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PubMed1989

The Cancer Research Campaign trials of adjuvant therapy for early breast cancer.

It is now assumed that for many women there has already been dissemination of tumour at the time of diagnosis of their early breast cancer. Systemic treatment is required if a cure is sought. The use of perioperative cyclophosphamide and long-term tamoxifen, either as single agents or in combination, has been investigated in the Cancer Research Campaign Breast Adjuvant Trial. A total of 2,230 women were recruited to the study. A benefit has been seen for both agents. The implications of these results for the current treatment of women with early breast cancer and for the design of future trials are discussed.

Aged↗
PubMed1996

Primary invasive breast carcinoma in Oslo 1980-1989. Incidence and delay.

A retrospective review was performed on 2704 consecutive patients in Oslo in whom histologically or cytologically confirmed primary invasive breast carcinoma had been diagnosed between 1980 and 1989. The age-adjusted incidence rates were significantly higher in the city of Oslo compared with those of the whole country and remained unchanged during the study period. The percentage of patients who could be treated radically remained unchanged. Among the patients with radical treatment the distribution of pT category and stage was similar during the first and last years. The median delay (from onset of symptoms to start of treatment) of two months remained unchanged during the decade and was not related to patient's age, histological grade or tumour localization in the quadrants of the breast. With increasing duration of delay the number of patients not suitable for radical treatment increased. When considering all 2704 patients, the radicality of treatment, the patient's age and delay were correlated with tumour-specific survival and remained independent factors of tumour-specific survival in the multivariate analysis. The unchanged distribution of pT category and stage in the radically treated patients during the decade surveyed is most probably related to the lack of screening mammography in Norway.

Adult↗
PubMed1994

Chemotherapy for angiosarcoma of the breast: case report of 30-year survival and analysis of the literature.

Angiosarcoma of the breast is a rare and highly malignant neoplasm with few long-term survivors. Little is known about the effects of chemotherapy for patients with disseminated disease or its role in the adjuvant setting. We report the case of a patient with metastatic angiosarcoma of the breast who achieved a long-term clinical and pathological remission after treatment with methotrexate. The 30-year course of her disease is the longest reported survival with documented metastatic angiosarcoma of the breast. Analysis of the role of chemotherapy in the adjuvant setting and its effects in relation to histological subtype is undertaken. Adjuvant chemotherapy for patients with poorly differentiated angiosarcoma of the breast results in a higher proportion of patients relapse-free (29.2%) compared to patients not receiving adjuvant chemotherapy (4.4%) (p < 0.05). Patients with well-differentiated tumors do not appear to derive benefit from adjuvant chemotherapy. The effects for patients with disseminated disease are reported.

Adult↗
PubMedDate not supplied

Breast metastasis in adolescents with alveolar rhabdomyosarcoma of the extremities: report of two cases.

We describe two adolescent girls with alveolar rhabdomyosarcoma arising from extremities who developed bilateral breast metastasis in their clinical course. In both cases, there was widespread systemic disease at initial presentation. Although complete remission was achieved on the 25th week post-chemotherapy initiation, the first patient developed breast metastasis in addition to systemic recurrence on the 44th week and expired. For the second patient, breast metastasis was noted in addition to systemic disease at initial presentation. Aggressive chemotherapy with autologous transplant and radiotherapy were given in addition to bilateral subcutaneous total mastectomy. The patient remained in complete remission 3 months post-therapy. We postulate that adolescent females with alveolar rhabdomyosarcoma of the extremities have a high risk of developing breast metastasis in the pubertal period, and aggressive multidisciplinary treatment is indicated.

Adolescent↗
PubMed1990

Management of primary, operable breast cancer in Victoria.

The study aimed to describe the surgical treatment in cases of primary, operable breast cancer in Victoria. All patients who were entered in a population-based cancer registry and who met the entry criteria over a six-month period were identified. In respect of each patient, the treating surgeon completed a questionnaire about patient characteristics, investigations, tumour description, surgery, radiotherapy and chemotherapy. For 716 eligible cases, 635 (89%) questionnaires were returned by 200 treating surgeons; this gave a mean rate of 6.3 breast-cancer patients per surgeon per year. Most (61%) surgeons treated one to four breast-cancer patients per year and only 4% of surgeons treated more than 20 breast-cancer patients each. Little systematic difference was found in the treatment approach that was adopted by the surgeons with heavy or light case-loads of patients with breast cancer. Twenty-two per cent of patients underwent breast-conserving operations. Virtually all the remainder underwent mastectomy, most commonly modified radical mastectomy.

Adult↗
PubMedDate not supplied

[Therapy of breast carcinoma in elderly women].

PURPOSE: To present an approach to the treatment of primary and metastatic breast cancer in the elderly. DESIGN: A large number of studies in elderly women with breast cancer have been reviewed. RESULTS: The studies reviewed demonstrate that the annual incidence of breast cancer increases with age, along with a longer life expectancy. Biennial mammography and annual physical examination are effective, but compliance with screening recommendations decreases with age. Most treatment decisions are based on studies that seldom include women over 65 years of age. With the exception of specific comorbid conditions that preclude anesthesia and surgery, older women tolerate breast surgery as well as younger women. Tamoxifen is the usual adjuvant systemic therapy given to older women. Metastatic breast cancer older women, in generally good condition, tolerate standard doses of chemotherapy as well as their younger counterparts. CONCLUSIONS: Future research should include clinical trials designed specifically for the elderly taking into account functional status and quality of life.

Adult↗
PubMed1999

A sociodemographic and economic comparison of breast reconstruction, mastectomy, and conservative surgery.

BACKGROUND: There are a variety of surgical choices for women with early-stage breast cancer, including breast-conserving surgery, mastectomy, or mastectomy plus reconstructive surgery. This report examines some of the factors that affect these choices and the costs of the various treatment options. METHODS: Data from the Virginia Cancer Registry were linked to insurance claims from the Trigon Blue Cross and Blue Shield Company for women with local and regional staged breast cancer from 1989 to 1991 in Virginia. Multivariate analyses and cost studies were performed. RESULTS: There were 592 women who underwent breast-conserving surgery (BCS, 26%), mastectomy (58%), or mastectomy plus reconstruction (16%). Increasing age reduced the use of reconstruction. The choice of reconstruction was not affected by tumor size, nodal status, or race. Sixty percent of women had immediate breast reconstruction at the time of mastectomy; the majority had the implant procedure. The cost of BCS ($21,582) was higher than that of mastectomy ($16,122, P < .01). The costs for BCS and mastectomy were significantly lower than for mastectomy plus reconstruction ($31,047, P < .05). The 2-year cost for immediate reconstruction was $8200 less than for delayed procedures and was similar to the cost of BCS. CONCLUSIONS: Age was the driving force in reconstruction decisions. Clinical factors such as tumor size and nodal status were more important for the choice between BCS and mastectomy. There are significant cost differences between the various procedures. For a similar cosmetic outcome, BCS is less expensive than breast reconstruction. When reconstruction is required, a simultaneous procedure is less expensive.

Blue Cross Blue Shield Insurance Plans↗
PubMed1999

Paget's disease of the male breast associated with intraductal carcinoma.

Paget's disease of the breast is a rare condition with an incidence of 3% to 5% of all mammary malignancies. Of all malignant breast cancer, 1% occurs in male patients, and thus, Paget's disease of the male breast is extremely rare. We present a case of intraductal carcinoma of the male breast presenting as Paget's disease.

Aged↗
PubMed1999

[In situ ductal carcinoma of the breast].

Ductal carcinoma in situ (DCIS) is an early, localized stage of breast cancer. The diagnosis of DCIS has increased due to the use on a large scale of mammography. The majority of these tumors are detected on the mammography by microcalcifications. It is very important to establish a new pathologic classification. The management is one of the most controversial part in the treatment of breast cancer; for several decades total mastectomy was considered the appropriate treatment. Conservative treatment is based on the surgical excision of the tumor plus irradiation of the remaining breast. Has an excellent prognosis when properly treated.

Adolescent↗
PubMedDate not supplied

[In situ ductal carcinoma of the breast: current status and our experience].

INTRODUCTION: Selecting the appropriate treatment strategy for the individual patient with DCIS represents a major challenge to the surgeon treating breast cancer in the 1990's. CASES AND METHODS: In this study 48 "pure" DCIS patients, treated at Surgical Department of Genoa University, have been selected and divided into Van Nuys prognostic groups. New prognostic classification (Van Nuys) defines three distinct and easily recognizable groups, each of which has a different likelihood of local recurrence if treated with breast conservation. RESULTS: Our results confirm that the risk of local recurrence increases in close relation with prognostic classification groups and suggests that different forms of DCIS may require different treatments.

Adult↗
PubMed1999

[Malignant phyllodes tumor with liposarcomatous differentiation. Description of a clinical case].

Sarcoma of the breast are a rare group of neoplasms representing less than 5% of Soft Tissue Sarcomas (STS). Between 1980 and 1995 in the National Institute foe Cancer Research (IST) of Genoa, 2188 patients were submitted to surgery for breast cancer. Seven of them were found to be affected by sarcoma, confirmed by histologic diagnosis. All the patients were between 39 and 87 years-old. Surgical treatments were: wide excision (1 case), total mastectomy (2 cases), radical mastectomy following Halsted (4 cases). A case of a 53 year-old woman with a phyllodes tumor initially transforming in to liposarcoma is reported. The patient was submitted to surgery (total mastectomy) and nowadays is alive and free of disease after 29 months. All authors agree that the treatment for sarcoma of the breast is early and complete surgical excision of the mass. The role of chemotherapy and radiotherapy is still uncertain. Outcome is based on histologic type, degree of differentiation and tumor size.

Adult↗
PubMedDate not supplied

[Local recurrence of breast cancer].

The Authors analyse the prognostic value of the breast cancer local recurrence which not influence survival. For this reason the surgical treatment sometime can be conservative like the first treatment.

Breast Neoplasms↗
PubMed1999

Retrospective study of the skin-sparing mastectomy in breast reconstruction.

The final appearance of the reconstructed breast is greatly dependent on the relative amounts of skin and breast tissue excised at the time of the mastectomy and on the exact location of the skin incision. A complete mastectomy may be performed using modified skin incisions to avoid the sacrifice of unnecessary breast skin. The type of skin-sparing incision used varies based on the exact location of the tumor and the size of the breast, but it always includes the nipple-areola complex and the biopsy site. The presence of local recurrence, distant disease, or death was determined in 50 consecutive patients who had skin-sparing mastectomies and immediate breast reconstruction between 1985 and 1991 to ascertain the safety of the procedure. The period of follow-up ranged from 23 to 121 months, with a mean of 57 months and a median of 51.5 months. There was no local recurrence, active distant disease was present in five patients, two patients died of distant disease, and there were two unrelated deaths.

Breast Neoplasms↗
PubMed1999

[Delayed appearance of maculopapular eruptions induced by tamoxifen].

BACKGROUND: Prescriptions of tamoxifen can be expected to increase over the next few years, particularly for primary prevention of breast cancer. We report a case of a delayed tamoxifen-induced skin reaction. CASE REPORT: A 50-year-old woman was hospitalized for a diffuse maculopapulous eruption which developed four months after beginning a tamoxifen regimen instituted to prevent recurrence of breast cancer after surgery, chemotherapy and radiotherapy. The eruption resolved rapidly after withdrawal of tamoxifen. The same skin reaction occurred 9 hours after rechallenge with tamoxifen. Patch tests performed later with Nolvadex tablets crushed in vaseline were negative. DISCUSSION: Tamoxifen-induced skin reactions are uncommon. The likelihood that tamoxifen was the cause in this case was very high (C3S3 = I4, B2). The late onset (4 months) in this case is remarkable and misled us to look for another cause which could not be found. Challenge with tamoxifen confirmed its causal role. Once again, negative patch tests were found in this type of skin reaction.

Adenocarcinoma↗
PubMed2000

[Angiosarcoma of the breast. Radiological aspects. About one case].

Angiosarcoma of the breast in an uncommon entity. The authors report a well documented case of angiosarcoma. The patient, a 23 years old woman, had a voluminous mass of the left breast without inflammation. The evolution was rapidly fatal. Physical examination revealed a large painful breast mass with purplish discoloration cutaneous area in front of the lesion. The palpation revealed a thrill. The mammography had shown an area of increased density in the left breast. A complementary ultrasound examination detected a well circumscribed voluminous mass with hypoechogenic heterogenous echostructure. The Doppler examination detected a venous blood flow in the tumor. This finding was compatible with vascular tumor as angioma or angiosarcoma. The angioscanner showed a peripheral vascular enhancement and a centripetal diffusion of the contrast product. This vascular kinetic is seen commontly in the angioma. Magnetic resonance imaging in the T1 and T2 relaxation times detected an intermediate signal mass with bleeding areas. The patient had had a mastectomy and the histopathologic examination confirmed the diagnostic of angiosarcoma. The radiological aspacts of angiosarcoma of the breast are discussed depending on the literature data.

Adult↗
PubMed2000

Outcomes and factors impacting local recurrence of ductal carcinoma in situ.

BACKGROUND: The optimal management of ductal carcinoma in situ (DCIS) remains controversial. Investigators have focused on identifying patients who are eligible for treatment by excision alone. A retrospective analysis of patients with DCIS treated by various modalities was conducted to compare outcomes and determine factors significant for local recurrence (LR). METHODS: Between 1985-1992, 88 consecutive diagnoses of DCIS were identified in 85 patients. Seventy-four percent were detected mammographically. The most common histologic subtypes were comedo (54%) and cribriform (23%). Tumor sizes were < 2.5 cm (49%), > 2.5-5 cm (26%), > 5 cm (23%), and unknown (2%). Final resection margins were tumor free (75%), close/positive (23%), and unknown (2%). Treatment methods included mastectomy (30%), localized surgery and radiation therapy (LSR) (43%), or wide localized surgery alone (LS) (27%). Radiation therapy (RT) was comprised of 50 grays to the breast, and 53% of treated patients received local "boost" irradiation. RESULTS: The median follow up was 8.3 years. The overall recurrence rate was 13. 6%, whereas the median time to LR was 27.8 months. Recurrence rates according to treatment modality were: LS: 25%; LSR: 13%; and mastectomy: 4%. However, if surgical margins were tumor free, LSR had a LR rate of 3.4%. After RT, no LR occurred prior to 15 months, and 4 of 5 tumors were noninvasive. Nine patients treated by excision alone conformed to the criteria of Lagios et al. criteria and LR occurred in three of nine tumors. Of the factors analyzed, margin status was found to be the best predictor for LR (P = 0.05). CONCLUSIONS: If surgical margins are tumor free, the LSR regimen is equivalent to mastectomy for local tumor control. Annual mammograms may be adequate for the follow-up of patients with irradiated breasts, but biannual studies still are recommended for patients treated with excision alone.

Adult↗