The Breast - Articles in Press

Following the case of fat grafting in glandular tissue, a comment on “lipomodelling of the breast: A review” in the breast volume 19, issue 3, 2010 - Corrected Proof

Frederic Arsenault, Michel Alain Danino — 2010-07-28

We first wanted to congratulate Drs ELFadl et coll for the exhaustive review. We want to discuss the section “Oncological safety of lipomodelling”: We think the reader must have a 360° view of the recently published literature on this hot topic.

Neoadjuvant pegylated liposomal doxorubicin in combination with cisplatin and infusional fluoruracil (CCF) with and without endocrine therapy in locally advanced primary or recurrent breast cancer - Corrected Proof

2010-07-20

Abstract: Purpose: To explore the activity of pegylated liposomal doxorubicin (PLD) as neoadjuvant therapy of breast cancer.Methods: The combination of PLD with cisplatin and infusional fluorouracil (CCF) for 8 courses was investigated in patients with primary or recurrent T2-T4a-d N0-3 M0 breast cancer. Patients with ER and/or PgR ≥10% tumors also received letrozole (±triptorelin).Results: Forty patients entered the study. Four patients had recurrent tumors and 13 had cT4d tumors. Overall, clinical response rate was 77.5% whereas a pathological complete response (pCR) was obtained in 3 patients (7.7%), 4 when considering bilateral tumors. Noticeably 3 pCR were observed among the 10 patients with T4d ER positive tumors (33%). Eleven patients discontinued treatment before completion of the 8 planned courses.Conclusions: Our results indicated that CCF yielded an appreciable rate of clinical responses in a series of very locally advanced tumors and an unusually high rate of pCR in T4d ER positive tumors, suggesting an enhanced cutaneous activity of PLD.

Prognostic and predictive value of TFF1 for adjuvant endocrine therapy in Chinese women with early ER positive breast cancer: Comparing aromatase inhibitors with tamoxifen - Corrected Proof

2010-07-12

Abstract: Factors that predict in favor of an aromatase inhibitors (AIs) over tamoxifen (TAM) in estrogen receptor (ER) breast cancer remains to be identified. We compared progesterone receptor (PR) and trefoil factor 1 (TTF1) status (+ve versus −ve) as predictive of superior effect of AI’s over tamoxifen among a total of 1973 Chinese women with early ER+ breast cancer. The expression of TFF1 was independently associated with ER and PR. However, there was no correlation with TFF1 and HER-2 expression. Treatment effect was more pronounced in the ER+/TFF1+ postmenopausal patients with a hazard ratio favoring AIs (HR = 0.397, 95%CI 0.183–0.860), but not in the PR positive cohorts (HR = 0.466, 95%CI 0.186–1.164). We suggested that AIs was better than TAM especially in the postmenopausal patients with ER+/TFF1+ breast cancer; however the clinical application of this observation still requires further prospective studies.

Factors affecting post-operative complications following skin sparing mastectomy with immediate breast reconstruction - Corrected Proof

Kerry Davies, Lyra Allan, Paul Roblin, David Ross, Jian Farhadi — 2010-07-12

Abstract: Skin sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is not only oncologically safe but provides also significant benefits both cosmetically and functionally. The superiority of this technique can only be fully established, however, by developing a framework for minimising complications. The present study seeks to elucidate the key factors affecting outcome.Methods: Data for all skin sparing mastectomies with immediate autologous and implant based reconstructions, performed in a three year period (2006–2008) was retrospectively collated. Complications were classified into major and minor. Patients were excluded who had flap loss due to vascular complications.Results: The total number analysed was 151. 17.2% had major complications, 23% had minor and 61% had no complications. The Wise and the “tennis” incision had significantly higher rates of wound dehiscence when compared with the periareolar incision (p = 0.025, p = 0.098). There was no significant difference between diathermy or blade dissection techniques, or the use of subcutaneous adrenaline infiltration. Increasing BMI was associated with increased skin flap necrosis and wound dehiscence, and an excised breast mass of greater than 750 g and a sternal notch to nipple length of greater than 26 cm are associated as well with increased flap-related complications (p = 0.0002, p = 0.0049).Conclusion: Factors such as Wise pattern and tennis racquet incision, BMI and breast mass and sternal notch to nipple length adversely affect skin sparing mastectomy flap morbidity. These factors should be factored in to patient selection and operative planning especially for obese and large breasted women undergoing skin sparing mastectomy with immediate breast reconstruction.

Intraoperative bone marrow puncture in breast cancer patients: Prospective assessment of adverse side-effects - Corrected Proof

2010-07-12

Abstract: Background and aim: In breast cancer patients, intraoperative bone marrow puncture (BMP) with positive detection of disseminated tumor cells has been reported to predict unfavorable clinical outcome due to increased risk of recurrence. In this study, we prospectively assessed BMP-associated untoward side-effects.Methods: Fifty-eight consecutive breast cancer patients were prospectively explored after intraoperative BMP for postoperative pain (visual analogue scale, VAS) and complications in terms of infection, hematoma, and sensibility disorder. Furthermore, the impact of BMP on hospital stay duration was analyzed in 254 patients.Results: In all subgroups analyzed, during five postoperative days patients complained about minor pain only at the site of BMP (VAS < 1) while the corresponding pain scores were significantly higher for the area of the operated breast. Post-BMP iliac crest hematomas were encountered in 13 out of 58 patients (22.4%) who were significantly older (p = 0.04), less frequently smokers (p = 0.02), and presented with higher body mass index (p = 0.01) than controls. Within the area of BMP no signs of infection or sensibility disorders were observed. Comparison of patients with and without BMP did not show any significant difference in postoperative hospital stay duration.Conclusion: Referring to the potential clinical benefit of intraoperative BMP its prospectively assessed adverse side-effects appear relatively mild and thus acceptable.

Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy - Corrected Proof

2010-07-09

Abstract: Previous studies have shown that 4–54% of breast lesions reported on core biopsies as atypical ductal hyperplasia (ADH) are upgraded on further excision to ductal carcinoma in situ (DCIS) or invasive carcinoma. We evaluated the rate of upgrading ADH to carcinoma at surgery for ADH diagnosed by percutaneous biopsy, and examined characteristics associated with malignancy. We identified 13,488 consecutive biopsies conducted at one center over a nine-year period. A total of 422 biopsies with ADH in 415 patients were included. DCIS or invasive carcinoma was found in 132 cases (31.3% upgrading). Multivariate model revealed that ipsilateral breast symptoms, mammographic lesion other than microcalcifications alone, 14G core needle biopsy, papilloma co-diagnosis, severe ADH and pathologists with lower volume of ADH diagnosis were factors statistically associated with malignancy. However, no subgroups were identified for safe clinical-only follow-up. Surgery is recommended in all cases of ADH diagnosed by percutaneous breast biopsy.

Defining ovarian failure in amenorrheic young breast cancer patients - Corrected Proof

Eitan Amir, Orit Freedman, Lisa Allen, Terence Colgan, Mark Clemons — 2010-07-08

Abstract: At present, there is no gold standard test for the investigation of ovarian function in pre-menopausal breast cancer patients who develop amenorrhea after chemotherapy. Clinical, biochemical and biophysical investigations continue to be utilized in clinical practice, despite concerns regarding their predictive value for menopause. The resulting uncertainty about a woman’s actual menopausal status has important consequences for patient management. These include choice of appropriate endocrine therapy, assessment of residual ovarian function and its effect on breast cancer recurrence, fertility issues and the prediction of the likelihood of conception. It is hoped that the development of novel surrogates may allow clinicians to more accurately assess menopausal status and thereby facilitate tailored and individualised therapy for this common group of patients.

Surgical specimen ultrasound: Is it able to predict the status of resection margins after breast-conserving surgery? - Corrected Proof

2010-07-07

Abstract: Purpose: To evaluate the accuracy of surgical specimen ultrasound in the assessment of the status of resection margins after breast-conserving surgery.Methods and materials: Sonographic examination of 46 surgical specimens of US-detectable malignant tumors was performed. Distance of the lesion from the specimen margins in four radial directions was measured and compared with distances measured on pathologic examination. Positive pathologic margins were defined when invasive or intraductal carcinoma was found within 2 mm of the specimen margin. Sensitivity, specificity, positive(PPV) and negative predictive values(NPV) of US in predicting surgical margins were calculated, considering both a 10-mm and a 4-mm sonographic threshold.Results: Of 184 margins(4 per lesion), pathology demonstrated 28 positive and 156 negative margins. Considering the 10-mm cut-off, US identified 32 positive and 152 negative margins, showing the following sensitivity, specificity, PPV and NPV: 28.5%, 84.6%, 25% and 86.8%, respectively. Considering the 4-mm cut-off, US identified 7 positive and 177 negative margins, with a sensitivity of 7.1%, a specificity of 96.8%, a PPV of 28.2% and a NPV of 85.3%. False-negative results were more frequent in case of invasive lobular carcinoma (20%) and presence of intraductal component (60%).Conclusion: Sonography demonstrated a poor performance in the evaluation of the status of resection margins in breast specimens; however, because of the high NPV -both with 10-mm and 4-mm thresholds- it might be helpful in confirming complete excision of a US-detected neoplasm and in ruling out the presence of macroscopic invasive ductal carcinoma at surgical margins.

Investigation of anaphylactic reaction after patent blue V dye injection - Corrected Proof

L. Barthelmes, A. Goyal, P. Sudheer, R.E. Mansel — 2010-06-25

Abstract: Background: Patent blue dye V (PBV) is in widespread use for sentinel node biopsy in breast cancer and melanoma. At present, the best diagnostic approach in investigating possible anaphylaxis due to PBV is not defined.Method: We reviewed our experience of patients and the cases reported in the literature that developed an anaphylactic reaction after injection of PBV and suggest a diagnostic protocol. From May 2006 to April 2009 six patients were known to the Cardiff anaesthetics department to have suffered a severe anaphylactic reaction after injection of PBV. We amalgamated the results of the investigations of our patients with those of 42 case reports published in the literature during the last 10 years.Results: Of 40 patients with a documented allergy history 31 patients did not have a past medical history of allergy. The median interval between PBV administration and allergic reaction was 15 min (range 1 min–180 min). Of 20 patients with hypotension 18 received inotropes. 4 patients had a fall in blood pressure as their sole symptom. 23 patients had urticaria or other allergic skin manifestations, 8 had blue wheals. 5 patients had bronchospasm. 2 patients had a cardiac arrest. They were successfully resuscitated. The median dose of PBV was 2 ml (range 0.5 ml–5 ml). Tryptase levels were elevated in 14 of 26 tested patients. Skin prick testing was positive in 24 of 30 tested patients. Intradermal testing was positive in all 13 tested patients.Conclusion: Most patients experiencing a severe allergic reaction to PBV have no past medical history of allergy. The value of formal allergy skin testing for PBV-related allergy lies in excluding other agents as the causative factor to avoid their exposure in the future.

Hypomethylation of the interleukin-10 gene in breast cancer tissues - Corrected Proof

2010-06-21

Abstract: The purpose of the study was to evaluate the methylation status of the interleukin-10 (IL-10) gene in breast cancer tissues compared with normal and benign breast disease tissues. Between 2000 and 2001, we used paraffin-embedded specimens of 30 normal, 31 benign and 72 breast cancer tissues from the National Cancer Center, Korea. The methylation patterns of the IL-10 gene were evaluated using bisulfite DNA sequencing and the expression levels of IL-10 mRNA were evaluated using real-time reverse transcriptase-polymerase chain reaction (qRT-PCR) and reverse transcriptase-polymerase chain reaction (RT-PCR). The methylation rates of the IL-10 gene were significantly lower in malignant tumors than in benign and normal tissues (normal; 63.3%, benign; 74.2%, cancer; 45.8%, p = 0.02). The methylation density rates of the IL-10 gene were also significantly lower in malignant tumors (normal; 59.68 ± 7.12%, benign; 48.89 ± 7.45%, cancer; 30.56 ± 4.18%, p = 0.001). Tissues with aberrant methylation of the IL-10 gene showed significantly lower rates of mRNA expression compared with unmethylated cases (12.5% vs. 68.0%, p = 0.012). The mRNA expression of tissues with unmethylated IL-10 was upregulated approximately ten thousand-fold compared to those with IL-10 methylation in the real-time RT-PCR experiment. IL-10 methylation demonstrated a significant association with lower expression of Ki-67 (9.36 ± 2.43 vs. 19.68 ± 3.42, p = 0.02). IL-10 methylation in cancer tissues is lower than that in normal and benign breast tissues, and DNA hypomethylation in the gene influences gene activation. Our data suggest that hypomethylation of the IL-10 gene can be involved in the process of breast carcinogenesis.

Self-reported arm-lymphedema and functional impairment after breast cancer treatment – A nationwide study of prevalence and associated factors - Corrected Proof

2010-06-21

Abstract: Lymphedema and impairment of function are well-established sequelae to breast cancer treatment and affect an increasing number of women due to continually improved survival. The aim of the present nationwide questionnaire study was to examine the impact of breast cancer treatment on perceived swelling/sensation of heaviness (lymphedema) and on function, reporting prevalence in 12 subgroups of modern treatment and offering estimates for treatment-related associated factors.3253 Women (87%) returned the study questionnaire. Depending on treatment group prevalence of perceived swelling/heaviness varied from 13 to 65%. Associated factors were young age, axillary lymph node dissection (ALND) and radiotherapy but not type of breast surgery or use of chemotherapy. Depending on treatment group 11–44% had to give up activities. Giving up activities was associated with pain and swelling/heaviness, younger age, ALND, chemotherapy, time elapsed since surgery, and surgery on the dominant side. Radiotherapy and type of breast surgery were of no importance.

CD105 (Endoglin) expression in breast carcinoma effusions is a marker of poor survival - Corrected Proof

2010-06-18

Abstract: We analyzed the expression and clinical role of endoglin (CD105) in breast carcinoma effusions. Endoglin levels were measured in 36 effusion supernatants by ELISA and studied for association with the cancer-associated markers calprotectin, VEGF, and the VEGF receptor sFlt1. Endoglin expression was further studied in 46 effusions and 22 primary carcinomas using immunohistochemistry. The four secreted molecules were detected in all specimens and their levels significantly correlated (p < 0.001). In effusions, endoglin was localized to carcinoma cells and reactive mesothelium using immunohistochemistry. Tumor cell expression was higher in effusions compared to primary carcinomas (p = 0.025), and in post-chemotherapy compared to pre-chemotherapy effusions (p = 0.017). Higher tumor endoglin expression was associated with poor overall (p = 0.021) and disease-free (p = 0.032) survival in univariate analysis, and was an independent predictor in Cox multivariate analysis (p = 0.001 and p = 0.038, respectively). Our data suggest that endoglin may be an important therapeutic target in metastatic breast cancer.

Trends in incidence of ductal carcinoma in situ: The effect of a population-based screening programme - Corrected Proof

Ragnhild Sørum, Solveig Hofvind, Per Skaane, Tor Haldorsen — 2010-06-18

Abstract: Background: The incidence of ductal carcinoma in situ (DCIS) has increased substantially in the western world in recent decades. The aim of this study was to investigate the incidence according to grade distribution, age, and implementation of a population-based screening programme.Methods: Cases of primary pure DCIS (n = 3167) were obtained from the Cancer Registry of Norway. Poisson regression was used to estimate trends in incidence.Results: Age-adjusted incidence of DCIS increased from 4 to 11 per 100 000 women-years from 1993 to 2007, in parallel with the implementation of screening. Higher incidence was observed among prevalent (IRR 3.3) and subsequent (IRR 2.8) invited women compared with those not invited. The proportion of DCIS among breast malignancies increased throughout the period, most markedly in the age range of screening.Conclusion: The increased proportion of DCIS during the study period is probably due to improved diagnostics resulting from the implementation of population-based screening.

Patient-subjective cosmetic outcomes following the varying stages of tissue expander breast reconstruction: The importance of completion - Corrected Proof

Donald W. Buck, Deana Shenaq, Kamaldeep Heyer, Caroline Kato, John YS. Kim — 2010-06-18

Abstract: Introduction: Tissue expander breast reconstruction consists of three major surgical steps: placement of the expander after mastectomy, exchange of the expander for an implant, and nipple-areola complex reconstruction. The evolution of patient satisfaction throughout this process has not been evaluated. Here we performed a stratified analysis of patient-subjective cosmetic outcomes during the stages of breast reconstruction.Methods: Twenty-eight consecutive tissue expander-implant reconstructions were performed by the senior author using human acellular dermis. Cosmetic outcomes were assessed after each reconstructive stage using a validated Breast Evaluation Questionnaire consisting of questions related to breast size, shape and firmness in three separate contexts: intimate or sexual activities, leisure or social activities, and professional or job-related activities.Results: Eighteen patients underwent unilateral reconstruction, while 10 underwent bilateral reconstruction. Satisfaction scores were statistically higher following Stage I and II procedures for bilateral reconstructions. For unilateral reconstructions, there was a statistically significant elevation in scores following Stage II. The addition of nipple-areola reconstruction resulted in the highest scores for both unilateral and bilateral reconstructions. These score elevations were significant (p < 0.05) in nearly every measured context for unilateral reconstructions and as such, the significant differences in scores between unilateral and bilateral cohorts after stages I and II were nearly eliminated after completion of the entire reconstructive process.Conclusion: Satisfaction with tissue expander reconstruction is significantly affected by the patients’ stage during the reconstructive process. Completion of all three stages, including nipple-areolar complex reconstruction, achieves maximal patient satisfaction. For unilateral reconstructions, completion of the entire reconstructive process, including contralateral symmetry procedures and nipple-areolar complex reconstruction, results in cosmesis scores that are similar to those in bilateral cases.

No evidence of human papillomavirus DNA in breast carcinoma in Tunisian patients - Corrected Proof

2010-06-14

Abstract: The aim of this study was to evaluate the prevalence of broad range of anogenital HPVs in a series of 123 Tunisian breast carcinoma cases. PCR assays were performed to amplify regions within the L1, E1, E6 and E7 open reading frames of a broad range of anogenital HPVs and specific types HPV16, 18, 31 and 33. In addition, we performed an in situ hybridization analysis using HPV biotinylated DNA probes for the detection of broad spectrum of anogenital HPV types, high-risk HPV types (16 and 18), intermediate-risk HPV types (31 and 33) and low-risk HPV types (6 and 11). None of the 123 breast carcinoma samples showed PCR amplification of HPV DNA using the broad spectrum consensus primer-pairs E1-350L/E1-547R and GP5+/GP6+ primers. Furthermore, neither high risk nor low-risk HPV types were detected in any of these cases. Moreover, using in situ hybridization for the detection of HPVs, we failed to detect a positive signal in neoplastic cells in any case. Our results suggest that anogenital papillomaviruses are unlikely to play a role in the development of breast carcinomas in Tunisian patients.

Alcohol consumption and the risk of breast cancer among BRCA1 and BRCA2 mutation carriers - Corrected Proof

2010-06-14

Abstract: Alcohol consumption increases the risk of breast cancer among women in the general population, but its effect on women who carry a BRCA gene mutation is unclear. We conducted a case-control study of 1925 matched pairs of predominantly premenopausal women who carry a BRCA1 or a BRCA2 mutation. Information on current alcohol consumption was obtained from a questionnaire administered during the course of genetic counselling or at the time of enrolment. A modest inverse association between breast cancer and reported current alcohol consumption was observed among women with a BRCA1 mutation (OR = 0.82, 95% CI 0.70–0.96), but not among women with a BRCA2 mutation (OR = 1.00; 95% CI 0.71–1.41). Compared to non-drinkers, exclusive consumption of wine was associated with a significant reduction in the risk of breast cancer among BRCA1 carriers (p-trend = 0.01). Alcohol consumption does not appear to increase breast cancer risk in women carrying a BRCA gene mutation.

Mammographic surveillance in women with a personal history of breast cancer: How accurate? How effective? - Corrected Proof

Nehmat Houssami, Stefano Ciatto — 2010-06-14

Abstract: We review the accuracy and potential effect of mammography in surveillance of women with a personal history of breast cancer (PHBC). A literature review was performed to identify studies on screening mammography or breast surveillance reporting data on the accuracy or detection capability of mammography, or the effect of early detection of second breast cancers, in women with a PHBC. Evidence on mammography screening in women with PHBC comes from non-randomised studies, and is generally limited by several factors including design limitations. The proportion of ipsilateral breast recurrences detected with mammography ranges between 50% and 80% (including cancers detected also on clinical examination) but is lower at 8%–51% for mammography-only detection. Mammography detects approximately 45%–90% of contralateral cancers. There is evidence of a potential benefit for asymptomatic/early-detected second breast cancers (range of estimated hazard ratios: 0.10–0.86) relative to symptomatic or clinical-detection, in various surveillance strategies that include mammography, however these estimates are likely to have overestimated screening benefit. New evaluations of screening women with a PHBC are needed from screening programs or population datasets, to provide comprehensive measures of screening accuracy and outcomes in this population of women.

Hormonal and metabolic modulation through nutrition: Towards a primary prevention of breast cancer - Corrected Proof

Alvaro L. Ronco, Eduardo De Stéfani, Mario Stoll — 2010-06-10

Abstract: Breast cancer (BC) is a polygenic and multifactorial disease for which estrogens have been recognized as the main risk factor, and for which lifestyle plays a key role. Previous epidemiologic cancer research performed in Uruguayan population delimited its dietary and anthropometric profiles. Recognizing the difficulty for universalizing a nutritional basis for prevention due to different eating patterns among regions and countries, we summarize the existent knowledge linking nutrition, estrogens, metabolism and BC. As an attempt towards primary prevention of BC, we present recommendations mainly based on country-specific research findings and modifiable putative risk and protective factors, proposing to modify the intake of meats and other fatty foods – especially sources of Ω-6 and Ω-3 fatty acids – adding olive oil, selected vegetables, citrus fruits and working towards adequate body fat/muscle proportions. From a medical and ethical viewpoint, it is justified to recommend certain nutritional changes to women, because no adverse side effects are expected to occur.

Management of radiation-induced sarcomas in a tertiary referral centre: A review of 25 cases - Corrected Proof

E. Erel, E. Vlachou, M. Athanasiadou, S. Hassan, C.R. Chandrasekar, F. Peart — 2010-06-09

Abstract: Introduction: Radiation-induced sarcomas are a rare and late complication of radiotherapy for breast carcinoma which often have poor prognosis.Methods: This study is a retrospective review of 25 patients referred to a regional sarcoma unit between 1978 and 2009.Results: Radiation-induced sarcoma following the diagnosis and treatment of breast cancer occurred after a mean period of 156 months. Anatomical sites involved were the breast, chest wall, clavicle, scapula, humerus and axilla. Twenty one patients had wide local excision followed by chest wall reconstruction, latissimus dorsi flap cover or limb amputation. The estimated five years survival following the diagnosis of the radiation-induced sarcoma was 27% and the local recurrence rate 52%.Conclusion: Radiation-induced sarcoma following breast cancer has high local recurrence rate and poor prognosis. They should be managed in a multi-disciplinary setting. Long-term follow-up of patients treated with radiotherapy for breast cancer is therefore advisable.

Non-pegylated liposomal doxorubicin in metastatic breast cancer patients: A valuable therapeutic option requiring caution - Corrected Proof

Daniele Bernardi, Domenico Errante, Micaela Stefani, Luigi Salvagno — 2010-06-09

We have read with interest the recent article by Venturini et al., focusing on non-pegylated liposomal doxorubicin (NPLD) in combination with trastuzumab and docetaxel as first-line therapy in metastatic breast cancer and we would like to share some comments on that, based on our experience.

Bilateral prophylactic mastectomy in women with inherited risk of breast cancer – Prevalence of pain and discomfort, impact on sexuality, quality of life and feelings of regret two years after surgery - Corrected Proof

Jessica Gahm, Marie Wickman, Yvonne Brandberg — 2010-06-04

Abstract: Background: Mastectomy due to breast cancer is associated with chronic pain and a negative impact on sexuality. The purposes of the study were to analyze the prevalence of pain and discomfort in the breasts, impact on sexuality, quality of life, and feelings of regret after bilateral prophylactic mastectomy and immediate reconstruction with implants.Methods: Fifty-nine women operated 2004–2006 were included. A questionnaire was sent out two years after the procedure. Complications and re-operations were recorded.Results: Mean follow-up time was 29 months. 93% of patients answered the questionnaire. 69% reported pain and 71% discomfort in the breasts. Lost or much reduced sexual sensations were reported by 85% and enjoyment of sex was negatively impacted for 75% of patients. Quality of life was not affected and feelings of regret were almost non-existent.Conclusions: It is important to inform women approaching this prophylactic procedure about the risk of having unwanted secondary effects.

Aesthetic and functional results after breast conserving surgery as correlates of quality of life measured by a German version of the Breast Cancer Treatment Outcome Scale (BCTOS) - Corrected Proof

2010-06-04

Abstract: This prospective cohort study was carried out to develop a German version of the Breast Cancer Treatment Outcome Scale (BCTOS) and to examine the relations of aesthetic and functional outcome after breast conserving surgery with quality of life (QoL).The study included 189 patients with one-sided, early stage breast cancer. A factor analysis indicated three internally consistent scales of the German BCTOS: Aesthetic Status, Functional Status and Breast Sensitivity Status.QoL was measured by the EORTC Quality of Life Questionnaire C30-BR23 (EORTC). All BCTOS scales were correlated with scales of the EORTC. Correlation magnitudes ranged from 0.24 to 0.67 (p < 0.001). A multiple regression analyses confirmed these results. The analysis of relevant covariates demonstrated that younger patients revealed poorer status on all BCTOS scales.Aesthetic and functional outcome seems to be closely related to quality of Life. The German BCTOS demonstrated to be a useful.

Blood transfusion requirements in elective breast reconstruction surgery - Corrected Proof

Sammy Al-Benna, Prachi Rajgarhia — 2010-06-04

Abstract: Introduction: Excess-ordering of cross-matched blood in preparation for elective surgery is expensive with associated blood shortages and time-expired wastage. Although, the maximum surgical blood order schedule (MSBOS) for breast reconstruction recommends pre-operative cross-match of 2–6 units of red cell concentrate, there is no data confirming whether this guideline is observed in practice or whether compliance results in improved outcome. The aim of this study was to examine the utility of this MSBOS in clinical practice by assessing its performance in a validation set of patients.Materials and Methods: Over a three year period, 49 patients undergoing 50 consecutive elective breast reconstruction surgery were assessed for demographic data, surgical information and hematological/transfusion data to compare the number of units of blood cross-matched with those subsequently transfused for elective breast reconstruction surgery. This was in lieu of updating the current maximal surgical blood order schedule of cross-matching 2–6 units pre-operatively.Results: Fifty elective operations were undertaken during the study period with a zero peri-operative blood transfusion requirement and a 8% post-operative blood transfusion requirement. Pre-operative cross-match to transfusion ratio was unacceptably high with a time-expired blood wastage of 8.7%.Discussion: These data thus indicate that adoption of a type and screen policy is satisfactory for haemorrhage risk management of elective breast reconstruction. The MSBOS is not designed to predict post-surgery blood needs and a requirement based blood ordering protocol will optimise blood utilisation efficiency.

Patient reported outcome measures following specialist nurse-led clinics in preparation for breast reconstruction surgery - Corrected Proof

2010-05-31

Abstract: We compared patient reported outcome measures following information given about breast reconstruction surgery by either a specialist nurse or operating consultant surgeon using a comparative and validated questionnaire. One hundred and nineteen patients considering breast reconstruction were seen by a single consultant plastic surgeon (60 participants) or by a single specialist nurse (59 participants). Response rates to the questionnaires were 70% and 71% respectively and the overall conversion rate to surgery was 86%. There were no significant differences between the outcome reported for those receiving information from the specialist nurse or the operating consultant. In conclusion we found that pre-operative specialist nurse-led information provision and preparation for breast reconstruction is effective and acceptable to patients.

Long-term observational follow-up study of breast cancer diagnosed in women ≤40 years old - Corrected Proof

Peeter Karihtala, Robert Winqvist, Risto Bloigu, Arja Jukkola-Vuorinen — 2010-05-31

Abstract: The prognosis of young breast cancer patients has been considered to be much poorer than in older patients. Two hundred and sixty-eight premenopausal women with a median follow-up time of 74.0 months were included in the study. 33.5% had oestrogen receptor-negative and 34.6% progesterone receptor-negative tumours. 15.2% of the tumours were HER2-positive. Five-year breast cancer-specific survival (BCSS) was 81.1% and the corresponding 10-year figure was 72.3%. 91.8% of all relapses occurred within seven years of surgery. Among the ≤35-year-old women, only 2 of 38 (5.3%) relapsed beyond seven years of follow-up. Lymph node ratio was the most significant independent prognostic factor of poor disease-free survival and BCSS. This study revealed a high relapse rate in the youngest women as early as during the first few years after diagnosis, although their prognosis as a whole was surprisingly good.

How can Nolvadex abolish arthralgia in women taking newer generic Tamoxifen preparations? - Corrected Proof

Ilyas Sahin, Erhan Ararat, Kadri Altundag — 2010-05-31

To The Editor, We read with great interest the article by Blencowe et al. in which they found that the newer, generic formulations of Tamoxifen (gT) are associated with arthralgia, whereas Nolvadex can abolish arthralgia. They hypothesized that either the excipient profile of gT induces arthralgia, or an unknown excipient of Nolvadex has a protective effect. We speculate on the hypothesis based on studies in the literature.

Changes in therapeutic strategies in Chinese male patients with breast cancer: 40 years of experience in a single institute - Corrected Proof

2010-05-24

Abstract: The changes in therapeutic strategies were determined and the efficacy of radical mastectomy (RM) and modified radical mastectomy (MRM) on Chinese male breast cancer (MBC) patients was compared. Seventy MBC patients, with a median age of 61 years, were enrolled. The characteristics of MBC were compared in cohort A (1969–1997) and cohort B (1998–2009), and the prognosis was compared between the RM and MRM groups. Infiltrating ductal carcinoma accounted for 81.4% of all cases; 93.7% were estrogen receptor (ER)/progesterone receptor (PR)-positive. More patients in cohort B accepted multidisciplinary treatment, MRM, adjuvant chemotherapy, and endocrine therapy than those in cohort A; however, the 5-year overall survival rates were similar in the two cohorts. The overall survival curves, locoregional recurrence rates, and systematic metastatic rates were similar in the RM and MRM groups. Currently, more MBC patients receive conservative surgery; MRM may be equally effective as RM for MBC.

Pre-operative breast MRI: What do women want? - Corrected Proof

Stefano Ciatto — 2010-05-21

Four papers in the first issue of the journal provide various perspectives on the role of MRI in pre-operative staging, given uncertain evidence on its potential benefit, and scarce evidence from randomised controlled trials (RCTs). Although the pre-operative MRI discussion highlighted in the journal is important and timely, and appears at the same time as the publication of the COMICE RCT, I am concerned that we are misunderstanding the context to some extent. The goal of pre-operative MRI is to provide a more exact assessment of tumor volume, allowing better surgical planning, at least in theory: this will prompt immediate mastectomy instead of breast conserving treatment (BCT) in some patients, or larger conservative resections, or will not change treatment in the majority of women. This application of MRI has been assumed to help reduce future ipsilateral breast recurrences (IBR).

The impact of the loco-regional treatment in elderly breast cancer patients: Hypo-fractionated exclusive radiotherapy, single institution long-term results - Corrected Proof

2010-05-19

Abstract: Purpose: : To assess the efficacy of exclusive hypo-fractionated radiotherapy (HFRT) without previous breast-conserving surgery (BCS) in elderly women.Materials and methods: : From 1995 to 1999, we have treated with breast-conserving treatment 396 patients older than 70 years with early-stage breast cancer (T1,T2 tumours) at the Institut Curie, Paris, France. Seventy-nine consecutive elderly non-metastatic patients treated for early breast cancer have been treated with HFRT. Of them, 50 underwent BCS followed by HFRT of 32.5 Gy/5 fractions/5 weeks, and 29 patients (presented with different co-morbidities, inoperable or patients’ refusal, and/or transportation problems) received the same HFRT schedule followed by a 13 Gy boost (two fractions of 6.5 Gy) as exclusive radiotherapy treatment. This population of 29 patients has been studied. In case of hormonal positive status, hormonal therapy was also proposed to the patients.Results: : There was a median follow-up of 93 months (9–140 months). At 7-year follow-up, the cause-specific survival was 96.4% (confidence interval (CI) 95: 89.8.6–100%), the metastasis-free survival rate was 92.4% (CI 95: 82.8–100%) and the loco-regional control rate was 95.8% (CI 95: 88.2–100%).Conclusions: : This long-term follow-up retrospective study demonstrated acceptable local control and good outcome in elderly patients treated by exclusive HFRT for early breast cancer. However, large-scale prospective randomised trials are needed to confirm these results.

Phase II study of preoperative systemic treatment with the combination of docetaxel and trastuzumab in patients with locally advanced HER-2-overexpressing breast cancer - Corrected Proof

2010-05-18

Abstract: We conducted a phase II study using docetaxel and trastuzumab as preoperative systemic treatment for locally advanced HER-2-overexpressing breast cancer (stage IIIB or IIIC) to evaluate the efficacy and safety, and to perform a subset analysis based on tumor biomarkers. Patients received 4mg/kg trastuzumab on day 1, followed by weekly treatments of 2mg/kg, in addition to 75mg/m2 docetaxel every 3 weeks for 4 cycles before surgery. The primary end point was clinical response rate measured by MRI or CT. Twenty-five patients were enrolled. The median age was 54 years and median tumor size was 63 mm. The overall clinical response rate was 68% [95% CI: 47–85%] and the pCR rate was 22% [95% CI: 8–44%]. The clinical response and the pCR rates of patients with ER- and PgR- tumors were 79% and 31%, respectively, while they were 55% and 10%, respectively, in the patients with ER+ and/or PgR+ tumors (p=0.34, p=0.34, respectively). Cardiac toxicity was well tolerated; there was no evidence of clinical cardiac events in any patient. The combination of docetaxel and trastuzumab produced highly favorable clinical and pathological responses for locally advanced HER-2-overexpressing breast cancer. Subgroup analysis suggests that ER/PgR negative tumors might be associated with pathological response in locally advanced breast cancer.

Lipomodelling or lipomodeling? - Corrected Proof

R. Sinna, S. Garson, E. Delay — 2010-05-18

The Medline database is a great and valuable tool. By selecting a single key word, one can manage to review all the articles concerning a related subject. But how do you write this keyword? We read with a great interest the article from Elfadi et al. concerning “lipomodelling of the breast”. But are we talking about lipomodeling or lipomodelling? Because if the single L option is chosen, one can find 7 articles, including a serie of 880 cases over 10-year experience. On the other hand, the double LL will bring out 5 different articles.

Patients’ opinions on quality of care before and after implementation of a short stay programme following breast cancer surgery - Corrected Proof

2010-05-13

Abstract: Purpose: To assess breast cancer patients’ opinions on quality of care during an implementation study on short hospital stay, and to formulate patient inspired targets for further quality improvement based on results of the QUOTE (Quality of Care Through the Patients’ Eyes) breast cancer instrument.Results: Quality of patient education regarding activities at home was in need of improvement in both measurements. Quality of services delivered by the surgeon improved somewhat after implementation. Although quality of waiting and process times improved after implementation, there was still room for further improvement on these aspects.Conclusion: A breast cancer care programme in short stay was introduced while, on average, preserving quality of care as perceived by the patient. However, aspects regarding education on drains, prosthesis, exercises after surgery, survival rates, and waiting and process times require continuing attention to enhance patients’ assessment of quality of care.

Variation in the management of early breast cancer in rural and metropolitan centres: Implications for the organisation of rural cancer services - Corrected Proof

2010-05-10

Abstract: The study examines the management and outcomes of women with early invasive breast cancer treated in rural and metropolitan centres over a nine-year observation period. A prospective audit of the treatment and outcomes of 2081 women with early breast cancer who underwent potentially curative surgery between 1997 and 2006 in metropolitan Canberra or in the surrounding rural region was completed. Overall, there was good agreement between published guidelines and the treatment received by the women in the study. However, women treated in rural centres were less likely to receive postoperative radiotherapy after breast-conserving surgery, or to undergo axillary lymph node surgery or sentinel lymph node biopsy compared with women treated in metropolitan centres. Surgery in a rural centre was associated with increased breast cancer recurrence (HR = 1.54, p < 0.001) and increased breast cancer mortality (HR = 1.84, p < 0.001), after adjustment for age and tumour characteristics. Non-cancer related mortality was increased in women treated in rural centres compared with women travelling to a metropolitan centre for surgery (HR = 2.08; p = 0.005). There were differences in both the care provided and treatment outcomes between women treated in rural centres and women treated in metropolitan centres. However, the increased non-cancer related mortality in women treated in rural centres suggests an increased medical comorbidity in this group. Initiatives supporting rural-based surgeons to adopt new procedures such as sentinel node biopsy may help to optimise rural breast cancer treatment.

Urban–rural differences in breast cancer incidence in Egypt (1999–2006) - Corrected Proof

2010-05-10

Abstract: Objective: To describe urban–rural differences in breast cancer incidence in Gharbiah, Egypt and to investigate if these differences could be explained by known risk factors of breast cancer.Methods: We used data from the population-based cancer registry of Gharbiah, Egypt to assess breast cancer incidence from 1999 through 2006. The Egyptian census provided data on district-specific population, age, and urban–rural classification. Incidence patterns of breast cancer by district and age-specific urban–rural differences were analyzed.Results: Overall, incidence rate of breast cancer was three to four times higher in urban areas than in rural areas (60.9/105-year for urban areas versus 17.8/105-year for rural areas; IRR=3.73, 95% CI=3.30, 4.22). Urban areas had consistently higher incidence of breast cancer across all age-groups for all years. Higher incidence of breast cancer was also seen in the more developed districts of Tanta and El-Mehalla.Conclusions: Higher incidence of breast cancer in urban and more developed populations might be related to higher exposure to xenoestrogens, as well as other endocrine disruptors and genotoxic substances.

Schizophrenia does not adversely affect the treatment of women with breast cancer: A cohort study - Corrected Proof

2010-05-06

Abstract: Background: Data on the natural course of patients with breast cancer and schizophrenia are limited. Although there have been studies in assessing the incidence of breast cancer in the setting of schizophrenia, there is very little information concerning the clinical profile of these women.Methods: We analyzed the data from our electronic notes system by searching for the terms ‘schizophrenia’ or ‘schizophrenic’ and ‘breast cancer’ or ‘tumour’ between 1993 and 2009. Information was collected on demographics, clinico-pathologic disease variables, treatment including anti-emetic use, chemotherapy delivery and outcomes.Results: From 90,676 patients screened, we identified 37 individuals who had breast cancer and a pre-existing underlying diagnosis of schizophrenia. Of these, 30 (81%) presented with early breast cancer and 7 (19%) presented with metastatic disease. Node positivity was observed in 14 individuals (38%). The average interval between diagnosis of schizophrenia and breast cancer was more than 20 years in the majority of the patients. Treatment outcomes, trial involvement, compliance and ability to provide informed consent were similar to our previously published cohort data.Conclusions: Schizophrenia does not affect treatment delivery or outcomes in women with breast cancer. The presence of schizophrenia should not be a limiting factor for entry into clinical trials. Breast cancer patients with this illness should be offered standard treatment without discrimination, including entry into clinical trials.

Drug associated osteonecrosis of the jaw - Corrected Proof

Tanja Fehm — 2010-04-30

we would like to thank the authors Fusco et al. for their useful statement on our publication (Fehm et al. The Breast 18(4):213–7, 2009). We would like to comment the following topics discussed by Fusco et al.

Oncoplastic surgery: “A rolling stone gathers no moss” - Corrected Proof

Florian Fitzal — 2010-04-26

When I was in my first residency year for general surgery in Austria 1999, the word “oncoplastic” was unpresentable at national meetings. Ten years and a couple of international breast cancer meetings later we have books about oncoplastic surgery and some countries even developed fellowship programs for oncoplastic surgery, some are planning to do so. What happened?

Return to activities after breast reduction - Corrected Proof

H.H.A. Schumacher, J.M. Pleat, J.M. Bailey — 2010-04-26

Abstract: Background: Uncertainty exists in the medical literature about recommendations for return to work or driving after breast reduction surgery.Methods: A survey was sent to 138 plastic surgeons in the United Kingdom enquiring about their recommended timing of return to work or driving a car depending of level of activity. Data was evaluated with univariate ANOVA test and a p<0.05 significance level.Results: Out of 73 surgeons who responded, 13% did not give any specific advice regards to return to work and 30% for return to driving. The remainder suggested to return to work and driving after about 19 days each.Conclusions: Based on this consensus of opinion of plastic surgeons with an interest in breast surgery it appears reasonable to suggest a recovery period of approximately 3 weeks subject to individual variations. Further evidence is needed to comment on the interaction of wound healing and pain and return to driving and work.

Training in oncoplastic surgery: An international consensus. The 7th Portuguese Senology congress, Vilamoura, 2009 - Corrected Proof

2010-04-23

Abstract: Oncoplastic Breast Surgery (OPBS) is becoming an integral part of breast cancer management, but few surgeons have received formal training in these techniques. An International Symposium has recently debated the key issues which impact on training and specialisation in OPBS, as well as patient access to these procedures. The Symposium concluded that increasing the availability of OPBS is a major challenge, which demands much closer collaboration and cooperation between breast and plastic surgeons, backed up by new training schemes, new curricula and new guidelines.

The psychosocial impact of ductal carcinoma in situ (DCIS): A longitudinal prospective study - Corrected Proof

Fiona Kennedy, Diana Harcourt, Nichola Rumsey, Paul White — 2010-04-22

Abstract: DCIS is a non-invasive breast cancer, increasingly detected through routine breast screening. Patients are reassured that the condition is early and not life-threatening but they undergo surgery similar to that used in the treatment of invasive breast cancer (IBC). Little research has explored the psychosocial impact of DCIS, especially in the UK. A longitudinal, prospective study was therefore conducted to address this gap. Fifty women newly diagnosed with DCIS were followed over the first year post-diagnosis. Anxiety and depression significantly reduced from baseline to 6 months. Body image distress was relatively stable, but extensive for some women. Those undergoing mastectomy with immediate reconstruction experienced significantly greater body image concerns. This study highlights that DCIS patients can experience psychosocial distress that is often transient but in some cases extensive and prolonged. Appropriate psychosocial support is needed to help DCIS patients adjust to the diagnosis, its treatment and long-term implications.

A retrospective study of metachronous and synchronous ipsilateral supraclavicular lymph node metastases in breast cancer patients - Corrected Proof

Ying Fan, Binghe Xu, Yuqian Liao, Shuyang Yao, Yan Sun — 2010-04-20

Abstract: Clinically, ipsilateral supraclavicular lymph node metastasis (ISLM) in breast cancer can be classified into 2 manifestations: metachronous and synchronous. Synchronous ISLM (T1-4, N3, M0) is stage IIIc. Metachronous ISLM is isolated supraclavicular lymph node relapse after curative treatment. Although both are featured with ipsilateral supraclavicular lymph node metastases they are two clinical entities needing to be addressed differently. It is of particular interest to know other potential discrepancies between them except for the timing of ISLM occurrence. We retrospectively reviewed 2486 breast cancer patients. Among them, 48 women were identified with metachronous ISLM and 33 with synchronous ISLM. No significant difference was found between them in terms of clinicopathological characteristics as well as survival. However, the multivariate analysis showed they had different independent prognostic factors. Axillary lymph node metastasis status (P = 0.009) and chemotherapy after occurrence of ISLM (P = 0.016) were independent prognostic predictors for metachronous ISLM whilst primary tumor size (P = 0.016) and radiotherapy after diagnosis of ISLM (P = 0.022) were independent prognostic factors for synchronous ISLM. The multidisciplinary management of ISLM patients is strongly recommended.

The WHI diet: Difficult to digest - Corrected Proof

Walter C. Willett, Meir J. Stampfer — 2010-04-20

In this issue, Dayal and Kalia suggest that women should follow the low-fat/high-carbohydrate diet used in the Women’s Health Initiative (WHI) trial because of a 9% lower risk of breast cancer in the intervention group, even though the finding was not significant (relative risk = 0.91, 95% CI = 0.83–1.01, P = 0.09 using the a priori statistical test). We agree with Dayal and Kalia that a nonsignificant result from one study should not lead us automatically to reject an intervention, particularly if substantial other information suggests a benefit. Such a decision should be based on the degree to which the hypothesis was adequately tested in the study, and all other available evidence. Robust evidence weighs against recommending the WHI diet.

Moderate dose capecitabine in older patients with metastatic breast cancer: A standard option for first line treatment? - Corrected Proof

A.A. Kotsori, J.L. Noble, S. Ashley, S. Johnston, I.E. Smith — 2010-04-14

Abstract: Single agent capecitabine is effective and well tolerated in metastatic breast cancer (MBC). We have retrospectively analysed capecitabine outcome as 1st, 2nd or 3rd line chemotherapy in 89 elderly patients ≥70 years with locally advanced or MBC treated in our Unit, 55 (62%) as 1st line and 34 (38%) as 2nd or 3rd line. Starting dose was 1000 mg/m2 twice daily, days 1–14 every 3 weeks, but 36 (41%) started on a 25% dose reduction because of frailty and 12 (13%) reduced dose after the 1st or the 2nd cycle.Overall response rate (ORR) was 45% (95% CI: 35–55%). A further 19 (21%) achieved stable disease (SD) for ≥6 months. Median time to progression (TTP) and overall survival (OS) were 30 (95% CI: 23–37) and 61 (95% CI: 44–77) weeks, respectively. The ORR for 1st line treatment was 51% compared with 35% for 2nd and 3rd line treatment (p = 0.03). No significant difference in efficacy was seen between patients receiving the full versus reduced dose. Capecitabine was well tolerated, although 35% had treatment delays and 57% required dose reduction. Grade 3–4 toxicities were hand–foot syndrome in 11%, lethargy 9% and diarrhoea 2%.Capecitabine is an effective and well-tolerated drug in elderly patients with MBC including for 1st line treatment. Dose reduction is frequently required but does not appear to affect outcome.

Cognitive function in postmenopausal women receiving adjuvant letrozole or tamoxifen for breast cancer in the BIG 1-98 randomized trial - Corrected Proof

2010-04-12

Abstract: Cognitive function in postmenopausal women receiving letrozole or tamoxifen as adjuvant endocrine treatment was compared during the fifth year of treatment in a substudy of the BIG 1-98 trial. In BIG 1-98 patients were randomized to receive adjuvant (A) 5-years tamoxifen, (B) 5-years letrozole, (C) 2-years tamoxifen followed by 3-years letrozole, or (D) 2-years letrozole followed by 3-years tamoxifen. The primary comparison was the difference in composite score for patients taking letrozole (B+C; N=65) vs. tamoxifen (A+D; N=55). The patients taking letrozole had better overall cognitive function than those taking tamoxifen (difference in mean composite z-scores=0.28, P=0.04, 95% CI: 0.02, 0.54, Cohen’s D=0.40 indicating small to moderate effect). In this substudy, breast cancer patients taking adjuvant letrozole during the fifth year of treatment had better cognitive function than those taking tamoxifen, suggesting aromatase inhibitors do not adversely impact cognition compared with tamoxifen.

Management of triple negative breast cancer - Corrected Proof

Catherine Oakman, Giuseppe Viale, Angelo Di Leo — 2010-04-12

Abstract: Triple negative breast cancer (TNBC) accounts for approximately 15% of breast cancer cases. TNBC is an immunohistochemically defined subtype, with significant diversity within the subtype. Generally TNBC occurs in younger women and is marked by high rates of relapse, visceral and CNS metastases, and early death. Current therapy fails to curtail the innate aggressive behaviour of TNBC in the majority of patients. The poor prognosis coupled with a lack of targeted use of therapies is reflected in the high mortality. In a minority of patients with highly chemosensitive disease, no robust clinical evidence exists to guide use of current cytotoxics. Critical to optimal future management are accurate identification of truly triple negative disease and adequately powered prospective TNBC trials to establish treatment efficacy and define predictive biomarkers.

Osteonecrosis of the jaw (ONJ) risk in breast cancer patients after zoledronic acid treatment - Corrected Proof

2010-04-05

We have read with interest the paper by T. Fehm. et al. published on August number of The Breast. We agree with recommendations for prevention of bisphosphonate-associated osteonecrosis of the jaw (ONJ) appointed by the multidisciplinary task force of the German society of senology, that lengthens the list of recommendations established worldwide by authorities and scientific societies to minimize the risk of ONJ in cancer patients.

Utility of mammaglobin and gross cystic disease fluid protein-15 (GCDFP-15) in confirming a breast origin for recurrent tumors - Corrected Proof

Shi Yun Chia, Aye Aye Thike, Poh Yian Cheok, Puay Hoon Tan — 2010-03-29

Abstract: There are limited data that compare the utility of immunohistochemical detection of mammaglobin with Gross Cystic Disease Fluid Protein-15 (GCDFP-15) in locally recurrent and metastatic breast cancers. Forty-three local and 72 distant recurrences of breast cancer, 8 metastatic lesions to the breast from other organs, and 30 metastases from non-breast primaries were immunohistochemically stained with mammaglobin and GCDFP-15 antibodies. Mammaglobin was expressed in 55 (47.8%) and GCDFP-15 detected in 13 (11.3%) locally and distantly recurrent breast cancers. A higher percentage of tumor cells was stained with mammaglobin at greater staining intensity than GCDFP-15, for both metastatic and locally recurrent breast cancers. The difference in staining intensity as well as mean percentage of tumor cells stained for both markers was statistically significant (p < 0.005). Metastases to the breast from other organs and metastatic lesions from non-breast primaries were uniformly negative for both mammaglobin and GCDFP-15. Our study demonstrates that immunohistochemical analysis of mammaglobin is superior to GCDFP-15 in detecting a tumor of breast origin, and can be incorporated into immunohistochemical panels evaluating tumors from unknown primary sites.

Accurate classification of sentinel lymph node metastases in patients with lobular breast carcinoma - Corrected Proof

Sophia K. Apple, Neda A. Moatamed, Rachel H. Finck, Peggy S. Sullivan — 2010-03-29

Abstract: Among pathologists there is low reproducibility in classifying small volume metastases in sentinel lymph node particularly in cases of invasive lobular carcinoma. We postulate that strict adherence to American Joint Commission on Cancer (AJCC) 2003 criteria may result in inaccurate staging of lobular carcinoma patients. We reviewed cases of metastatic lobular carcinoma in sentinel lymph node biopsies between 1998 and 2008. All sentinel lymph nodes were reassessed using strict adherence to AJCC 2003 criteria. Subsequent axillary lymph node dissection and clinical follow-up were reviewed. Fifty-one patients met our inclusion criteria and were originally classified by the primary pathologist as follows: 10 isolated tumor cells, 8 micrometastases, 27 macrometastases, and 6 ‘positive’ cases without further classification. Cases were re-classified using strict adherence to AJCC 2003 criteria as follows: 21 isolated tumor cells, 2 micrometastases, and 28 macrometastases. Twelve isolated tumor cells cases underwent full axillary dissection, and 3 (25%) had additional macrometastases. All micrometastatic cases underwent axillary dissection; all were negative. Twenty-two macrometastatic cases underwent full axillary dissection and 16 (73%) had additional macrometastases. Diffuse single cells or small clusters should not be interpreted as isolated tumor cells in invasive lobular carcinoma sentinel lymph nodes. The criteria for assessing small volume metastases in the sentinel lymph node of patients with invasive lobular carcinoma need to be more clearly defined.

Sternal/para-sternal resection for parasternal local recurrence in breast cancer - Corrected Proof

Jill Noble, Bahwna Sirohi, Sue Ashley, George Ladas, Ian Smith — 2010-03-22

Abstract: Background: Locoregional recurrence occurs in a significant number of patients with breast cancer. This can result in substantial morbidity and mortality. Chest wall resection is well-documented for palliation and local control in chest wall relapse; an extension of this surgery is parasternal or sternal resection.Methods: A retrospective review of medical records of eighteen women who underwent sternal or parasternal resection with curative intent between 1998 and 2007 was undertaken.Results: 12 patients had total sternal resection, five patients had sub-total sternal resection and one patient had resection of tumour and ribs. 17 patients required the insertion of a composite Marlex® methyl-methacrylate chest wall prosthesis, followed by soft tissue reconstruction with a pectoralis major or latissimus dorsi flap, in the majority of cases. In-hospital and 30-day mortality was 0%. One and two-year overall survival was 87% and 80% respectively. The median recurrence-free survival was 18 months (95% CI 4–31 months). There was local and distant recurrence in one patient (5%), local recurrence in two patients (11%) and distant recurrence in eight patients (44%), with 15 out of 18 patients (77%) remaining free from local recurrence at 5 years.Conclusions: En bloc sternal resection for parasternal recurrence in breast cancer involves extensive surgery but in our experience can be performed with very low mortality and morbidity. In selected patients it provides good long term local control, relief of pain and improved cosmesis.

Preventing breast cancer in postmenopausal women by achievable diet modification: A missed opportunity in public health policy - Corrected Proof

Hari H. Dayal, Alok Kalia — 2010-03-22

Abstract: The Diet Modification trial of the Women's Health Initiative studies was reported to be inconclusive as the overall risk reduction was not statistically significant at the 0.05 level. By our calculation, the trial's demonstrated risk reduction at average adherence to a simple diet modification translates into avoiding 7.3% invasive breast cancers in post-menopausal women in the USA. The trial also demonstrated a clear dose response between diet modification and risk reduction, meaning a higher percentage of breast cancers can be avoided among women whose diet modification was better than average. Yet, the DM trial findings as reported and interpreted in public sent the message to post-menopausal women that reducing the fat intake does not reduce the risk of breast cancer. Clearly, a valuable opportunity to affect public health policy was missed because the contextual significance and policy implications of the findings were ignored.