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Breast Conserving Surgery (breast + conserving_surgery)
Selected AbstractsPatterns of Surgical Treatment for Women with Breast Cancer in Relation to AgeTHE BREAST JOURNAL, Issue 1 2010Jim Wang PhD Abstract:, Although treatment recommendations have been advocated for all women with early breast cancer regardless of age, it is generally accepted that different treatments are preferred based on the age of the patient. The aim of this study was to assess the pattern of breast cancer surgery after adjusting for other major prognostic factors in relation to patient age. Data on cancer characteristics and surgical procedures in 31,298 patients with early breast cancer reported to the National Breast Cancer Audit between 1999 and 2006 were used for the study. There was a close association between age and surgical treatment pattern after adjusting for other prognostic factors, including tumor size, histologic grade, number of tumors, lymph node positivity, lymphovascular invasion (LVI), and extensive intraduct component. Breast Conserving Surgery (BCS) was highest among women aged ,40 years (OR = 1.140; 95% CI: 1.004,1.293) compared to women aged 51,70 years (reference group). BCS was lowest in women aged >70 years (OR = 0.498, 95% CI: 0.455,0.545). Significantly more women aged ,50 years underwent more than one operation for breast conservation (20.4,24.8%) compared with women aged >50 years (11.4,17.0%). Women aged >70 years were more likely to receive no surgical treatment, 3.5% versus 1.0,1.3% in all other age groups (,40, 41,50 51,70 years). There is an association between patient age and the type of breast cancer surgery for women in Australia and New Zealand. Women age ,40 years are more likely to undergo BCS despite having adverse histologic features and have more than one procedure to achieve breast conservation. Older women (>70 years) more commonly undergo mastectomy and are more likely to receive no surgical treatment. [source] Breast conserving surgery: adequate local clearance of the cancer is mandatoryANZ JOURNAL OF SURGERY, Issue 12 2003Peter L. Malycha FRACS No abstract is available for this article. [source] Skin Angiosarcoma Arising in an Irradiated Breast: Case-Report and Literature ReviewDERMATOLOGIC SURGERY, Issue 3 2006FAUSTO CATENA MD BACKGROUND Angiosarcoma (AS) is a rare, invasive malignancy originating from endothelial cells caused by many different clinical situations. AS following radiotherapy for breast cancer after conservative surgery is a rare but well-known association. OBJECTIVE The aim of this article is to describe a case of AS after breast conserving surgery and to review the literature to date. RESULTS We report the case of an 84-year-old woman who developed AS four years after she was subjected to quadrantectomy for invasive ductal cancer, followed by 30 tangent field radiotherapy sessions. She presented with a one-month history or red papular skin eruptions on the operated breast. Skin lesions were submitted for biopsy, and they were positive for AS. The patients was subjected to surgical excision of the remaining breast including all AS lesions. She is alive with no evidence of disease after 10 months follow-up. CONCLUSION Post-radiotherapy AS is rare neoplasm, but it should be considered in the case of patients with red lesions after breast conserving surgery and adjuvant radiotherapy. [source] Racial/Ethnic Disparities in Knowledge about Risks and Benefits of Breast Cancer Treatment: Does It Matter Where You Go?HEALTH SERVICES RESEARCH, Issue 4 2008Sarah T. Hawley Objective. To evaluate the association between provider characteristics and treatment location and racial/ethnic minority patients' knowledge of breast cancer treatment risks and benefits. Data Sources/Data Collection. Survey responses and clinical data from breast cancer patients of Detroit and Los Angeles SEER registries were merged with surgeon survey responses (N=1,132 patients, 277 surgeons). Study Design. Cross-sectional survey. Multivariable regression was used to identify associations between patient, surgeon, and treatment setting factors and accurate knowledge of the survival benefit and recurrence risk related to mastectomy and breast conserving surgery with radiation. Principal Findings. Half (51 percent) of respondents had survival knowledge, while close to half (47.6 percent) were uncertain regarding recurrence knowledge. Minority patients and those with lower education were less likely to have adequate survival knowledge and more likely to be uncertain regarding recurrence risk than their counterparts (p<.001). Neither surgeon characteristics nor treatment location attenuated racial/ethnic knowledge disparities. Patient,physician communication was significantly (p<.001) associated with both types of knowledge, but did not influence racial/ethnic differences in knowledge. Conclusions. Interventions to improve patient understanding of the benefits and risks of breast cancer treatments are needed across surgeons and treatment setting, particularly for racial/ethnic minority women with breast cancer. [source] Multidetector row computed tomography for diagnosing intraductal extension of breast carcinomaJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2005Takeo Fujita Abstract Objectives Several reports supported the association of higher ipsilateral breast tumor recurrence rates with positive or intermediate margins compared with negative pathologic margins. Precise evaluation of intraductal component and adequate surgical margin are important factors affecting the tumor recurrence after breast conserving surgery. Numerous studies have reported the utility of magnetic resonance imaging for diagnosing developing intraductal extension of breast cancer, but few have investigated multidetector-row computed tomography (MD-CT). The present study evaluated the clinical utility of MD-CT for detecting intraductal extension of breast carcinoma, and analyzed clinical parameters affecting the detection of intraductal extension under MD-CT. Methods Subjects comprised 44 patients grouped into three categories according to degree of intraductal extension of the main tumor under MD-CT (Intraductal spread grade 1,3: IDS 1,3). Tumors were also categorized histopathologically (p-IDS 0,3), and CT-pathological correlations were examined retrospectively. Clinical parameters were evaluated to determine the affect on detection of intraductal components. Results MD-CT detected 44 breast lesions (100%). Sensitivity for detection of intraductal component was 81.2%, specificity was 67.8%, and accuracy was 72.7%. Regarding extent of intraductal components, significant correlations were found between histopathological and MD-CT findings. A strong correlation was found in postmenopausal women between T2 tumor and high histological grade. Conclusions MD-CT findings of intraductal extension from breast carcinoma correlate with histological degree of intraductal extension, and MD-CT may be useful for preoperative assessment of breast-conserving surgery, particularly for postmenopausal women with histological high nuclear grade and T2 tumor. J. Surg. Oncol. 2005;91:10,16. © 2005 Wiley-Liss, Inc. [source] Persistent Pain After Breast Cancer SurgeryPAIN MEDICINE, Issue 7 2007B Lau Purpose of the study:, To identify strengths and weaknesses in current studies with a view to carrying out a major multi-center study in Australia. Methods:, The literature was reviewed using standard Medline and Ovid methods. Bibliography of well known key recent papers were used to identify further papers. Results:, Studies evaluating persistent pain after breast cancer surgery have been small and few were prospective controlled studies with adequate power. Like Jung et al[1] we found that the literature was inconsistent in defining chronic pain and differentiating the breast cancer surgery pain syndromes. Marked variations in prior studies are due to differences in: study size (n = 22 to 282 patients), methodology, diagnostic criteria, pain assessment instruments, and distribution of demographic and clinical characteristics in the samples studied. Unfortunately the largest study to date, the ALMANAC Trial (n = 1031) which compared sentinel node biopsy vs "standard axillary dissection" evaluated arm and shoulder function and quality of life, but not pain[2]. From the current literature, it appears that neuropathic breast and arm pain are most common. Widely varying prevalence estimates of different neuropathic pain syndromes have been reported: phantom breast pain (3,44%); intercostobrachial neuralgia (ICBN) (16,39%); ICBN in breast conserving surgery (14,61%); and "neuroma pain" (23,49%). The most established risk factors for surgically related neuropathic pain syndromes are intraoperative nerve trauma, severe acute postoperative pain, and high use of postoperative analgesics[1]. Psychosocial distress is reported to be a risk factor and a consequence of chronic pain[1]. Conclusions:, Well-designed large multi-center studies are required to identify prevalences of various pain types, associated risk factors and treatment success for pain after breast cancer surgery. Such a study is in progress through the collaboration of our group with the Sentinel Node vs Axillary Clearance (SNAC) Study of 1000 women following breast surgery, conducted by the Royal Australian College of Surgeons (RACS). [source] Randomized Trial Comparing Locoregional Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at the Presentation (Protocol MF07-01): A Study of Turkish Federation of the National Societies for Breast DiseasesTHE BREAST JOURNAL, Issue 4 2009Atilla Soran MD, FACS Abstract:, The MF07-01 trial is a phase III randomized controlled trial which compares breast cancer patients with distant metastases at presentation who receive locoregional treatment for intact primary tumor with those who do not receive such treatment. The primary objective of the study is to assess whether locoregional treatment of the primary tumor provides a better overall survival. Secondary objectives include progression-free survival, quality-of-life, and morbidity related to locoregional treatment. Locoregional treatments consist of either mastectomy or breast conserving surgery with level I-II axillary clearance in clinically or sentinel lymph node positive patients. Radiation therapy to the whole breast follows breast conserving surgery. Standard systemic therapy is given to all patients either immediately after randomization in no-locoregional treatment arm or after surgical resection of the intact primary tumor in locoregional treatment arm. The study is conducted in Turkey as a multicenter trial with central randomization. Total accrual target is 271. The trial was activated in October 2007 and authorized centers started to recruit patients since then. ClinicalTrials.gov identifier number is NCT00557986. [source] Neo-Adjuvant Hormonal TherapyTHE BREAST JOURNAL, Issue 3 2008Marcia Valenzuela MD Abstract:, Neo-adjuvant endocrine therapy has opened new alternatives for locally advanced breast cancer. Such therapy, which has permitted us to expand the treatment role of neo-adjuvant therapies, may be of great benefit to patient groups such as the elderly, those not suited for chemotherapy, and those whose response may not be optimal. This therapy also may be able to help us identify agents that could improve outcomes in the adjuvant setting as well as possible biologic predictors for outcome. The latest generation of endocrine therapy for breast cancer, aromatase inhibitors, has proved superior to tamoxifen in terms of toxicity and efficacy in the adjuvant setting and is currently being studied in other clinical trials. Current findings indicate that these agents are less toxic and better tolerated than neo-adjuvant chemotherapy and that third-generation anti-hormomal therapy offers improved tumor response compared with tamoxifen, which has resulted in increased breast conserving surgery. Biomarker findings of improved response in tumors that are both estrogen receptor positive and HER-2 positive as well as progesterone receptor positivity only will be important for planning future selective treatment and clinical trials. [source] TREATMENT FOR DUCTAL CARCINOMA IN SITU IN AN ASIAN POPULATION: OUTCOME AND PROGNOSTIC FACTORSANZ JOURNAL OF SURGERY, Issue 1-2 2008Esther W. L. Chuwa Background: Breast cancer is the most common cancer among Singapore women and ductal carcinoma in situ (DCIS) is believed to be the precursor of most invasive breast cancers. The incidence of DCIS has increased dramatically with mammographic screening, but its treatment remains controversial. Further, results of treatment for DCIS in Asians, and in particular Singapore women, are lacking. We review our institution's results treating a predominantly Chinese population with DCIS of the breast before the introduction of mammographic screening and aim to determine treatment outcomes and identify prognostic factors for disease recurrence. Methods: Between January 1994 and December 2000, 170 consecutive patients with DCIS were treated at our institution. One hundred and three (60.5%) were managed with breast conservation (17 with local wide excision alone and 86 with adjuvant irradiation following wide excision) whereas 67 (39.4%) underwent mastectomy. Of those who underwent wide local excision, 56 (54.3%) underwent re-excision for margin clearance. Overall, the axilla was surgically staged in 47 (27.6%) and no nodal involvement was found in all cases. Pathological specimens were reviewed by one of the authors. Median follow up was 86 months (range 4,151 months). Results: Sixty-two patients (36%) were asymptomatic at presentation whereas most (64%) presented with clinical symptoms; out of these more than half (54%) presented with a palpable lump. The median size of tumours was 13 mm (range 1.5,90 mm). Patients who underwent breast conservation surgery had oncologically more favourable lesions , with a significantly higher incidence of smaller and non-palpable lesions and lesions of lower nuclear grade. However, there was also a significantly higher incidence of local recurrence in this group. At the end of follow up, there were 12 patients (7.1%) who developed local recurrence and 8 patients (4.7%) developed contralateral disease. The crude incidence of all breast events (including both local failure and contralateral events) at 5 years was 5.6%. Median time to the development of any breast event (local recurrence or contralateral disease) was 60 months (range 12,120 months). The cumulative 5-year recurrence-free survival for patients who underwent breast conservation surgery was 94%. Factors influencing local recurrence rate were close or involved margins (,1 mm) and lack of adjuvant radiotherapy. There were no cancer-specific deaths during the period of follow up. Conclusion: Our results indicate that rates of cancer-specific survival were similar after mastectomy and breast conserving surgery. However, a close or involved margin (,1mm) and lack of adjuvant radiotherapy were associated with local recurrence, with margin status being the independent predictor for local recurrence. Our results reinforce that optimizing local therapy is crucial to improve local control rates in women treated with DCIS in our population. [source] BREAST SPECIMEN ULTRASOUND AND MAMMOGRAPHY IN THE PREDICTION OF TUMOUR-FREE MARGINSANZ JOURNAL OF SURGERY, Issue 12 2006Kok-Yang Tan Background: Adequacy of margins is important for local recurrence control in breast-conserving surgery for breast cancer. This study aims to compare the accuracy of intraoperative specimen ultrasonography (IOUS) and specimen mammography in the prediction of achieving adequate histologically tumour-free margins during breast-conserving surgery. Methods: Between March 2003 and September 2004, a prospective study was carried out on 25 patients who underwent breast-conserving surgery. After wide excision, IOUS and specimen mammography were used to assess adequacy of margins. Further surgery was undertaken when either method showed an inadequate margin. The margins were assessed histologically and correlated with IOUS and mammographic findings. Results: Using IOUS alone, higher rates of histologically tumour-free margins were achieved compared with mammography alone. Combined IOUS and mammography achieved similar or slightly higher rates of histologically tumour-free margins compared with IOUS alone. If the margin measured on IOUS is twice the desired histological margin, this will result in achieving a histologically tumour-free rate of >90%. Associated ductal carcinoma in situ was the only significant factor found to decrease the rate of achieving adequate margins. Conclusion: Intraoperative specimen ultrasonography is useful in predicting histologically tumour-free margins during breast conserving surgery for cancer. [source] Is there a relationship between skin erythema and fatigue in women undergoing irradiation after breast conserving surgery for early breast cancer?ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 4 2009A prospective study Abstract Aim: A prospective study was conducted to determine whether any relationship exits between skin erythema, fatigue and biological factors during and after adjuvant radiotherapy for early breast cancer. Methods: Breast erythema was assessed objectively using reflectance spectrophotometry. Fatigue was recorded utilising the functional assessment of cancer therapy fatigue subscale. A number of potential systemic indicators (biological factors) of the effects of radiotherapy was measured, including circulating cytokines, coagulation factors, peripheral blood indices and biochemistry. Measurements for erythema, fatigue and biological factors were taken at baseline and intervals during and following completion of radiotherapy. Results: A total of 52 eligible patients was included in the analysis. Breast erythema was shown to progressively increase during treatment, peaking on day 36 and returning to baseline by 4 months post-irradiation. Fatigue also progressively increased during treatment, reaching a plateau between day 22 and 2 weeks post-radiotherapy. A statistically significant association was demonstrated between total breast erythema and fatigue at days 4, 8, 22 and 29 of irradiation and 2 and 6 weeks post-radiotherapy. When only the increase in erythema attributable to radiotherapy was considered, statistically significant associations remained for day 4 of irradiation and 2 and 6 weeks post-radiotherapy. When multiple time points were considered together, an association between increased erythema and fatigue was present only post-radiotherapy. No relationship was demonstrated between the biological factors and erythema or fatigue during radiotherapy. Conclusion: This study demonstrates a significant and consistent relationship between radiotherapy-induced breast erythema and fatigue, particularly in the period immediately following breast irradiation. [source] | ||||||||||