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Biomedical subjects

D J Marchant

Publications and source records attributed to D J Marchant.

At least 19 recordsLinked to original sources
PubMed1994

Breast conservation in elderly women for clinically negative axillary lymph nodes without axillary dissection.

BACKGROUND: A prospective study was initiated to explore an approach of limited therapy in elderly patients with early clinical stage breast cancer. METHODS: Between 1982 and 1989, 73 women with American Joint Committee on Cancer Stage I/II, clinically negative axillary lymph nodes aged 65 years or older (median age, 74 years) were enrolled in a treatment program consisting of tumor excision, breast and regional lymph node irradiation, and, in 66 patients, tamoxifen. Patients were assessed for disease outcome and complications. RESULTS: At a median follow-up of 54 months, 8-year rates of local and regional lymph node control were 92.5% and 100%, respectively. Eight-year probabilities of disease free, overall, and breast cancer specific survival were 84%, 52.5%, and 93.8%, respectively. There was minimal morbidity associated with either regional irradiation or tamoxifen. CONCLUSIONS: An approach to early breast cancer in the elderly that seeks to limit the aggressiveness of local and systemic therapies appears to result in a satisfactory disease outcome with few complications.

Age Factors↗
PubMed1994

Supplemental estrogen replacement.

In the current aging society, more than 30 million women have an average postmenopausal life expectancy of 28 years. Coronary heart disease is the leading cause of death in older women, and osteoporosis results in an estimated 1.5 million fractures per year. Various studies have suggested that postmenopausal estrogen-replacement therapy could reduce the morbidity and mortality associated with these conditions. Given the uncertainty about hormone interactions and the molecular genetics of breast cancer, it seems unwise to inject yet another element into the prognostic equation, and currently it is not recommended that estrogen-replacement therapy be used routinely in patients who have been treated successfully for breast cancer. The final decision, of course, rests with the patient and her treating physicians and is subject to medical/legal interpretation.

Breast Neoplasms↗
PubMed1994

Breast cancer in pregnancy.

The traditional view that breast cancer during pregnancy is associated with poor prognosis is no longer tenable. The reported poor prognosis usually is the result of late stage of presentation. It is important for physicians to consider breast cancer in the differential diagnosis of a breast problem discovered during pregnancy. When patients are separated into similar stage at presentation with positive or negative lymph nodes, the 5- and 10-year rates of survival for pregnancy-associated or nonpregnancy-associated breast cancer are identical. The breasts should be carefully examined at least during the first prenatal visit and thereafter if signs and symptoms appear. Operable disease in the first and second trimesters should be treated by modified radical mastectomy, and chemotherapy should be considered if indicated during the second and third trimesters. Breast-conservation treatment presents special problems, and the risks and benefits should be discussed with the patient. There is no evidence that termination of pregnancy improves survival.

Breast Neoplasms↗
PubMed1994

The efficacy of specimen radiography in evaluating the surgical margins of impalpable breast carcinoma.

OBJECTIVE: The purpose of this study was to determine if the presence or absence of tumor at the surgical margin in cases of impalpable breast carcinoma could be predicted accurately with specimen radiography. MATERIALS AND METHODS: We obtained single-view radiographs of 119 consecutive surgical biopsy specimens of impalpable invasive or in situ ductal carcinoma. Radiographic lesions were classified as a mass with moderately well defined margins, a mass with poorly defined margins, or microcalcifications without an associated mass. The radiographic appearance of the impalpable cancer, the margin as judged from the specimen radiograph, the tumor's histologic appearance, and the histologic appearance of the tumor margin were then correlated. RESULTS: Specimen radiographs showed tumor at the surgical margin in 63 cases; 62 of these were confirmed histologically (positive predictive value, 98%). Specimen radiographs showed tumor-free surgical margins in 56 cases; 18 of these were confirmed histologically (negative predictive value, 32%). These results were independent of the radiographic appearance of the lesion or the tumor's histologic appearance. CONCLUSION: Decisions based on findings on specimen radiographs were valid only if the radiographs showed tumor at the margin of the specimen.

Biopsy↗
PubMed1994

Contemporary management of breast cancer.

The diagnosis and treatment of breast cancer have changed dramatically during the past two decades. The most important risk factor for breast cancer is advancing age; however, 80% of women with breast cancer have none of the currently identified risk factors. It is undeniable that early detection and treatment of breast cancer reduces morbidity and mortality, and mammography screening is the only method available to detect cancer at the earliest stage when it is most likely to be cured. Although a number of organizations have recommended breast conservation therapy (BCT) as the preferred treatment for early stage breast cancer, marked geographic variations in treatment occur. It is suggested that appropriate education programs be developed for physicians and women to increase familiarity with the selection criteria for BCT and to encourage objective discussions of the treatment options during the patient and physician encounter.

Adult↗
PubMed1994

Risk factors.

Risk factors for breast cancer whose modification would be culturally acceptable have not been established. Nearly all women in the United States are at a substantial risk for the development of breast cancer. The majority of women, however, in whom breast cancer will be diagnosed will live out their lives without recurrence of the disease. Newer strategies include prevention and the development of effective chemopreventive programs. Phase III clinical trials are underway to assess the value of retinoids and tamoxifen. Phase I and II studies are underway to assess the potential of more specific treatments to inhibit growth factors important in maintaining the malignant phenotype. Obviously, more studies are needed to address this major public health problem.

Adult↗
PubMed1994

Making the diagnosis.

Dramatic changes have occurred in the approach to the diagnosis of breast cancer. Increased screening has resulted in the diagnosis of occult lesions, many of which represent tumors that are not invasive, and smaller invasive cancers. It is now generally accepted that the diagnosis and treatment of breast cancer requires a multidisciplinary approach and that open biopsy not only provides the histologic diagnosis but also may represent definitive surgical treatment. Thus, diagnostic studies should represent the optimal approach to establishing the histology of the lesion without compromising later definitive treatment.

Biopsy↗
PubMed1994

Invasive breast cancer. Surgical treatment alternatives.

It is now widely accepted that cancer of the breast is a systemic disease and that some patients will not be cured even with the most extensive local treatment. This acceptance has resulted in a more conservative approach and participation of the patient in treatment planning. A number of factors influence the definitive surgical treatment for breast cancer. Important considerations include the size and histology of the lesion, the skill and experience of the multidisciplinary team, and the wishes of the patient.

Axilla↗
PubMed1994

Role of the obstetrician/gynecologist in the management of breast disease.

The obstetrician/gynecologist is the primary physician to women. The breast is an organ of reproduction, and complete breast examination is part of the obstetric and gynecologic examination. In addition to history and physical examination, the obstetrician/gynecologist should be prepared to undertake simple diagnostic studies. Cancer, on the other hand, presents a number of challenges. The appropriate role for the obstetrician/gynecologist is one of surveillance and as a resource for patients, including the discussion of risk factors and treatment alternatives.

Biopsy, Needle↗
PubMed1993

Breast conservation therapy for early stage breast carcinoma with outstanding 10-year locoregional control rates: a case for aggressive therapy to the tumor bearing quadrant.

PURPOSE: Between 1982 and 1988 233 American Joint Committee on Cancer Stage I and II invasive breast carcinomas were prospectively treated in 225 women with conservative tumor excision, careful assessment of histopathological margins, and dose-adjusted irradiation to maximum doses of 70 Gy to the tumor bearing quadrant of the breast. METHODS AND MATERIALS: The pathological stages at presentation were T1N0 and T1N1 in 57% and 13% and T2N0 and T2N1 in 19% and 10% of the patients, respectively. All patients were irradiated according to a policy that, beyond the 50 Gy to the whole breast and draining lymphatics, the tumor-bearing quadrant was boosted in adjustment to the histopathological margin. Normal tissue margins of < 2 mm were considered positive, margins 2-5 mm close, and margins > 5 mm negative and were boosted with 20, 15, and 10 Gy, respectively. Patients in whom the margin could not be assessed were re-excised or boosted to 20 Gy. Re-excisions with no residual carcinoma were not boosted. Most patients boosted to 20 Gy to the tumor-bearing quadrant received interstitial 192-Ir implantations. RESULTS: The actuarial local control rates in the treated breast were 97.5% at 10 years with three recurrences having occurred at a median of 4.5 years after completion of radiotherapy. An additional two patients failed regionally outside the irradiation portals. The overall and disease-free survival of the whole group is 87.5% and 77%, respectively. CONCLUSION: The approach to breast conservation therapy followed in this study has resulted in outstanding local control rates and suggests that there may be a subset of patients that could be irradiated to the tumor bearing quadrant only.

Adult↗
PubMed1993

Estrogen-replacement therapy after breast cancer. Risks versus benefits.

In the current aging society, more than 30 million women have an average postmenopausal life expectancy of 28 years. Coronary heart disease is the leading cause of death in older women, and osteoporosis results in an estimated 1.5 million fractures per year. Various studies have suggested that postmenopausal estrogen-replacement therapy could reduce the morbidity and mortality associated with these conditions. Based on the results of several "natural experiments," it was proposed that estrogen-replacement therapy should be considered for menopausal women who have been treated successfully for breast cancer. The benefits and risks of estrogen-replacement therapy are reviewed, and recommendations for management and future research are suggested.

Adult↗
PubMed1993

Breast cancer. Challenge and responsibility.

The diagnosis and treatment of breast cancer has changed dramatically during the last quarter century, a fact perhaps not fully appreciated by many primary care physicians. Breast cancer presents a number of challenges for the obstetrician/gynecologist. The disease is common and the mortality rate is second only to lung cancer. The appropriate role for the obstetrician/gynecologist is one of surveillance, including taking a history and physical examination and selected diagnostic studies, and as a resource for patients, including a discussion of risk factors and treatment alternatives. Because of the increasing involvement of obstetrics and gynecology in molecular genetics and hormone interactions, basic research in genetic alterations and hormonal therapy directed toward decreasing morbidity from cardiovascular disease and osteoporosis is recommended.

Adolescent↗
PubMed1993

Diagnosis of breast disease and the role of the gynecologist.

The American Board of Obstetrics and Gynecology has recognized the special role of the obstetrician/gynecologist in the diagnosis and treatment of breast disease and indicated in 1985 that it would require a knowledge of breast disease in its certification process. It was also recommended that the obstetrician/gynecologist provide adequate information concerning screening and perform simple diagnostic studies including aspiration of cysts, fine-needle aspiration, and appropriate follow-up studies for patients treated for breast cancer. Because open biopsy often becomes part of the treatment for breast cancer, the Board stopped short of recommending that every obstetrician/gynecologist perform this procedure. The American College of Obstetricians and Gynecologists also has increased its efforts to more clearly define the role of the obstetrician/gynecologist in the diagnosis and treatment of breast disease. Questions have been raised concerning the lack of national standards to evaluate training in the diagnosis of breast disease surgery, and the College has convened a number of workshops to address these issues. This review discusses the issues raised both by the Board and the College. Diagnostic studies including simple procedures such as aspiration of cysts, fine-needle aspiration, and open biopsy are discussed. The role of the obstetrician/gynecologist in the screening examination is emphasized.

Biopsy, Needle↗
PubMed1992

Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma.

PURPOSE: The study was undertaken to assess the relationship among cosmesis and complications to factors related to disease presentation, surgical and radiotherapeutic technique, and adjuvant systemic therapy in conservative treatment for early-stage breast carcinoma. PATIENTS AND METHODS: Between 1982 and 1988, 234 women with stage I/II breast carcinoma were treated with conservation therapy by a highly standardized protocol of limited excision and radiotherapy. Radiation boost and/or reexcision were determined by careful quantitation of the normal tissue margin around the primary tumor. Boosts to 20 Gy were preferentially performed with interstitial iridium-192 (192Ir) implants. Axillary node dissections were performed in all patients aged less than 70 years. Adjuvant therapy consisted of cyclophosphamide, methotrexate, (doxorubicin), and fluorouracil (CM[A]F) six to eight times for node-positive premenopausal women and tamoxifen for node-positive or -negative postmenopausal women. Median follow-up was 50 months (range, 20 to 80 months). Cosmesis was graded by defined criteria, and complications were individually scored. RESULTS: Factors found to impact cosmesis adversely were palpable tumors (P = .046), volume of breast tissue resected (P = .027), reexcision of the tumor bed (P = .01), number of radiation fields (P = .03), radiation boost (P = .01), and chest wall separation (P = .01). There was a trend toward worse cosmesis (P = .062) in patients receiving tamoxifen. Cosmesis was not adversely affected by interstitial implant in spite of a higher prescribed dose. Factors influencing complication risk were axillary node dissection (P = .02), number of lymph nodes harvested (P = .05), and chemotherapy (P = .03). CONCLUSIONS: Optimal cosmesis and minimal complication risk require careful attention to the technical details of surgery and radiotherapy. The impact of systemic therapies needs to be more thoroughly examined.

Adult↗
PubMed1991

Utilization of screening mammography--1990.

Although much has been accomplished in the last few years toward the early detection of breast cancer, we are far from a goal of universal acceptance of the recommended preventive health program of screening mammography. To take an analogy from the Papanicolaou smear, we are somewhere in the 1960s. Both women and physicians have more to learn, and they need to transfer that knowledge into practice.

Adult↗