo  

Microsoft Academic Search

A clinical prototype of the laser optoacoustic imaging system (LOIS) was employed for breast cancer detection and localization in patients with confirmed breast cancer and scheduled for radical mastectomy. The prototype LOIS used a single optical fiber for delivery of laser pulses, an arc shaped 32-element PVDF transducer array for ultrawide-band piezoelectric detection of optoacoustic signals and a single-channel data

Alexander A. Oraevsky; Alexander A. Karabutov; Sergey V. Solomatin; Elena V. Savateeva; Valeri A. Andreev; Zoran Gatalica; Harbans Singh; R. Declan Fleming

2001-01-01

221

Metastatic breast cancer with constantly low CEA blood levels  

Microsoft Academic Search

The capability of breast cancer to secrete CEA might have biological significance. In 105 patients with metastatic breast cancer serial CEA determinations and clinical follow-up data were available during progression of disease up to death. In this series, 39 patients (37%) had constantly low CEA levels (P=0.001) after mastectomy (39 versus 65 months) and after recurrence (18 versus 28 months)

G. Krieger; H.-E. Wander; M. Kneba; M. Prangen; G. Bandlow; G. A. Nagel

1984-01-01

222

Inflammatory Breast Cancer  

MedlinePLUS

... breast cancer (IBC) is a rare and very aggressive disease in which cancer cells block lymph vessels ... difficult. Also, because inflammatory breast cancer is so aggressive, it can arise between scheduled screening mammograms and ...

223

Breast Cancer Steering Committee  

Cancer.gov

The Breast Cancer Intergroup (TBCI) began its transition to the NCI Breast Cancer Steering Committee (BCSC) at the American Society of Clinical Oncology (ASCO) Breast Cancer Symposium in September 2008 in Washington DC. The TBCI and the National Surgical Adjuvant Breast and Bowel Project (NSABP) came together along with the Correlative Science Committee chair of the TBCI to form the BCSC.

224

Factors Predicting the Axillary Lymph Node Metastasis in Breast Cancer: Is Axillary Node Clearance Indicated in Every Breast Cancer Patient?  

Microsoft Academic Search

The study was carried out to find out predictors of axillary lymph node metastasis in breast cancer and to evaluate its significance\\u000a in selecting the group of patients in whom axillary dissection could be avoided. Ninety-five breast cancer patients who underwent\\u000a mastectomy and axillary dissection were included in the study. Factors like patient’s age, tumor size, histopathological type,\\u000a histological grade

Amrut V. Ashturkar; Gayatri S. Pathak; Sanjay D. Deshmukh; Harshal T. Pandave

225

Meta-analysis of the second collaborative study of adjuvant chemoendocrine therapy for breast cancer (acetbc) in patients with stage ii, estrogen-receptor-positive breast cancer  

Microsoft Academic Search

The second 5-year study of postoperative adjuvant therapy in patients with breast cancer between 1985 and 1988 was performed\\u000a by the Study Group for Adjuvant Chemoendocrine Therapy for Breast Cancer (ACETBC). This report describes the results of a\\u000a meta-analysis of the outcome. A total of 3012 patients with stage II, estrogen-receptor-positive primary breast cancer who\\u000a underwent radical surgery (total mastectomy

Minoru Yoshida; Osahiko Abe; Junichi Uchino; Kaneo Kikuchi; Rikiya Abe; Kohji Enomoto; Takeshi Tominaga; Atsuo Fukami; Keizo Sugimachi; Yasuo Nomura; Takao Hattori; Nobuya Ogawa

1997-01-01

226

Efficient reduction of loco-regional recurrences but no effect on mortality twenty years after postmastectomy radiation in premenopausal women with stage II breast cancer – A randomized trial from the South Sweden Breast Cancer Group  

Microsoft Academic Search

PurposeTo study long term loco-regional and distant recurrence rate and survival after post-mastectomy radiotherapy in combination with oral cyclophosphamide in premenopausal women with stage II breast cancer.

Fredrika Killander; Harald Anderson; Stefan Rydén; Torgil Möller; L. O. Hafström; Per Malmström

2009-01-01

227

Experience with endoscopic axillary lymphadenectomy using needlescopic instruments in patients with breast cancer  

Microsoft Academic Search

Background: The purpose of this study was to evaluate the safety and efficacy of endoscopic axillary lymphadenectomy using needlescopic instruments in patients with breast cancer. Methods: Five patients with breast cancer were treated by partial mastectomy and endoscopic axillary lymphadenectomy. We evaluated the results of the surgical procedure and the postoperative course. Results: In all the patients, endoscopic axillary lymphadenectomy

N. Tagaya; K. Kubota

2002-01-01

228

Sensory changes after treatment of operable breast cancer  

Microsoft Academic Search

A study has been conducted to compare the nature and severity of post-operative sensory changes (sensory loss, paraesthesiae, and pain) among patients with breast cancer treated by either modified radical mastectomy or a conservative procedure (tumourectomy, axillary clearance, iridium implant, and external radiotherapy). There was a similar incidence of post-operative sensory loss in the two groups, reported by 82% of

I. Karydas; I. S. Fentiman; F. Habib; J. L. Hayward

1986-01-01

229

[New tools in adjuvant breast cancer radiotherapy].  

PubMed

During the last century management of breast cancer became increasingly less aggressive for small tumors. Randomized trials demonstrated similar overall survival between mastectomy and breast-conservative surgery (BCS) followed by adjuvant radiation therapy (RT). BCS plus adjuvant RT +/- systemic therapy has become the standard of care for women with early breast cancer. Advances in modern RT technology allowed significant increase in high precision of target definition. Intensity modulated radiation therapy (IMRT) and gating, under investigation in miscellaneous cancers, are also in development for breast-cancer patients. These techniques decrease radiation toxicities and could be useful in the setting of concurrent use of RT and new systemic therapies such as trastuzumab. Another advance in RT is the development of accelerated partial breast irradiation (APBI) as a new concept in the adjuvant setting for early-stage breast cancer. Intraoperative RT (IORT), immediate postoperative RT (interstitial brachytherapy or Mammosite device implantation) and delayed postoperative RT (external beam of photons or protons with 3D conformation) are under investigation. In this review, the role of modern whole breast irradiation is discussed, the rational of partial breast irradiation is argued and the different techniques are detailed. PMID:17449442

Belkacémi, Yazid; Azria, David

2007-04-01

230

Accurate assessment of breast volume: a study comparing the volumetric gold standard (direct water displacement measurement of mastectomy specimen) with a 3D laser scanning technique.  

PubMed

Preoperative assessment of breast volume could contribute significantly to the planning of breast-related procedures. The availability of 3D scanning technology provides us with an innovative method for doing this. We performed this study to compare measurements by this technology with breast volume measurement by water displacement. A total of 30 patients undergoing 39 mastectomies were recruited from our center. The volume of each patient's breast(s) was determined with a preoperative 3D laser scan. The volume of the mastectomy specimen was then measured in the operating theater by water displacement. There was a strong linear association between breast volumes measured using the 2 different methods when using a Pearson correlation (r = 0.95, P < 0.001). The mastectomy mean volume was defined by the equation: mastectomy mean volume = (scan mean volume × 1.03) -70.6. This close correlation validates the Cyberware WBX Scanner as a tool for assessment of breast volume. PMID:21587046

Yip, Jia Miin; Mouratova, Naila; Jeffery, Rebecca M; Veitch, Daisy E; Woodman, Richard J; Dean, Nicola R

2012-02-01

231

Lymphatic mapping in breast cancer: combination technique.  

PubMed

The current standard of care for patients with invasive breast cancer is complete removal of the tumor by mastectomy or lumpectomy, with documentation of negative margins, followed by complete axillary dissection. Our group has examined the efficacy of lymphatic mapping of the sentinel node via the combination technique in 594 patients with breast cancer. A radiocolloid was injected at six intraparenchymal locations surrounding the tumor 2 hours prior to the operation. A 1% solution of isosulfan blue dye was injected into the breast just before prepping the patient. The breast was compressed and massaged for 5 minutes. The surgical and pathological data were prospectively collected. Lymphatic mapping of the sentinel node with a combination of blue dye and radiocolloid enhanced preop localization, operation efficiency, internal mammary node detection, and quantitative measure of detection. The combined technique also significantly reduced the learning curve for achieving proficiency. PMID:11599905

Cox, C E

2001-10-01

232

Surgical treatment of liver metastasis from breast cancer.  

PubMed

We report five patients who underwent laparotomy for liver metastasis from breast cancer without extrahepatic spread, with the intention to perform liver resection. All these patients had been subjected to modified radical mastectomy following systemic chemotherapy and periodical consecutive investigations to detect distant spreading. After laparotomy, patients have been regularly followed. Case 1, right trisegmentectomy in a 53-year-old woman, 36.5 months after the mastectomy. In the 17th postoperative month she continues without relapse. Case 2, hepatic artery ligature in a 41-year-old woman, 15 months after the mastectomy. In the 17th postoperative month she died. Case 3, bisegmentectomy (VI-VII) in a 51-year-old woman, 24 months after the mastectomy. In the 17th postoperative month she died. Case 4, exploratory laparotomy in a 51-year-old woman, 91 months after the mastectomy. In the 31th postoperative month she remains alive. Case 5, segmentectomy (IV) in a 59-year-old woman, 112 months after the mastectomy. In the 33th postoperative month she continues without relapse. As a conclusion, the surgical resection of liver metastasis from breast tumors after chemotherapy must be used in selected cases. PMID:15086209

Marín Gómez, Luis Miguel; Jiménez Romero, Carlos; Pérez Saborido, Baltasar; González-Pinto Arrillaga, Ignacio; Loinaz Segurola, Carmelo; Ortiz Johansson, Carlos; Ferrero Celemin, Esther; Moreno González, Enrique

2004-01-01

233

Hormones and Breast Cancer.  

National Technical Information Service (NTIS)

Grant consists of separate projects; The first aims at assessing the association between lifestyle factors (hormone use) and breast cancer; the second aims at elucidating the role of estrogen metabolism in the development of breast cancer; the third aims ...

G. Ursin

1995-01-01

234

Coping after Mastectomy: Antecedents and Outcomes.  

ERIC Educational Resources Information Center

Psychological well-being following mastectomy is a concern of rehabilitation psychologists as the life expectancy of women treated for breast cancer is increasing. Well-being can be threatened by stress that these women may suffer from the diagnosis of cancer and amputation of a significant body part. A study was conducted to examine the…

Heinemann, Allen W.; And Others

235

A randomized, double-blind, placebo-controlled trial of preemptive analgesia with bupivacaine in patients undergoing mastectomy for carcinoma of the breast  

PubMed Central

Summary Background In this prospective, randomized, placebo-controlled, double-blinded clinical trial we tested the hypothesis that preemptive analgesia with bupivacaine applied in the area of the surgical incision in patients undergoing mastectomy for breast cancer would reduce post-operative acute pain and would reduce the amount of analgesics used during surgery and in the post-operative period. Material/Methods Participants were assigned into 1 of 2 groups – with bupivacaine applied in the area of surgical incision or with placebo. We assessed the intraoperative consumption of fentanyl, the postoperative consumption of morphine delivered using a PCA method, and the subjective pain intensity according to VAS score reported by patients in the early post-operative period. Results Out of 121 consecutive cases qualified for mastectomy, 112 women were allocated randomly to 1 of 2 groups – group A (bupivacaine) and group B (placebo). The final study group comprised 106 breast cancer cases. Between the groups, a statistically significant difference was observed with respect to: lower fentanyl consumption during surgery (p=0.011), lower morphine (delivered by means of a PCA) consumption between the 4–12th postoperative hours (p=0.02) and significantly lower pain intensity assessed according to VAS score at the 4th and 12th hours after surgery (p=0.004 and p=0.02 respectively) for the group A patients. Conclusions Preemptive analgesia application in the form of infiltration of the area of planned surgical incisions with bupivacaine in breast cancer patients undergoing mastectomy decreases post-operative pain sensation, limits the amount of fentanyl used during surgery, and reduces the demand for opiates in the hours soon after surgery.

Zielinski, Jacek; Jaworski, Radoslaw; Smietanska, Irmina; Irga, Ninela; Wujtewicz, Maria; Jaskiewicz, Janusz

2011-01-01

236

Breast Cancer Tissue Repository.  

National Technical Information Service (NTIS)

During the preceding year, the Duke Breast Cancer Tissue Repository collected breast cancer tissue from 126 patients undergoing surgery for a primary breast cancer. This compares to 124 entries in the first year of the repository. As before, nearly all of...

J. D. Iglehart

1996-01-01

237

Breast Cancer -- Male  

MedlinePLUS

... DCIS) is the most common type of in situ breast cancer, but it is uncommon in men. Inflammatory breast ... common sites of distant metastasis are the bones, lungs, and liver. Less commonly, breast cancer may spread to the brain. The cancer can ...

238

Clinicopathological features of gastric metastasis from breast cancer in three cases  

Microsoft Academic Search

The common sites for metastases from breast cancer are lymph nodes, bone, lung, liver, and brain. Gastrointestinal (GI) metastasis\\u000a is rarely found or diagnosed in patients with breast cancer. This report presents three cases of gastric metastasis from breast\\u000a cancer. Case 1 was a 42-year-old female diagnosed with gastric metastasis after mastectomy with axillary lymph node dissection\\u000a for invasive lobular carcinoma

Kenta Koike; Kenji Kitahara; Mayumi Higaki; Masako Urata; Fumio Yamazaki; Hirokazu Noshiro

239

Ipsilateral breast tumor recurrence after breast conservation therapy: Outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation  

SciTech Connect

Purpose: To compare outcomes of salvage mastectomy (SM) and salvage breast-conserving surgery (SBCS) and study the feasibility of SBCS. Methods and Materials: Of 2,038 patients treated with breast-conserving therapy at Yale-New Haven Hospital before 1999, 166 sustained an ipsilateral breast tumor recurrence (IBTR). Outcomes and prognostic factors of patients treated with SM or SBCS were compared. Patients were considered amenable to SBCS if the recurrence was localized on mammogram and physical examination, and had pathologic size <3 cm, confined to the biopsy site, without skin or lymphovascular invasion, and with {<=}3 positive nodes. Results: Of the 146 patients definitively managed at IBTR, surgery was SM (n = 116) or SBCS (n 30). The median length of follow-up after IBTR was 13.8 years. The SM and SBCS cohorts had no significant differences, except at IBTR the SM cohort had a greater tumor size (p = 0.049). Of the SM cohort, 65.5% were considered appropriate for SBCS, and a localized relapse was predicted by estrogen-receptor positive, diploid, and detection of recurrence by mammogram. Multicentric disease correlated with BRCA1/2 mutation, estrogen-receptor negative, lymph node positive at relapse, and detection of recurrence by physical examination. Survival after IBTR was 64.5% at 10 years, with no significant difference between SM (65.7%) and SBCS (58.0%). Only 2 patients in the SBCS cohort subsequently had a second IBTR, and were salvaged with mastectomy. Conclusions: While mastectomy is considered the standard surgical salvage of IBTR, SBCS is feasible and prognostic factors are related to favorable tumor biology and early detection. Patients with BRCA1/2 germline mutations may be less appropriate for SBCS, as multicentric disease was more prevalent. Patients who underwent SBCS had comparable outcomes as those who underwent SM, but remain at continued risk for IBTR. A prospective trial evaluating repeat lumpectomy and partial breast reirradiation is discussed.

Alpert, Tracy E. [Department of Radiation Oncology, Upstate Medical University, Syracuse, NY (United States); Kuerer, Henry M. [Department of Surgical Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, TX (United States); Arthur, Douglas W. [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Lannin, Donald R. [Department of Surgery, Yale University School of Medicine, New Haven, CT (United States); Haffty, Bruce G. [Department of Radiation Oncology, Robert Wood Johnson Medical School-UMDNJ and Cancer Institute of New Jersey, New Brunswick, NJ (United States)]. E-mail: hafftybg@umdnj.edu

2005-11-01

240

The Basic Facts of Korean Breast Cancer in 2011: Results of a Nationwide Survey and Breast Cancer Registry Database  

PubMed Central

Breast cancer is the second most frequent malignancy in Korean women, with a continuously increasing incidence. The Korean Breast Cancer Society has constructed a nationwide breast cancer database through an online registration program. The aim of the present study was to report the fundamental facts on Korean breast cancer in 2011, and to analyze the changing patterns in clinical characteristics and breast cancer management in Korea over the last 10 years. Data on newly diagnosed breast cancer patients, including the total number of cases, age, stage, and type of surgery, for the year 2011 were collected from 84 hospitals and clinics nationwide using a questionnaire survey. Additional data relating to the changing patterns of breast cancer in Korea were collected from the online breast cancer registry database and analyzed. According to nationwide survey data, a total of 16,967 patients were newly diagnosed with breast cancer in 2011. The crude incidence of female breast cancer, including invasive cancer and in situ cancer, was 67 cases per 100,000 women. Analysis of the survey and registry data gave equivalent results in terms of age distribution, stage, and type of surgery. The median age at diagnosis was 50 years, and the proportion of postmenopausal women (51.3%) was higher than that of premenopausal women (48.7%) with breast cancer. The incidence of stage 0 and stage I breast cancer increased continuously over the last 10 years (56.3% in 2011), and breast conserving surgery (65.7%) was performed more frequently than total mastectomy (33.8%). The total number of breast reconstruction surgeries increased approximately 8-fold. We conclude that the clinical characteristics of breast cancer have changed over the past 10 years in Korea, and surgical management has changed accordingly. Analysis of nationwide registry data will contribute to a better understanding of the characteristics of breast cancer in Korea.

Kim, Zisun; Min, Sun Young; Yoon, Chan Seok; Lee, Hun Jae; Lee, Jung Sun; Youn, Hyun Jo; Park, Heung Kyu; Noh, Dong-Young

2014-01-01

241

Tibolone and breast cancer.  

PubMed

Tibolone is a synthetic steroid marketed for the treatment of menopausal symptoms. A cohort study of women with no history of breast cancer showed that tibolone was associated with an increased risk of breast cancer. In women with a history of breast cancer, a placebo-controlled trial showed a higher risk of breast cancer recurrence with tibolone. A placebo-controlled trial of half the standard dose of tibolone showed no increased risk of breast cancer but was interrupted due to an increased risk of stroke. In practice, it is better simply not to use tibolone. PMID:21355381

2010-12-01

242

Progressive Wound Necrosis Associated With Postoperative Thrombocytosis in Mastectomy and Immediate Breast Reconstruction Surgery: Report of a Case  

PubMed Central

A 37-year-old who underwent splenectomy for motor vehicle accident-related injuries was diagnosed with stage IIA carcinoma of left breast 12 years later. She underwent bilateral mastectomy and bilateral immediate unipedicle TRAM flap reconstruction. Her preoperative platelet counts ranged from 332 to 424 K/cmm. Intraoperative fluorescein confirmed mastectomy flap viability. On postoperative day 1, platelet count was 374 K/cmm and all suture lines appeared benign. The patient was discharged 3 days later with healthy appearing tram flaps and slight epidermolysis in the abdominal region. Over the next 2 weeks, both the mastectomy flaps and the abdominal region underwent progressive necrosis as the platelet count increased to 1390 K/cmm. Aspirin therapy was instituted at this time. The TRAM flaps remained completely viable. Eighteen days later, the patient required wound debridement with secondary closure of the breast wounds. Platelet count peaked at 1689 K/cmm 2 days later (postoperative day 38). The wounds deteriorated again and were managed conservatively. Two months after mastectomy, the first area of spontaneous healing was documented (platelet count 758 K/cmm). Ultimately, wounds healed as platelet count reached its preoperative baseline. We hypothesize that an abnormal secondary thrombocytosis at subdermal plexus level caused problematic healing in this patient's mastectomy and abdominal flaps.

Murphy, Robert X.; Holko, Ginger A.; Khoury, Afifi A.; Bleznak, Aaron D.

2009-01-01

243

Ultra-conservative skin-sparing 'keyhole' mastectomy and immediate breast and areola reconstruction.  

PubMed Central

The popularity of skin-sparing mastectomy (SSM) which preserves the breast skin envelope is increasing, but the risks and benefits of this approach are only beginning to emerge. A technique involving ultra-conservative SSM and immediate breast reconstruction (IBR) has been evaluated to establish the surgical and oncological sequelae of skin conservation. Between 1994-1998, 67 consecutive patients underwent 71 SSM and expander-assisted immediate latissimus dorsi (LD) breast reconstructions (follow up, 24.1 months; range, 2-52 months). Breast resection, axillary dissection and reconstruction were performed through a 5-6 cm circular peri-areolar 'keyhole' incision. Patients were discharged 6.5 days (range, 5-15 days) after the 3.9 h (range, 3.0-5.5 h) procedure, and expansion was completed by 4.0 months (range, 0-10 months). Local recurrence occurred in 3% of breasts at risk, skin envelope necrosis occurred in 10%, and contralateral surgery was required to achieve symmetry in 14%. SSM and IBR is an oncologically safe, minimal-scar procedure which can be performed by surgeons trained in 'oncoplastic' techniques. It results in low rates of local recurrence and complication, and reduces the need for contralateral surgery. Images Figure 1 Figure 2

Peyser, P. M.; Abel, J. A.; Straker, V. F.; Hall, V. L.; Rainsbury, R. M.

2000-01-01

244

Breast cancer prevention: a review of current evidence.  

PubMed

The National Cancer Institute has created a breast cancer risk assessment tool that quickly estimates a woman's individualized absolute risk of developing breast cancer. Understanding the magnitude of risk is important because recent data show that breast cancer incidence may be reduced. All women may improve their overall health and thus perhaps minimize breast cancer risk by maintaining a healthy weight, avoiding cigarettes, limiting alcohol consumption, getting regular exercise, and avoiding non-diagnostic ionizing radiation. Nevertheless, no lifestyle modifications have yet been proven to prevent or definitively lower the risk of breast cancer. In addition, women whose personal breast cancer risk is high may consider reducing risk by pharmacologic or surgical means. In such women, a five-year course of tamoxifen reduced the risk of invasive breast cancer by 49%; women with lobular carcinoma in situ or atypical hyperplasia experienced even greater risk reductions. Because of the potential for vascular and endometrial side effects, women who are candidates for a preventive course of tamoxifen must be counseled regarding its relative risks and benefits. Prophylactic mastectomy offers at least a 90% reduction in the risk of breast cancer, but the physical and psychological changes involved in such a procedure make it a difficult choice for many women. Breast cancer risk assessment and appropriate counseling are becoming standard components of breast cancer screening and overall health maintenance. PMID:10901739

Vogel, V G

2000-01-01

245

Breast Cancer Multifocality and Multicentricity and Locoregional Recurrence  

PubMed Central

Background. The impact of multifocal (MF) or multicentric (MC) breast cancer on locoregional (LR) control rates is unknown. Methods. MF was defined as two or more separate invasive tumors in the same quadrant of the breast. MC was defined as two or more separate invasive tumors occupying more than one quadrant of the same breast. Patients were categorized by LR treatment: breast conservation therapy (BCT; n = 256), mastectomy (n = 466), or mastectomy plus postmastectomy radiation therapy (PMRT; n = 184). All patients with MC disease had mastectomy (10 patients treated with BCT for MC disease were excluded). The Kaplan-Meier product limit method was used to calculate 5-year LR control rate. Cox proportional hazards models were used to determine independent associations of multifocality or multicentricity with LR control. Results. A total of 906 patients had either MF disease (n = 673) or MC disease (n = 233). With median follow-up of 52 months, the 5-year LR control rate was 99% for MF, 96% for MC, and 98% for unifocal tumors (p = .44). Subset analysis revealed no difference in LR control regardless of the LR treatment (p = .67 for BCT, p = .37 for mastectomy, p = .29 for mastectomy plus PMRT). There were five in-breast recurrences after BCT in the MF group. MF and MC did not have an independent impact on LR control rate on multivariate analysis. Conclusion. MF and MC disease are not independent risk factors for LR recurrence. Patients with MF and MC breast cancer had rates of LR control similar to those of their unifocal counterparts. These data suggest that BCT is a safe option for patients with MF tumors and that MF or MC disease alone is not an indication for PMRT.

Lynch, Siobhan P.; Lei, Xiudong; Hsu, Limin; Meric-Bernstam, Funda; Buchholz, Thomas A.; Zhang, Hong; Hortobagyi, Gabriel N.; Valero, Vicente

2013-01-01

246

For Women Facing a Breast Biopsy  

MedlinePLUS

... Cancer Caregivers Nearing the End of Life Find Support Programs and Services in Your Area Cancer Information Cancer ... Facts & Statistics News About Cancer Expert Voices Blog Programs & Services Breast Cancer Support TLC Hair Loss & Mastectomy Products Hope Lodge® Lodging ...

247

Oncoplastic breast surgery for centrally located breast cancer: a case series  

PubMed Central

Oncoplastic breast surgery (OBS), which combines the concepts of oncologic and plastic surgery, is becoming more common worldwide. We herein report the results of OBS in Japanese patients with centrally located breast cancer (CLBC) and Paget’s disease. We performed OBS combining partial mastectomy and immediate volume replacement on patients with non-ptotic and/or small breasts, and volume reduction surgery for patients with ptotic breasts, as reported in Western countries. Japanese encounters are described in this report as a case series.

Yoshinaka, Heiji; Shinden, Yoshiaki; Hirata, Munetsugu; Nakajo, Akihiro; Arima, Hideo; Okumura, Hiroshi; Kurahara, Hiroshi; Ishigami, Sumiya; Natsugoe, Shoji

2014-01-01

248

Modulation of Growth and Differentiation in Breast Cancer by Soy Isoflavones.  

National Technical Information Service (NTIS)

The purpose of our project is to investigate the effects of soy isoflavone supplementation on biomarkers of growth and differentiation on the breast tissues of women with breast cancer scheduled for mastectomy or lumpectomy. Seventy-two women will be rand...

O. Kucuk

1999-01-01

249

Models of Understanding: Historical Constructions of Breast Cancer in Medicine and Public Health  

ERIC Educational Resources Information Center

The era of technical and scientific progress ushered in with the twentieth century brought new medical knowledge such as the Halstead 'radical' mastectomy, which promised a cure for breast cancer. These advances in medical knowledge were premised on an epidemiological model of disease, which shaped the treatment and public understanding of breast

Petersen, Jennifer

2004-01-01

250

Current strategies for the prevention of breast cancer  

PubMed Central

Due to the high incidence of breast cancer in the United States, optimal strategies for its prevention are imperative. This entails identification of women who are at an increased risk for breast cancer and an integrative approach that includes effective screening methods as well as nutritional, pharmacologic, and surgical management. Several breast cancer risk-assessment tools, such as the Gail and Claus models, can help clinicians determine the quantitative risk of breast cancer. The role of selective estrogen receptor modulators, such as tamoxifen and raloxifene, for the prevention of breast cancer has been well established. Several other agents, such as aromatase inhibitors, are currently being investigated. The potential adverse effects of these chemopreventive agents, which include an impact on the quality of life, must be discussed with the patient before deciding on this approach. Additionally, breast cancer risk factors have been identified over the years; some of them are modifiable, but others are not. Although there is no conclusive evidence to suggest the protective role of specific dietary components, alcohol consumption and obesity are associated with an increased breast cancer risk; thus lifestyle changes can lead to a lower risk of developing breast cancer. Surgical approaches, including bilateral risk-reduction mastectomy and salpingo-oophorectomy, are usually limited to women with a hereditary predisposition to development of breast cancer. The objective of this review is to summarize the various approaches directed at reducing the incidence of breast cancer.

Advani, Pooja; Moreno-Aspitia, Alvaro

2014-01-01

251

Breast Cancer Trends  

MedlinePLUS

... Burden by County Helping Rural Counties Access Screening Trends for Other Types of Cancer Cervical Colorectal (Colon) Lung Ovarian Prostate Skin Cancer Home Breast Cancer Trends Note: The word "significantly" below refers to statistical ...

252

Hormones and Breast Cancer.  

National Technical Information Service (NTIS)

This grant consisted of 4 separate projects; Projects 1 and 4 aimed at assessing the association between lifestyle factors (exogenous hormone use) and breast cancer. The other two projects aimed at elucidating the role of estrogen metabolism in breast can...

G. Ursin

1997-01-01

253

Identifying Breast Cancer Oncogenes.  

National Technical Information Service (NTIS)

Breast cancer is attributed to genetic alterations, the majority of which are yet to be characterized. Oncogenic alterations that give rise to breast tumors need to be identified to develop targeted treatment options and consequently, improve clinical out...

Y. Shrestha

2009-01-01

254

Esthetic outcome of immediate reconstruction with latissimus dorsi myocutaneous flap after breast-conservative surgery and skin-sparing mastectomy.  

PubMed

With the recent advances in oncologic breast surgery, breast reconstruction with the latissimus dorsi myocutaneous (LDM) flap without an implant has become a good option among other autologous tissue reconstructions available. However, only a few large-scale studies have so far evaluated the critical factors affecting its esthetic outcomes. We retrospectively reviewed 97 consecutive patients who underwent breast reconstruction with the LDM flap between 2001 and 2005 at our institution. The esthetic outcome in comparison with the normal breast was evaluated by means of observer assessment consisting of 7 criteria. A stratified analysis was performed to determine the factors affecting the esthetic outcomes after the breast-conservative surgery and skin-sparing mastectomy. We found that reconstruction of the lower half of the breast and exposure of the skin paddle resulted in poor esthetic outcomes after breast-conservative surgery. Large preoperative brassiere cup size, radiation history, axillary node dissection, and exposure of the skin paddle were the factors which negatively affected the overall outcomes after skin-sparing mastectomy. Age, body mass index, presence of nipple areola-complex defect, or design of skin paddle did not affect the esthetic outcomes. On the basis of these critical factors, we could determine the indications and limitations of breast reconstruction with LDM flap. In some cases, further technical modifications are still warranted, and we believe that these modifications will optimize the use of this flap in breast reconstruction. PMID:18580144

Tomita, Koichi; Yano, Kenji; Matsuda, Ken; Takada, Akiyoshi; Hosokawa, Ko

2008-07-01

255

The modified B-mammoplasty incision: an alternative skin-conserving technique for mastectomy with immediate breast reconstruction.  

PubMed Central

A modification of the B-mammoplasty incision (originally described by Regnault for reduction mammoplasty) is presented for patients undergoing skin-conserving mastectomy and reconstruction. This approach has several advantages; not only does it facilitate good exposure for the oncological surgeon to carry out the mastectomy, but it can easily be extended into the axilla to allow nodal clearance and microvascular access. It creates a suitable pocket into which a flap can be tailored or implant/expander inserted, and further adjustment of the breast size or shape can be undertaken easily. Most importantly, the scar is confined to the infralateral aspect of the breast, leaving the aesthetically important upper and medial breast skin scar free. Images Figure 1 Figure 2 Figure 3 Figure 4

Munnoch, D. A.; Preece, P. E.; Stevenson, J. H.

1998-01-01

256

[Breast cancer in the male. A long-term follow-up study of 55 patients].  

PubMed

Between 1964 and 1988, 55 male patients were treated for breast cancer. Fifty-one patients were treated by radical mastectomy; only four patients underwent a simple mastectomy. Nineteen cases received postoperative radiotherapy, eleven cases chemotherapy, six cases adjuvant hormonal therapy, and one patient was submitted to orchiectomy. The five-year survival rate for tumors with nodal metastases was 37%, as compared with 57% for patients with negative nodes. PMID:2341109

Teleky, B; Fruhwirth, J; Reiner, G; Schmid, C; Reiner, A; Hausberger, H; Spona, J; Steindorfer, P; Jakesz, R

1990-03-30

257

Counterview: Pre-operative breast MRI (magnetic resonance imaging) is not recommended for all patients with newly diagnosed breast cancer.  

PubMed

For the woman with a newly diagnosed early stage breast cancer, the routine use of pre-operative breast MRI (magnetic resonance imaging) is not indicated beyond conventional breast imaging (i.e., mammography with correlation ultrasound as indicated). There is no consistent evidence that a pre-operative breast MRI confers a benefit to the patient by improving clinical outcomes or surgical procedures. In a meta-analysis of studies reporting on the use of pre-operative breast MRI for the patient with an established index cancer, multifocal or multicentric disease was found on breast MRI in 16% of the patients, a rate substantially higher than the rate of local recurrence after breast conserving surgery plus definitive radiation treatment. In the largest retrospective study of patients treated with breast conserving surgery plus radiation, no gain was found for adding a breast MRI to conventional breast imaging. No randomized clinical trial has been designed to evaluate long term clinical outcomes associated with adding a pre-operative breast MRI. Adding pre-operative breast MRI can alter clinical management in ways that are potentially harmful to patients, for example, increased ipsilateral mastectomies, increased contralateral prophylactic mastectomies, increased work-ups, and delay to definitive surgery. In summary, the routine use of pre-operative breast MRI is not warranted for the typical patient with a newly diagnosed early stage breast cancer. PMID:20159457

Solin, Lawrence J

2010-02-01

258

Stages of Male Breast Cancer  

MedlinePLUS

... standard treatment are used to treat men with breast cancer: Surgery Surgery for men with breast cancer is usually ... the chest wall muscle may also be removed. Breast-conserving surgery , an operation to remove the cancer but not ...

259

Triple Negative Breast Cancer  

MedlinePLUS

... to 10 PM EST. FACTS FOR LIFE Triple Negative Breast Cancer Who gets triple negative breast cancer? About 15-20 percent of all ... Women who have BRCA1 mutations What makes triple negative cancer unique? TNBC is less likely to be ...

260

ACTH-Producing Breast Cancer: A Patient Report  

PubMed Central

Ectopic ACTH secretion in the setting of breast cancer is extremely rare but when present affects both the tumor’s behavior and the incidence of complications. The patient, a 58-year-old woman, first presented with a mass in her left breast as well as multiple osseous metastases and a right femur fracture. Laboratory data revealed a hypokalemic alkalosis. Her plasma ACTH level was elevated. She was diagnosed with breast cancer with ectopic ACTH secretion, and underwent a left mastectomy and axillary lymph node dissection. Histological examination demonstrated a poorly differentiated neuroendocrine carcinoma with ectopic ACTH secretion. Although the signs and symptoms of ectopic ACTH secretion from a breast cancer are frequently subtle, the recognition of ectopic ACTH secretion from breast cancer is important for patient management.

Uchida, Naotaka; Ishiguro, Kiyosuke; Suda, Takako; Horie, Yasushi; Nishimura, Motonobu

2010-01-01

261

Consensus Development Conference on the Treatment of Early-Stage Breast Cancer. Held in Bethesda, Maryland on June 18-21, 1990.  

National Technical Information Service (NTIS)

The Journal of the National Cancer Institute Monograph presents research in optimal treatment strategies, including discussion of mastectomy, breast conservation, adjuvant therapy, and the use of prognostic factors. Directions for future research are also...

D. C. Ihde

1992-01-01

262

Breast Cancer in Young Women  

MedlinePLUS

... Cervical Cancer Burden by County Helping Rural Counties Access Screening Cancer Home Breast Cancer in Young Women Cancer is a disease in which cells in the body grow out of control. When cancer starts in the breast, it is ...

263

Surgery to Reduce the Risk of Breast Cancer  

MedlinePLUS

... intact (subcutaneous or nipple-sparing mastectomy). Subcutaneous mastectomies preserve the nipple and allow for more natural-looking ... body image and the loss of normal breast functions. Although most women who choose to have this ...

264

Smallpox Vaccine and Cancer  

MedlinePLUS

... Cancer Caregivers Nearing the End of Life Find Support Programs and Services in Your Area Cancer Information Cancer ... Facts & Statistics News About Cancer Expert Voices Blog Programs & Services Breast Cancer Support TLC Hair Loss & Mastectomy Products Hope Lodge® Lodging ...

265

Talking about Cancer  

MedlinePLUS

... Cancer Caregivers Nearing the End of Life Find Support Programs and Services in Your Area Cancer Information Cancer ... Facts & Statistics News About Cancer Expert Voices Blog Programs & Services Breast Cancer Support TLC Hair Loss & Mastectomy Products Hope Lodge® Lodging ...

266

Breast Cancer and Autism  

PubMed Central

Case Study Amy is a 44-year-old woman with severe autism. She lives with her sister Susan, who is her caregiver and guardian. Amy is ambulatory and able to dress and feed herself. She is a healthy individual with no other significant comorbidities. She walks daily and enjoys her sister’s company. Amy’s life expectancy is greater than 10 years. However, she is difficult to care for medically, as she will not allow a physical examination and strikes out when strangers try to touch her. She is nonverbal and unable to participate in decision-making. INITIAL DIAGNOSIS Amy has a history of breast cancer diagnosed 2 years ago, originally presenting as a stage I lesion (T2N0) that was palpated by her caregiver while bathing. She underwent right simple mastectomy with sentinel lymph node resection. Susan recalls that the mastectomy was a very challenging ordeal, as Amy kept pulling out IV lines, drains, and dressings. Susan felt that Amy withdrew from her after the procedure as she most likely associated Susan with the cause of the pain, making her role as caregiver more difficult. Pathology confirmed an invasive ductal carcinoma, moderately differentiated, 2.4 cm, estrogen/progesterone receptor negative, HER2/neu negative, with negative surgical margins. Two right axillary sentinel lymph nodes were negative for disease. The standard of care for a patient with these tumor features is surgery plus adjuvant chemotherapy (National Comprehensive Cancer Network [NCCN], 2012). According to the Adjuvant Online! database (2012), Amy’s risk for relapse was approximately 40% without adjuvant treatment; her risk for mortality was approximately 29%. After meeting with a medical oncologist, Amy did not receive adjuvant chemotherapy. According to Susan, she was not offered the choice, and the decision was not explained to them. She was simply told that it was not necessary. Aside from pathology, previous records were unavailable for review. Medical assessment of Amy’s level of autism reveals marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction. She exhibits a total lack of development of spoken language, with no attempt to compensate through alternative modes of communication such as gesture. During the visit, she occupies herself with repetitive motor mannerisms. Susan believes that Amy struggles with overstimulation from tactile input. Therefore, she is combative with health-care providers and intolerant of invasive devices. Susan has an intimate understanding of Amy’s ability to communicate her needs and wants through nonverbal changes. RECURRENCE Approximately 2 months ago, Amy began favoring her right arm and appeared to be in pain when participating in various activities. Susan became aware of Amy’s pain issues by noticing that her posture was slightly altered and she was carrying herself differently. Further investigation with a CT scan showed concern for local disease recurrence involving the axillary lymph nodes. No distant metastases were seen. The standard of care for this diagnosis is surgical resection and consideration of radiation therapy, followed by adjuvant chemotherapy (NCCN, 2012). Susan does not want Amy to undergo further surgery and believes radiation would be too difficult to maneuver. The next best option would be a medical approach with chemotherapy as the main modality. DIFFICULT DECISIONS If treatment is pursued, the advanced practitioner will need to perform regular examinations and prescribe and monitor chemotherapy. The delivery of therapy, requiring frequent blood draws and IV access, will be a challenge for the health-care staff. The APN is apprehensive about the ability to accomplish these tasks safely given Amy’s limited capacity to participate. The APN is also concerned with how treatment will affect Amy’s life. The APN may have her own individual conflict of morals to contend with, given the limited understanding of the patient vs. nontreatmen

Radcliff, Lisa

2013-01-01

267

Breast Cancer Chemoprevention  

Microsoft Academic Search

\\u000a A significant amount of evidence has accumulated from randomized clinical trials supporting the use of pharmacologic agents\\u000a for breast cancer risk reduction. All of these trials have capitalized on the known expression of estrogen receptors on many\\u000a breast cancer cells, and the demonstrated efficacy of selective estrogen receptor modulators (SERMs) to treat breast cancer.\\u000a Two SERMs, tamoxifen and raloxifene, have

Mary B. Daly

268

Recurrent granulomatous mastitis mimicking inflammatory breast cancer  

PubMed Central

Granulomatous mastitis (GM) is an uncommon benign breast lesion. Diagnosis is a matter of exclusion from other inflammatory, infectious and granulomatous aetiologies. Here, we presented an atypical GM case, which had clinical and radiologic features overlapping with inflammatory breast cancer (IBC). The disease had multiple recurrences. The patient is a 40-year-old Caucasian woman with a sudden onset of left breast swelling accompanied by diffuse skin redness, especially of the subareolar region and malodorous yellow nipple discharge from the left nipple. The disease progressed on antibiotic treatment and recurred after local resection. A similar lesion developed even after bilateral mastectomy. GM may show clinical/radiologic features suggestive of IBC. Multiple recurrences can be occasionally encountered. GM after recurrence could be much more alarming clinically. Pathology confirmation is the key for accurate diagnosis and a multidisciplinary approach is important to rule out IBC.

Ergin, Ahmet Bahadir; Cristofanilli, Massimo; Daw, Hamed; Tahan, Gulgun; Gong, Yun

2011-01-01

269

Recurrent granulomatous mastitis mimicking inflammatory breast cancer.  

PubMed

Granulomatous mastitis (GM) is an uncommon benign breast lesion. Diagnosis is a matter of exclusion from other inflammatory, infectious and granulomatous aetiologies. Here, we presented an atypical GM case, which had clinical and radiologic features overlapping with inflammatory breast cancer (IBC). The disease had multiple recurrences. The patient is a 40-year-old Caucasian woman with a sudden onset of left breast swelling accompanied by diffuse skin redness, especially of the subareolar region and malodorous yellow nipple discharge from the left nipple. The disease progressed on antibiotic treatment and recurred after local resection. A similar lesion developed even after bilateral mastectomy. GM may show clinical/radiologic features suggestive of IBC. Multiple recurrences can be occasionally encountered. GM after recurrence could be much more alarming clinically. Pathology confirmation is the key for accurate diagnosis and a multidisciplinary approach is important to rule out IBC. PMID:22715267

Ergin, Ahmet Bahadir; Cristofanilli, Massimo; Daw, Hamed; Tahan, Gulgun; Gong, Yun

2011-01-01

270

Phenothiazines and Breast Cancer  

PubMed Central

This study, based in a psychiatric hospital, reviews the incidence of breast cancer in 93 patients who had received phenothiazines prior to developing breast cancer compared with a control group of 28 patients who did not receive phenothiazines. The results indicate no significant difference in the incidence of breast cancer between those patients receiving phenothiazines and those that did not. The retrospective study covered a period of 21 years. The overall incidence of breast cancer in 63,000 female patients was found to be 1.85/1,000 as compared with 2/1,000 in the general population.

Kanhouwa, Suryabala; Gowdy, John M.; Solomon, James D.

1984-01-01

271

Five Methods of Breast Volume Measurement: A Comparative Study of Measurements of Specimen Volume in 30 Mastectomy Cases  

PubMed Central

Background: To compare breast volume measurement techniques in terms of accuracy, convenience, and cost. Methods: Breast volumes of 30 patients who were scheduled to undergo total mastectomy surgery were measured preoperatively by using five different methods (mammography, anatomic [anthropometric], thermoplastic casting, the Archimedes procedure, and the Grossman-Roudner device). Specimen volume after total mastectomy was measured in each patient with the water displacement method (Archimedes). The results were compared statistically with the values obtained by the five different methods. Results: The mean mastectomy specimen volume was 623.5 (range 150–1490) mL. The breast volume values were established to be 615.7 mL (r = 0.997) with the mammographic method, 645.4 mL (r = 0.975) with the anthropometric method, 565.8 mL (r = 0.934) with the Grossman-Roudner device, 583.2 mL (r = 0.989) with the Archimedes procedure, and 544.7 mL (r = 0.94) with the casting technique. Examination of r values revealed that the most accurate method was mammography for all volume ranges, followed by the Archimedes method. Conclusion: The present study demonstrated that the most accurate method of breast volume measurement is mammography, followed by the Archimedes method. However, when patient comfort, ease of application, and cost were taken into consideration, the Grossman-Roudner device and anatomic measurement were relatively less expensive, and easier methods with an acceptable degree of accuracy.

Kayar, Ragip; Civelek, Serdar; Cobanoglu, Murat; Gungor, Osman; Catal, Hidayet; Emiroglu, Mustafa

2011-01-01

272

Breast cancer in China.  

PubMed

The health burden of cancer is increasing in China, with more than 1·6 million people being diagnosed and 1·2 million people dying of the disease each year. As in most other countries, breast cancer is now the most common cancer in Chinese women; cases in China account for 12·2% of all newly diagnosed breast cancers and 9·6% of all deaths from breast cancer worldwide. China's proportional contribution to global rates is increasing rapidly because of the population's rising socioeconomic status and unique reproductive patterns. In this Review we present an overview of present control measures for breast cancer across China, and emphasise epidemiological and socioeconomic diversities and disparities in access to care for various subpopulations. We describe demographic differences between China and high-income countries, and also within geographical and socioeconomic regions of China. These disparities between China and high-income countries include younger age at onset of breast cancer; the unique one-child policy; lower rates of provision and uptake for screening for breast cancer; delays in diagnosis that result in more advanced stage of disease at presentation; inadequate resources; and a lack of awareness about breast cancer in the Chinese population. Finally, we recommend key measures that could contribute to improved health outcomes for patients with breast cancer in China. PMID:24872111

Fan, Lei; Strasser-Weippl, Kathrin; Li, Jun-Jie; St Louis, Jessica; Finkelstein, Dianne M; Yu, Ke-Da; Chen, Wan-Qing; Shao, Zhi-Ming; Goss, Paul E

2014-06-01

273

Breast Cancer  

MedlinePLUS Videos and Cool Tools

... the lump is cancerous, other more specialized pathological tests may be done on the tissue. Your surgeon ... may also ask you to have more radiological tests. Some of the pathological tests can determine how ...

274

Prospective evaluation of immediate reconstruction after mastectomy.  

PubMed Central

OBJECTIVE: The authors prospectively studied the impact of immediate breast reconstruction on patients undergoing mastectomy. SUMMARY BACKGROUND DATA: Despite the advocation of a breast-conserving approach to the treatment of breast cancer, many women continue to medically require or choose mastectomy for the treatment of breast cancer. In recent years, immediate breast reconstruction has become an alternative to either mastectomy alone or to delayed reconstruction. METHODS: A prospective database of 216 patients who underwent mastectomy with immediate reconstruction was established. In this series, 94 procedures involved implants or tissue expanders, and 124 tissue transfers were performed. RESULTS: The overall complication rate was 15.3%; only 9% of patients who underwent autologous tissue transfers required secondary procedures. When implants were performed, the overall rate of prosthetic loss was 8%. The majority of patients (n = 101) underwent transverse rectus abdominis musculocutaneous (TRAM) flaps. Twenty-six of the 38 (17.5%) patients who required transfusion were from this group. Partial flap losses in this group (7%) were correlated to a history of heavy smoking. With a median follow-up of 33.2 months, only two patients had recurred locally. According to patient opinion, autologous tissue transfers resulted in a statistically better cosmetic result. CONCLUSIONS: Immediate reconstruction can be performed safely and with excellent cosmetic results. Images Figure 1. Figure 2. Figure 3.

Eberlein, T J; Crespo, L D; Smith, B L; Hergrueter, C A; Douville, L; Eriksson, E

1993-01-01

275

Less invasive treatment associated with improved survival in early stage breast cancer  

Cancer.gov

Patients with early stage breast cancer who were treated with lumpectomy plus radiation may have a better chance of survival compared with those who underwent mastectomy, according to a study from Duke Medicine and the Duke Cancer Institute. The study, which appears online Jan. 28, 2013, in the journal CANCER, raises new questions as to the comparative effectiveness of breast-conserving therapies such as lumpectomy, where only the tumor and surrounding tissue is surgically removed.

276

Clinical studies on the use of radiation therapy as primary treatment of early breast cancer  

SciTech Connect

The treatment of operable breast cancer by primary radiation therapy instead of mastectomy is undergoing evaluation in the United States and Europe. Retrospective studies of patients treated by primary radiation therapy show that local control and survival rates are comparable to those obtained by mastectomy. Detailed analysis of local failure following primary radiation therapy indicates the importance of excisional biopsy of the primary tumor, moderate doses of radiation to the breast and draining lymph node areas, and the use of a boost to the primary tumor area in maximizing local control. Further, the judicious use of local excision combined with meticulous radiotherapy technique yields highly satisfactory results for the majority of treated patients. Preliminary results from prospective trials also indicate that primary radiation therapy provides both local control and survival rates equivalent to mastectomy. Primary radiation therapy is becoming an increasingly important alternative to mastectomy where surgical and radiotherapeutic expertise are available to optimize both local tumor control and the final cosmetic outcome.

Harris, J.R.; Beadle, G.F.; Hellman, S.

1984-02-01

277

Carboplatin and Eribulin Mesylate in Triple Negative Breast Cancer Patients  

ClinicalTrials.gov

Estrogen Receptor-negative Breast Cancer; HER2-negative Breast Cancer; Male Breast Cancer; Progesterone Receptor-negative Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Triple-negative Breast Cancer

2014-06-03

278

University of Michigan study finds most women who have double mastectomy don't need it  

Cancer.gov

About 70 percent of women who have both breasts removed following a breast cancer diagnosis do so despite a very low risk of facing cancer in the healthy breast, new research from the University of Michigan Comprehensive Cancer Center finds. Recent studies have shown an increase in women with breast cancer choosing this more aggressive surgery, called contralateral prophylactic mastectomy, which raises the question of potential overtreatment among these patients.

279

TCGA Proteomics: Breast Cancer  

Cancer.gov

National Cancer Institute (NCI) Clinical Proteomic Tumor Analysis Consortium (CPTAC) scientists have released a dataset of proteins and phophorylated phosphopeptides identified through deep proteomic and phosphoproteomic analysis of breast tumor samples, previously genomically analyzed by The Cancer Genome Atlas (TCGA).

280

Breast Cancer Prevention  

MedlinePLUS

... decreases the amount of estrogen made by the body and lowers the risk of breast cancer. However, it is very important to have a cancer risk assessment and counseling before making this decision. The sudden ...

281

Breast cancer stem cells  

Microsoft Academic Search

Since the initial discovery of leukemia stem cells nearly a decade ago, a great deal of cancer research has focused on the\\u000a identification of cancer stem cells (CSCs) in many types of solid tumors, including breast cancer. Through analysis of cell\\u000a surface markers and xenotransplant models, a subpopulation of putative human breast cancer stem cells (BCSCs) that is CD24-negative\\/CD44-positive\\u000a (CD24?\\/CD44+)

Kazuharu Kai; Yoshimi Arima; Toshio Kamiya; Hideyuki Saya

2010-01-01

282

Conservative treatment for breast cancer. Complications requiring reconstructive surgery  

SciTech Connect

Women who select conservative treatment for carcinoma of the breast (tumor excision followed by supervoltage radiation therapy) place a premium on breast preservation and aesthetics. When local control fails and they require a mastectomy, or when the aesthetic appearance is unacceptable, they may request breast reconstruction. The goal of this study is to evaluate a series of 10 patients who required reconstructive breast surgery after complications of conservative treatment. Patient classification: I. Breast or chest wall necrosis (3). II. Breast fibrosis and gross asymmetry (3). III. Local recurrence of breast cancer (5). IV. Positive margins after the initial lumpectomy (1). The mean age was 34 years. Radiation dosage average was 5252 rads with two patients receiving iridium-192 implant boosts. The reconstructive management was complex and usually required a major musculocutaneous flap because of the radiation effects.

Bostwick, J. 3d.; Paletta, C.; Hartrampf, C.R.

1986-05-01

283

Symptomatic cardiac metastases of breast cancer 27 years after mastectomy: a case report with literature review - pathophysiology of molecular mechanisms and metastatic pathways, clinical aspects, diagnostic procedures and treatment modalities  

PubMed Central

Metastases to the heart and pericardium are rare but more common than primary cardiac tumours and are generally associated with a rather poor prognosis. Most cases are clinically silent and are undiagnosed in vivo until the autopsy. We present a female patient with a 27-year-old history of an operated primary breast cancer who was presented with dyspnoea, paroxysmal nocturnal dyspnoea and orthopnoea. The clinical signs and symptoms aroused suspicion of congestive heart failure. However, the cardiac metastases were detected during a routine cardiologic evaluation and confirmed with computed tomography imaging. Additionally, this paper outlines the pathophysiology of molecular and clinical mechanisms involved in the metastatic spreading, clinical presentation, diagnostic procedures and treatment of heart metastases. The present case demonstrates that a complete surgical resection and systemic chemotherapy may result in a favourable outcome for many years. However, a lifelong medical follow-up, with the purpose of a detection of metastases, is highly recommended. We strongly call the attention of clinicians to the fact that during the follow-up of all cancer patients, such heart failure may be a harbinger of the secondary heart involvement.

2013-01-01

284

Male breast cancer  

Microsoft Academic Search

Male breast cancer (MaleBC) is a rare disease, accounting for <1% of all male tumors. During the last few years, there has been an increase in the incidence of this disease, along with the increase in female breast cancer (FBC). Little is known about the etiology of MaleBC: hormonal, environmental and genetic factors have been reported to be involved in

Laura Ottini; Domenico Palli; Sergio Rizzo; Mario Federico; Viviana Bazan; Antonio Russo

2010-01-01

285

Phytoestrogens after breast cancer  

Microsoft Academic Search

The current extension of the indications for adjuvant chemotherapy, which predisposes to early menopause, and the media coverage of the benefits of hormone replacement therapy (HRT) have led patients with a history of breast cancer to seek treatments for estrogen deprivation. In breast cancer survivors, most physicians avoid HRT because of concern regarding the potential promotion of growth of occult

A De la Rochefordiere; K Clough; A Fourquet; H Magdelenat

2001-01-01

286

Synchronous bilateral breast cancer in a male.  

PubMed

Male breast cancer, which represents only 1% of all breast cancers, is occasionally associated with a family history of breast cancer. Sporadic male breast cancers presenting with another primary breast cancer are extremely rare. In this article, we report on a 70-year-old male patient with bilateral multifocal and synchronous breast cancer and without a family history of breast cancer. PMID:24319497

Rubio Hernández, María Caridad; Díaz Prado, Yenia Ivet; Pérez, Suanly Rodríguez; Díaz, Ronald Rodríguez; Aleaga, Zaili Gutiérrez

2013-01-01

287

[Epidemiology of breast cancer].  

PubMed

Each year, 50,000 new cases of breast cancer are diagnosed in France and 11,000 women die from it. After a sharp increase, partly explained by the screening program implementation, the incidence rate has decreased for few years. Since the 2000s, the mortality rate has been declining steadily. Many risk factors for breast cancer are known or suspected. Endogenous hormonal factors (age at menarche, menopause, first pregnancy, lactation, number of children) and exogenous (hormone replacement therapy, contraception...) are known risk factors. The lifestyle (weight, diet, physical activity, night work), the family past history as well as environmental pollution may also play a role in breast cancer development. Even if all these factors have individually only a low impact on the occurrence of breast cancer, their effects are additive. However, many patients who will develop breast cancer do not present currently known risk factors. PMID:24579329

Arveux, Patrick; Bertaut, Aurélie

2013-12-01

288

Infections in People with Cancer  

MedlinePLUS

... Cancer Caregivers Nearing the End of Life Find Support Programs and Services in Your Area Cancer Information Cancer ... Facts & Statistics News About Cancer Expert Voices Blog Programs & Services Breast Cancer Support TLC Hair Loss & Mastectomy Products Hope Lodge® Lodging ...

289

Benefits versus risks in conservation surgery with irradiation for breast cancer  

SciTech Connect

This report analyzes the survival and complications inherent in the conventional treatment of breast cancer, radical mastectomy, and the more conservative procedure, conservation surgery with irradiation. Both procedures have benefits and risks. The benefits as measured by survivorship appear to be approximately the same. The major benefit of conservation surgery with irradiation is that the breast is left intact. The possible complication of irradiation carcinogenesis is addressed, and the literature analyzed. This review indicates that the absolute risk of breast cancer developing in the second breast is not nearly as great as originally thought. It is concluded that if a woman with breast cancer is a candidate for either mastectomy or the conservative procedure, it is the clinician's obligation to objectively present the evidence regarding the benefits and risks of these procedures.

Levitt, S.H.; Mandel, J.

1984-07-01

290

Early-Stage Young Breast Cancer Patients: Impact of Local Treatment on Survival  

SciTech Connect

Purpose: In young women, breast-conserving therapy (BCT), i.e., lumpectomy followed by radiotherapy, has been associated with an increased risk of local recurrence. Still, there is insufficient evidence that BCT impairs survival. The aim of our study was to compare the effect of BCT with mastectomy on overall survival (OS) in young women with early-stage breast cancer. Methods and Materials: From two Dutch regional population-based cancer registries (covering 6.2 million inhabitants) 1,453 women <40 years with pathologically T1N0-1M0 breast cancer were selected. Cox regression survival analysis was used to study the effect of local treatment (BCT vs. mastectomy) stratified for nodal stage on survival and corrected for tumor size, age, period of diagnosis, and use of adjuvant systemic therapy. Results: With a median follow-up of 9.6 years, 10-year OS was 83% after BCT and 78% after mastectomy, respectively (unadjusted hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.09-1.72). In N0-patients, 10-year OS was 84% after BCT and 81% after mastectomy and local treatment was not associated with differences in OS (HR 1.19; 95% CI, 0.89-1.58; p = 0.25). Within the N1-patient group, OS was better after BCT compared with mastectomy, 79% vs. 71% at 10 years (HR 1.91; 95% CI, 1.28-2.84; p = 0.001) and in patients treated with adjuvant hormonal therapy (HR 0.34; 95% CI, 0.18-0.66; p = 0.001). Conclusions: In this large population-based cohort of early-stage young breast cancer patients, 10-year OS was not impaired after BCT compared with mastectomy. Patients with 1 to 3 positive lymph nodes had better prognosis after BCT than after mastectomy.

Bantema-Joppe, Enja J. [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Munck, Linda de [Comprehensive Cancer Center North East, Groningen/Enschede (Netherlands); Visser, Otto [Comprehensive Cancer Center Amsterdam, Amsterdam (Netherlands); Willemse, Pax H.B. [Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Langendijk, Johannes A. [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Siesling, Sabine [Comprehensive Cancer Center North East, Groningen/Enschede (Netherlands); Department of Health Technology and Services Research, University of Twente, Enschede (Netherlands); Maduro, John H., E-mail: j.h.maduro@rt.umcg.nl [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands)

2011-11-15

291

pynk : Breast Cancer Program for Young Women  

PubMed Central

Consider this scenario: A 35-year-old recently married woman is referred to a surgeon because of a growing breast lump. After a core biopsy shows cancer, she undergoes mastectomy for a 6-cm invasive lobular cancer that has spread to 8 axillary nodes. By the time she sees the medical oncologist, she is told that it is too late for a fertility consultation, and she receives a course of chemotherapy. At clinic appointments, she seems depressed and admits that her husband has been less supportive than she had hoped. After tamoxifen is started, treatment-related sexuality problems and the probability of infertility contribute to increasing strain on the couple’s relationship. Their marriage ends two years after the woman’s diagnosis. Six years after her diagnosis, this woman has completed all treatment, is disease-free, and is feeling extremely well physically. However, she is upset about being postmenopausal, and she is having difficulty adopting a child as a single woman with a history of breast cancer. Could this woman and her husband have been offered additional personalized interventions that might have helped them better cope with the breast cancer diagnosis and the effects of treatment? Compared with their older counterparts, young women with breast cancer often have greater and more complex supportive care needs. The present article describes the goals, achievements, and future plans of a specialized interdisciplinary program—the first of its kind in Canada—for women 40 years of age and younger newly diagnosed with breast cancer. The program was created to optimize the complex clinical care and support needs of this population, to promote research specifically targeting issues unique to young women, and to educate the public and health care professionals about early detection of breast cancer in young women and about the special needs of those women after their diagnosis.

Ali, A.; Warner, E.

2013-01-01

292

Was Breast Conserving Surgery Underutilized for Early Stage Breast Cancer? Instrumental Variables Evidence for Stage II Patients from Iowa  

PubMed Central

Objective To estimate the average survival effects of breast conserving surgery plus irradiation relative to mastectomy for marginal stage II breast cancer patients in Iowa from 1989–1994. Data Sources/Data Setting Secondary linked Iowa SEER Cancer Registry—Iowa Hospital Association discharge abstract data for women in Iowa with stage II breast cancer from 1989–1994. Study Design Observational instrumental variables (IV) analysis. Data Collection/Extraction Methods Women with stage II breast cancer from the Iowa SEER Cancer Registry 1989–1994 who received all of their inpatient care in Iowa were linked with their respective hospital discharge abstracts. Principal Findings Breast conserving surgery plus irradiation decreased survival relative to mastectomy for marginal stage II breast cancer patients in Iowa during the early 1990s. In this study marginal patients were those whose surgery choices were affected by differences in area treatment rates and access to radiation facilities. Conclusions If marginal patients are representative of patients whose treatment choices would be affected by changes in treatment rates, an increase in the breast conserving surgery plus irradiation rate for stage II early stage breast cancer patients would have decreased survival in Iowa during the early 1990s. Further research with newer data and broader samples is needed to make more current and specific assessments.

Brooks, John M; Chrischilles, Elizabeth A; Scott, Shane D; Chen-Hardee, Shari S

2003-01-01

293

Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer  

Microsoft Academic Search

Background  After neoadjuvant chemotherapy, women with locally advanced breast cancer (LABC) undergo a modified radical mastectomy or\\u000a lumpectomy with axillary lymph node dissection (ALND) and radiotherapy. Sentinel lymphadenectomy (SL) is accepted for axillary\\u000a evaluation in early breast cancer. We assessed the feasibility and predictive value of SL after neoadjuvant chemotherapy.\\u000a \\u000a \\u000a \\u000a Methods  Eligible women received neoadjuvant therapy for LABC and were scheduled to

Vered Stearns; C. Alexander Ewing; Rebecca Slack; Marie F. Penannen; Daniel F. Hayes; Theodore N. Tsangaris

2002-01-01

294

Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications  

Microsoft Academic Search

The objective is to prospectively determine the factors responsible for reconstruction failure and capsular contracture in\\u000a mastectomized breast cancer patients who underwent immediate two-stage breast reconstruction with a tissue expander and implant,\\u000a followed by radiotherapy. This is a multicenter, prospective, non-randomized study. Between February 1998 and September 2006,\\u000a we prospectively examined 141 consecutive patients, each of which received an implant

Didier CowenE; E. Gross; P. Rouannet; E. Teissier; S. Ellis; M. Resbeut; A. Tallet; V. Vaini Cowen; D. Azria; J. M. Hannoun-Levi

2010-01-01

295

Axillary dissection in breast-conserving surgery for stage i and ii breast cancer: a national cancer data base study of patterns of omission and implications for survival 1 1 No competing interests declared  

Microsoft Academic Search

Background: Breast conservation (partial mastectomy, axillary node dissection or sampling, and radiotherapy) is the current standard of care for eligible patients with Stages I and II breast cancer. Because axillary node dissection (AND) has a low yield, some have argued for its omission. The present study was undertaken to determine factors that correlated with omission of AND, and the impact

Kirby I Bland; Carol E. H Scott-Conner; Herman Menck; David P Winchester

1999-01-01

296

Skin-sparing mastectomy. Oncologic and reconstructive considerations.  

PubMed Central

OBJECTIVE: The authors compared skin-sparing mastectomy and traditional mastectomy both followed by immediate reconstruction in the treatment of breast cancer. SUMMARY BACKGROUND DATA: Skin-sparing mastectomy is used increasingly in the treatment of breast cancer to improve the aesthetic results of immediate reconstruction. The oncologic and reconstructive outcomes of this procedure have never been analyzed closely. METHODS: Institutional experience with 435 consecutive patients who underwent total mastectomy and immediate reconstruction from January 1989 through December 1994 was examined. Mastectomies were stratified into skin-sparing (SSM) and non-skin-sparing (non-SSM) types. RESULTS: Three hundred twenty-seven SSMs and 188 non-SSMs were performed. The mean follow-up was 41.3 months (SSM, 37.5 months, non-SSM, 48.2 months). Local recurrences from invasive cancer occurred after 4.8% of SSMs versus 9.5% of non-SSMs. Sixty-five percent of patients who underwent SSMs had nothing performed on the opposite breast versus 45% in the group of patients who underwent non-SSM (p = 0.0002). Native skin flap necrosis occurred in 10.7% of patients who underwent SSMs versus 11.2% of patients who underwent non-SSMs. CONCLUSIONS: Skin-sparing mastectomy facilitates immediate breast reconstruction by reducing remedial surgery on the opposite breast. Native skin flap necrosis is not increased over that seen with non-SSM. Skin-sparing mastectomies can be used in the treatment of invasive cancer without compromising local control. Images Figure 1. Figure 3. Figure 4. Figure 5.

Carlson, G W; Bostwick, J; Styblo, T M; Moore, B; Bried, J T; Murray, D R; Wood, W C

1997-01-01

297

Triciribine Phosphate, Paclitaxel, Doxorubicin Hydrochloride, and Cyclophosphamide in Treating Patients With Stage IIB-IV Breast Cancer Or Other Cancers  

ClinicalTrials.gov

HER2-negative Breast Cancer; HER2-positive Breast Cancer; Male Breast Cancer; Malignant Neoplasm; Recurrent Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer

2014-07-01

298

How breast cancer presents.  

PubMed Central

A study of 501 new breast cancers in patients seen in a consulting surgical practice revealed that 87% were in patients 45 years of age or older. The patients had found 83% of the cancers. The distributions of size and stage were the same for the tumours found by the patients and those found by the referring physicians. Two thirds of the cancers had an associated visible clinical sign, demonstrating the importance of inspection in the examination of the breast. Dimpling, sometimes apparent only on manipulation of the tumour, was present with 264 of the cancers and was often associated with "minimal" lesions. Mammography was done for 63 of the breast cancers but it missed 27. Of the physician-found cancers 15 were in patients who had already had breast cancer, 4 were in patients presenting with symptomatic metastases and 14 were in women presenting with other disorders. Of the 52 cancers found by periodic examination 3 were locally advanced and 21 had axillary metastases, while among the 28 "early" cancers 12 were in women who were senile, mentally defective or psychotic. Only four of the cancers found by the physicians were in women under age 45; two were rapidly fatal, one had an axillary metastasis, and the fourth was in a woman who had had cancer of the opposite breast. The remaining 284 lesions found by periodic or routine examination in women under age 45 were benign. Thus, periodic or routine examination for unsuspected breast cancer in women under age 45 seems unjustified except in those who have already had breast cancer. Images FIG. 1 FIG. 2

Devitt, J. E.

1983-01-01

299

Conservative treatment of breast cancer: mammography in patient selection and follow-up  

SciTech Connect

Conservative surgery and radiotherapy for breast cancer with favorable prognosis results in a low recurrence rate similar to that after mastectomy but with the added benefit of preserving the breast. The mammographic characteristics of the malignant disease before biopsy and the presence of residual disease on the mammogram after biopsy strongly influence the choice of treatment. After radiotherapy, follow-up mammography can accurately monitor postirradiation changes and the occasional development of recurrent cancer.

Paulus, D.D.

1984-09-01

300

Breast Cancer Patient Protection Act of 2013 (HR 1531; 113th Congress)  

Cancer.gov

In addition, the bill would prohibit insurers from restricting benefits for any hospital length of stay in connection with a lymph node dissection for the treatment of breast cancer to less than 24 hours; and from providing incentives to a physician to reduce the length of inpatient stays following a mastectomy, lumpectomy, or a lymph node dissection for the treatment of breast cancer below certain limits or to limit referrals for secondary consultations.

301

The risk of angiosarcoma following primary breast cancer  

PubMed Central

Lymphangiosarcoma of the upper extremity is a rare and aggressive tumour reported to occur following post-mastectomy lymphoedema (Stewart–Treves syndrome). Haemangiosarcoma, a related rare tumour, has occasionally been reported to occur in the breast following irradiation. We conducted a case-control study using the University of Southern California-Cancer Surveillance Program, the population-based cancer registry for Los Angeles County, to evaluate the relationship between invasive female breast cancer and subsequent upper extremity or chest lymphangiosarcoma and haemangiosarcoma together referred to as angiosarcoma. Cases were females diagnosed between 1972 and 1995 with angiosarcoma of the upper extremity (n = 20) or chest (n = 48) who were 25 years of age or older and residing in Los Angeles County when diagnosed. Other sarcomas at the same anatomic sites were also studied. Controls were females diagnosed with cancers other than sarcoma during the same time period (n = 266 444). Cases and controls were then compared with respect to history of a prior invasive epithelial breast cancer. A history of breast cancer increased the risk of upper extremity angiosarcoma by more than 59-fold (odds ratio [OR] = 59.3, 95% confidence interval [95% CI] = 21.9–152.8). A strong increase in risk after breast cancer was also observed for angiosarcoma of the chest and breast (OR = 11.6, 95% CI = 4.3–26.1) and for other sarcomas of the chest and breast (OR = 3.3, 95% CI = 1.1–1.7). © 1999 Cancer Research Campaign

Cozen, W; Bernstein, L; Wang, F; Press, M F; Mack, T M

1999-01-01

302

When Someone You Know Has Cancer  

MedlinePLUS

... Cancer Caregivers Nearing the End of Life Find Support Programs and Services in Your Area Cancer Information Cancer ... Facts & Statistics News About Cancer Expert Voices Blog Programs & Services Breast Cancer Support TLC Hair Loss & Mastectomy Products Hope Lodge® Lodging ...

303

Talking with Your Doctor about Cancer  

MedlinePLUS

... Cancer Caregivers Nearing the End of Life Find Support Programs and Services in Your Area Cancer Information Cancer ... Facts & Statistics News About Cancer Expert Voices Blog Programs & Services Breast Cancer Support TLC Hair Loss & Mastectomy Products Hope Lodge® Lodging ...

304

PET/CT in Evaluating Response to Chemotherapy in Patients With Breast Cancer  

ClinicalTrials.gov

HER2-positive Breast Cancer; Recurrent Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer

2014-03-04

305

Breast cancer screening  

Microsoft Academic Search

Radiographic imaging of the breast began in the early years of the twentieth century. Continuous advances in film quality, energy sources, targets, grids, and filters have all contributed to superior image resolution. Federal quality standards now regulate screening mammography, and mass screening for breast cancer has become widely accepted in the United States. Wider application of screening has resulted in

Kathleen M. Harris; Victor G. Vogel

1997-01-01

306

Smoking and breast cancer.  

PubMed

The potential role of smoking in breast cancer risk has been the subject of over 100 publications, numerous scientific reviews, and animated debate. Tobacco exposure is a well-established cause of lung cancer, and is thought to account for nearly one third of all cancer deaths. Tobacco smoke contains thousands of chemicals, many of which are known to be mammary carcinogens. Although not initially thought to be a tobacco-related cancer, over the last several decades evidence has been accumulating on the role of both active smoking and secondhand smoking in the etiology of breast cancer. The human health evidence has been systematically evaluated not only by several independent researchers but also by several expert agency panels including those of the U.S. Surgeon General, the International Agency for Research on Cancer, the California Environmental Protection Agency, and a coalition of Canadian health agencies. Although the assessments have varied with time and across reviewers, the most recent weight of the evidence has suggested a potentially casual role for active smoking and breast cancer, particularly for long-term heavy smoking and smoking initiation at an early age. The role of secondhand smoking and breast cancer is less clear, although there has been some suggestion for an increased risk for premenopausal breast cancer. Recent studies evaluating the possible modifying role of polymorphisms in genes involved in the metabolism of tobacco products, particularly NAT2, have contributed another dimension to these assessments, although to date that evidence remains equivocal. PMID:23179580

Reynolds, Peggy

2013-03-01

307

Immediate reconstruction with implants in women with invasive breast cancer does not affect oncological safety in a matched cohort study  

Microsoft Academic Search

Physicians are still concerned about the oncological safety regarding immediate breast reconstruction (IBR) in breast cancer\\u000a patients. This study aimed to evaluate possible differences between local, regional, and distant recurrences between women\\u000a having implant-based reconstruction versus women operated with mastectomy alone. Secondary aims were to evaluate time to oncological\\u000a treatment as well as disease-free and breast-cancer-specific survival. In a retrospective

C. Eriksen; J. Frisell; M. Wickman; E. Lidbrink; K. Krawiec; K. Sandelin

2011-01-01

308

Fertility after breast cancer.  

PubMed

Breast cancer is the most common tumor in childbearing women. In the last decades, considerable improvement in breast cancer-related death has been achieved with adjuvant therapies (chemotherapy, endocrine and targeted therapies, radiotherapy) but at cost of significant long-term sequels, including infertility. Reproductive issues are of great importance to young women, in particular for those who did not complete their families before breast cancer diagnosis: patients should be adequately informed at the time of diagnosis about the risk of infertility and the available methods for fertility preservation. This review will focus on incidence and impact of infertility secondary to breast cancer treatment, the available options for ovarian function preservation, including embryo and oocyte cryopreservation, ovarian tissue cryopreservation, and ovarian suppression with gonadotropin-releasing hormone agonists. We will also discuss the optimal time of subsequent pregnancy, the potential risks for the mother and the fetus, and the impact of therapies on breastfeeding. PMID:23020991

Christinat, Alexandre; Pagani, Olivia

2012-11-01

309

Breast Cancer: Early Detection  

MedlinePLUS

... My Saved Articles » My ACS » Breast Cancer Early Detection Download Printable Version [PDF] » Learn about the factors ... Local Offices Volunteer Employment Become a Supplier Report Fraud or Abuse More ACS Sites Bookstore ACS CAN ...

310

Metastatic Breast Cancer Network  

MedlinePLUS

... Stage IV or advanced breast cancer. Join our email list! View previous email newsletters SAVE the DATE Sept ... MBC Fact A Day with your friends on Facebook Advocacy Kit - Shirley's Call to Action! News Headlines ...

311

Breast Cancer (PDQ): Treatment  

MedlinePLUS

... called lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast ... the tumor is 2 centimeters or smaller. Small clusters of cancer cells (larger than 0.2 millimeter ...

312

Diet and breast cancer  

Microsoft Academic Search

Clarification of the role of diet in breast cancer pathogenesis is important in order to identify modifiable risk factors\\u000a on which to focus prevention efforts. Excess weight and weight gain in adult life are related to higher risk of postmenopausal\\u000a breast cancer, and weight loss after menopause is associated with substantially reduced risk. Even moderate alcohol consumption\\u000a contributes considerably to

Eleni Linos; Michelle D. Holmes; Walter C. Willett

2007-01-01

313

Male Breast Cancer  

Microsoft Academic Search

\\u000a The aim of studying the epidemiology of breast cancer is to identify risk factors that could be eliminated or inhibited. Unfortunately,\\u000a the two major risk factors are gender and increasing age, neither of which can be avoided. Nevertheless, the relative rarity\\u000a of male breast cancer (MBC) has prompted investigations in the hope that the disease in men can give clues

Ian S. Fentiman

314

Laser optoacoustic imaging of breast cancer in vivo  

NASA Astrophysics Data System (ADS)

A clinical prototype of the laser optoacoustic imaging system (LOIS) was employed for breast cancer detection and localization in patients with confirmed breast cancer and scheduled for radical mastectomy. The prototype LOIS used a single optical fiber for delivery of laser pulses, an arc shaped 32-element PVDF transducer array for ultrawide-band piezoelectric detection of optoacoustic signals and a single-channel data acquisition card for signal processing. The resonance ultrasound frequency of the 110 micrometers PVDF film was outside detectable range of ultrasound. Spatial resolution of the transducer array was slightly better than 1mm in radial direction and slightly worse than 1 mm in lateral direction. The system was optimized for contrast and sensitivity. Data acquisition, signal conditioning and image processing were significantly improved and optimized resulting in reduced image frame rate of 2 seconds employing 700 MHz Aphlon processor. The computer code for digital signal processing employed band-pass hyper-Gaussian filtering and denoising. An automatic recognition of the optoacoustic signal detected from the irradiated surface was implemented in order to visualize the breast surface and improve the accuracy of tumor localization. Radial back- projection algorithm was employed adopting combination of integration along spherical wavefronts and integration along planar wavefronts (as in Radon transform) for image reconstruction. The system performance was evaluated initially in breast tissue-like phantoms with embedded blood vessels. Clinical studies in breast cancer patients scheduled for surgical mastectomy were performed and compared with x-ray radiography, ultrasound and pathology reports.

Oraevsky, Alexander A.; Karabutov, Alexander A.; Solomatin, Sergey V.; Savateeva, Elena V.; Andreev, Valeri A.; Gatalica, Zoran; Singh, Harbans; Fleming, R. Declan

2001-06-01

315

Nutrition and breast cancer.  

PubMed

Breast cancer incidence is rising worldwide with an increase in aggressive neoplasias in young women. Suspected factors responsible for the global increase include lifestyle changes, notably diet. Currently accepted risk factors directly linked to diet are greater body weight and alcohol consumption. Weight gain in adulthood is associated with increased risk of breast cancer in post-menopausal women, suggesting that weight gain before and around menopausal age may be determinant for breast cancer development among postmenopausal women. Numerous studies also show an impact of specific diets and nutrients - fatty acids, carbohydrates, vitamins B, D, carotenoids, phytoestrogens, fiber - on breast cancer risk, and evidence supports a mechanistic basis for an influence of specific nutrients. However, these studies are plagued with conflicting results. In this review, a new examination of the relationship between nutrition and breast cancer is proposed in light of recent epidemiological studies. Successful development of breast cancer prevention strategies will require identification of biological markers of dietary exposure, and to coordinate worldwide research to discern the effects of diet. PMID:24215727

Chajès, Véronique; Romieu, Isabelle

2014-01-01

316

Natural history of human breast cancer: Recent data and clinical implications  

Microsoft Academic Search

Summary This study of the natural history of human breast cancer was based on the analysis of a series of 3000 patients treated by radical mastectomy at a single institution (Institut Gustave Roussy) at a time when adjuvant chemotherapy was not prescribed. The follow-up of the patients ranged from 15 to 30 years; for each patient the tumor size, the

Maurice Tubiana; Serge Koscielny

1991-01-01

317

The role of post-operative radiotherapy in the treatment of operable breast cancer  

Microsoft Academic Search

Summary In current practice, the management of early stage breast cancer involves a multidisciplinary cooperation among surgeons, radiation therapists, and medical oncologists. The goals of local treatment in this setting are to secure tumor control and to identify patients who are to be treated with adjuvant systemic therapy. For patients treated by mastectomy, the value of post-operative radiotherapy in primary

Geoffrey F. Beadle; Jay R. Harris

1984-01-01

318

Treatment of Early Breast Cancer: A Report after Ten Years of a Clinical Trial  

Microsoft Academic Search

A controlled clinical trial has been carried out to compare radical mastectomy with wide excision (extended tylectomy) in the treatment of early breast cancer. Only patients aged 50 and over were included and 370 entered the trial during a period of 10 years. Postoperative radiotherapy was given in each case. In patients with clinically involved axillary nodes there was a

Hedley Atkins; J. L. Hayward; D. J. Klugman; A. B. Wayte

1972-01-01

319

Post-operative serum sialyltransferase levels and prognosis in breast cancer  

Microsoft Academic Search

Summary Serum sialyltransferase (SST) activity was measured 10 days after mastectomy in 153 patients with operable breast cancer. Enzyme activity declined with time in storage (1–42 months). After correction for loss of activity in storage, patients with SST activity below the median value had a longer disease-free interval (DFI) than those with SST activity above the median, and this difference

John Stewart; Robert Rubens; Rosemary Millis; John Hayward; Susan Hoare; Richard Bulbrook; David Kessel

1983-01-01

320

Tibolone and breast cancer  

PubMed Central

Tibolone is a relatively new drug for postmenopausal women, which is structurally related to 19?nortestosterone derivatives and exhibits weak oestrogenic, progestogenic and androgenic activities. The effect of tibolone on breast tissue is still obscure. In vitro studies have shown conflicting results regarding the effects of tibolone on breast cells. On the other hand, although epidemiological studies show an increase in the risk of breast cancer among women treated with tibolone, accumulation of data obtained from radiological studies presents promising results. However, the safety of tibolone with regard to breast tissue needs to be investigated further, especially through well?designed, large?scale, randomised?controlled trials.

Erel, C Tamer; Senturk, Levent M; Kaleli, Semih

2006-01-01

321

Axillary metastases from occult breast cancer. Our experience.  

PubMed

We report the case of a 63-year-old woman with occult breast cancer who presented with a hard metastatic nodule in the left axilla. Although histology identified a metastatic carcinoma in the lymph nodes, numerous tests failed to detect the primary tumor. Resected lymph node was positive for both estrogen and progesterone receptors, suggesting the breast as the site of the primary tumor. Left modified radical mastectomy was performed. Pathology revealed an invasive lobular carcinoma (2.5 x 2 mm in size) with extensive lymphatic involvement, which strongly expressed both vascular endothelial growth factor-C (VEGF-C) and VEGF-D. PMID:24576904

Sanguinetti, Alessandro; Polistena, Andrea; D'Ermo, Giuseppe; Lucchini, Roberta; Triola, Roberta; Conti, Claudia; Avenia, Stefano; Cavallaro, Giuseppe; De Toma, Giorgio; Avenia, Nicola

2014-02-01

322

Breast size and breast cancer risk.  

PubMed

The relationship between brassière size, as an indicator of breast size, and breast cancer risk was considered in a case--control study conducted between 1991 and 1994 in six Italian centres. Cases were 2,557 women, below age 75, with histologically confirmed breast cancer, and controls were 2,566 women admitted to hospital for a wide spectrum of acute, non-neoplastic, non-hormone-related diseases. Odds ratio (ORs) of breast cancer and their 95% confidence intervals (CIs) were obtained from multiple logistic regression equations including terms for study centre and age, as well as main breast cancer risk factors. A slight inverse relationship was observed between breast size and the risk of breast cancer, with an OR of 1.37 (95% CI 1.05-1.80) for the smallest brassière size compared with the largest; the increase in risk disappeared after adjustment for main recognized breast cancer risk factors, with an OR of 1.16 (95% CI 0.87-1.54) for brassière size < or = 1 compared with > or = 5. No significant heterogeneity in risk of breast cancer with breast size was found in strata of age at diagnosis, parity, age at first birth, age at menopause, family history of breast cancer, benign breast disease, ever use of oral contraceptives and/or hormone replacement therapy. Thus, this study, based on large number of caucasian women, provides conclusive evidence of a lack of appreciable association between breast size and breast cancer risk in this Italian population. PMID:8972252

Tavani, A; Pregnolato, A; La Vecchia, C; Negri, E; Favero, A; Franceschi, S

1996-10-01

323

[Somatostatin in breast cancer].  

PubMed

In man, somatostatin is a hormone mostly produced by hypothalamus. It plays different parts in hormonal regulation through many specific receptors in human body. It has also two interesting actions such as an anti-secretory activity, mostly on the gastrointestinal system and an antiproliferative action on tumor cells. Many synthetic somatostatin analogues, more stable than the natural one, have been developed and are already used in digestive surgery to treat postoperative digestive fistula. Also, the development of specific polyclonal antibodies allowed the identification of five specific somatostatin receptors and their localization in different cell species. The presence of the five receptors in breast cancer cells has than been demonstrated. The purpose of this literature review is to clarify the potential antitumor effect of somatastatin analogues in breast cancer; its use as a preventive agent on lymphorrhea after breast surgery and its employment in imaging for early breast cancer detection. PMID:21896402

Frati, Albane; Antoine, Martine; Rodenas, Anita; Gligorov, Joseph; Rouzier, Roman; Chéreau, Elisabeth

2011-01-01

324

Preinvasive Breast Cancer  

PubMed Central

Preinvasive breast cancer accounts for approximately one-third of all newly diagnosed breast cancer cases in the United States and constitutes a spectrum of neoplastic lesions with varying degrees of differentiation and clinical behavior. High-throughput genetic, epigenetic, and gene-expression analyses have enhanced our understanding of the relationship of these early neoplastic lesions to normal breast tissue, and they strongly suggest that preinvasive breast cancer develops and evolves along two distinct molecular genetic and biological pathways that correlate with tumor grade. Although unique epigenetic and gene-expression changes are not observed in the tumor epithelial compartment during the transition from preinvasive to invasive disease, distinct molecular alterations are observed in the tumor-stromal and myoepithelial cells. This suggests that the stromal and myoepithelial microenvironment of preinvasive breast cancer actively participates in the transition from preinvasive to invasive disease. An improved understanding of the transition from preinvasive to invasive breast cancer will pave the way for novel preventative and therapeutic strategies.

Sgroi, Dennis C.

2014-01-01

325

Stereotactic Image-Guided Navigation During Breast Reconstruction in Patients With Breast Cancer  

ClinicalTrials.gov

Ductal Breast Carcinoma in Situ; Lobular Breast Carcinoma in Situ; Recurrent Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer

2012-11-14

326

Viruses and Breast Cancer  

PubMed Central

Viruses are the accepted cause of many important cancers including cancers of the cervix and anogenital area, the liver, some lymphomas, head and neck cancers and indirectly human immunodeficiency virus associated cancers. For over 50 years, there have been serious attempts to identify viruses which may have a role in breast cancer. Despite these efforts, the establishment of conclusive evidence for such a role has been elusive. However, the development of extremely sophisticated new experimental techniques has allowed the recent development of evidence that human papilloma virus, Epstein-Barr virus, mouse mammary tumor virus and bovine leukemia virus may each have a role in the causation of human breast cancers. This is potentially good news as effective vaccines are already available to prevent infections from carcinogenic strains of human papilloma virus, which causes cancer of the uterine cervix.

Lawson, James S.; Heng, Benjamin

2010-01-01

327

Aromatase and breast cancer susceptibility  

Microsoft Academic Search

Based on experimental and epidemiological evidence it is hypothesized that estrogen increases breast cancer risk by increasing mitotic activity in breast epithelial cells. Aromatase is crucial to the biosynthesis of estrogens and may therefore play a role in breast cancer development. Supporting data for an etiological role of aromatase in breast tumor biology are several-fold. First, the association between weight

N M Probst-Hensch; S A Ingles; A T Diep; R W Haile; F Z Stanczyk; L N Kolonel; B E Henderson

1999-01-01

328

Photodynamic therapy of breast cancer with photosense  

NASA Astrophysics Data System (ADS)

Photodynamic Therapy (PDT) using photosensitizer Photosense (PS) in dose 0.5 mg per kg of body weight have been provided in 24 patients with breast cancer. In 22 patients with T1-T2N0M0 primary tumor was treated as the preoperative treatment, radical mastectomy has been fulfilled 7-10 days after PDT with subsequent histological examination. 2 patients had recurrencies of breast cancer with lymph node metastases after radiotherapy. Fluorescent diagnostics of tumor, accumulation of PS in tumor, adjacent tissue, skin before and during PDT was fulfilled with spectranalyzer LESA-01. We used semiconductive laser for PDT - ? = 672+2nm, P=1,5 W, interstitial irradiation 2-24 hours after PS injection has been done in light dose 150-200 J/cm3, 1-3 irradiations with interval 24-48 hours and total light dose 400-600 J/cm3 depending mostly of size and fluorescent data. Partial regression of tumor with pathomorphosis of 2-4 degrees has been found in 19 cases. Our experience shows pronounced efficacy of PDT for treating breast cancer as preoperative modality and as palliation in cases of recurrencies.

Vakoulovskaya, Elena G.; Shental, Victor V.; Oumnova, Loubov V.; Vorozhcsov, Georgiu N.

2003-06-01

329

Breast Cancer Screening Rates  

MedlinePLUS

... Regarding Genetic Testing Cancers Diagnosed at Late Stages African American Women and Mass Media Campaign Public Service Announcements Public ... Differences in knowledge of breast cancer screening among African American, Arab American, and Latina ... of survey responses and black-white disparity ...

330

MD Anderson study finds majority of older, early-stage breast cancer patients benefit from radiation after lumpectomy  

Cancer.gov

For the majority of older, early-stage breast cancer patients, radiation therapy following breast conserving surgery may help prevent the need for a later mastectomy, according to research from The University of Texas MD Anderson Cancer Center. The findings, published in the journal Cancer, are contrary to current national treatment guidelines, which recommend that older women with early stage, estrogen-positive disease be treated with lumpectomy followed by estrogen blocker therapy alone -- and forgo radiation therapy post-surgery.

331

Breast Cancer Prevention Clinical Trials  

Cancer.gov

Programs and Projects Breast Cancer Prevention Clinical Trials Ongoing Phase I/II Prevention Trials Funded and Monitored by the Breast and Gynecologic Cancer Research Group (BGCRG) Principal Investigator Funding Mechanism Title of Award

332

Computer Aided Breast Cancer Diagnosis.  

National Technical Information Service (NTIS)

The long range goal of this project is to improve the accuracy and consistency of breast cancer diagnosis by developing a Computer Aided Diagnosis (CAD) system for early prediction of breast cancer from patients' mammographic findings and medical history....

C. E. Floyd

1998-01-01

333

Men Develop Breast Cancer, Too  

MedlinePLUS

... on this page, please enable JavaScript. Men Develop Breast Cancer, Too But little research is done on ... Monday, July 7, 2014 Related MedlinePlus Page Male Breast Cancer MONDAY, July 7, 2014 (HealthDay News) -- While ...

334

Risks of Breast Cancer Screening  

MedlinePLUS

... is available from the NCI Web site . Three tests are used by health care providers to screen for breast cancer: Mammogram Mammography is the most common screening test for breast cancer . A mammogram is an x- ...

335

The utility of hyperthermia for local recurrence of breast cancer  

PubMed Central

Background Hyperthermia has long been used in combination with chemotherapy or radiation therapy for the treatment of superficial malignancies, in part due to its sensitizing capabilities. Patients who suffer from superficial recurrences of breast cancer have poor clinical outcomes. Skin metastases may particularly impair the quality of life due to the physical appearance, odor and bleeding. Case presentation A 66-year-old woman underwent mastectomy and axillary lymph node dissection for breast cancer. Nine years post-operatively, local metastases developed in the left axillary area (measuring 5 cm in diameter). Initially the tumor did not respond to radiation therapy and chemotherapy. Therefore, we added hyperthermia combined with them. Eight weeks later, the tumor became nearly flat and the patient noted improved activity in her daily life. Conclusion Hyperthermia may accelerate the antitumor effects of radiation therapy and chemotherapy. This treatment provides an alternative for unresectable breast cancer skin metastases.

2012-01-01

336

Azacitidine and Entinostat in Treating Patients With Advanced Breast Cancer  

ClinicalTrials.gov

Estrogen Receptor-negative Breast Cancer; Estrogen Receptor-positive Breast Cancer; HER2-negative Breast Cancer; Male Breast Cancer; Progesterone Receptor-negative Breast Cancer; Recurrent Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer; Triple-negative Breast Cancer

2014-03-24

337

Evolving role of skin sparing mastectomy  

PubMed Central

Skin sparing mastectomy (SSM) can facilitate immediate breast reconstruction and is associated with an excellent aesthetic result. The procedure is safe in selected cases; including invasive tumours < 5 cm, multi-centric tumours, ductal carcinoma in situ and for risk-reduction surgery. Inflammatory breast cancers and tumours with extensive involvement of the skin represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy do not preclude SSM, however the aesthetic outcome may be compromised. Preservation of the nipple areola complex is safe for peripherally located node negative tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be considered in these cases. The advent of acellular tissue matrix systems has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetic outcome.

Kasem, Abdul; Mokbel, Kefah

2014-01-01

338

Evolving role of skin sparing mastectomy.  

PubMed

Skin sparing mastectomy (SSM) can facilitate immediate breast reconstruction and is associated with an excellent aesthetic result. The procedure is safe in selected cases; including invasive tumours < 5 cm, multi-centric tumours, ductal carcinoma in situ and for risk-reduction surgery. Inflammatory breast cancers and tumours with extensive involvement of the skin represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy do not preclude SSM, however the aesthetic outcome may be compromised. Preservation of the nipple areola complex is safe for peripherally located node negative tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be considered in these cases. The advent of acellular tissue matrix systems has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetic outcome. PMID:24829848

Kasem, Abdul; Mokbel, Kefah

2014-05-10

339

Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation  

SciTech Connect

In 1971 a randomized trial was begun to compare alternative local and regional treatments of breast cancer, all of which employ breast removal. Life-table estimates were obtained for 1665 women enrolled in the study for a mean of 126 months. There were no significant differences among three groups of patients with clinically negative auxillary nodes, with respect to disease-free survival, distant-disease-free survival, or overall survival (about 57%) at 10 years. The patients were treated by radical mastectomy, total (simple) mastectomy without auxillary dissection but with regional irradiation, or total mastectomy without irradiation plus auxillary dissection only if nodes were subsequently positive. Similarly, no differences, were observed between patients with clinically positive nodes treated by radical mastectomy or by total mastectomy without auxillary dissection but with regional irradiation. Survival at 10 years was about 38% in both groups. Our findings indicate that the location of a breast tumor does not influence the prognosis and that irradiation of internal mammary nodes in patients with inner-quadrant lesions does not improve survival. The data also demonstrate that the results obtained at five years accurately predict the outcome at 10 years. It was concluded that the variations of local and regional treatment used in this study are not important in determining survival of patients with breast cancer. 25 references, 6 figures, 1 table.

Fisher, B.; Redmond, C.; Fisher, E.R.; Bauer, M.; Wolmark, N.; Wickerham, L.; Deutsch, M.; Montague, E.; Margolese, R.; Foster, R.

1985-03-14

340

Adiponectin and breast cancer  

Microsoft Academic Search

Adiponectin, an adipose tissue-derived hormone, has been studied intensively for the past decade because of its anti-inflammatory,\\u000a anti-atherogenic, and anti-diabetic properties. Recent advances suggest that adiponectin also plays an important role in the\\u000a development and progression of various cancers, especially obesity-related cancers. In this review, the authors focus on the\\u000a potential role of adiponectin in breast cancer, an obesity- and

Xiuping Chen; Yitao Wang

341

Environmental Factors in Breast Cancer  

Microsoft Academic Search

The role of diet for the risk of breast cancer is of great interest as a potentially modifiable risk factor. The evidence from prospective observational studies was reviewed and summarized on selected dietary factors, gene-diet interactions, and breast cancer incidence. Dietary factors were considered that, based on their nutritional constituents, are of particular interest in the context of breast cancer:

Karin B. Michels; Anshu P. Mohllajee; Edith Roset-Bahmanyar; Gregory P. Beehler; Kirsten B. Moysich

342

Biology of Breast Cancer Metastasis.  

National Technical Information Service (NTIS)

Breast cancer is the second most common cause of brain metastases, diagnosed in 10 to 15% of breast cancer patients and found at autopsy in 20 to 30%. Relatively little is known about how breast cancer cells metastasize to the brain, and what phenotypes c...

J. E. Price

2002-01-01

343

Breast cancer in young women  

Microsoft Academic Search

ABSTRACT: Although uncommon, breast cancer in young women is worthy of special attention due to the unique and complex issues that are raised. This article reviews specific challenges associated with the care of younger breast cancer patients, which include fertility preservation, management of inherited breast cancer syndromes, maintenance of bone health, secondary prevention, and attention to psychosocial issues.

Courtney A Gabriel; Susan M Domchek

2010-01-01

344

Breast cancer in young women  

PubMed Central

Although uncommon, breast cancer in young women is worthy of special attention due to the unique and complex issues that are raised. This article reviews specific challenges associated with the care of younger breast cancer patients, which include fertility preservation, management of inherited breast cancer syndromes, maintenance of bone health, secondary prevention, and attention to psychosocial issues.

2010-01-01

345

Clinical proteomics in breast cancer  

Microsoft Academic Search

Breast cancer imposes a significant healthcare burden on women worldwide. Early detection is of paramount importance in reducing mortality, yet the diagnosis of breast cancer is hampered by a lack of adequate detection methods. In addition, better breast cancer prognostication may improve selection of patients eligible for adjuvant therapy. Hence, new markers for diagnosis and prognosis are warranted to improve

M. C. W. Gast

2009-01-01

346

Breast Magnetic Resonance Imaging and Its Impact on the Surgical Treatment of Breast Cancer  

PubMed Central

Breast MRI focuses on the detection of multifocality, multicentricity, and bilaterality of newly diagnosed breast cancer. A retrospective study was carried out on 833 patients that were diagnosed and treated for breast cancer between January 2002 and December 2011. Patients were divided into two groups: those that had a presurgery breast MRI and those that did not. The two groups were compared on the basis of the several parameters. The aim of the study was to determine whether the use of MRI in breast cancer screening changes the initial treatment decision. In 18% of the patients, MRI revealed a multifocal or a multicentric unilateral breast cancer, a bilateral tumour, or a larger cancer than initially diagnosed. Most of these patients underwent a second-look breast ultrasound, with or without an additional biopsy. The percentage of mastectomies did not increase as a result of an MRI exam. Neoadjuvant chemotherapy was used more often and the percentage of reoperations decreased when an MRI was performed.

Tsina, Georgia; Simon, Philippe

2014-01-01

347

Targeted intra-operative radiotherapy (Targit): An innovative method of treatment for early breast cancer  

Microsoft Academic Search

Summary Introduction: We believe that conservative treatment of early breast cancer may not require radiotherapy that encompasses the whole breast.We present here the clinico-pathological basis for this view, as well as a novel therapeutic approach that allows intra-operative radiotherapy to be safely and accurately delivered to the target tissues in a standard operating theatre. The rationale: Whole-organ analysis of mastectomy

J. S. Vaidya; M. Baum; J. S. Tobias; D. P. D'Souza; S. V. Naidu; S. Morgan; M. Metaxas; K. J. Harte; A. P. Sliski; E. Thomson

348

[Silicone implants and breast cancer: real or fictitious problem? A case report and review of the literature].  

PubMed

We present a case of breast cancer 9 years after subcutaneous mastectomy for bilateral phylloid tumor with silicone implants. The patient had a stage III adenocarcinoma (T4 N1 M0) at diagnosis; a modified radical mastectomy was done, followed by radiotherapy and chemotherapy. Later on, Tamoxifen was prescribed (positive hormone receptors). Reviewing the literature about this subject in a context of a moratorium of the Food and Drug Administration (FDA) in the United States recommending suspension of silicone breast implantation, we can propose several conclusions: Previous and recent studies did not show any direct relation between cancer and silicone implants for augmentation mammoplasty; on the contrary, a lower incidence of breast cancer is noted. Breast cancer incidence with silicone implants seems to be higher with reconstructive mammoplasty after mastectomy for benign disease (fibrocystic disease, dysplasia, phylloid tumor), or prophylactic reason, or malignancy (carcinoma in situ, lobular and multifocal carcinoma, early breast cancer...). This can be related to recurrence or cancer development on residual breast tissue. Breast cancer with silicone implants is of poorer prognosis because of the later diagnosis of the disease. PMID:7629835

Daher, M; Rizkallah, P; Abdel-Hak, E

1994-01-01

349

Omega-3 Fatty Acid in Treating Patients With Stage I-III Breast Cancer  

ClinicalTrials.gov

Ductal Breast Carcinoma in Situ; Lobular Breast Carcinoma in Situ; Male Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

2014-01-22

350

Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO)  

Microsoft Academic Search

In order to reduce mutilation, nipple-areola complex (NAC) conservation can be proposed for the treatment of breast cancer\\u000a when mastectomy is indicated. To reduce the risk of retro areolar recurrence, a novel radiosurgical treatment combining subcutaneous\\u000a mastectomy with intraoperative radiotherapy (ELIOT) is proposed. One thousand and one nipple sparing mastectomies (NSM) were\\u000a performed from March 2002 to November 2007 at

J. Y. Petit; U. Veronesi; R. Orecchia; P. Rey; S. Martella; F. Didier; G. Viale; P. Veronesi; A. Luini; V. Galimberti; R. Bedolis; M. Rietjens; C. Garusi; F. De Lorenzi; R. Bosco; A. Manconi; G. B. Ivaldi; O. Youssef

2009-01-01

351

Cryosurgery of breast cancer  

PubMed Central

With recent improvements in breast imaging, the ability to identify small breast tumors is markedly improved, prompting significant interest in the use of cryoablation without surgical excision to treat early-stage breast cancer. The cryoablation is often performed using ultrasound-guided tabletop argon-gas-based cryoablation system with a double freeze/thaw cycle. Recent studies have demonstrated that, as a primary therapy for small breast cancer, cryoablation is safe and effective with durable results, and can successfully destroy all cancers <1.0 cm and tumors between 1.0 and 1.5 cm without a significant ductal carcinoma-in-situ (DCIS) component. Presence of noncalcified DCIS is the cause of most cryoablation failures. At this time, cryoablation should be limited to patients with invasive ductal carcinoma <1.5 cm and with <25% DCIS in the core biopsy. For unresectable advanced breast cancer, cryoablation is a palliation modality and may be used as complementary for subsequent resection or other therapies.

Zhou, Liang; Xu, Kecheng

2012-01-01

352

Surgical resection for persistent seroma, following modified radical mastectomy  

PubMed Central

Background Seroma formation following modified radical mastectomy with axillary lymph node dissection for breast cancer is a most common wound complication. In our experience seroma occurs in approximately 50% of patients undergoing mastectomy. Postmastectomy seromas usually vanishes within a few weeks after operation. Case presentation In this report we present the case of a 73 year old woman who had undergone mastectomy with axillary lymph node dissection for breast cancer, complicated by lymphorrhea and formation fibrous encapsulated seroma resistant to conservative treatment which required surgical resection. Conclusion We stand in opinion that in some cases of prolonged seromatous effusion with confirmed formation of thick walled reservoir the operation with resection and closure of supplying regional lymph vessels may be the best treatment, if possible preceded by arm lymphoscyntygraphy.

Stanczyk, Marek; Grala, Bartlomiej; Zwierowicz, Tomasz; Maruszynski, Marek

2007-01-01

353

Cyclophosphamide With or Without Veliparib in Patients With Locally Advanced or Metastatic Breast Cancer  

ClinicalTrials.gov

Estrogen Receptor-positive Breast Cancer; HER2-negative Breast Cancer; Male Breast Cancer; Progesterone Receptor-positive Breast Cancer; Recurrent Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer

2014-03-20

354

MRI and Mammography Before Surgery in Patients With Stage I-II Breast Cancer  

ClinicalTrials.gov

Estrogen Receptor-negative Breast Cancer; HER2-negative Breast Cancer; HER2-positive Breast Cancer; Progesterone Receptor-negative Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Triple-negative Breast Cancer

2014-03-24

355

Accelerated Radiation Therapy After Surgery in Treating Patients With Breast Cancer  

ClinicalTrials.gov

Inflammatory Breast Cancer; Invasive Ductal Breast Carcinoma; Invasive Lobular Breast Carcinoma; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Tubular Ductal Breast Carcinoma

2014-04-30

356

Experience with reduction mammaplasty combined with breast conservation therapy in the treatment of breast cancer.  

PubMed

As the inclusion criteria for breast conservation therapy have continued to evolve to include lower quadrant tumors, very large breasts, and central tumors, the potential for significant disfigurement after breast conservation therapy has also increased. This has led some centers to develop coordinated oncology-plastic surgery approaches to ensure both adequate cancer resection and aesthetic appearance to the breasts. The authors applied this principle to a specific group of breast cancer patients--women with macromastia--who would benefit from reduction mammaplasty. Eleven women were identified from the senior author's (S.L.S.) reconstructive practice who underwent breast conservation therapy followed by breast reconfiguration and bilateral reduction mammaplasty. Preoperative brassiere sizes ranged from 34D to 46D. All women had immediate reduction after frozen sections from the lumpectomy/partial mastectomy margins were determined to be negative. A total of 22 reduction mammaplasties were performed (eight free-nipple grafts, five inferior pedicle flaps, seven superomedial pedicle flaps, and two superolateral flaps) and an average of 1085 g was removed per breast. All patients underwent radiation therapy postoperatively. There were eight minor complications in six patients (one hematoma, one keloid, one radiation burn, two cases of nipple hypopigmentation, and three cases of fat necrosis). After an average of 24 months' follow-up, there were no local recurrences and one death from distant metastasis. Seven of the 11 patients were available and agreed to rate their aesthetic satisfaction on the basis of a scale from 1 to 4, with 4 being the best. The mean satisfaction score was 3.3. Aesthetic outcomes before radiation therapy and after radiation therapy were evaluated by a panel of plastic surgery residents blinded to the purpose of the study. Using a scale of 1 to 4, the aesthetic mean before radiation therapy was 2.9 and the aesthetic mean after radiation therapy was 3.03. By combining breast conservation therapy with breast reconfiguration or reduction in large-breasted women, multiple benefits are derived. Larger segmental or partial mastectomies can be performed without disfigurement risk, ensuring adequate surgical margins. Immediate reconfiguration of the breast with reduction of the contralateral side creates symmetric, aesthetically pleasing breasts; allows contralateral breast tissue to be evaluated; and spares women from undergoing a second operative procedure. Such a coordinated program gives women an important boost, both physically and psychologically, during management of their breast cancer. PMID:12621180

Spear, Scott L; Pelletiere, Christopher V; Wolfe, Andrew J; Tsangaris, Theodore N; Pennanen, Marie F

2003-03-01

357

Knowledge about breast cancer risk factors and hereditary breast cancer among early-onset breast cancer survivors  

Microsoft Academic Search

Little is known about knowledge levels regarding hereditary breast cancer among breast cancer survivors. This study explored, among women with early-onset breast cancer (<50 years): 1) knowledge regarding breast cancer risk factors and hereditary breast cancer; and 2) differences in knowledge based on risk for hereditary disease. Participants recruited from 34 Virginia hospitals responded to two questionnaires. The Family History

Susan Miesfeldt; Wendy Cohn; Mary Ropka; Susan Jones

2001-01-01

358

Management of early cancer of the breast. Report on an international multicentre trial supported by the Cancer Research Campaign.  

PubMed Central

In the largest controlled clinical study so far undertaken on the management of early cancer of the breast in women the results of a radical regimen (simple mastectomy and radiotherapy) were compared with those of a conservative policy (simple mastectomy alone). The study included enough patients (2268) to ensure that small but significant differences between the two treatments would emerge. With a five-year follow-up there was no evidence that routine postoperative radiotherapy was harmful or that it conferred further benefit as regards survival or distant recurrence. Radiotherapy did, however, reduce the incidence of local recurrence. Neither form of treatment can counter occult disease far from the breast that is present at the time of initial treatment, which probably accounts for the high death rate from breast cancer, but the results of the study would support the view that conservative primary treatment and subsequent adjuvant chemotherapy may be the treatment of choice in future.

1976-01-01

359

A novel, validated method to quantify breast cancer-related lymphedema (BCRL) following bilateral breast surgery.  

PubMed

We sought to develop a formula to quantify breast cancer-related lymphedema (BCRL) after bilateral breast surgery, which functions independently of the contralateral arm and accounts for fluctuations in patient weight. Perometer arm measurements from 265 unilateral breast surgery patients were analyzed. We assessed the relationship between change in patient weight and contralateral arm volume and developed a weight-adjusted volume change formula (WAC). The WAC formula and previously-established RVC formula were compared for classification of BCRL (> or = 10% volume increase) in unilateral breast surgery patients. We then evaluated BCRL incidence using the WAC formula in 225 bilateral mastectomy patients. Change in patient weight and contralateral arm volume demonstrated an approximately linear relationship. Weight-adjusted arm volume change (WAC) was therefore calculated as WAC = (A2*W1)/(W2*A1) - 1 where A1 is pre-operative and A2 is post-operative arm volume, and W1, W2 are the patient's corresponding weights. In the unilateral analysis, there was no significant difference in number of patients classified as having BCRL using the RVC and WAC formulas (p = 0.65). In bilateral mastectomy patients 11.1% (25/225) developed BCRL, defined as > or = 10% WAC. Independent risk factors for lymphedema included axillary lymph node dissection (ALND) and higher pre-operative BMI (p<0.05). Use of this weight-adjusted arm volume change formula should be of value for quantification of BCRL after bilateral breast surgery. PMID:24354105

Miller, C L; Specht, M C; Horick, N; Skolny, M N; Jammallo, L S; O'Toole, J; Taghian, A G

2013-06-01

360

Health-Related Quality of Life and Patient Satisfaction After Treatment for Breast Cancer in Northern Taiwan  

SciTech Connect

Purpose: To evaluate health-related quality of life (QoL) and attitudes toward surgical procedures for breast cancer among patients in northern Taiwan. Methods and Materials: Two hundred twenty posttreatment breast cancer patients completed a QoL survey at two different hospitals in northern Taiwan. Patients (median age, 49 years; range, 32-69 years) had either undergone mastectomy (n = 157) or breast conservation treatment (BCT) (n 63). The Functional Assessment of Chronic Illness Therapy-Breast questionnaire was used to assess QoL. The patients were also asked about breast reconstruction or use of an artificial breast or not, as well as the decision-making process. Result: There was no significant difference in QoL between patients treated with BCT or mastectomy. Significantly more mastectomy patients had had breast reconstruction or wore an artificial breast (49.7% vs. 3.2%; p < 0.001). Of those who had BCT, 81% would make the same choice again, compared with only 49% of mastectomy patients (p < 0.001). Only 7.6% of patients who made the treatment decision themselves were dissatisfied with their treatment, compared with 25% for whom the decision was made by someone else (p = 0.004). Conclusions: Taiwanese women with breast cancer who had undergone mastectomy did not report a worse QoL than those who received BCT, but they were more likely to be concerned about their resulting body image. Half would have chosen a less extensive procedure if they had it to do over. Women were more likely to be satisfied with the results of their treatment if they had decided themselves.

Chang, Joseph Tung-Chieh [Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan (China); Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan (China)], E-mail: jtchang@adm.cgmh.org.tw; Chen, C.-J. [Department of General Surgery, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan (China); Lin, Y.-C. [Department of Hematology and Oncology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan (China); Chen, Y.-C.; Lin, C.-Y. [Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan (China); Cheng, Ann-Joy [Department of Medical Biotechnology, Chang Gung University, Taoyuan, Taiwan (China)

2007-09-01

361

Local regional effectiveness of surgery and radiation therapy in the treatment of breast cancer  

SciTech Connect

Although gross tumor can be controlled with high doses of radiation therapy, control is achieved at the expense of severe radiation sequelae. In order to improve tumor control with minimum complications, the field of treatment should contain only subclinical disease. This article reviews the successful combination of surgery for the removal of gross cancer and radiation of moderate dose for the treatment of subclinical disease in patients with breast cancer. In patients with clinically favorable and operable disease, the combination of a radical or modified radical mastectomy and postoperative radiation therapy of 5000 rad to the peripheral lymphatics and chest wall can secure 90% of the treated areas. For patients with locally and regionally advanced breast cancer, the combination of a simple mastectomy and dissection of the lateral axilla followed by postoperative irradiation of 5000 rad in 5 weeks to the chest wall, axilla, and peripheral lymphatic areas will control more than 85% of the patients treated as compared with approximately 70% control when surgery or radiotherapy alone is used, even with chemotherapy. Yet another clinical application of the subclinical disease concept is the successful combination of conservation surgery (whether segmental mastectomy, quadrantectomy, or wide excision) for gross tumor in the breast and axilla and irradiation for residual microscopic and multiple foci of tumor, yielding more than 90% control of locoregional disease with survival rates equal to those patients treated with radical or modified radical mastectomy. Results of multiple clinical trials and reported series are reviewed.

Montague, E.D.; Fletcher, G.H.

1985-05-01

362

[Breast cancer imaging].  

PubMed

Imaging of breast cancer is multimodal. Mammography uses X-rays, the development of digital mammography has improved its quality and enabled implementations of new technologies such astomosynthesis (3D mammography) or contrast-enhanced digital mammography. Ultrasound is added to mammography when there is need to improve detection in high-density breast, to characterize an image, or guide apuncture or biopsy. Breast MRI is the most sensitive imaging modality. It detects a possible tumor angiogenesis by highlighting an early and intense contrast uptake. This method has an excellent negative predictive value, but its lack of specificity (false positives) can be problematic, thus it has to be prescribed according to published standards. An imaging breast screening report must be concluded by the BI-RADS lexicon classification of the ACR and recommendations about monitoring or histological verification. PMID:24579332

Canale, Sandra; Balleyguier, Corinne; Dromain, Clarisse

2013-12-01

363

[Expanders and the prosthetic short line in breast reconstruction after mastectomy: experience with the first 130 surgically treated cases].  

PubMed

Breast reconstruction as now to be consider as a complementary treatment of breast cancer surgery. Between 1998-1999 we developed a project of collaboration with Polytech-Silimed Europe Gmbh for a new textured tissue expander. This new system allows expansion of the middle and lower quadrant of the breast acting a physiologic ptosis of the breast. Authors report their experience on the first 130 patients. PMID:16437967

Arelli, F; Caravelli, G; Cricrì, G; Lorenzon, L; Marcasciano, F; Pompei, S

2005-01-01

364

Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy  

SciTech Connect

Purpose: We reviewed our institution's experience treating patients with ductal carcinoma in situ (DCIS) of the breast to determine risk factors for ipsilateral breast tumor recurrence (IBTR) and cause-specific survival (CSS) after breast-conserving therapy (BCT) or mastectomy. Materials and Methods: Between 1981 and 1999, 410 cases of DCIS (405 patients) were treated at our institution; 367 were managed with breast-conserving surgery (54 with lumpectomy alone and 313 with adjuvant radiation therapy (RT) [median dose, 45 Gy]). Of these 313 patients, 298 received also a supplemental boost of RT to the lumpectomy cavity (median dose, 16 Gy). Forty-three patients underwent mastectomy; 2 (5%) received adjuvant RT to the chest wall. A true recurrence/marginal miss (TR/MM) IBTR was defined as failure within or adjacent to the tumor bed in patients undergoing BCT. Median follow-up for all patients was 7 years (mean: 6.1 years). Results: Thirty patients (8.2%) experienced an IBTR after BCT (25 [8%] after RT, 5 [9.3%] after no RT), and 2 patients (4.7%) developed a chest wall recurrence after mastectomy. Of the 32 local failures, 20 (63%) were invasive (18/30 [60%] after BCT and 2/2 [100%] after mastectomy), and 37% were DCIS alone. Twenty-four (80%) of the IBTRs were classified as TR/MM. The 10-year freedom from local failure, CSS, and overall survival after BCT or mastectomy were 89% vs. 90% (p = 0.4), 98% vs. 100% (p = 0.7), and 89% vs. 100% (p = 0.3), respectively. Factors associated with IBTR on Cox multivariate analysis were younger age (p = 0.02, hazard ratio [HR] 1.06 per year), electron boost energy {<=}9 MeV (p = 0.03, HR 1.41), final margins {<=}2 mm (p = 0.007; HR, 3.65), and no breast radiation (p = 0.002, HR 5.56). On Cox univariate analysis for BCT patients, IBTR, TR/MM failures, and predominant nuclear Grade 3 were associated with an increased risk of distant metastases and a reduced CSS. Conclusions: After treatment for DCIS, 10-year rates of local control, CSS, and overall survival were similar after mastectomy and BCT. Young age (<45 years), close/positive margins ({<=}2 mm), no breast radiation, and lower electron boost energies ({<=}9 MeV) were associated with IBTR. Local failure and predominant nuclear Grade 3 were found to have a small (4%-12%) but statistically significantly negative impact on the rates of distant metastasis and CSS. These results suggest that optimizing local therapy (surgery and radiation) is crucial to improve local control and CSS in patients treated with DCIS.

Vargas, Carlos [Department of Radiation Oncology, William Beaumont Hospital, Beaumont Cancer Institute, Royal Oak, MI (United States); Kestin, Larry [Department of Radiation Oncology, William Beaumont Hospital, Beaumont Cancer Institute, Royal Oak, MI (United States); Go, Nel [Department of Radiation Oncology, William Beaumont Hospital, Beaumont Cancer Institute, Royal Oak, MI (United States); Krauss, Daniel [Department of Radiation Oncology, William Beaumont Hospital, Beaumont Cancer Institute, Royal Oak, MI (United States); Chen, Peter [Department of Radiation Oncology, William Beaumont Hospital, Beaumont Cancer Institute, Royal Oak, MI (United States); Goldstein, Neal [Department of Pathology, William Beaumont Hospital, Beaumont Cancer Institute, Royal Oak, MI (United States); Martinez, Alvaro [Department of Radiation Oncology, William Beaumont Hospital, Beaumont Cancer Institute, Royal Oak, MI (United States); Vicini, Frank A. [Department of Radiation Oncology, William Beaumont Hospital, Beaumont Cancer Institute, Royal Oak, MI (United States)]. E-mail: fvicini@beaumont.edu

2005-12-01

365

Breast Cancer Screening  

MedlinePLUS

... ongoing clinical trials is available from the NCI Web site . Three tests are used by health care providers to screen ... ongoing clinical trials is available from the NCI Web site . Risks of Breast Cancer Screening Screening tests have risks. Decisions about screening tests can be ...

366

Breast Cancer Statistics  

Cancer.gov

The maps show a pattern of elevated mortality rates for female breast cancer extending from the Mid-Atlantic through the Northeastern states has persisted for many years. Established risk factors are believed to be largely responsible, but the remaining reasons are unknown.

367

Breast Cancer (PDQ): Screening  

MedlinePLUS

... ongoing clinical trials is available from the NCI Web site . Three tests are used by health care providers to screen ... ongoing clinical trials is available from the NCI Web site . Risks of Breast Cancer Screening Screening tests have risks. Decisions about screening tests can be ...

368

Better breast cancer detection  

Microsoft Academic Search

X-rays go digital, computers read film, and chemicals mark tumors, but will these new technologies make it in the clinic? The imaging technologies considered for breast cancer include film-screen mammography, full field digital mammography, ultrasound, magnetic resonance imaging, scintimammography, thermography, electrical impedance imaging, optical imaging, electric potential measurement, positron emission tomography, novel ultrasound techniques, elastography, magnetic resonance spectroscopy, thermoacoustic computed

S. K. Moore

2001-01-01

369

Loss of Heterozygosity in Bilateral Breast Cancer  

Microsoft Academic Search

Women who develop bilateral breast cancer at an early age are likely to harbour germline mutations in breast cancer susceptibility genes. The aim of this study was to test for concordant genetic changes in left and right breast cancer of young women (age <50) with bilateral breast cancer that may suggest an inherited breast cancer predisposition. Microsatellite markers were used

J. Kollias; S. Man; M. Marafie; K. Carpenter; S. Pinder; I. O. Ellis; R. W. Blamey; G. Cross; J. D. Brook

2000-01-01

370

Local and paravertebral block anesthesia for outpatient elective breast cancer surgery.  

PubMed

Most breast cancer operations in the United States are performed with the patient given general anesthesia. We retrospectively reviewed our prospective breast cancer database to determine the percentage of patients who underwent breast cancer operations with either local or paravertebral block regional anesthesia from January 1 through June 30, 2008. Fifty-two of 70 patients (74%) were able to undergo breast cancer surgery with local or paravertebral block regional anesthesia. Operations included mastectomy, full axillary dissections, and expander or implant reconstruction. There were no conversions to general anesthesia and no unplanned overnight admissions. Only 5 of 52 patients (10%) undergoing surgery with local or paravertebral block regional anesthesia developed postoperative nausea or vomiting. We conclude that most elective outpatient breast cancer surgery operations can be performed with the patients given local or regional anesthesia. PMID:20566982

Kitowski, Nicholas J; Landercasper, Jeffrey; Gundrum, Jacob D; De Maiffe, Brooke M; Chestnut, David H; Bottcher, Michael L; Johnson, Jeanne M; Johnson, Rebecca L

2010-06-01

371

Mucinous Breast Cancer with Solitary Metastasis to Humeral Head: A Case Report  

PubMed Central

Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed.

Aljarrah, Adil; Al-Hashmi, Maryam; Malik, Kamran Ahmad; Sukhpal, Sawhney; Hussein, Samir; Al-Riyami, Marwa; Al-Moundhri, Mansour

2013-01-01

372

Radiation-Induced Leiomyosarcoma after Breast Cancer Treatment and TRAM Flap Reconstruction  

PubMed Central

The development of a radiation-induced sarcoma (RIS) in the post mastectomy thoracic treatment volume is an infrequent, but recognized, event. Its frequency is rising in relation with increasing survival of breast cancer patients treated with adjuvant radiation therapy, and is associated with poor prognosis despite treatment. We present a case of leiomyosarcoma in a patient who underwent mastectomy followed by radiotherapy for invasive ductal carcinoma. A delayed TRAM flap reconstruction was performed 10 years after and a rapid growing mass under the reconstructed flap appeared, on routine follow-up, twenty years later. This report analyzes the diagnostic and therapeutic approach of patients with RIS.

Olcina, M.; Merck, B.; Gimenez-Climent, M. J.; Almenar, S.; Sancho-Merle, M. F.; Llopis, F.; Vazquez-Albadalejo, C.

2008-01-01

373

Radiation-Induced Leiomyosarcoma after Breast Cancer Treatment and TRAM Flap Reconstruction.  

PubMed

The development of a radiation-induced sarcoma (RIS) in the post mastectomy thoracic treatment volume is an infrequent, but recognized, event. Its frequency is rising in relation with increasing survival of breast cancer patients treated with adjuvant radiation therapy, and is associated with poor prognosis despite treatment. We present a case of leiomyosarcoma in a patient who underwent mastectomy followed by radiotherapy for invasive ductal carcinoma. A delayed TRAM flap reconstruction was performed 10 years after and a rapid growing mass under the reconstructed flap appeared, on routine follow-up, twenty years later. This report analyzes the diagnostic and therapeutic approach of patients with RIS. PMID:18464918

Olcina, M; Merck, B; Giménez-Climent, M J; Almenar, S; Sancho-Merle, M F; Llopis, F; Vázquez-Albadalejo, C

2008-01-01

374

Breast Cancer Research at NASA  

NASA Technical Reports Server (NTRS)

Dr. Harry Mahtani analyzes the gas content of nutrient media from Bioreactor used in research on human breast cancer. NASA's Marshall Space Flight Center (MSFC) is sponsoring research with Bioreactors, rotating wall vessels designed to grow tissue samples in space, to understand how breast cancer works. This ground-based work studies the growth and assembly of human mammary epithelial cells (HMEC) from breast cancer susceptible tissue. Radiation can make the cells cancerous, thus allowing better comparisons of healthy vs. tunourous tissues.

1998-01-01

375

Quality of life in women with breast cancer and the use of complementary and alternative medicine.  

PubMed

The aim of this study was to evaluate quality of life and complementary and alternative medicine use among patients with breast cancer in Turkey. The sample consists of women who had modified undergone radical mastectomy or breast conserving surgery. Data were collected using a questionnaire addressing personal/medical characteristics use of complementary and alternative medicine and the 36-Item Short Form Health Survey (SF-36) to measure quality of life. A majority of subjects underwent modified radical mastectomy procedures. The social and physical mean scores were the highest and role physical and role emotional mean score were the lowest. The most common complementary and alternative methods were praying, exercise, and herbs use. In conclusion, women with breast cancer have a moderate level of quality of life, and that they use complementary and alternative methods widely. PMID:24919096

Gül, Asiye; Ustünda?, Hülya; Andsoy, I?l I?k

2014-01-01

376

Chemotherapy With or Without Trastuzumab After Surgery in Treating Women With Invasive Breast Cancer  

ClinicalTrials.gov

Estrogen Receptor-negative Breast Cancer; Estrogen Receptor-positive Breast Cancer; HER2-positive Breast Cancer; Progesterone Receptor-negative Breast Cancer; Progesterone Receptor-positive Breast Cancer; Recurrent Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIC Breast Cancer

2014-07-08

377

Cancer risk of incremental exposure to polycyclic aromatic hydrocarbons in electrocautery smoke for mastectomy personnel  

PubMed Central

Background Electrocautery applications in surgical operations produce evasive odorous smoke in the cleanest operation rooms. Because of the incomplete combustion of electrical current in the tissues and blood vessels during electrocautery applications, electrocautery smoke (ES) containing significant unknown chemicals and biological forms is released. The potential hazards and cancer risk should be further investigated from the perspective of the occupational health of surgical staff. Methods The particle number concentration and the concentration of polycyclic aromatic hydrocarbons (PAHs) in ES were thoroughly investigated in 10 mastectomies to estimate the cancer risk for surgical staff. The particle number concentration and gaseous/particle PAHs at the surgeons’ and anesthetic technologists’ (AT) breathing heights were measured with a particle counter and filter/adsorbent samplers. PAHs were soxhlet-extracted, cleaned, and analyzed by gas chromatography/mass spectrometry. Results Abundant submicron particles and high PAH concentrations were found in ES during regular surgical mastectomies. Most particles in ES were in the size range of 0.3 to 0.5 ?m, which may potentially penetrate through the medical masks into human respiration. The average particle/gaseous phase PAH concentrations at the surgeon’s breathing height were 131 and 1,415 ng/m3, respectively, which is 20 to 30 times higher than those in regular outdoor environments. By using a toxicity equivalency factor, the cancer risk for the surgeons and anesthetic technologists was calculated to be 117?×?10-6 and 270?×?10-6, respectively; the higher cancer risk for anesthetic technologists arises due to the longer working hours in operation rooms. Conclusions The carcinogenic effects of PAHs in ES on the occupational health of surgical staff should not be neglected. The use of an effective ES evacuator or smoke removal apparatus is strongly suggested to diminish the ES hazards to surgical staff.

2014-01-01

378

Surgical treatment for women with breast cancer in relation to socioeconomic and insurance status.  

PubMed

Based on the National Breast Cancer Audit of the Royal Australasian College of Surgeons an association between patient age and type of breast cancer surgery received has already been demonstrated. The aim of this study is to assess the patterns of surgical treatment for women with early breast cancer in relation to socioeconomic and insurance status. Data on patient demographics, diagnostic, and surgical procedures and cancer characteristics in 115,872 episodes of early breast cancer reported to the National Breast Cancer Audit between 1998 and 2012 is used for this study. Tumor size, histologic grade, number of tumors, lymph node positivity, and lymphovascular invasion are the major prognostic factors adjusted for. Reconstruction following mastectomy is the most likely surgical procedure for the higher socioeconomic and privately insured patients. Mastectomy alone is the most likely surgical procedure for the lower socioeconomic and for public patients. No surgery is the most likely surgical outcome for the lower socioeconomic and the least likely for the higher socioeconomic population. Open biopsy is the most likely diagnostic procedure for the lower socioeconomic and fine needle aspiration for the higher socioeconomic population. Socioeconomic and insurance status, are both independently associated with the types of treatment and diagnostic procedure for women with breast cancer. Opportunities present to investigate an association of these factors with morbidity and survival outcomes. PMID:24164659

Azzopardi, Jonathan; Walsh, David; Chong, Chilton; Taylor, Corey

2014-01-01

379

The place of subcutaneous mastectomy with immediate silicone prosthetic implantation in diseases of the breast.  

PubMed Central

Subcutaneous mastectomy with immediate silicone prosthetic implantation has been performed on 32 patients. The main indications for this were severe fibrocystic disease and non-invasive carcinoma. Five patients with advanced invasive carcinoma were also included. An improved operative technique is described. The indications and results are discussed. Images FIG. 4

Burnand, K. G.; Bulman, A. S.; Nash, A. G.

1980-01-01

380

Biomarkers in Tissue Samples From Patients With Newly Diagnosed Breast Cancer Treated With Zoledronic Acid  

ClinicalTrials.gov

Estrogen Receptor-negative Breast Cancer; Estrogen Receptor-positive Breast Cancer; Invasive Ductal Breast Carcinoma; Progesterone Receptor-negative Breast Cancer; Progesterone Receptor-positive Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer

2014-02-10

381

Azacitidine in Treating Patients With Triple Negative Stage I-IV Invasive Breast Cancer That Can Be Removed By Surgery  

ClinicalTrials.gov

Recurrent Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer; Triple-negative Breast Cancer

2014-02-05

382

[Hereditary breast cancer].  

PubMed

Norwegian health care for women at risk of inherited breast cancer conforms with the European consensus guidelines published in 1999 and the Norwegian legislation regulating the use of predictive genetic testing. This paper represents a consensus between all medical genetic institutions in Norway handling inherited breast cancer through the Norwegian Group on Inherited Cancer. It is an update based on new knowledge, the structure of our health service and locally available technology and health care resources. The indications for referring patients to genetic testing are maintained. The demonstration of local founder BRCA1 mutations has been used to develop a high capacity for testing for these mutations. Mutation carriers should be offered annual MRI of the breasts for early diagnosis. Oophorectomy at end of childbearing ages is advocated in BRCA mutation carriers and breast-ovarian kindreds. The clinical geneticists have the role of coordinating health service to those in need, and are required to collaborate to present the empirical results of the effects of the interventions. PMID:16299574

Møller, Pål; Maehle, Lovise; Apold, Jaran

2005-11-17

383

Effect of preoperative MRI on mastectomy and contralateral prophylactic mastectomy rates at a community hospital by a single surgeon.  

PubMed

Magnetic resonance imaging (MRI) use in the preoperative evaluation of newly diagnosed breast cancer (BC) patients is rising. We evaluated MRI as a function of surgical year with respect to mastectomy and contralateral prophylactic mastectomy (CPM) rates by a single surgeon. From January 2000 to December 2010, 1,279 patients with 1,296 breast cancers were identified. Our breast MRI was installed in April 2006. Mastectomy and CPM rates were evaluated by surgical year and stratified as "pre-MRI" or "MRI" depending on whether surgery occurred before or after April 2006. There was a significant increase in the percentage of patients undergoing MRI in the "pre-MRI" versus "MRI" era (17.2% versus 78.7%, p < 0.001). In contrast, mastectomy rates decreased with 29.9% undergoing mastectomy before 2006 versus 24.5% after 2006 (p = 0.038). Except for 2007, where CPM rates dropped to 7.1%, CPM rates increased from 16.7% in 2000 to 51.9% in 2010 (p = 0.033). The use of MRI, additional MRI findings and additional MRI biopsies were not associated with the decision for CPM. Age <50 was the only factor associated with CPM (RR = 2.12, p = 0.001). In our community hospital, mastectomy rates have decreased despite the increased use of preoperative MRI. MRI alone may not explain the increasing rates of mastectomy reported in other series. CPM rates have dramatically increased over time, seemingly independent of MRI use. Prospective studies are needed to assess the role of surgeon bias, along with other factors, in surgical decision making. PMID:24438066

Guilfoyle, Caramarie; Christoudias, Moira; Collett, Abigail E; Gracely, Edward J; Frazier, Thomas G; Barrio, Andrea V

2014-01-01

384

Prognostic Value of Extracapsular Tumor Spread for Locoregional Control in Premenopausal Patients With Node-Positive Breast Cancer Treated With Classical Cyclophosphamide, Methotrexate, and Fluorouracil: Long-Term Observations From International Breast Cancer Study Group Trial VI  

Microsoft Academic Search

Purpose We sought to determine retrospectively whether extracapsular spread (ECS) might identify a subgroup that could benefit from radiotherapy after mastectomy, especially patients with 1 to 3 positive lymph nodes (LN1-3). Patients and Methods We randomized 1,475 premenopausal women with node-positive breast cancer to three, six, or nine courses of \\

Gunther Gruber; Marco Bonetti; M. Laura Nasi; Karen N. Price; Monica Castiglione-Gertsch; Carl-Magnus Rudenstam; Stig B. Holmberg; Jurij Lindtner; Rastko Golouh; John Collins; Diana Crivellari; Antonino Carbone; Beat Thurlimann; Edda Simoncini; Martin F. Fey; Richard D. Gelber; Alan S. Coates; Aron Goldhirsch

385

Treatment of early stage breast cancer by limited surgery and radical irradiation  

SciTech Connect

Eighty-five female patients with early stage breast cancer, i.e., Stage I and II were treated by limited surgery followed by radical radiation therapy at Massachusetts General Hospital between January, 1956 and December, 1974. Patients included those who were medically inoperable or who refused mastectomy. The 5-year survival rate was 83% and 76% for Stage I and II, respectively. The corresponding disease free survival (absolute) was 67% and 42%. Although the number of patients so treated is small, there was no significant difference in survival from the results of the radical mastectomy series at the same institution. No major complications were encountered. Seventeen of eighty-five patients developed minor problems; mostly fibrosis and minimal arm lymphedema stemmming from older orthovoltage equipment and treatment techniques. With the current availability of megavoltage equipment, improvements in techniques and dosimetry, complications should decrease. Combined limited surgery and radical radiation therapy should be considered in those patients where a radical mastectomy is not feasible because of psychological or medical problems. Since this procedure results in a cosmetically acceptable breast, radical radiation in early stage breast cancer seems a reasonable alternative to radical mastectomy.

Chu, A.M.; Cope, O.; Russo, R.; Wang, C.C.; Schulz, M.D.; Wang, C.; Rodkey, G.

1980-01-01

386

Contact Nd-YAG laser in mastectomy and axillary evacuation: a prospective randomized study  

Microsoft Academic Search

Thirty patients underwent modified mastectomy for breast cancer. They were allocated into three operation groups. Group A (n=10) underwent conventional operation, group B (n=10) contact Nd-YAG laser operation, and group C (n=10) conventional mastectomy with laser evacuation of the axillary lymph nodes. The operation with contact Nd-YAG laser was slower (pp<0.01), but there were post-operative wound seromas in 50% of

Juha Hahl

1991-01-01

387

Comparison of Treatment Outcome Between Breast-Conservation Surgery With Radiation and Total Mastectomy Without Radiation in Patients With One to Three Positive Axillary Lymph Nodes  

SciTech Connect

Purpose: To test the difference in treatment outcome between breast-conservation surgery with radiation and total mastectomy without radiation, to evaluate the benefits of adjuvant radiotherapy in patients with one to three positive axillary lymph nodes. Methods and Materials: Using the Severance Hospital Breast Cancer Registry, we divided the study population of T1, T2 and one to three axillary node-positive patients into two groups: breast-conservation surgery with radiation (BCS/RT) and total mastectomy without radiation (TM/no-RT). Data related to locoregional recurrence, distant recurrence, and death were collected, and survival rates were calculated. Results: The study population consisted of 125 patients treated with BCS/RT and 365 patients treated with TM/no-RT. With a median follow-up of 68.4 months, the 10-year locoregional recurrence-free survival rate with BCS/RT and TM/no-RT was 90.5% and 79.2%, respectively (p = 0.056). The 10-year distant recurrence-free survival rate was 78.8% for patients treated with BCS/RT vs. 68.0% for those treated with TM/no-RT (p = 0.012). The 10-years overall survival rate for patients treated with BCT/RT and TM/no-RT was 87.5% and 73.9%, respectively (p = 0.035). After multivariate analysis, patients treated with BCT/RT had better distant recurrence-free survival (hazard ratio [HR], 0.527; 95% confidence interval [CI], 0.297-0.934; p = 0.028), with improving locoregional recurrence-free survival (HR, 0.491; 95% CI, 0.231-1.041; p = 0.064) and overall survival trend (HR, 0.544; 95% CI, 0.277-1.067; p = 0.076). Conclusions: This study provides additional evidence that adjuvant radiation substantially reduces local recurrence, distant recurrence, and mortality for patients with one to three involved nodes.

Kim, Seung Il; Park, Seho; Park, Hyung Seok [Department of Surgery, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Bae; Suh, Chang Ok [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Byeong-Woo, E-mail: bwpark@yuhs.ac [Department of Surgery, Yonsei University College of Medicine, Seoul (Korea, Republic of); Brain Korea 21 Project, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2011-08-01

388

Breast-Conserving Surgery Followed by Radiation Therapy With MRI-Detected Stage I or Stage II Breast Cancer  

ClinicalTrials.gov

Ductal Breast Carcinoma in Situ; Estrogen Receptor-negative Breast Cancer; Estrogen Receptor-positive Breast Cancer; HER2-negative Breast Cancer; HER2-positive Breast Cancer; Invasive Ductal Breast Carcinoma; Invasive Lobular Breast Carcinoma; Male Breast Cancer; Medullary Ductal Breast Carcinoma With Lymphocytic Infiltrate; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Progesterone Receptor-negative Breast Cancer; Progesterone Receptor-positive Breast Cancer; Stage I Breast Cancer; Stage II Breast Cancer; Tubular Ductal Breast Carcinoma

2011-12-07

389

Developing strategies for intervention and prevention in hereditary breast cancer.  

PubMed

Prophylactic mastectomy, intensified breast cancer screening, and the use of chemopreventive agents have all been recommended to reduce breast cancer risk in women with a family history of breast cancer. Yet, little is currently known about the efficacy of these approaches in reducing breast cancer mortality. The recent identification of BRCA1 and the localization of BRCA2 lend urgency to the need to assess breast cancer intervention and prevention strategies for women likely to carry germline mutations at these loci. At present, families with a history consistent with a BRCA1 or BRCA2 mutation should be tested within the confines of a research protocol and encouraged to participate in intervention and prevention trials. Both retrospective studies and prospective clinical trials are critically needed. While randomized clinical trials would be the optimal mechanism to assess the relative efficacy of these potential interventions, no consensus was obtained as to whether such a trial would be feasible because of strong patient preference for intervention type. It is likely that optimal intervention and prevention strategies will consist of a combined approach to risk reduction. Participants must be appropriately informed of the potential risks as well as the potential benefits of such testing. The potential risks of testing for genetic susceptibility include not only potential psychosocial harm that may result from learning one's carrier status, but also the potential for altered family relationships and insurance and job discrimination. Participants and their family members must be counseled concerning the implication of their test results. PMID:8573465

Weber, B L; Giusti, R M; Liu, E T

1995-01-01

390

Progestins and breast cancer.  

PubMed

In the last years there has been an extraordinary development in the synthesis of new progestins. These compounds are classified, in agreement with their structure, in various groups which include progesterone, retroprogesterones, 17alpha-hydroxyprogesterones, 19-norprogesterones, 17alpha-hydroxyprogesterone derivatives, androstane and estrane derivatives. The action of progestins is a function of many factors: its structure, affinity to the progesterone receptor or to other steroid receptors, the target tissue considered, the biological response, the experimental conditions, dose, and metabolic transformation. The information on the action of progestins in breast cancer patients is very limited. Positive response with the progestins: medroxyprogesterone acetate and megestrol acetate was obtained in post-menopausal patients with advanced breast cancer. However, extensive information on the effect of progestins was obtained in in vitro studies using hormone-dependent and hormone-independent human mammary cancer cell lines. It was demonstrated that in the hormone-dependent breast cancer cells, various progestins (nomegestrol acetate, tibolone, medrogestone, promegestone) are potent sulfatase inhibitory agents. The progestins can also involve the inhibition of mRNA of this enzyme. In another series of studies it was also demonstrated that various progestins are very active in inhibiting the 17beta-hydroxysteroid dehydrogenase for the conversion of estrone to estradiol. More recently it was observed that the progestins promegestone or medrogestone stimulate the sulfotransferase for the formation of estrogen sulfates. Consequently, the blockage in the formation of estradiol via sulfatase, or the stimulatory effect on sulfotransferase activity, by progestins can open interesting and new possibilities in clinical applications in breast cancer. PMID:9699877

Pasqualini, J R; Paris, J; Sitruk-Ware, R; Chetrite, G; Botella, J

1998-04-01

391

The Centre H. Becquerel studies in inflammatory non metastatic breast cancer. Combined modality approach in 178 patients  

Microsoft Academic Search

One hundred and seventy-eight patients with non metastatic inflammatory breast cancer (IBC) have been treated at the Centre H. Becquerel. Median follow up is 67 months (6-178). Every patient received neoadjuvant chemotherapy (mean number of cycles = 4; range: 2-8), followed by a loco regional treatment (radiotherapy = XRT or modified radical mastectomy = S), followed by adjuvant chemotherapy. During

B Chevallier; P Bastit; Y Graic; JF Menard; JP Dauce; JP Julien; B Clavier; A Kunlin; J D'Anjou

1993-01-01

392

Tamoxifen in high-risk premenopausal women with primary breast cancer receiving adjuvant chemotherapy. Report from the Danish Breast Cancer Cooperative Group DBCG 82B trial  

Microsoft Academic Search

Following modified radical mastectomy, pre- and perimenopausal (amenorrhoea for <5 years) patients with stage II or III breast cancer received CMF (cyclophosphamide 600, methotrexate 40, 5-fluorouracil 600mg\\/m2 intravenously (i.v.) every 4 weeks, 9 cycles). The effect on recurrence-free survival (RFS) and overall survival (OS) of the addition of adjuvant tamoxifen (TAM) to adjuvant chemotherapy was examined by randomisation either to

M. Andersson; C. Kamby; M.-B. Jensen; H. Mouridsen; B. Ejlertsen; P. Dombernowsky; C. Rose; S. Cold; M. Overgaard; J. Andersen; M. Kjær

1999-01-01

393

Breast cancer and the "materiality of risk": the rise of morphological prediction.  

PubMed

This paper follows the history of "morphological risk" of breast cancer. In the early twentieth century, surgeons and pathologists arrived at the conclusion that specific anatomical and cytological changes in the breast are related to a heightened risk of developing a malignancy in the future. This conclusion was directly related to a shift from macroscopic to microscopic diagnosis of malignancies, and to the integration of the frozen section into routine surgery for breast cancer. In the interwar era, conditions such as "chronic mastitis" and "cystic disease of the breast" were defined as precancerous, and women diagnosed with these conditions were advised to undergo mastectomy. In the post-World War II era, these entities were replaced by "carcinoma in situ." The recent development of tests for hereditary predisposition to breast cancer is a continuation of attempts to detect an "embodied risk" of cancer and to eliminate this risk by cutting it out. PMID:17369670

Löwy, Ilana

2007-01-01

394

Your Rights After a Mastectomy  

MedlinePLUS

... plan or coverage. I just changed jobs and am enrolled under my new employer’s plan. I underwent ... If I have a mastectomy and breast reconstruction, am I also entitled to the minimum hospital stay? ...

395

Breast Cancer Research at NASA  

NASA Technical Reports Server (NTRS)

Breast tissue specimens in traditional sample dishes. NASA's Marshall Space Flight Center (MSFC) is sponsoring research with Bioreactors, rotating wall vessels designed to grow tissue samples in space, to understand how breast cancer works. This ground-based work studies the growth and assembly of human mammary epithelial cells (HMEC) from breast cancer susceptible tissue. Radiation can make the cells cancerous, thus allowing better comparisons of healthy vs. tunourous tissues.

1998-01-01

396

Breast Cancer Research at NASA  

NASA Technical Reports Server (NTRS)

Dr. Robert Richmond extracts breast cell tissue from one of two liquid nitrogen dewars. NASA's Marshall Space Flight Center (MSFC) is sponsoring research with Bioreactors, rotating wall vessels designed to grow tissue samples in space, to understand how breast cancer works. This ground-based work studies the growth and assembly of human mammary epithelial cells (HMEC) from breast cancer susceptible tissue. Radiation can make the cells cancerous, thus allowing better comparisons of healthy vs. tunourous tissues.

1998-01-01

397

Sentinel Lymphadenectomy in Breast Cancer  

Microsoft Academic Search

An estimated 178,480 people in the United States will be diagnosed with and 40,460 will die from breast cancer in 2007.With\\u000a the institution of screening mammography guidelines between 1980 and 1987, there was a doubling in the incidence of small\\u000a breast cancers (? 2 cm) with a concomitant decrease by 27% in the incidence of larger breast cancers (? 3

Hannah W. Hazard; Nora M. Hansen

398

Glucocorticoid receptor and breast cancer  

Microsoft Academic Search

Stress enhances glucocorticoid (GC) synthesis, which alters inflammation and immune responses, as well as cellular proliferation\\u000a and apoptosis in a number of tissues. Increasingly, stress has been associated with cancer progression, and in particular\\u000a in breast cancer. Consequently, an operational glucocorticoid receptor system in breast tissue influences breast cancer development.\\u000a In this review, we summarize the data on the GC\\/GR

Myriam Vilasco; Laudine Communal; Najat Mourra; Aurélie Courtin; Patricia Forgez; Anne Gompel

399

Cancer Stem Cells in Breast Cancer  

Microsoft Academic Search

\\u000a Breast cancer is one of the leading causes of cancer-related deaths among women worldwide. While it is highly treatable during\\u000a the primary stages, the disease is often lethal if it successfully metastasizes. Breast cancer stem cells (CSCs) show distinct\\u000a similarities to normal breast stem cells, have been shown to be the driving force behind primary tumorigenesis, and are postulated\\u000a to

Jenny E. Chu; Alison L. Allan

400

Breast Cancer Research at NASA  

NASA Technical Reports Server (NTRS)

High magnification view of human primary breast tumor cells after 56 days of culture in a NASA Bioreactor. The arrow points to bead surface indicating breast cancer cells (as noted by the staining of tumor cell intermediate filaments). NASA's Marshall Space Flight Center (MSFC) is sponsoring research with Bioreactors, rotating wall vessels designed to grow tissue samples in space, to understand how breast cancer works. This ground-based work studies the growth and assembly of human mammary epithelial cell (HMEC) from breast cancer susceptible tissue. Radiation can make the cells cancerous, thus allowing better comparisons of healthy vs. tunorous tissue. Credit: Dr. Jearne Becker, University of South Florida

1998-01-01

401

Sexuality After Breast Cancer  

MedlinePLUS

... area of the missing breast is more visible. Breast surgery or radiation to the breasts does not physically ... chest or arms may help. If you had breast-conserving surgery followed by radiation therapy, the breast may be ...

402

Improving quality of breast cancer surgery through development of a national breast cancer surgical outcomes (BRCASO) research database  

PubMed Central

Background Common measures of surgical quality are 30-day morbidity and mortality, which poorly describe breast cancer surgical quality with extremely low morbidity and mortality rates. Several national quality programs have collected additional surgical quality measures; however, program participation is voluntary and results may not be generalizable to all surgeons. We developed the Breast Cancer Surgical Outcomes (BRCASO) database to capture meaningful breast cancer surgical quality measures among a non-voluntary sample, and study variation in these measures across providers, facilities, and health plans. This paper describes our study protocol, data collection methods, and summarizes the strengths and limitations of these data. Methods We included 4524 women ?18 years diagnosed with breast cancer between 2003-2008. All women with initial breast cancer surgery performed by a surgeon employed at the University of Vermont or three Cancer Research Network (CRN) health plans were eligible for inclusion. From the CRN institutions, we collected electronic administrative data including tumor registry information, Current Procedure Terminology codes for breast cancer surgeries, surgeons, surgical facilities, and patient demographics. We supplemented electronic data with medical record abstraction to collect additional pathology and surgery detail. All data were manually abstracted at the University of Vermont. Results The CRN institutions pre-filled 30% (22 out of 72) of elements using electronic data. The remaining elements, including detailed pathology margin status and breast and lymph node surgeries, required chart abstraction. The mean age was 61 years (range 20-98 years); 70% of women were diagnosed with invasive ductal carcinoma, 20% with ductal carcinoma in situ, and 10% with invasive lobular carcinoma. Conclusions The BRCASO database is one of the largest, multi-site research resources of meaningful breast cancer surgical quality data in the United States. Assembling data from electronic administrative databases and manual chart review balanced efficiency with high-quality, unbiased data collection. Using the BRCASO database, we will evaluate surgical quality measures including mastectomy rates, positive margin rates, and partial mastectomy re-excision rates among a diverse, non-voluntary population of patients, providers, and facilities.

2012-01-01

403

[Health-related quality of live in breast cancer patients--actuality and problems].  

PubMed

Women with early breast cancer have three surgical options fir this current moment: conservative treatment (lumpectomy, quadrantectomy); mastectomy alone and mastectomy plus reconstruction (immediate or delayed). When randomized trials showed oncological safety of breast--conservative treatment compared with mastectomy, the question of cosmetic results assessment become actual, because of its impact on quality of live. The current state of the art permits achievement of good oncological results and good cosmetics ones. There are some technical factors affecting cosmetic results after breast--conservative treatment: orientation of resection; the breast / resection ratio; tumor localization; orientation of axillary dissection. Combination of extended resection (quadrantectomy) plus axillary dissection through the same incision results in cosmetic failure. After operation there is a remarkable breast asymmetry, retraction of the mammilla and inferior contour distortion. The main reasons for cosmetic failures are: volume of resection (lumpectomy, quadrant-ectomy), postoperative radiotherapy, deviation from normal breast morphology and tumor location. There are a lot of questionnaires for quality of live assessment. For Bulgarian population N. Mashonov created and adopted original questionnaire. The author investigated quality of live among patients with hard failure during recovery period. PMID:16044875

Molov, V; Tepavicharova, P; Deenichin, G; Dimov, R; Stefanov, Ch

2004-01-01

404

Interleukin-19 in Breast Cancer  

PubMed Central

Inflammatory cytokines within the tumor microenvironment are linked to progression in breast cancer. Interleukin- (IL-) 19, part of the IL-10 family, contributes to a range of diseases and disorders, such as asthma, endotoxic shock, uremia, psoriasis, and rheumatoid arthritis. IL-19 is expressed in several types of tumor cells, especially in squamous cell carcinoma of the skin, tongue, esophagus, and lung and invasive duct carcinoma of the breast. In breast cancer, IL-19 expression is correlated with increased mitotic figures, advanced tumor stage, higher metastasis, and poor survival. The mechanisms of IL-19 in breast cancer have recently been explored both in vitro and in vivo. IL-19 has an autocrine effect in breast cancer cells. It directly promotes proliferation and migration and indirectly provides a microenvironment for tumor progression, which suggests that IL-19 is a prognostic marker in breast cancer and that antagonizing IL-19 may have therapeutic potential.

Chen, Ying-Yin; Li, Chien-Feng; Yeh, Ching-Hua; Chang, Ming-Shi; Hsing, Chung-Hsi

2013-01-01

405

Neoadjuvant Treatment in Patients with HER2-Positive Breast Cancer  

PubMed Central

Approximately 20%–25% of patients with breast cancer demonstrate amplification of the human epidermal receptor type 2 (HER2) gene, resulting in an overexpression of the HER2 receptor. This overexpression is associated with aggressive disease, relatively poor prognosis, and worse clinical outcomes. Neoadjuvant therapy is the standard treatment in patients with locally advanced, inflammatory, or inoperable primary breast cancer. It is generally used to downstage the tumors and therefore to improve surgical options including breast-conserving surgery rather than mastectomy. It has been confirmed that patients with pathological complete response (pCR) to neoadjuvant treatment have better disease-free survival (DFS) and overall survival (OS). Neoadjuvant treatment can also serve as in vivo test of sensitivity to the used therapeutic regimen. The preferred neoadjuvant approach to patients with HER2-positive breast cancer is a sequential anthracycline-taxane-based chemotherapy in combination with trastuzumab. Addition of other anti-HER2 agents has increased pCR rate up to 75% and will probably become a new therapeutic direction. In the first part of this paper, we summarize the information about HER2-positive breast cancer, the various treatment possibilities, and the results of the major neoadjuvant trials. The second part focuses on the data concerning the importance of pCR and the poten