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PubMed2001

The Indian scene.

Breast cancer is the second most common cancer among women in India, after cancer of the cervix uteri. Presently, 75,000 new cases occur in Indian women every year. This figure must be viewed against the backdrop that the national cancer registry and the hospital-based tumor registries hardly sample 3% of the total population. Locally advanced breast cancer constitutes more than 50% to 70% of patients presenting for treatment. The management of the patients varies according to the hospital the patient seeks treatment from. In this vast country, hospitals vary from peripheral hospitals with basic facilities to the specialized institutions in the metropolitan centers with all specialists, medical oncologists, radiation oncologists, surgical oncologists, and supporting facilities. In the peripheral hospitals, the treatment is invariably a radical mastectomy with or without radiotherapy. In the metropolitan areas and in specialized cancer institutions, management mirrors international recommendations with brachiocephalic trunk or modified radical mastectomy, radiation therapy, and chemotherapy.

Adult↗

PubMed1992

Breast cancer surgery: understanding the story.

1. Research has shown that mastectomy, with or without reconstruction, is no more effective in the long run than breast conservation and irradiation. Therefore, the important factor seems to be choice. 2. A Halsted radical mastectomy involves the removal of the whole breast along with the pectoralis major and minor muscles and a complete axillary dissection. A modified radical mastectomy involves removal of the whole breast and most or all of the axillary lymph nodes, but preserves the pectoralis major muscle. 3. Breast preserving strategies remove the malignant cells and minimal surrounding tissue. These segmental resections include lumpectomy, quadranectomy, and wedge resection along with axillary node dissection.

Breast Neoplasms↗

PubMedDate not supplied

Subcutaneous mastectomy with axillary dissection for early breast cancer.

From 1983 to 1990, subcutaneous mastectomy with axillary dissection was carried out for 46 patients with early breast cancer including three bilateral breast cancer patients (four breasts). Cancer cells were recognized histopathologically in the resection margins of small mammary gland resting under the nipple in four cases, and the remaining 42 cases underwent a curative resection. Multicentric lesions were found out histopathologically by continuous sections in five cases (six breasts). There was no difference in the prognosis using the case-control comparison method between 34 patients with ipsilateral invasive carcinoma who underwent a subcutaneous mastectomy in this study group and 34 patients who underwent a radical or modified radical mastectomy in the control group. Cosmetic results of the subcutaneous mastectomy were evaluated in 37 patients, and 9 were excellent, 17 were good, 9 were not so good and 2 were poor. Subcutaneous mastectomy with axillary dissection was an effective operation for early breast cancer including multicentric lesions and some non-invasive ductal carcinomas from the prognostic and cosmetic standpoints.

Adult↗

PubMed1992

Impaired primary antibody responses after vaccination against hepatitis B in patients with breast cancer.

The response to hepatitis B (HBV) vaccination was studied in 32 breast cancer patients who were HBV antigen- and antibody-negative at the time of diagnosis. Ten of the patients included into the study received radical mastectomy without adjuvant therapy, 15 patients underwent breast-conserving surgery with subsequent irradiation with or without tamoxifen treatment, and 7 patients were treated by modified radical mastectomy plus adjuvant chemotherapy. Eight patients received the first dose of vaccine 3 months after irradiation therapy. Seven patients were first vaccinated 6 months following irradiation therapy. Seven healthy age-matched persons were vaccinated as controls. Antibody response in the patients was significantly delayed. Four weeks after the second vaccination 6 out of 7 controls showed a significant (> 10 IU/ml) HBs antibody titer, while only 6 out of 32 patients responded. In addition, HBs antibody titers were also significantly lower after the second vaccination even in those patients treated with surgery alone, although they were first vaccinated 3 months after surgery and had no residual tumors. This difference disappeared after the second booster immunization, at which time the frequency of significant antibody titers and the levels of HBs antibody titers were comparable between patients and controls. As the population of patients undergoing treatment for breast cancer is increasing, additional studies are needed to determine optimal immunization regimens in this group of patients.

Adult↗

PubMed1982

Chemotherapy before and after mastectomy in stage III breast cancer.

Seventeen patients with stage III breast cancer were treated by modified radical mastectomy preceded and followed by multiagent cytotoxic chemotherapy. The preoperative treatment resulted in a decrease in size of the primary tumor, facilitating the subsequent surgical procedure. There were no serious surgical complications. Wound healing was uneventful. Median disease-free survival time was 29 months and median survival time was 40+ months. Six of the 17 patients are living free of recurrence from more than 33 to more than 79 months after initial therapy.

Adult↗

PubMed2000

Comparison of two radiation dose schedules in post mastectomy carcinoma of the breast.

In 108 histopathologically proved breast cancer patients, after surgical treatment with modified radical mastectomy, two radiation dose schedules have been compared. Radiation therapy was given on a 60Co teletherapy machine using gent pair technique for chest wall irradiation and direct fields for lymphatic drainage areas. The patients were randomly divided into two groups (Group A and Group B). 54 patients were given external radiotherapy 40 Gy/17 F/3.2 weeks and remaining 54 patients were given 45 Gy/20 F/4 weeks. Results of treatment in Group A versus Group B were as follows; chest wall failure 5/50(10%) versus 3/54 (5.6%), axillary lymphnods failure 3/50(6%) versus 4/54(7%), distant metastasis 16/50(32%) versus 15/54(28%). Radiation reactions were almost similar in both the groups. Skin reactions were most common radiation effects [45/50 (90%) in Group A and 43/54 (79.6% in Group B]. Thus no statistically significant difference in local control and efficacy of these two radiation dose schedules was observed in postmastectomy carcinoma of the breast.

Adult↗

PubMed1989

[Clinical significance of measurement of nuclear DNA content in breast cancer].

Nuclear DNA content measured by a cytofluorometric method was investigated to evaluate its clinical significance in 73 cases with breast cancer which had extended radical mastectomy. Many cases of D type (diploid type) which had a prominent peak at the 2c region (control DNA content of lymphocytes) were safe indications for modified radical mastectomy. Bone recurrence was significantly more frequent in D type than in N type (non-diploid type) which did not have a prominent peak at the 2c region. Because D type had high positive rate of hormone receptors, endocrine therapy might be effective for many cases. Local or lung recurrence was more common in cases with N type which had a significant low cumulative survival rate compared with D type and especially N type 4c-3 of which over 4c cells more than 30% had the poorest prognosis. Therefore, multidisciplinary treatment composed of extended operation, radiation and chemotherapy was necessary to improve the prognosis of breast cancer patients with N type 4c-3. It was concluded that the measurement of nuclear DNA content in breast cancer might be useful for decision of therapy suitable for each case based on malignancy grading.

Breast Neoplasms↗

PubMed1976

[Clinical problems of the breast carcinoma in situ].

A report of carcinoma in situ of the breast, including problems of diagnosis and treatment. Over a 6-year period cut of a total of 743 carcinomas of the breast, 77 carcinomas in situ were observed. The difficulties of diagnosis are reviewed. Treatment consisted of simple mastectomy. In view of the inadequate therapeutic results it is recommended that a modified radical mastectomy should also be done in all cases of carcinoma in situ of the breast. The pros and cons of postoperative radiation are discussed.

Adolescent↗

PubMed1984

Surgical management of locally advanced and recurrent breast cancer.

Considerations for surgical treatment of locoregional recurrences of breast cancer are particularly relevant at a time when many primary breast malignancies are being treated in a more conservative manner. The past experience with local recurrence after radical mastectomy was dismal: every patient with recurrence eventually developed systemic disease. Over 80% of such patients died within 2 years. The observations after local recurrence in patients with modified radical mastectomy are generally the same, although those with better prognostic lesions may have a marked delay in mortality. For patients with partial mastectomy and radiation, there are data which suggest that subsequent mastectomy for "in breast" recurrence may salvage approximately 50% of women and achieve long-term freedom from disease. This is a crucial question which will require more patients and time for confirmation. The author reviews patterns of locoregional recurrence after primary treatment of breast cancer, presents a plan for workup of such patients, and describes prognostic factors. The various treatment options, with their results, are discussed, and their dependency on the initial therapy is stressed. For patients with advanced Stage III primary breast cancer (T4 or N2, N3 lesions) and inflammatory carcinoma, a multimodal approach is proposed, with systemic multidrug chemotherapy as the initial treatment. The interlocking roles of surgical resection of the breast and radiation therapy must be considered, depending on the response to chemotherapy. Algorithms for therapy have been constructed to demonstrate the options.

Antineoplastic Agents↗

PubMed1996

Pain after breast surgery: a survey of 282 women.

Breast surgery is a common procedure performed in women. Many women who undergo breast surgery suffer from ill-defined pain syndromes. Although there exists a few reports on the incidence of post mastectomy pain, there are no published reports on chronic pain after breast reconstruction. This investigation attempts to characterize the pain after four types of breast surgery: (1) mastectomy, (2) mastectomy with reconstruction, (3) cosmetic augmentation, and (4) breast reduction. A questionnaire was mailed to 479 women who underwent breast surgery at the University of California, San Diego Medical Center between January 1988 and December 1992. A second mailing was sent to women who did not respond to the first mailing. Women were divided into four groups; mastectomy, mastectomy with reconstruction, cosmetic augmentation, and breast reduction. In the mastectomy and mastectomy with reconstruction groups, only women who had a lumpectomy with axillary dissection, a modified radical mastectomy, or a radical mastectomy were used in the study. 59% of the women responded. The incidence of pain occurring at least one year after surgery in the mastectomy + reconstruction group (49%) was significantly higher than the mastectomy (31%) and breast reduction (22%) groups. Thirty-eight percent of the women with breast augmentation complained of pain. Women who had reconstruction using breast implants had a higher incidence of pain (53%) than those without (30%). The pain incidence in women who had reconstruction without implants was identical to women who had a mastectomy without reconstruction. There was no relationship between the use of silicone or saline implants and pain (22% and 33% respectively). However, the submuscular placement of the implants resulted in a significantly higher incidence of pain (50%) than the subglandular placement (21%). Of the women that reported pain, arm pain was significantly higher in the mastectomy and mastectomy + reconstruction group (56% and 42%, respectively) as compared to the breast reduction group (0%). Most patients reported intermittent pain in all groups. Of the women that reported pain, the mastectomy and mastectomy + reconstruction group had higher pain related to movement (41% and 42%, respectively) than the augmentation and breast reduction groups (15% and 9%, respectively). The peak pain intensity was significantly higher in the augmentation group as compared to the mastectomy group. Our incidence of post mastectomy pain is higher than most reports. The incidence of breast pain is highest in the mastectomy + reconstruction and augmentation groups which is assumed to be secondary to breast implants. Every effort should be made to achieve the best cosmetic result in breast reconstruction which in many cases justifies the use of breast implants. However, these women should be counseled on the possibility of developing chronic pain.

Adult↗

PubMed2005

Staged sentinel lymph node biopsy before mastectomy facilitates surgical planning for breast cancer patients.

BACKGROUND: In patients with breast cancer who choose mastectomy with immediate reconstruction, the sentinel lymph node (SLN) status on permanent histology may complicate treatment if a metastasis is found. The purpose of this study was to determine how performing an SLN biopsy (SLNB) before the definitive operation would influence subsequent surgical procedures. METHODS: Our SLN database was searched for patients who underwent staged SLNB with subsequent mastectomy between 2001 and 2004. RESULTS: Twenty-five patients with 27 breast cancers underwent SLNB before mastectomy. Of them, 9 of 27 (33%) were node positive. All 9 patients underwent modified radical mastectomy. Three node-positive patients did not undergo immediate reconstruction. Of the remaining 6 node-positive patients, 5 underwent reconstruction with autologous tissue rather than a tissue expander. In contrast, 6 of 16 (37%) node-negative patients underwent reconstruction with a tissue expander. CONCLUSIONS: Staged SLNB assists in selecting the appropriate operation in patients who are considering immediate reconstruction.

Adult↗

PubMed1984

Contemporary options in the operative treatment of breast cancer.

The past decade has witnessed many changes in the basic concepts and understanding of breast cancer. The classic radical mastectomy, which prevailed for almost 100 years, has given way to a less aggressive surgical approach that aims to provide a better quality of life without compromising survival. Modified radical mastectomy, simple mastectomy, and breast-conserving local excision are discussed.

Adult↗

PubMed2004

Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma.

BACKGROUND: Among middle-aged and older women with early breast carcinoma, breast-conserving therapy (BCT) has been shown to have an effect on survival that is similar to that of modified radical mastectomy (RM). Nonetheless, it remains to be established whether BCT also is the optimal treatment option for early breast carcinoma in young women, because these women generally have more aggressive disease and a higher frequency of local recurrence compared with older women. METHODS: We investigated a cohort of 9285 premenopausal women with primary breast carcinoma who were age < 50 years at diagnosis. These women were identified from a population-based Danish breast carcinoma database containing detailed information on patient and tumor characteristics, predetermined treatment regimens, and survival. RESULTS: In total, 7165 patients (77.2%) were treated with RM, and 2120 patients (22.8%) were treated with BCT. We calculated the relative risk of death within the first 10 years after diagnosis according to surgical treatment and age, both before and after adjustment for known prognostic factors. No increased risk of death was observed among women who received BCT compared with women who underwent RM, regardless of age at diagnosis (< 35 years, 35-39 years, 40-44 years, or 45-49 years), despite the increased risk of local recurrence among young women. Restricting the analysis to women with small tumors (size < 2 cm) yielded similar results. CONCLUSIONS: Despite having a higher rate of local recurrence, young women with breast carcinoma who receive BCT are similar to young women treated with RM in terms of survival.

Adult↗

PubMed1978

Breast reconstruction following radical mastectomy, using custom designed implants.

Procedures are described for total breast reconstruction in patients who have undergone radical and modified radical mastectomies. The reconstruction includes restoration of the contour of the breast, including the nipple-areola complex and filling the defect from loss of the pectoral muscles. The reconstructions have been done in 37 patients with good results, and several are illustrated.

Adult↗

PubMed1977

Recurrent operable breast cancer following incomplete mastectomy.

Forty patients have been treated with recurrent operable breast cancer after having undergone procedures less extensive than modified radical mastectomy as a treatment of the primary, with or without radiation therapy. Initial pathology was invasive cancer in 21 patients, and treatment (excision or simple mastectomy, with or without radiation therapy) has been offered as the treatment of choice. Completion of radical mastectomy was done here in 30 patients, extended radical mastectomy in 3, and local excision in 7. Eleven received postoperative radiation therapy. The overall 5-year survival rate from the time of treatment, free of disease, was 40 per cent, and the 10-year survival rate was 20 per cent. If initial treatment included radiation therapy, survival was improved (12/25 vs 4/15 having no radiation therapy). Axillary nodal involvement was extensive, with 13 patients having positive level III nodes. Such patients should be followed closely in order to detect recurrence earlier. Adjuvant radiation therapy and chemotherapy trials post mastectomy should be evaluated in the hope of improving survival.

Adult↗

PubMed2002

An evaluation of resident training in breast procedures.

BACKGROUND: The purpose of this study was to determine if senior residents are participating in advanced level breast cases. METHODS: A retrospective review of 1,583 breast procedures on 1,213 patients over 2 years was performed. Each case was evaluated for the type of case: (1) junior level (PGY 1 and 2)--core needle biopsy, fine needle aspirate, excisional biopsy, needle localized biopsy, lumpectomy, partial mastectomy, and simple mastectomy; and (2) senior level--stereotactic breast biopsy, sentinel lymph node biopsy, axillary dissection, and modified radical mastectomy. All cases were reviewed for level of resident involved. RESULTS: Overall, seniors performed 31% of the cases, junior residents performed 42%, and 27% were unattended by any resident. Senior level breast cases were specifically examined to compare whether a senior or junior was present. Overall, 891 defined senior cases were performed. A senior level resident attended 34% of these, leaving 66% covered by junior residents or uncovered altogether. CONCLUSIONS: It is clear when evaluating breast procedures that senior residents are less involved than junior residents. Furthermore, the fact that many of the reported cases (28%) and, more significantly, senior level cases (26%) have no resident involved leads us to conclude that senior level residents are not taking advantage of the opportunity to gain experience in performing advanced level breast procedures in our surgical program.

Breast↗

PubMed1978

Histopathologic study of subcutaneous mastectomy specimens from patients with carcinoma of the contralateral breast.

Fifty subcutaneous mastectomy specimens, each of which were removed from a patient who had previously undergone radical or modified radical mastectomy of the contralateral breast for carcinoma, were age and date matched to a control group of patients with which carcinoma was not associated. The patients were evaluated with regard to specific types of epithelial proliferative lesions and other entities of fibrocystic disease without knowledge of their group membership. The results included a statistically significant dominance of certain epithelial hyperplasias in the study population and a lack of statistical significance in intergroup difference of some previously suspected lesions, such as sclerosing adenosis and gross cystic disease. It is concluded that the recognition of those forms of epitheliosis associated with carcinoma may help in the management of patients at high clinical risk for carcinoma of the breast.

Adult↗

PubMed1982

[Changing patterns in surgery of breast cancer].

The ideal surgical procedure for the treatment of breast cancer has been a matter of controversy. Halsted radical mastectomy has been the treatment of choice, at the cancer institute hospital, in the management of breast cancer. Over the past five years, there has been a definite trend toward modified radical mastectomy preserving the pectoral muscles in the treatment of patients with early breast cancer. From 1975 to 1890 we treated 755 breasts with radical mastectomy, 723 with Patey's operation, 373 with Auchincloss operation and 58 with extended mastectomy. Extended mastectomy has been gradually abandoned.

Breast Neoplasms↗