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PubMed1975

Mixed tumor of female breast of unusual duration and size.

A 72-year-old black woman presented with huge enlargement of the right breast beginning approximately 30 years earlier and progressively enlarging over the years. The breast was stony hard, painless, and inconvenient only because of size and weight. Simple mastectomy was done and pathologic examination showed a benign mixed tumor with large areas of pseudocartilage, osteoid, and bone formation. Preoperatively the serum calcium was 11.0 mg/100 ml and alkaline phosphatase, 550 mU/ml (SMA-12). Postoperative course was uneventful and within several weeks the alkaline phosphatase fell to a normal range (35-115 mU/ml). The case presented requires little comment other than its unusual nature and duration. Extensive bone formation was undoubtedly responsible for the elevated alkaline phosphatase and, as expected, it returned to normal limits following excision of the tumor. Simple mastectomy is considered the treatment of choice.

Aged↗

PubMed2002

Smoking as a risk factor for wound healing and infection in breast cancer surgery.

AIM: Clinical studies suggest that smoking is associated with wound necrosis after breast cancer surgery. However, the significance of smoking as a risk factor for wound infection, skin flap necrosis, and epidermolysis when adjusting for other potential risk factors remains to be studied. METHODS: From June 1994 through August 1996, 425 patients underwent breast cancer surgery as simple mastectomy, modified radical mastectomy, or breast conserving surgery. The patients were evaluated postoperatively for wound infection, skin flap necrosis, and epidermolysis. Association between these complications and 17 patient, operative, and postoperative variables were analysed by three separate multiple logistic regression analyses. RESULTS: When compared to non-smoking, smoking was significantly associated with wound infection after all types of surgery (light smoking (1-14 grams per day): [odds ratio (OR)=2.95, 95% confidence interval (95% CI)=1.07-8.16], and heavy smoking (>/=15 grams per day): OR=3.46 (1.52-7.85). A similar significant association was found as regards skin flap necrosis and epidermolysis after simple mastectomy and modified radical mastectomy: both light and heavy smoking were predictive for skin flap necrosis: light smoking: OR=6.85 (1.96-23.90), heavy smoking: OR=9.22 (2.91-29.25) and for epidermolysis: light smoking: OR=3.98 (1.52-10.43) and heavy smoking: OR=4.28 (1.81-10.13). No significant dose-response relation was disclosed. Other risk factors and confounders associated with complicated wound healing were adjusted for in the analysis: diabetes, obesity, alcohol, NSAIDs, duration of surgery, and surgical experience. CONCLUSION: Independent of other risk factors, smoking is predictive for post-mastectomy wound infection, skin flap necrosis, and epidermolysis.

Adult↗

PubMed1979

Long-term survival of patients with breast cancer: a study of the curability of the disease.

A retrospective analysis was made of 3878 cases of breast carcinoma first seen in Edinburgh from 1954 to 1964. During this time there was a policy to treat breast cancer by simple mastectomy and x-ray therapy, and over 90% of cases classified as international stages I and II were so treated. The mortality in these women was compared with that in an equivalent normal population using Scottish national age-specific death rates. For every year of follow-up within 20 years of initial treatment there was an excess mortality from all causes. There was an overall excess mortality of 58% among patients with breast cancer 15-20 years after initial treatment, and 20 times more deaths occurred in this period from breast cancer than in a normal population. For patients disease-free after 15 years there was still a 28% excess mortality from all causes. Factors known to be of major prognostic significance for five-year survivorship had less influence than might have been expected when the ratio of observed to expected deaths was considered for longer periods of follow-up. The effect of clinical staging (I, II, or III), though initially marked, largely disappeared by the 10th year of follow-up, and after allowing for age there was no evidence beyond 10 years of an effect on survival of the original stage of the disease. Similarly, the effect of tumour size on survival disappeared after 10 years. Women who were premenopausal at presentation still had a significant excess of deaths in the fourth quinquennium of follow-up. In the menopausal and postmenopausal groups combined there was still a small non-significant excess of deaths from all causes after 15 years but this almost disappeared when patients who had already relapsed were excluded. In terms of overall mortality only patients who have undergone the menopause before presentation and who are disease-free 15 years after primary treatment may prove to be cured by conventional techniques such as simple mastectomy and postoperative radiotherapy.

Adult↗

PubMed1974

Male breast cancer. 6. Factors influencing prognosis.

A series of 257 cases of carcinoma of the male breast in Denmark has been examined with a view to establishing the factors which might influence the prognosis. Observed and corrected 5-year survival rates of 36% and 46% respectively correspond well with the results in other series. Expressed by corrected survival rate, the prognosis appears to be somewhat more favourable during the period 1958-71 than during the period 1943-57. This improvement of prognosis can be related to a significantly better clinical stage of advancement during the latter period. Comparison of the 5-year corrected survival rates in series of male and female breast cancer shows that the prognosis in male breast cancer is not much worse than the prognosis in females. It has been proved that the duration of disease, the clinical stage and the histological degree of malignancy influence the prognosis considerably. The therapeutic results in our series correspond well with the results found in other series. We did not find any evidence to indicate that it would be better to carry out radical mastectomy than to do simple mastectomy since radical mastectomy has not given consistently better results. It is recommended that treatment of this rather uncommon disease be centralized as far as possible.

Age Factors↗

PubMedDate not supplied

The safety and accuracy of sentinel-node biopsy in early-stage invasive breast cancer--Turkish experience.

The purpose of this prospective study was to investigate the correlation of sentinel lymph node (SLN) and axillary lymph node (ALN) metastasis in early-stage invasive breast cancer in a single institution. One hundred and fifteen patients with early-stage invasive breast cancer first underwent SLND followed by an appropriate surgical procedure (modified radical mastectomy, lumpectomy + axillary dissection, simple mastectomy + mammoplasty). In this series, a radioactive agent (technetium) was used to investigate the sentinel lymph node/nodes. In 28 (24.3%) patients, metastases were found in both SLN and axillary dissections. There were no metastases in either of these procedures in 69 (60%) patients. SLN metastasis was found in 13 (11.3%) patients, but no axillary metastasis was found. No skip metastasis was detected. Five patients in whom the sentinel node was not found were also negative for axillary metastasis. As the studies progress in this direction, it might be possible to avoid axillary dissection in patients with early breast cancer in whom metastasis in SLN cannot be detected. We believe this will reduce morbidity from breast cancer surgeries.

Adult↗

PubMed2006

Evidence-based risk factors for seroma formation in breast surgery.

BACKGROUND: Seroma is a common problem in breast surgery. The aim of this systematic review was to identify risk factors for seroma formation. METHODS: Articles published in English were obtained from searches of Medline and additional references were found in the bibliographies of these articles. Risk factors were graded according to the quality and strength of evidence and to the direction of association. RESULTS: One meta-analysis, 51 randomized controlled trials, 7 prospective studies and 7 retrospective studies were identified. There was no risk factor supported by strong evidence, but there was moderate evidence to support a risk for seroma formation in individuals with heavier body weight, extended radical mastectomy as compared with simple mastectomy, and greater drainage volume in the initial 3 days. On the other hand, the following factors did not have a significant influence on seroma formation: duration of drainage; hormone receptor status; immobilization of the shoulder; intensity of negative suction pressure; lymph node status or lymph node positivity; number of drains; number of removed lymph nodes; previous biopsy; removal of drains on the fifth postoperative day versus when daily drainage volume fell to minimal; stage; type of drainage (closed suction versus static drainage); and use of fibrinolysis inhibitor. In contrast, sentinel lymph node biopsy reduced seroma formation. Evidence was weak, or unproven, for other factors that were commonly cited in the literature. CONCLUSIONS: Although a number of factors have been correlated with seroma formation, strong evidence is still scarce. However, there is evidence showing that sentinel lymph node biopsy reduces seroma formation.

Breast Neoplasms↗

PubMedDate not supplied

Pain and sensory dysfunction after breast cancer surgery: neurometer CPT evaluation.

The purpose of our study was to evaluate the presence of anatomical and functional damage to the afferent and sensorial fibres using the Neurometer CPT test. A questionnaire regarding pain was sent to 300 women who had undergone surgery six months earlier. Out of 300 patients 67 did not respond; 105 experienced no pain; while 128 felt pain. One hundred and twenty-eight women were divided into two groups: mastectomy with reconstruction and simple mastectomy. The intensity of pain at T0 in women with reconstruction was significantly higher; at T4, on the other hand, was lesser and there was no significant difference between the two groups. In both groups at T4, the daily diary revealed that interference with sleep and normal daily activities were more evident in patients who had undergone reconstruction (p > 0.001). The final results at T4 demonstrated that among patients with reconstruction, 47% showed slight hypoesthesia-paraesthesia in the breast, armpit and arm zones, 39% slight hypoesthesia in the same locations and 18% severe hypoesthesia. Patients with reconstruction, instead, showed different percentages: 75% showed slight hypoesthesia-paraesthesia, 16% a slight hypoesthesia and 9% severe hypoesthesia. Our results support the utilization of the Neurometer CPT test as a device for monitoring post-mastectomy pain.

Breast Neoplasms↗

PubMed1992

Surgical treatment of ductal carcinoma in situ of the breast. 10- to 20-year follow-up.

Between 1967 and 1977, 36 patients received treatment at the Virginia Mason Medical Center in Seattle, Wash, for ductal carcinoma in situ of the breast. Twenty-five patients had modified radical mastectomies, 10 had radical mastectomies, and one had a simple mastectomy. Twenty-seven patients have been followed up for at least 10 years and are without known recurrence (mean follow-up, 17.7 years; range, 8 to 24 years), eight patients died without known recurrence (mean follow-up, 10.6 years; range, 6 to 14 years), and one patient with a prior contralateral mastectomy for infiltrating cancer of the breast had a recurrence in the scalene nodes on the side of the infiltrating cancer and died of metastatic cancer. No patients with ductal carcinoma in situ had local recurrences in the ipsilateral breast or chest wall, and no patients developed cancers in the contralateral breast; one patient had axillary metastasis. Twenty-eight (78%) of 36 patients had multicentric ductal carcinoma in situ in their mastectomy specimens. Twenty-three (88%) of 26 patients with comedocarcinoma-type ductal carcinoma in situ had multicentric lesions. Conversely, patients with low-grade nuclear papillary ductal carcinoma in situ did not have multicentric lesions. Five (14%) of 36 patients had incidental microinvasion discovered in the mastectomy specimens; all had comedocarcinoma. In summary, our study of patients with ductal carcinoma in situ revealed that (1) mastectomy provided excellent local and systemic control; (2) cancer in the contralateral breast was infrequent; (3) axillary metastasis was rare; and (4) histologic features of tumors markedly affected the frequency of multicentricity and chance for microinvasion.

Breast Neoplasms↗

PubMed1992

[Retrospective studies on the relation between fibrocystic disease and cancer of the breast with therapeutic conclusions].

On the basis of 597 cases of benign and malignant tumoral, respectively dysplastic diseases of the breast, operated at the IInd Surgical Clinic of Tirgu-Mureş during the period 1977-1983, the authors consider the fibrocystic disease (FCD) of the II and III degree as a facultative precancerous lesion. The extremely high frequency of FCD associated to the mammary cancer in young women, as well as of intense epithelial proliferations and intermediate forms, of transition from typical epithelial hyperplasias to the atypical forms observed in some of these cases, is pointed out. The 4 cases (1.94%) of mammary neoplasms which occurred late after a mammary sectorectomy performed for FCD illustrate that the risk of mammary neoplasm in FCD is 7.4 times higher than the mammary cancer rate in women without FCD. In the extensive forms of FCD with marked epithelial proliferations, especially if additional risk factors are also present, the authors recommend a uni- or bilateral subcutaneous mastectomy, a uni- or bilateral simple mastectomy respectively. They deem necessary the setting up, in all departments of general surgery, of an adequate organizational framework for the dispensary care, the hormonal therapy and the control of women with FCD.

Adult↗

PubMed1989

West Midlands Oncology Association trials of adjuvant chemotherapy in operable breast cancer: results after a median follow-up of 7 years. I. Patients with involved axillary lymph nodes.

The aim of this study was to test the effectiveness of a regimen of combination chemotherapy known to be active in advanced breast cancer when given as an adjuvant treatment after mastectomy. A total of 569 patients with cancer of the breast and involvement of axillary lymph nodes were randomised, after simple mastectomy with axillary sampling, to receive either no adjuvant treatment or intravenous adriamycin 50 mg, vincristine 1 mg, cyclophosphamide 250 mg, methotrexate 150 mg and fluorouracil 250 mg (AVCMF) every 21 days for eight cycles. Randomisation was stratified according to menopausal status and tumour size. Treatment was started within 14 days of surgery in 94% of patients. Eighty-eight per cent of patients received at least seven cycles of chemotherapy with no dose reduction. The median relapse-free survival was prolonged by 14 months in patients treated with AVCMF (chi2 1 = 11.7; P = 0.0006). In the premenopausal group this period was 17 months (chi2 1 = 8.8; P = 0.003) compared with 8 months in the post-menopausal group (chi2 1 = 3.3; P = 0.07). Neither overall survival nor survival in these subgroups was significantly influenced by treatment.

Adult↗

PubMed1980

Reconstructive breast surgery following mastectomy and adjunctive radiation therapy.

With modern radiation, surgical therapy, and surgical reconstructive techniques, it is now possible to give adequate treatment for breast cancer and to reconstruct the breast as well, using a silicone implant prosthesis. Twelve mastectomies and reconstructions were performed on 8 patients. Seven of these had pre- or postoperative irradiation to one breast region, and 1 patient received irradiation to both breast areas. The clinical staging of patients with combined irradiation and surgery was Stage I--3 cases; Stage II--4 cases; and Stage III--1 case. Primary surgical procedures consisted of modified radical mastectomy for ten breast lesions and simple mastectomy for two others. Megavoltage radiotherapy was administered with a CO-60 Unit. Pre-operative irradiation of 4000 rads to the breast, chest wall, and regional lymphatics was given to 3 patients. Postoperative radiation therapy of 5000 rads to the chest wall and 4400-5000 rads to the regional lymphatics was given to 5 other patients, one of whom received bilateral irradiation. Adjunctive chemotherapy was employed in 5 patients with interruption during the period of implant surgery. Reconstructive surgery was performed 5 months to 14 months after irradiation in 7 patients and 51/2 years later in one patient. The procedure was a single stage operation with placement of a silicone prosthesis under the pectoralis muscle. No significant morbidity was encountered from radiotherapy, chemotherapy, or from the surgical procedures. Healing of surgical wounds after implantation was uncomplicated. Cosmetic results have been good. All patients are alive and well, 8 months to 6 1/2 years postirradiation and three months to three years post-breast reconstruction. Results to date have been most gratifying.

Adult↗

PubMed1976

Some international differences in treatment and survival in breast cancer.

In a recent study, 5-year survival rates for breast cancer patients in Boston (Massachusetts), Glamorgan (Wales), Slovenia (Yugoslavia) and Tokyo (Japan) were 57.3%, 49.5%, 41.9% and 74.9%, respectively. In this report, data are presented on the types of treatment used in the four areas and on the relationship of differences in treatment practices to the differences in survival rates. Generally, surgically treated patients who also had radiotherapy had lower survival rates than patients in the same area who had similar operations without radiotherapy. In each area, the survival rate was higher for patients who had radical mastectomy than for those who had simple mastectomy. The Japanese patients had the highest survival rate within nearly every treatment and extent-treatment category. Thus, the high survival rate of these patients was not explained by the variables considered. Survival differences between Boston, Glamorgan and Slovenia were largely explained by differences in extent of disease and type of treatment. As the nature of the treatment--survival trends was consistent with the interpretation that treatment tended to be selected according to apparent prognosis, the degree to which treatment customs were determinants of the differences in survival rate among the three areas is uncertain.

Boston↗

PubMed1986

Mucocele-like tumors of the breast.

Ruptured cysts of the breast containing mucinous material may discharge secretions and epithelium into the surrounding tissues. This is a benign, little-known condition analogous to mucocele of the minor salivary glands. The age at diagnosis of six women with mucocele-like lesions (MLL) of the breast averaged 40 years (range, 25-61) and all but one were premenopausal. The lesion caused a mass in five cases. In one it was an incidental finding, and this patient had a separate unrelated nonmucinous intraductal carcinoma treated by mastectomy. One woman was treated by simple mastectomy. Four patients were treated by excision. All have remained well with follow-up of 6-88 months. The histological appearance of MLL of the breast simulates colloid carcinoma and should be considered in the differential diagnosis of such lesions. This is particularly important in young, premenopausal women, among whom colloid carcinoma is very uncommon. The contents of mammary MLL may be difficult to distinguish from colloid carcinoma in an aspiration biopsy.

Adenocarcinoma, Mucinous↗

PubMedDate not supplied

Locally advanced breast cancer in the elderly: curettage mastectomy.

AIMS AND BACKGROUND: Locally advanced breast tumor represents 5-20% of new cases diagnosed every year. The purpose of this study was to report our experience and to compare it with the literature. METHODS: From 1998 to 2003 at the Molinette Hospital in the Turin University Third Division of General Surgery, there were 34 cases of breast cancer in older women (between 70 and 94 years of age), 14 of which (41.18%) were locally advanced breast tumor. We evaluated the type of surgical intervention and anesthesia used, muscular invasion, the presence of receptors positive to estrogens and progesterone, the operative mortality, the percentage of local-regional recurrence, and relapses after a period of time. RESULTS: Among the patients with locally advanced breast tumor, 21.43% (3/14) were at stage IIIA and 78.57% (11/14) at stage IIIB. In 14.29% (2/14) of the cases, Patey's radical mastectomy was performed, in 57.14% (8/14) Halsted's radical mastectomy, and in 28.57% (4/14) a simple mastectomy with the removal of the fascia of the major pectoral muscle. Three (21.43%) patients underwent a second intervention for local-regional disease. None of the patients had distant metastasis in the first 2 years after the operation. Mortality after 2 years was 23.1% (3/13). None of the patients who underwent surgery had adjuvant therapy, usually because it was refused by the patients themselves or their families. All the negative and positive hormone receptor patients received tamoxifen. CONCLUSIONS: Locally advanced breast tumors are frequent in elderly women. In the past, there has been a tendency to surgical under-treatment. As regards locally advanced breast tumor, curettage operations represent the only possibility to improve the quality of life of the elderly. These should be performed after carefully evaluating a series of variables in the general and local condition of the patient, the aggressiveness of the intervention and the life expectancy.

Aged↗

PubMed1990

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

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.

Adult↗

PubMed1979

On the diagnosis and treatment of breast cancer.

Randomized trials comparing surgical treatments of breast cancer show that radical mastectomy offers no greater benefit than simple mastectomy followed by radiotherapy. Furthermore, in terms of survival, radical mastectomy seems to be no better than wide excision followed by radiotherapy when the disease is clinically diagnosed as stage 1. The incidence of diagnosed breast cancer showed an 18% increase between 1935 and 1965 and a 50% increase between 1965 and 1975. However, breast cancer mortality has remained unchanged for at least the past 40 years. Analysis of survival curves of women with breast cancer suggests that two or more populations exist, with about 40% suffering fatal outcome unaffected by treatment. The remaining 60% exhibit a relative mortality only modestly different from that of women of similar ages without evidence of disease. Increasing detection of an entity that is histologically defined as malignant but biologically relatively benign could account for the observed increase in incidence.

Breast Neoplasms↗

PubMed1997

Patient satisfaction with 23-hour "short-stay" observation following breast cancer surgery.

PURPOSE/OBJECTIVES: To determine what problems patients undergoing breast cancer surgery experienced following discharge after participating in a 23-hour short-stay observation program and to explore their perceptions of the short-stay experience. DESIGN: Descriptive and exploratory. SETTING: A comprehensive cancer center in an urban setting. SAMPLE: 52 women undergoing modified radical mastectomy, segmental mastectomy (lumpectomy) with axillary node dissection, simple mastectomy, or other breast procedures. METHODS: Telephone interviews 24-72 hours and 7-10 days after discharge using questionnaires developed by the investigators. MAIN RESEARCH VARIABLES: Postoperative difficulties, satisfaction with pain relief, positive and negative aspects of the short-stay process, and discharge to home. FINDINGS: Most patients had no difficulty with drain and incision care (84%), reported satisfactory analgesic relief with their prescribed medications (> 95%), and were prepared to leave the hospital on first postoperative day (85%). Patient education and care provided by physicians and nurses were highly rated. Although most responses were highly favorable, some women desired longer hospitalization (21%) and greater privacy while on the observation unit (13%). CONCLUSIONS: By coordinating inpatient and outpatient services, short-stay observation following breast cancer surgery can be accomplished in a safe environment that patients perceive to be satisfactory and of high quality. IMPLICATIONS FOR NURSING PRACTICE: Short-stay observation is feasible for appropriately prepared postoperative patients who normally are managed on traditional impatient units.

Activities of Daily Living↗

PubMed1989

West Midlands Oncology Association trials of adjuvant chemotherapy in operable breast cancer: results after a median follow-up of 7 years. II. Patients without involved axillary lymph nodes.

The aim of this study was to test the effectiveness of a regimen of combination chemotherapy when given as an adjuvant treatment after mastectomy to patients with histologically negative axillary lymph nodes. A total of 574 patients with cancer of the breast and no involvement of axillary lymph nodes were randomised, after simple mastectomy with axillary sampling, to receive either no adjuvant treatment or oral fluorouracil 500 mg, methotrexate 25 mg and chlorambucil 10 mg p.o. on day 1 and fluorouracil 500 mg and chlorambucil 10 mg p.o. on day 2 (LMF) every 21 days for eight cycles. Randomisation was stratified according to menopausal status and tumour size. Treatment was started within 14 days of surgery in 97% of patients. Ninety per cent of patients received eight cycles of chemotherapy with no dose reduction. At a median follow-up of 7 years, there was no evidence that relapse-free or overall survival time were influenced by treatment.

Adult↗