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  • 1
    Electronic Resource
    Electronic Resource
    Mammography of Breast Cancer in Women Under 30 (1995)
    Oxford, UK : Blackwell Publishing Ltd
    The @breast journal 1 (1995), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: The purpose of this study was to assess the efficacy of mammography of breast cancer in women less than 30 years old. A retrospective record review revealed 47 breast cancers in 45 women age 29 and younger who had preoperative mammography. Patients ranged in age from 22 to 29 years (mean = 27 years). All presented with clinically evident disease. Mammography revealed focal abnormality in 26 (55.3%) of 47 cases. Specific positive mammographic findings (n = 22) included uncalcified mass in ten (45.5%), calcification without mass in nine (40.9%), mass and calcifications in two (9.1%), and skin ulceration in one. Mammographic parenchymal density (n= 21) was P2 in 9 (42.9%) and DY in 12 (57.1%). The mean time interval from symptom onset to biopsy was 4.5 months, but was shorter if the mammogram was positive. High parenchymal density contributes to the diminished sensitivity of mammography in women under age 30. A positive mammogram may hasten the diagnosis of carcinoma in a young woman with palpable malignant breast disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1524-4741.1995.tb00228.x
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  • 2
    Electronic Resource
    Electronic Resource
    Pregnancy influences breast cancer stage at diagnosis in women 30 years of age and younger (1996)
    Springer
    Annals of surgical oncology 3 (1996), S. 204-211 
    Details
    ISSN: 1534-4681
    Keywords: Breast cancer ; Pregnancy ; Young age ; Cancer stage ; Survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: To evaluate the purported decreased survival of pregnancy-associated (PA) breast cancer, a previously described homogeneous cohort of women of childbearing age with primary operable cancer was studied. The current analysis was designed to (a) identify those patients among the cohort known to have PA cancer and (b) compare clinical factors, pathologic characteristics, stage at diagnosis, and survival statistics for PA and non-PA cancer subgroups. Methods: All patients ⩽30 years of age who underwent definitive operation between 1950 and 1989 at the Memorial Sloan-Kettering Cancer Center (MSKCC) for primary operable (stages 0-IIIA) breast adenocarcinoma were analyzed. Results:|Twenty-two of the 227 young women with primary operable breast cancer had PA cancer. Disease-related survival was decreased (p=0.004) in these 22 women compared with the remaining 205 patients with non-PA cancer. PA cancer patients were found to have larger tumors (p〈0.005), and a greater proportion had advanced staged (IIB or IIIA) cancers (p〈0.02). Among patients diagnosed with early invasive cancers (stages I or IIA), no difference (p=NS) in survival was observed comparing PA and non-PA subgroups (73% vs. 74% 10-year survival). Patients with stage IIIA cancer had shorter disease-free and overall survival when associated with pregnancy (0% vs. 35% 10-year survival). Conclusions: Women 30 years of age or younger with PA breast cancer have decreased survival compared with patients with non-PA cancer from the same cohort. Women with PA cancer have larger, more advanced cancers at the time of definitive surgery. Women with early staged PA cancers appear to have survival similar to that for women with early staged non-PA cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02305802
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  • 3
    Electronic Resource
    Electronic Resource
    Volume of resection in patients treated with breast conservation for ductal carcinoma in situ (1998)
    Springer
    Annals of surgical oncology 5 (1998), S. 757-763 
    Details
    ISSN: 1534-4681
    Keywords: Age ; Intraductal breast carcinoma ; Breast ductal carcinoma in situ ; Volume of resection ; Breast conservation ; Local recurrence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The optimal treatment of ductal carcinoma in situ (DCIS) is one of the most controversial issues in the management of breast cancer. Identification of factors that affect the risk of local recurrence is very important as the incidence of DCIS increases and the use of breast conservation becomes more widespread. Because the extent of resection may affect the relapse rate, we hypothesized that larger volumes of resection (VR) may account for the lower local recurrence rates we have previously found in elderly patients. Methods: Between 1978 and 1990, 173 cases of histologically confirmed DCIS were treated at MSKCC with breast conservation therapy. Of these, complete VR data were available for 126 cases. The VRs thus obtained were divided into two groups, 〈60 cm3 and ⩾60 cm3, and were evaluated for correlating factors. The patients were divided into three groups by age at diagnosis: younger than 40 years, 40 to 69 years, and 70 years or older. Results: The eldest group had a significantly greater proportion of large VRs (30%) as compared to the middle group (11%) and the youngest group (9%) (P=.03, x2). Although not statistically significant, the large VR group had a lower 6-year actuarial local recurrence rate (5.6%) than did the small VR group (21.3%) (P=.16, log-rank test). This trend was observed even though adjuvant radiotherapy was used less often in patients who had large VRs. Conclusion: Breast conservation surgery for DCIS in elderly patients is more likely to employ a large VR. This may explain, at least in part, the observation that elderly patients have a lower local recurrence rate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303488
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  • 4
    Electronic Resource
    Electronic Resource
    Issues of Regret in Women With Contralateral Prophylactic Mastectomies (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 546-552 
    Details
    ISSN: 1534-4681
    Keywords: Prophylactic mastectomy ; Contralateral breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Patients with a history of carcinoma of one breast have an estimated risk of 0.5% to 0.75% per year of developing a contralateral breast cancer. This risk prompts many women to consider contralateral prophylactic mastectomy (CPM) as a preventive measure. Virtually nothing is known about patient acceptance following CPM. We have developed a National Prophylactic Mastectomy Registry comprised of a volunteer population of 817 women from 43 states who have undergone prophylactic (unilateral or bilateral) mastectomy. Methods: Of the 346 women with CPM who responded to national notices, 296 women returned detailed questionnaires. The information obtained included patient demographics, family history, reproductive history, ipsilateral breast cancer staging and treatment, as well as issues involving the CPM. Results: At median follow-up of 4.9 years, the respondents were primarily married (79%), white (97%) women who had some level of college education or above (81%). These women cited the following reasons for choosing CPM: (1) physician advice regarding the high risk of developing contralateral breast cancer (30%); (2) fear of developing more breast cancer (14%); (3) desire for cosmetic symmetry (10%); (4) family history (7%); (5) fibrocystic breast disease (4%); (6) a combination of all of these reasons (32%); (7) other (2%); and (8) unknown (1%). Eighteen of the 296 women (6%) expressed regrets regarding their decision to undergo CPM. Unlike women with bilateral prophylactic mastectomies, regrets tended to be less common in the women with whom the discussion of CPM had been initiated by their physician (5%) than in the women who had initiated the discussion themselves (8%) (P = ns). Family history and stage of index lesion had no impact on regret status. The reasons for regret included: (1) poor cosmetic result, either of the CPM or of the reconstruction (39%); (2) diminished sense of sexuality (22%); (3) lack of education regarding alternative surveillance methods or CPM efficacy (22%); and (4) other reasons (17%). Conclusions: To minimize the risk of regrets in women contemplating CPM, it is imperative that these women be counseled regarding an estimation of contralateral breast cancer risk, the alternatives to CPM, and the efficacy of CPM. In addition, these women should have realistic expectations of the cosmetic outcomes of surgery and understand the potential impact on their body image.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0542-1
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  • 5
    Electronic Resource
    Electronic Resource
    Intradermal Radiocolloid and Intraparenchymal Blue Dye Injection Optimize Sentinel Node Identification in Breast Cancer Patients (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 450-454 
    Details
    ISSN: 1534-4681
    Keywords: Breast cancer surgery ; Sentinel node biopsy.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Radiotracer and blue dye mapping of sentinel lymph nodes (SLN) have been advocated as accurate methods to stage the clinically negative axilla in breast cancer patients. The technical aspects of SLN biopsy are not fully characterized. In this study we compare the results of intraparenchymal (IP) and intradermal (ID) injection of Tc-99m sulfur colloid, to establish an optimal method for SLN localization. Methods: 200 consecutive patients had SLN biopsy performed by a single surgeon. Of these, 100 (Group I) had IP injection and 100 (Group II) had ID injection of Tc-99m sulfur colloid. All patients had IP injection of blue dye as well. Endpoints included (1) successful SLN localization by lymphoscintigraphy, (2) successful SLN localization at surgery, and (3) blue dye–isotope concordance (uptake of dye and isotope by the same SLN). Results: Isotope SLN localization was successful in 78% of Group I and 97% of group II patients (P 〈 .001). When isotope was combined with blue dye, SLN were found in 92% of group I and 100% of Group II (P 〈 .01). In cases where both dye and isotope were found in the axilla, dye mapped the same SLN as radiotracer in 97% of Group I and 95% of Group II patients. Conclusions: The dermal and parenchymal lymphatics of the breast drain to the same SLN in most patients. Because ID injection is easier to perform and more effective, this technique may simplify and optimize SLN localization.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0450-4
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  • 6
    Electronic Resource
    Electronic Resource
    Six-Year Follow-Up of Patients With Microinvasive, T1a, and T1b Breast Carcinoma (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 591-598 
    Details
    ISSN: 1534-4681
    Keywords: Early breast cancer ; Minimal breast cancer ; Microinvasive breast cancer ; Axillary lymph node metastases ; Axillary dissection ; Regional metastases ; Prognosis disease-free survival ; Sentinel node biopsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Management of patients with breast cancers ≤1 cm remains controversial. Reports of infrequent nodal metastases in tumors ≤5 mm has led to suggestions that axillary dissection should be selective, and that tumor characteristics should guide adjuvant therapy. Methods: A retrospective review of 290 patients with breast cancer 1 cm in size or smaller from 1989 to 1991 was done. Distant disease-free survival (DDFS) was the primary outcome measure. Results: There were 95 T1a (≤5 mm) and 196 T1b (6–10 mm) cancers. Nodal metastases were found in 8 T1a and 26 T1b tumors. Larger size, poorer differentiation, and lymphovascular invasion (LVI) were associated with more nodal metastases, but none of these trends reached statistical significance. The 6-year DDFS was 93% for node-negative and 87% for node-positive patients (P = .02). Overall, breast cancers with poorer differentiation and LVI trended toward a poorer outcome. For patients with node-negative tumors, LVI was associated with a poorer outcome (P = .03). The size of the primary tumor was not predictive of outcome. There were no nodal metastases or recurrences in the 18 patients with microinvasive breast cancer. Conclusions: Lymph node status is the major determinant of outcome in breast cancers 1 cm in size or smaller. Accurate axillary assessment remains crucial in management of small breast cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0591-5
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  • 7
    Electronic Resource
    Electronic Resource
    Magnetic Resonance Imaging Facilitates Breast Conservation for Occult Breast Cancer (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 411-415 
    Details
    ISSN: 1534-4681
    Keywords: Occult breast cancer ; Axillary adenopathy ; Breast MRI.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Introduction: Occult primary breast cancer, i.e., isolated axillary adenocarcinoma without detectable tumor in the breast by either physical exam or mammography, represents up to 1% of operable breast cancer. Modified radical mastectomy (MRM) is generally the accepted treatment for this condition although tumor is identified in only two-thirds of mastectomy specimens. Breast magnetic resonance imaging (MRI) can identify occult breast carcinoma and may direct therapy. This study examined the ability of breast MRI to detect occult breast cancer and to facilitate breast conservation therapy. Methods: Forty women with biopsy-proven metastatic adenocarcinoma to an axillary lymph node and no evidence of primary cancer were studied. All patients had a physical examination, mammography, and MRI of the breast. Using a dedicated breast coil, MRI imaging was performed with and without gadolinium enhancement. Positive MRI scans were compared with histopathologic findings at the time of operation (n 5 21). Results: MRI identified the primary breast lesion in 28 of 40 women (70%). Of these 28 patients, 11 had MRM, 11 had lumpectomy/axillary lymph node dissection (ALND)/radiotherapy (XRT), 2 had ALND/XRT alone, and 4 had no local treatment secondary to stage IV disease. Two women initially treated with lumpectomy/ALND subsequently had mastectomy for positive margins. Of the women with positive MRI who had breast surgery, 21 of 22 (95%) had tumor within the surgical specimen. Twelve women had negative MRI of the breast. Five of these 12 underwent MRM, of whom 4 had no tumor in the mastectomy specimen. The remaining 7 patients had ALND and whole breast radiation (ALND/XRT) (n 5 5), or were observed (n 5 2). Overall, 18 of 34 women surgically treated had MRM, while 16 (47%) preserved their breast. Tumor yield for patients having breast surgery was 81%. Conclusions: MRI of the breast can identify occult breast cancer in many patients and may facilitate breast conservation in select women. Negative breast MRI predicts low tumor yield at mastectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0411-4
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  • 8
    Electronic Resource
    Electronic Resource
    Improved survival in young women with breast cancer (1995)
    Springer
    Annals of surgical oncology 2 (1995), S. 407-415 
    Details
    ISSN: 1534-4681
    Keywords: Breast cancer ; Young age ; Local recurrence ; Chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Young age has been hypothesized to be an adverse prognostic factor for women with breast cancer. This association, based on historical data, may not reflect recent advances in breast cancer management. Methods: A retrospective study was conducted of all women age 30 or younger who underwent definitive operation at our institution for primary operable breast carcinoma during one of two consecutive 20-year periods (1950–1969 or 1970–1989). All cancers were restaged according to current staging criteria. Actuarial survival and recurrence-free survival rates from the two patient eras were compared with each other and with published statistics for older breast cancer patients. Results: Eligibility criteria were met by 81 women from the 1950–1969 era and 146 women from the 1970–1989 era. Histologic diagnoses, tumor sizes, incidence of axillary nodal metastases, number of positive nodes, and American Joint Committee on Cancer stage at presentation were similarly distributed in the two eras. Despite these similarities, improved survival (p=0.009) was observed in the later era. Local recurrences were also more common (p〈0.05) in the later era in association with less extensive resections. These local recurrences had an adverse impact on recurrence-free survival in the later era, but no concomitant decrease in overall survival was observed. Node-positive patients who received chemotherapy demonstrated a trend toward improved survival (p=0.06) compared with node-positive patients who did not. Survival for patients in the later era was similar to that for older women as reported in other published series. Conclusions: The stage of presentation of breast cancer in women 30 years or younger appears unchanged from prior decades, but survival has improved in association with the use of less extensive surgical resections and the introduction of cytotoxic chemotherapy. With current treatment, primary operable breast cancer in young women appears to have a similar prognosis to breast cancer in older women.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02306373
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  • 9
    Electronic Resource
    Electronic Resource
    Women’s Regrets After Bilateral Prophylactic Mastectomy (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 150-154 
    Details
    ISSN: 1534-4681
    Keywords: Breast cancer ; Prophylactic mastectomy ; Psychological distress ; Genetic risk
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Primary prevention strategies such as chemopreventive agents (e.g., tamoxifen) and bilateral prophylactic mastectomy (PM) have received increasingly more attention as management options for women at high risk of developing breast cancer. Methods: A total of 370 women, who had registered in the Memorial Sloan-Kettering Cancer Center National Prophylactic Mastectomy Registry, reported having undergone a bilateral PM. Twenty-one of these women expressed regrets about their decision to have a PM. A psychiatrist and psychologist interviewed 19 of the women about their experiences with the PM. Results: A physician-initiated rather than patient-initiated discussion about the PM represented the most common factor in these women. Psychological distress and the unavailability of psychological and rehabilitative support throughout the process were the most commonly reported regrets. Additional regrets about the PM related to cosmesis, perceived difficulty of detecting breast cancer in the remaining breast tissue, surgical complications, residual pain, lack of education about the procedure, concerns about consequent body image, and sexual dysfunction. Conclusions: Although a PM statistically reduces the chances of a woman developing breast cancer, the possibility of significant physical and psychological sequelae remains. Careful evaluation, education, and support both before and after the procedure will potentially reduce the level of distress and dissatisfaction in these women. We discuss recommendations for the appropriate surgical and psychiatric evaluation of women who are considering a PM as risk-reducing surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0150-6
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  • 10
    Electronic Resource
    Electronic Resource
    Is Routine Intraoperative Frozen-Section Examination of Sentinel Lymph Nodes in Breast Cancer Worthwhile? (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 651-655 
    Details
    ISSN: 1534-4681
    Keywords: Sentinel lymph nodes ; Frozen section ; Macrometastases ; Micrometastases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Routine intraoperative frozen section (FS) of sentinel lymph nodes (SLN) can detect metastatic disease, allowing immediate axillary dissection and avoiding the need for reoperation. Routine FS is also costly, increases operative time, and is subject to false-negative results. We examined the benefit of routine intraoperative FS among the first 1000 patients at Memorial Sloan Kettering Cancer Center who had SLN biopsy for breast cancer. Methods: We performed SLN biopsy with intraoperative FS in 890 consecutive breast cancer patients, none of whom had a back-up axillary dissection planned in advance. Serial sections and immunohistochemical staining for cytokeratins were performed on all SLN that proved negative on FS. The sensitivity of FS was determined as a function of (1) tumor size and (2) volume of metastatic disease in the SLN, and the benefit of FS was defined as the avoidance of a reoperative axillary dissection. Results: The sensitivity of FS ranged from 40% for patients with T1a to 76% for patients with T2 cancers. The volume of SLN metastasis was highly correlated with tumor size, and FS was far more effective in detecting macrometastatic disease (sensitivity 92%) than micrometastases (sensitivity 17%). The benefit of FS in avoiding reoperative axillary dissection ranged from 4% for T1a (6 of 143) to 38% for T2 (45 of 119) cancers. Conclusions: In breast cancer patients having SLN biopsy, the failure of routine intraoperative FS is largely the failure to detect micrometastatic disease. The benefit of routine intraoperative FS increases with tumor size. Routine FS may not be indicated in patients with the smallest invasive cancers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0651-3
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