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PubMedDate not supplied

Underutilization of breast-conservation surgery with radiation therapy for women with stage Tis, I or II breast cancer.

Despite clinical evidence from the National Institutes of Health consensus panel in 1991 that breast-conservation surgery (BCS) with radiation therapy (RT) is appropriate treatment in early-stage breast cancer, the overall rate of acceptance and actual practice of BCS with RT has remained low. We retrospectively reviewed 228 cases of breast cancer in female patients with stage Tis, I or II breast cancer treated between 1987 and 1995. Thirty-five cases (15.4%) were stage Tis, 70 cases (30.7%) were stage I, and 123 cases (53.9%) were stage II, Overall, 57% of Tis, I or II breast cancers received conservative treatment; 57% of stage Tis, 79% of stage I, and 44% of stage II tumors. These rates of conservative therapy are higher than in other reported series in the literature. BCS with RT produces equivalent rates of morbidity and survival as MRM, and, because it preserves the breast, is preferable for the majority of women who present with stage Tis, I, or II breast cancer.

Adult↗
PubMed1997

Prophylactic laparoscopic ovarian ablation for premenopausal breast cancer: medical and economic efficacy.

Worldwide analysis showed a highly significant reduction in the annual rates both of recurrence and of death produced by ovarian ablation. We examined the safety, efficacy, and cost-effectiveness of prophylactic laparoscopic oophorectomy for premenopausal breast cancer. Prophylactic laparoscopic oophorectomy was attempted in 15 selected premenopausal patients with breast cancer. After mastectomy, these patients had laparoscopic ovarian ablation as treatment for breast carcinoma with positive estrogen receptors. To evaluate the economic impact of laparoscopic oophorectomy, comparisons were made between patients treated laparoscopically and those treated with conventional surgery, chemotherapy, and hormonal therapy. The average time required for laparoscopic bilateral oophorectomy was 44 min. Oral intake was resumed the next morning, and the patients were discharged 3 days after surgery. No limitation on physical activity and no complications were required during postoperative days. There was no reduction in the overall costs of laparoscopic surgery and conventional surgery in Japan. The cost of one year's supply of tamoxifen was equivalent to the overall cost of surgical oophorectomy. From medical and economic viewpoints, we conclude that laparoscopic ovarian ablation should be considered an alternative to adjuvant chemotherapy in premenopausal women.

Activities of Daily Living↗
PubMed1997

[The mental foramen syndrome].

The authors outline an extraordinary rare case of metastatic mandible carcinoma. The examined patient who earlier had a mastectomy due to breast carcinoma showed signs of the foramen mentale syndrome (numbness, pain, swelling) also on the right side after 5 years. The process of the generalized malignant tumour was first indicated by the mandibula metastatic tumour of the foramen mentale syndrome.

Breast Neoplasms↗
PubMed1997

[Approach to male breast cancer. Our experience].

Male breast cancer is a rare neoplasia and represents only 1% of all forms of breast cancer. The etiopathogenesis of breast carcinoma is still unknown in both males and females, but an altered hormonal metabolism may play a role in its genesis. The prognosis of breast cancer is slightly worse in males, especially in cases with axillary lymph node metastases. The paper discusses the therapy administered to 8 patients with male breast cancer who were treated by the authors between January 1983 and April 1990.

Age Factors↗
PubMed1997

Cardiac metastasis from carcinoma breast--a case report.

Secondary neoplasms of the heart are more common than primary tumours. Metastasis occurs most commonly from bronchogenic carcinoma followed by lymphoma and carcinoma breast. Most often cardiac metastasis go undetected as they are asymptomatic and occurs as a terminal event. A 51 year old lady who developed cardiac metastasis from carcinoma breast diagnosed during life is reported with brief review of the literature.

Bone Neoplasms↗
PubMed1997

[Analgesia in breast surgery with interpleural bupivacaine].

A control group of 15 patients undergoing breast surgery was given general anesthesia. In 15 other patients an interpleural block with 0.4 ml/kg bupivacaine, 0.5%, was performed 20 minutes before induction of general anesthesia for pre-emptive analgesia. This was extended further by continuous administration of bupivacaine 0.25%, 0.125 ml/kg/hr by automatic infusion pump, with supplements of opiates for postoperative pain management. The combined technique was associated with significantly reduced perioperative opiate requirement with better emergence from anesthesia, fewer side effects, a prolonged pain-free period, and overall better quality of postoperative recovery.

Analgesia↗
PubMed1997

[Primary sarcoma of the breast: criteria for radical surgery].

The experience in a case of primitive stromal sarcoma of the breast brought the Authors to study and to characterize the surgical interventions to prefer in these tumors. Criteria of radicality are considered in the light of the modern notion of "anatomical compartment" already applied to the sarcomas of the musculoskeletal or parenchymal location, from which breast sarcomas don't differ in order to the clinical behavior.

Breast Neoplasms↗
PubMed1997

[Paget's carcinoma of the breast. Clinical contribution].

The authors present a clinical contribution on Paget's disease of the breast, concerning 194 cases of mammary carcinoma observed in the period 1988-1995. Treatment strategy is discussed, particularly regarding the cases without a palpable node or positive mammography that can be cured by conservative operations or, more recently, radiotherapy alone.

Aged↗
PubMed1997

[Breast reconstruction using free rectus abdominis myocutaneous flap].

More than 50% of patients who have breast cancer do not need a mastectomy. Since 1976, reconstruction of the breast is suitable. From 1976 to 1995, we have performed 220 breast reconstructions with a pediculed latissimus dorsi and 510 reconstructions with a pediculed transverse rectus abdominis myocutaneous flap (TRAM). So, in all, 1100 immediate breast reconstruction with either a prosthesis or a pediculed flap were performed. The specialised teams aim is to use the TRAM free transplant for immediate breast reconstruction. Between 1990 to 1995 we have performed 5 free TRAM for breast reconstruction for cancer and 6 TURBOTRAM. It is important for the woman to have an abdominal adiposity, to be able to give an excellent breast. Four out of five of the free TRAM reconstructions were successful and one give partial necrosis (4 x 4 cm). All the 6 TURBOTRAM operations were uneventful. There are many advantages with this technique: the free TRAM allows a large resection of the thoracic skin and gives a natural form to the breast, without any prosthesis. The taking of the free TRAM gives only few abdominal hernia and realize an abdominoplasty. Our aim is to perform immediate breast reconstruction with free TRAM flap.

Adult↗
PubMed1998

An audit of outcome including patient satisfaction with immediate breast reconstruction performed by breast surgeons.

Reconstruction of the female breast is becoming ever more frequently requested by patients after mastectomy for cancer. One of the least complex techniques is that of local tissue expansion with a permanent prosthesis. We present our experience and the clinical outcomes of the first 100 patients to have undergone surgery in the 4 years since the introduction of this method of breast reconstruction in our unit. A retrospective study was performed with a detailed questionnaire being sent to each patient for subjective assessment of satisfaction. Data were also collected on the rates of clinical infection of the prosthesis and the need for further surgery, including capsulotomy, nipple reconstruction and contralateral procedures. With 84% expressing their satisfaction at the final result, immediate breast reconstruction is both feasible and highly acceptable to the majority of patients.

Adult↗
PubMed1998

[Do indications remain for total mastectomy for cancer?].

Does radical mastectomy for cancer remain needed? Breast conserving treatment may be achieved by surgery, primary chemotherapy followed by radiotherapy and surgery. This article attempts at defining (according to clinical and pathological parameters of the tumor and patient's characteristics), when conservative treatment is not allowed and radical mastectomy must be performed. Mastectomy must be performed first when there are multiple tumors or a tumor too large with respect to the breast volume or diffuse microcalcifications on mammograms. Sometimes the stage of pregnancy, a personal history of collagen vascular disease or prior radiotherapy or the willing of the patient lead to perform radical mastectomy. Secondary mastectomy is necessary in case of failure of conservative treatment or recurrence after breast conserving treatment.

Breast Neoplasms↗
PubMed1998

[Breast cancer after radiation treatment for Hodgkin disease].

Mammary carcinoma was diagnosed in two women aged 31 and 38 years after they had been subjected to mantle irradiation for Hodgkin's disease at the ages of 17 and 20 years, respectively. Breast amputation was performed in one case, lumpectomy in the other; the subsequent courses were uncomplicated. During follow-up there was no sign of recurrence. Lifelong follow-up by specialists of women irradiated for Hodgkin's disease should be considered; monthly self-examination of the breasts should be advised and mammography should be carried out annually as from 10 years after thoracic or axillary irradiation. It is especially women treated before their 20th year of life who run a relatively high risk.

Adolescent↗
PubMedDate not supplied

The treatment of breast cancer in the elderly: a community hospital experience.

The physician's dilemma in choosing the optimal management for breast cancer in the elderly arises from long-held beliefs that elderly patients 1) have a limited life expectancy from comorbid conditions other than breast cancer and 2) do not tolerate standard treatment. To determine if these beliefs were indeed reflective of the clinical behavior of breast cancer in the elderly, we reviewed the hospital and tumor registry records of 182 women age 70 years and older who received treatment for locoregional invasive breast cancer (Stage I and II) at CAMC between 1977 and 1987. The median time interval between diagnosis and last contact or death was 82 months. Actuarial survival was calculated on the basis of this interval Statistical Analysis System (SAS). Eighty-five percent of patients underwent mastectomy and 15% had breast conservation surgery. There was only one postoperative death. Forty-eight (26%) of 182 patients received systemic adjuvant therapy. The breast cancer-specific survival rate of all patients in this study was 84% at five years and 71% at 10 years. The 5-year and 10-year breast cancer specific survivals were 94% and 86% for stage I patients respectively and for stage II patients the five-year and 10-year survivals were 74% and 56% respectively. Our results indicate that the majority of elderly women with breast cancer can tolerate standard surgical therapy and survive disease-free for many years.

Actuarial Analysis↗
PubMed1998

[Phyllodes tumors of the breast].

Phyllodes tumors are mixed tumors of the mammary gland. They account for 0.3 to 0.5 per cent of all breast tumors. This is a report on nineteen cases presenting phyllodes tumors. Depending on the number of mitoses, growth pattern and atypism degree, the neoplasms are classified as benign (12 cases), borderline (2) and malignant (5). Fourteen of them (9 with benign and 5 with malignant phyllodes tumors) undergo clinical follow-up study. A case with bilateral location of the neoplasm exhibiting strongly expressed susceptibility to relapse is described. The basic methods of preoperative diagnosis and the operative treatment procedures used are outlined.

Adolescent↗