Menstrual cycle and breast cancer.
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Breast Neoplasms↗
Biomedical subjects
W L Donegan
Publications and source records attributed to W L Donegan.
Carcinoma of the breast in males: a multiinstitutional survey.
BACKGROUND: Breast carcinoma in males is infrequent, and information regarding the results of modern treatment is limited. Cases of breast carcinoma in males were accrued from multiple hospitals in one region to determine treatment, survival, and prognostic factors. METHODS: A retrospective review was performed of 217 cases of breast carcinoma in males accessioned at tumor registries of 18 health care institutions in eastern Wisconsin between 1953 and 1995. RESULTS: Of the 217 cases, 215 (99.1%) were carcinomas. The majority of carcinomas were of invasive ductal type and presented as masses. Carcinoma in situ accounted for 5.5% of cases. The 5- and 10-year observed survivals for men were 50.6% and 23.7%, respectively. A high rate of post-treatment mortality from comorbid disease was found. Stage, axillary lymph node status, number of lymph nodes with metastases, and tumor hormone receptors were significant indicators of prognosis. Adjuvant systemic chemotherapy and hormone therapy improved the prognosis of patients with axillary lymph node metastases and hormone receptor positive tumors. Earlier stage at presentation and improved 5-year survival were found in cases occurring between 1986-1995 compared with those occurring in earlier years. Use of modified radical mastectomy and systemic adjuvant therapy also increased since 1986. CONCLUSIONS: The clinical, pathologic, and prognostic features of breast carcinoma in men are similar to those reported for women. The poorer prognosis of men is related to older age at diagnosis, more advanced stage of disease at presentation, and high mortality from comorbid disease. Earlier diagnosis, less radical surgery, and use of systemic adjuvant therapy are coincident with an improved prognosis for men.
Adult↗
New screening guidelines for colorectal cancer.
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Colonoscopy↗
Breast cancer in men.
Aside from its much lower frequency, breast cancer in men is remarkably similar to the disease in women. The cause remains equally obscure; the clinical presentation, pathology, and natural history are similar; and men are probably as curable in similar circumstances. Men are generally older and in more advanced stages than women when diagnosed, the tumors are located more often beneath the nipple and are more often responsive to hormonal therapy, but otherwise differences are negligible. Stage and axillary node status are strong prognostic indicators. Modified radical mastectomy has replaced radical mastectomy for surgical treatment of early states, and systemic adjuvant therapy appears to improve the prognosis for cases with involvement of lymph nodes.
Breast Neoplasms↗
Follow-up after treatment for breast cancer: how much is too much?
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Breast Neoplasms↗
Implications of extracapsular nodal metastases for treatment and prognosis of breast cancer.
BACKGROUND: Extracapsular extension of nodal metastases from cancer of the breast is a frequent histologic finding, but its significance for prognosis and treatment is unclear. METHODS: One hundred forty-three patients with breast cancer who had metastases to axillary lymph nodes were identified and divided into two groups: those with entirely intracapsular metastases (ICM), and those with extracapsular metastases (ECM). RESULTS: ECM was found in 58.7% of patients. A direct correlation was found between ECM and both the number of metastases and their size. Overall survival was significantly lower in patients with ECM, but an influence on survival independent of node count could be demonstrated only in patients with one to three involved nodes. ECM did not influence the pattern (i.e., locoregional versus distant) of recurrence and was not associated with increased recurrence in the axilla. Radiation therapy reduced locoregional failures in both ICM and ECM groups, but it did not improve survival. CONCLUSIONS: It is concluded that ECM has limited influence on prognosis independent of the number of positive nodes and is not an indication for radiation therapy of the axilla after a complete axillary dissection.
Breast Neoplasms↗
Prognosis of patients with breast cancer related to the timing of operation.
Whether the timing of mastectomy during the menstrual cycle influences the prognosis of premenopausal women with breast cancer is controversial. We retrospectively reviewed the cases of 97 regularly menstruating women treated for operable stages of breast cancer. At operation, 55 women were in the perimenstrual phase of the menstrual cycle (days 0 through 6 and days 21 through 36) and 42 were in the periovulatory phase (days 7 through 20). No relationship could be identified between the timing of surgical treatment and subsequent recurrence or survival. The timing of biopsy was also not associated with prognosis. We conclude that no delay of surgical treatment for breast cancer need be based on the phase of the menstrual cycle of premenopausal women.
Adult↗
Evaluation of a palpable breast mass.
A palpable mass in a woman's breast represents a potentially serious lesion and requires evaluation by history taking, physical examination, and mammography. The initial objective is to distinguish simple cysts from solid lesions, which can be accomplished with needle aspiration (Fig. 2). A solid lesion requires a firm diagnosis, and this usually calls for removing the lesion for histologic examination. A positive result on cytologic examination after aspiration is sufficiently accurate to justify one-stage diagnosis and treatment, with confirmation by examination of a frozen section obtained during the procedure. A negative or suspicious finding on cytologic evaluation is inconclusive, and outpatient biopsy is indicated. Perfection in diagnosis will require the removal of every solid mass. This can be expected to result in the biopsy of many benign lesions, but removal of many of them is desirable on other grounds. Although in some instances the probability of cancer may be exceedingly small, it is never zero. If biopsy is not recommended, the probability of cancer should be estimated so that the patient can decide whether the level of risk is acceptable to her.
Breast Diseases↗
Prognostic factors. Stage and receptor status in breast cancer.
BACKGROUND: Anatomic and biologic indicators of prognosis provide the bases for management of patients with cancer of the breast. Combinations of these indicators are potentially more accurate than any alone. This review was undertaken to evaluate the prognostic relationship between stage and steroid hormone receptors. METHODS: The literature was reviewed relative to the influences of tumor size, axillary metastases, and tumor estrogen receptors on the survival of patients with cancer of the breast. RESULTS: Axillary node status is of primary importance as a predictor of recurrence and survival. Tumor size has only a secondary influence, but is prognostically useful in the absence of metastases. Estrogen and progesterone receptors provide prognostic information that is independent of axillary stage, but the influence is weak, often transient, and attributable at least partly to a close association with other biologic indicators of favorable prognosis. CONCLUSIONS: Hormone receptors add to the prognostic information provided by anatomic stage, but the contribution is insufficient to support a decision for or against systemic adjuvant therapy.
Breast Neoplasms↗
Recent trends in the management of breast cancer. 1. Carcinoma in situ of the breast.
Because of widespread screening for breast cancer, noninvasive (in-situ) cancer of the breast is diagnosed with increasing frequency. The two variants--lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS)--can be cured with conservation of the breast. The diagnosis of LCIS indicates a high risk for future development of invasive carcinoma in either breast. Bilateral total mastectomy, with reconstruction if desired, is the only method of eliminating this risk, but local excision alone with close observation is acceptable. For DCIS, total mastectomy, with or without low axillary lymph-node dissection, offers near-complete cure. For selected cases, wide local excision, with or without dissection of the low axillary nodes, followed by breast irradiation provides survival rates comparable to those for mastectomy and a low risk of recurrence in the breast. Studies are in progress to determine if breast irradiation after local excision is necessary in all instances.
Breast Neoplasms↗
Recent trends in the management of breast cancer. 3. Controversies in the use of adjuvant chemotherapy, hormonotherapy and radiotherapy for breast cancer.
Systemic adjuvant therapy has become a regular part of the treatment for patients with potentially curable breast cancer. At the same time radiotherapy has declined in popularity as an adjunct to mastectomy and has taken on a new role in breast conservation. Although systemic therapy has improved the prognosis for breast cancer, numerous issues, such as the optimal combination and dosage of drugs, the worth of chemohormonotherapy and the appropriate sequencing of treatment, remain the subjects of continuing investigation.
Aged↗
Patient satisfaction with breast reconstruction.
Thirty-two women were surveyed to assess their satisfaction with breast reconstruction after mastectomy for cancer. Most reconstructions consisted of a submuscular implant, and were performed after an average interval of 11.3 months. The procedures averaged 2.4 per individual, and nearly half of the women reported requiring an operation on the opposite breast to attain symmetry. Despite the fact that 60% of the reconstructions resulted in a complication or complaint, women reported that they felt more balanced and whole and less depressed, and all were glad that they had breast reconstruction.
Adult↗
Gastric cancer after gastric bypass for obesity. Case report.
We describe a patient in whom gastric cancer developed after gastric bypass for morbid obesity. In addition, we review the literature to emphasize the technical problems involved in diagnosing disease in the excluded portion of the stomach.
Adenocarcinoma↗
Combined therapy for inflammatory breast cancer.
The prognosis for patients with inflammatory breast cancer has improved in recent years. This review was undertaken to evaluate current management in three Milwaukee (Wis) hospitals and to identify determinants of prognosis. We identified 25 patients with inflammatory breast carcinoma diagnosed between 1967 and 1987. Most of the patients were treated with combination chemotherapy and radiation therapy, and 10 had mastectomies. The 5-year survival of patients without initial distant metastases was 24%. The 5-year survival of patients who received chemotherapy before local treatment was 40%. Patients who had clinically involved axillary nodes or a palpable mass in the breast had poorer survival than those who did not; the presence of dermal lymphatic invasion had no significant effect on survival. Initial chemotherapy has become an important part of the care of patients with inflammatory breast cancer. It remains uncertain whether mastectomy improves on irradiation in achieving local control or improves survival.
Adult↗
Are we positive about node negative breast cancer?
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Breast Neoplasms↗
An investigation of colon cancer associated with urinary diversion.
The mechanism by which ureterocolic anastomoses promote cancer of the colon is uncertain. To investigate the role of anastomotic healing, rats were exposed to the colon carcinogen azoxymethane after which they had either 1) a sham operation, 2) colotomy with suture, or 3) colovesical anastomosis, performed randomly. The first two groups had an equally low frequency of colon cancers, whereas rats with colovesical fistulas had a significantly higher frequency, and cancers were concentrated at the anastomotic site. It was concluded that prompt healing does not promote cancer in this model. It is probably not responsible for suture-line recurrences seen clinically, nor for the increased frequency of cancer at the site of urinary diversion into the colon.
Adenocarcinoma↗
Changes in estrogen and progesterone receptor content of primary breast carcinoma during the menstrual cycle.
This study was undertaken to determine if hormone receptor activity in breast cancers changes during different phases of the menstrual cycle. Estrogen (ER) and progesterone (PgR) receptors in seventy-eight primary breast carcinomas from premenopausal women were compared with the phase of the menstrual cycle at the time of biopsy. The frequency of ER positivity did not change, but PgR positivity became significantly higher after the early follicular phase. An increase in mean ER and PgR concentration was found (p less than .05) in the late luteal phase. The results indicate that tumor ER and PgR values change during the menstrual cycle, probably in response to endogenous hormonal fluctuations, and this may account for some vicissitudes in establishing hormone dependence.
Adult↗
Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons.
A nationwide survey of the clinical presentation, pathology, and management of soft tissue sarcomas in adults was carried out under the auspices of the Commission on Cancer of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977-1978 (2355 patients) and 645 institutions in 1983-1984 (3457 patients). Pretreatment findings of interest included some evidence of physician delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for Cancer Staging (AJCSS) system, and major reliance on CT for pretreatment patient evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three fourths of the patients. The other one fourth were primarily patients with distant metastasis at the time of diagnosis. Some increase in multimodal therapy did occur in the second period but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCCS system and the value of complete resection of soft tissue sarcomas. Adverse prognostic factors included positive surgical margins, large tumors, retroperitoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. Patients receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting patients for these therapies. Approximately one half of the treatment failures in the 1977-1978 series were locoregional, whereas 18% were limited to lung metastasis. Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year survival rates.
Adult↗