The Breast RSS feed: Articles in Press. The Breast is an international, multidisciplinary journal for clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention and therapy. The Editors welcome the submission of original research articles, systematic reviews, viewpoint and debate articles, and correspondence on all areas of pre-malignant and malignant breast disease, including: • Surgery • Medical oncology and translational medicine • Radiation oncology • Breast endocrinology • Epidemiology and prevention • Gynecology • Imaging, screening and early diagnosis • Pathology • Psycho-oncology and quality of life • Advocacy • Supportive and palliative care • Nursing • Research and management in countries with limited resources The Breast is a valuable source of information for surgeons, medical oncologists, gynecologists, radiation oncologists, endocrinologists, epidemiologists, radiologists, pathologists, breast care nurses, breast cancer advocates, psychologists and all those with a special interest in breast cancer.http://www.thebreastonline.com//inpress?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. The Breast0960-97762010-03-08 © 2010 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.thebreastonline.com/article/PIIS0960977610000068/abstract?rss=yesSeventh Scientific Meeting of the Australasian Society for Breast Disease: 1-3 October 2009 Surfers Paradise Marriott Resort & Spa Gold Coast - Corrected Proof10.1016/j.breast.2010.01.004The Breast (2010)2010-03-08The Breast2010-03-08SELECTED ABSTRACTS FOR PROFFERED PAPERS AND POSTERShttp://www.thebreastonline.com/article/PIIS096097761000007X/abstract?rss=yesLaval Grimard Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, CanadaInterval between breast-conserving surgery and radiotherapy in early-breast cancer: How long before an effect on local control? - Corrected Proof10.1016/j.breast.2010.01.005The Breast (2010)2010-03-08The Breast2010-03-08http://www.thebreastonline.com/article/PIIS0960977610000081/abstract?rss=yesN. Pathmanathan * 1,2,3,4, A-F.Albertini 1,2, P. Provan 3,4, J. Milliken 1,2, E. Salisbury 1,2, M. Bilous1,2, K. Byth 3, R. Balleine 2,3,4 1 Institute of Clinical Pathology and Medical Research, 2 Sydney West Area Health Service, 3 Westmead Millennium Institute, 4 University of Sydney, Westmead, NSW, AustraliaCore biopsy evaluation of papillary lesions of the breast - Corrected Proof10.1016/j.breast.2010.01.006The Breast (2010)2010-03-08The Breast2010-03-08http://www.thebreastonline.com/article/PIIS0960977610000093/abstract?rss=yesRL Balleine* 1,2,3, JE Carpenter 3, CL Clarke1,2,3 1 Translational Oncology, Sydney West Area Health Service, 2 Westmead Institute for Cancer Research,3 Westmead Millennium Institute, University of Sydney, Western Clinical School, Westmead, NSW, AustraliaThe breast cancer tissue bank - Corrected Proof10.1016/j.breast.2010.01.007The Breast (2010)2010-03-08The Breast2010-03-08http://www.thebreastonline.com/article/PIIS096097761000010X/abstract?rss=yesC Cho, P Craft, J Price, A Rezo, Y Zhang, R. Stuart-Harris* for the ACT and SE NSW Breast Cancer Treatment Group, Canberra, Australia In 1997, a database for newly diagnosed patients with breast cancer in the ACT and the surrounding area of SE NSW was established. The database was approved by the ACT Health Human Research Ethics Committee. From 01/07/1997-30/06/2007, a total of 2829 patients were entered, representing approximately 96% of all newly diagnosed breast cancers in the region. A total of 2371 women (84%) had unilateral invasive disease, 293 women (10%) had DCIS, 58 women (2%) had bilateral synchronous breast cancer, 49 women (2%) had metastatic disease at presentation, 19 (<1%) were male and 39 (1%) women did not have surgery. Of the 2371 patients with unilateral invasive disease, 1157 (49%) had breast conserving surgery (BCS) and 1214 (51%) had a mastectomy (Mx). The majority of patients only underwent one surgical procedure. Of the women who had BCS, 1099 (95%) received radiotherapy (RT) compared with 457 (38%) of the Mx patients. Of the 2371 patients with unilateral invasive disease, 1229 (52%) received adjuvant chemotherapy and 1846 (78%) received adjuvant endocrine therapy (AET), predominantly with tamoxifen.Ten years of a breast cancer database in the ACT and SE NSW - Corrected Proof10.1016/j.breast.2010.01.008The Breast (2010)2010-03-08The Breast2010-03-08http://www.thebreastonline.com/article/PIIS0960977610000111/abstract?rss=yesCusack L1,2* Moore K1,2, Brennan M.1,2 1 Breast Cancer Care Centre, Royal North Shore Hospital, Sydney, NSW, AustraliaBreast clinic triage tool: A 4-item questionnaire for telephone assessment of new referrals - Corrected Proof10.1016/j.breast.2010.01.009The Breast (2010)2010-03-08The Breast2010-03-08http://www.thebreastonline.com/article/PIIS0960977610000123/abstract?rss=yesElder, E* and Moore, K. Department of Oncological Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW, AustraliaFactors influencing treatment recommendations in node-negative breast cancer - Corrected Proof10.1016/j.breast.2010.01.010The Breast (2010)2010-03-08The Breast2010-03-08http://www.thebreastonline.com/article/PIIS0960977610000135/abstract?rss=yesGlover AR*, Segara D, Hargreaves W. Department of Surgery, St Vincent's Hospital, Sydney, NSW, AustraliaFrozen section for intra-operative detection of nodal metastatic disease in breast cancer - Corrected Proof10.1016/j.breast.2010.01.011The Breast (2010)2010-03-08The Breast2010-03-08http://www.thebreastonline.com/article/PIIS0960977610000147/abstract?rss=yesCK Lee, SJ Lord, MR Stockler, AS Coates, V Gebski, RJ Simes on behalf of Australian New Zealand Breast Cancer Trials Group (ANZBCTG) Purpose: Randomised controlled trials (RCTs) provide optimal evidence to assess the benefits of new treatments. However, clinicians routinely rely on cross-trial comparisons to assess competing treatments when head-to-head randomised comparisons are not available. We investigate the validity of cross-trial comparisons using individual patient data (IPD) where patients received the same treatment protocol. We also examine the extent statistical adjustment for baseline prognostic characteristics can account for the differences in outcomes observed across trials.Historical cross-trial comparisons for competing treatments in advanced breast cancer – an empirical analysis of bias - Corrected Proof10.1016/j.breast.2010.01.012The Breast (2010)2010-03-08The Breast2010-03-08http://www.thebreastonline.com/article/PIIS0960977610000159/abstract?rss=yesR Stuart-Harris*, B Shadbolt The Canberra Hospital, Woden, ACT, AustraliaThe prognostic significance of single hormone receptor positive metastatic breast cancer: An analysis of three randomised phase III trials of aromatase inhibitors - Corrected Proof10.1016/j.breast.2010.01.013The Breast (2010)2010-03-08The Breast2010-03-08http://www.thebreastonline.com/article/PIIS0960977610000354/abstract?rss=yesAbstract: To evaluate the cardiotoxicity, general toxicity, and activity of non-pegylated liposomal doxorubicin, in combination with docetaxel and trastuzumab, as first-line therapy in metastatic breast cancer.Thirty-one patients with metastatic human epidermal growth factor receptor 2-overexpressing breast cancer, who had not previously received chemotherapy for metastatic disease, received non-pegylated liposomal doxorubicin (50mg/m2), docetaxel (75mg/m2) and trastuzumab (2mg/kg/week) for up to eight cycles, followed by trastuzumab alone for up to 52 weeks. Cardiotoxicity was defined as a decrease in left ventricular ejection fraction (LVEF) to below 45%, or a decrease in LVEF of at least 20% from baseline.Mean LVEF was maintained at baseline level also in the subset of patients who had received anthracycline previously. Cardiotoxicity developed in three patients during the treatment cycles, and in two further patients after the end of the study. The most common adverse events were haematological toxicity, alopecia, asthenia and fever. The best overall response rate was 65.5%. Median time to progression was 13.0 months.The combination of non-pegylated liposomal doxorubicin, docetaxel and trastuzumab combines acceptable cardiac and general toxicity and promising activity as first-line therapy in metastatic breast cancer.A multicentre Phase II study of non-pegylated liposomal doxorubicin in combination with trastuzumab and docetaxel as first-line therapy in metastatic breast cancer - Corrected ProofM. Venturini, C. Bighin, F. Puglisi, N. Olmeo, E. Aitini, G. Colucci, O. Garrone, A. Paccagnella, G. Marini, L. Crinò, M. Mansutti, B. Baconnet, A. Barbato, L. Del Mastro10.1016/j.breast.2010.01.018The Breast (2010)2010-02-25The Breast2010-02-25ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977610000056/abstract?rss=yesAbstract: The involvement of a breast care nurse (BCN) in breast cancer treatment can improve the physical and psychological outcomes and provide the continuity of care and better information about the disease and treatment process. This survey examined the current status of BCNs access to determine the extent and how BCNs were accessed by breast surgeons across Australia and New Zealand in different geographical settings or health service sectors.The survey was disseminated in December 2006. Response rate was 91%.The results show that the majority of Australian and New Zealand breast surgeons either work with a BCN in their practice or can access a BCN outside their practice. Patients are more likely to have access to a BCN immediately after diagnosis while around a third of practices have access to a BCN more than once, usually “after diagnosis” and “after surgery”. More public practices have direct access to a BCN than private practices, particularly in the metropolitan and regional areas while access to BCN is poor in rural public and private practices. The difference in overall access, either in the practice or external access (Yes or No but can access a BCN), to a BCN between public and private practices is smaller. Access to a BCN was best in metropolitan public practices and worst in rural private practices with one quarter rural private practices had no access to a BCN and no rural patients can access a BCN more than once in private practice.The results of this survey demonstrated some evidence of disparity in access to a BCN which needs to be reduced through more attention and/or extra resources in this area.Disparities in access to breast care nurses for breast surgeons: A National Breast Cancer Audit survey - Corrected ProofClaire Marsh, Jim Wang, James Kollias, Margaret Boult, Janet Rice, Guy Maddern10.1016/j.breast.2010.01.003The Breast (2010)2010-02-22The Breast2010-02-22ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977610000366/abstract?rss=yesAbstract: Majority of breast cancer are diagnosed at >65 years. Efforts to develop clinical service and research are spent mainly on younger patients. Little is known about the biology and long-term clinical outcome of breast cancer in the elderly. However there is data suggesting that there are differences. Knowledge related to breast cancer in the elderly is urgently needed and we need to optimise their management – not ‘over’ or ‘under’ treating them, taking into account of both physical and psychosocial dimensions. The Nottingham Breast Services established a dedicated elderly primary breast cancer service from its inception over 30 year ago, which has recently developed into a combined surgical/oncology facility. A joint effort and team approach are required in both developing clinical service and research, in order to optimise management. There is an immense need to develop a dedicated elderly breast cancer service and to support ongoing research.A vision to optimise the management of primary breast cancer in older women - Corrected ProofK.L. Cheung, D.A.L. Morgan, L. Winterbottom, H. Richardson, I.O. Ellis, D. Porock, D. Porock10.1016/j.breast.2010.01.019The Breast (2010)2010-02-22The Breast2010-02-22LETTER TO THE EDITORhttp://www.thebreastonline.com/article/PIIS096097761000038X/abstract?rss=yesAbstract: Studies conducted in different areas of North America and Europe showed a 5–10% decline in the incidence of breast cancer following reductions up to 70% in menopause hormone therapy (HT) use after 2002. The observation that the decline was larger in (or limited to) women aged ≥50 years weighs in favour of an effect of reduced HT use on breast cancer incidence. However, changes in screening are also likely to play a role in the decreasing incidence of breast cancer observed in several countries. In particular, the technical improvements and the increased effectiveness of breast cancer screening and detection during the 1990s led to a decreased number of pre-clinical cases found by screening in subsequent years. Further, disentangling the effects of HT use and screening is difficult, as women who stop using HT may also undergo mammography screening less frequently. Thus, the reasons of the falls in incidence remain open to discussion.The rise and fall in menopausal hormone therapy and breast cancer incidence - Corrected ProofClaudio Pelucchi, Fabio Levi, Carlo La Vecchia10.1016/j.breast.2010.01.021The Breast (2010)2010-02-22The Breast2010-02-22REVIEWhttp://www.thebreastonline.com/article/PIIS0960977610000172/abstract?rss=yesAbstract: Vinorelbine (i.v.) plus capecitabine (oral) combination therapy is active in anthracycline/taxane pretreated patients with metastatic breast cancer. Availability of oral vinorelbine provides this combination in an all-oral formulation. Two consecutive phase II trials differing only in vinorelbine administration routes evaluated their respective activities and tolerabilities in this population. In the i.v. group (n = 38) disease control was 61% (37% PR, 24% SD), median TTP 6.8 months and median survival 11.3 months. In the oral group (n = 38) disease control was 77% (5.4% CR, 34% PR, 38% SD), median TTP 7 months and median survival 10 months. G3–G4 neutropenia was more common in the oral group (p < 0.05); G2–G3 anaemia and G3 thrombocytopenia were observed only in the oral group. Although the comparison between the two regimens was not randomized, the results observed in these two consecutive phase II studies may suggest that oral and iv vinorelbine, in combination with capecitabine, can achieve similar responses in patients with metastatic breast cancer refractory to anthra–taxane combinations.Intravenous versus oral vinorelbine plus capecitabine as second-line treatment in advanced breast cancer patients. A retrospective comparison of two consecutive phase II studies - Corrected ProofVito Lorusso, Saverio Cinieri, Marianna Giampaglia, Mariangela Ciccarese, Andrea Tinelli, Vincenzo Chiuri, Corrado Manca, Nicola Silvestris, Giampiero Gasparini, Giuseppe Colucci10.1016/j.breast.2010.01.015The Breast (2010)2010-02-18The Breast2010-02-18ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977610000330/abstract?rss=yesAbstract: The purpose of this study was to determine the safety and efficacy of percutaneous ultrasound (US) guided preferential radiofrequency ablation (PRFA) of unifocal human invasive breast carcinoma with largest radiological diameters of up to 16 mm. Thirty-three patients were enrolled in a study to be treated prior to scheduled partial mastectomy. A needle-shaped treatment electrode, successively developed in two different sizes, was placed into the center of the lesions using ultrasound guidance. A temperature of 85 °C was maintained for 10 min. The analysis of the resected specimen was performed using conventional histopathological methods with the aim to determine the size of the lesion as well as the potential viability of tumor cells. Of the 33 patients enrolled 31 were treated. In 26 (84%) patients a complete ablation of the tumor was achieved. Ultrasound guided preferential radiofrequency ablation of small breast carcinoma is feasible and patient friendly. The success rate depends on accurate preoperative diagnostic imaging as well as an exact position of the needle electrode.Feasibility study on the treatment of small breast carcinoma using percutaneous US-guided preferential radiofrequency ablation (PRFA) - Corrected ProofHans Wiksell, Lars Löfgren, Kai-Uwe Schässburger, Helene Grundström, Marina Janicijevic, Ulla Lagerstedt, Karin Leifland, Rolf Nybom, Samuel Rotstein, Ariel Saracco, Inkeri Schultz, Karin Thorneman, Carl Wadström, Lars Westman, Hans Wigzell, Brigitte Wilczek, Gert Auer, Bengt Sandstedt10.1016/j.breast.2010.01.016The Breast (2010)2010-02-18The Breast2010-02-18ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977610000342/abstract?rss=yesAbstract: Background: Although radioguided occult lesion localization (ROLL) has become a widely accepted technique, the optimal time interval between the radioisotope injection and surgery has not yet been determined.Aim: To delineate the effects of time from the injection of the radionuclide until surgery on the ROLL success rate in a patient population diagnosed as having non-palpable breast cancer.Methods: Between December 2004 and May 2009, 75 patients underwent ROLL procedure. The day-before protocol and same-day protocols included 50 and 25 breast cancer patients respectively.Results: The two study groups were comparable in terms of age, localization technique, radiological findings and the type of surgical procedures (P > 0.05). No statistically significant difference was noticed in the pathological diagnosis, cancer size and the surgical margin clearance between the two groups (P > 0.05).Conclusions: Same-day injection of the radiotracer was not superior to the day-before injection in ROLL. The day-before protocol can be scheduled for the convenience of both patients and hospital staff.Radioguided occult lesion localization (ROLL) for non-palpable breast cancer: A comparison between day-before and same-day protocols - Corrected ProofFatih Aydogan, Volkan Ozben, Varol Celik, Cihan Uras, Gülgün Tahan, Ertugrul Gazioglu, Ali Cengiz, Mehmet Ferahman, Ali Cercel, Mehmet Halit Yilmaz, Metin Halac, Hilal Unal10.1016/j.breast.2010.01.017The Breast (2010)2010-02-18The Breast2010-02-18ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977610000160/abstract?rss=yesAbstract: Background: Conservative breast resection with subsequent sentinel lymph node biopsy (SNB) is an increasingly popular initial approach for the treatment of breast cancer due to decreased invasiveness. SNB is a shorter procedure with fewer side effects than more substantial surgical procedures, but it sometimes fails to identify metastatic disease. Therefore, a highly sensitive and convenient method is needed to identify sentinel lymph nodes (SLN) with a high probability of containing disease in SNB. We compared the combination of radioisotope or dye with a fluorescence compound to analyze lymph flow to identify targets for SNB.Materials and methods: We examined patients with breast cancer lacking metastases in the axillary lymph node (ALN). Two methods for targeted SNB were developed: (1) Indocyanine Green (ICG) and Patent blue were injected into the skin overlying the tumor and sub-areolar region just before the surgical procedure. (2) ICG and radiocolloid were injected into the skin overlying the tumor and sub-areolar region. The draining fluorescent lymphatic duct was visualized using a Photodynamic Eye (PDE). We removed the SLNs that were identified by the dye and fluorescence imaging methods. Method 1 was applied to 113 patients undergoing SNB, and 29 patients were treated with Method 2. In our study, patients were grouped by lymph flow into two types: Type C demonstrated convergence to one lymph duct. Type S demonstrated separate lymph ducts.Results: Using the fluorescence imaging method, 99.3% of SLNs were identified, and 3.8 SLNs per patient were seen. The SLN identification rates for Patent blue dye and radiocolloid were 92.9% and 100%, respectively, while 1.9 and 2.0 SLNs per patient, respectively, were seen with these methods. We classified two types of lymph flow based on the pattern of lymphatic drainage. Type C converged to a single lymph duct, while Type S drained to separate ducts. Type S lymph drainage was seen in 29/142 patients (20.4%), and Type C drainage was found in 113/141 patients (79.6%). Of the patients with Type S drainage, there were 4.1 SLNs per patient, but only 3.4 SLNs per patient were seen in individuals with Type C drainage. Forty cases had metastases found in the ALNs, and five of these cases were dye-negative and fluorescence-positive. Among these cases, the average number of SLNs identified was one.Conclusion: The combination of fluorescence with a visible dye is a highly sensitive method for SLN identification. When SNB is guided by only the dye method, there is a risk of missing appropriate SLNs in patients with Type S lymph drainage or weak dye staining. The use of a fluorescence method together with dye could increase sensitivity of detection in these cases. Furthermore, fluorescent methods are ideal for hospitals that cannot use conventional radioactive measures.Evaluation of sentinel node biopsy by combined fluorescent and dye method and lymph flow for breast cancer - Corrected ProofTakashi Hojo, Tomoya Nagao, Mizuho Kikuyama, Sadako Akashi, Takayuki Kinoshita10.1016/j.breast.2010.01.014The Breast (2010)2010-02-15The Breast2010-02-15ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977609001787/abstract?rss=yesAbstract: Background: The aim of that study was to analyze the impact of German-S3-breast cancer guideline adherence on clinical outcomes.Methods: A retrospective study analyzed 3976 patients first diagnosed with primary breast cancer according to an S3-guideline-based model that classified patients retrospectively into groups receiving “guideline-adherent and “guideline non-adherent” therapy.Results: There was a significant association between treatment adherence and prolonged recurrence free and overall survival (p = 0.0001). The greater the number of violations in guideline adherence, the lower was overall survival (p = 0.0001). Advanced age at initial diagnosis was additionally associated with a reduction in guideline adherence. The percentage of guideline adherence for the therapeutic modalities BCT, mastectomy, axillary dissection and hormone therapy was greater than 80%. For chemotherapy, the percent of guideline adherence totaled 71.4%.Conclusion: Therapies dispensed in adherence with guidelines may improve recurrence-free survival and overall survival in patients with breast cancer.Effects of guideline adherence in primary breast cancer–A 5-year multi-center cohort study of 3976 patients - Corrected ProofAchim Wöckel, Christian Kurzeder, Verena Geyer, Igor Novasphenny, Regine Wolters, Manfred Wischnewsky, Rolf Kreienberg, Dominic Varga10.1016/j.breast.2009.12.006The Breast (2010)2010-02-01The Breast2010-02-01ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977610000020/abstract?rss=yesSummary: Background: Combined trastuzumab and intravenous vinorelbine yielded high clinical activity as preoperative treatment in patients (pts) with HER 2/neu positive breast cancer.Patients and methods: We tested a preoperative combination of trastuzumab with oral vinorelbine (oV) in pts with locally advanced (T2-T4 N0-3 M0) HER2-positive breast cancer. Trastuzumab was administered i.v q 3 wks and oV was administered at the dose of 55 mg/sqm on days 1 and 3 q 3 wks, for 8 courses. Pts with ER ≥ 10% tumors received endocrine therapy with letrozole 2.5 mg/day, plus monthly triptorelin if premenopausal.Results: Forty-five pts entered the study. The overall response rate (CR + PR) was 76% (95% CI: 60%–87%). pCR was observed in 4 pts (10%). Among ER-positive tumors 21/25 pts obtained a clinical response (84%) and two pts obtained a pCR (8%).Conclusions: The combination of trastuzumab and oral vinorelbine demonstrated encouraging activity in patients with HER 2 positive ER-positive tumors. Alternative strategies should be investigated in patients with endocrine non responsive disease.Preoperative therapy with trastuzumab and oral vinorelbine (± endocrine therapy) in patients with HER2-positive breast cancer - Corrected ProofMonica Iorfida, Vincenzo Bagnardi, Alessandra Balduzzi, Silvia Dellapasqua, Anna Cardillo, Alberto Luini, Mattia Intra, Ida Minchella, Paolo Veronesi, Giuseppe Viale, Aron Goldhirsch, Marco Colleoni10.1016/j.breast.2009.12.011The Breast (2010)2010-02-01The Breast2010-02-01ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977610000032/abstract?rss=yesAbstract: Background and aim: Breast cancer in males is an uncommon tumor whose management is extrapolated from that used in female breast cancer. This study compared the histopathological and immunohistochemical features of symptomatic breast cancers in males and females.Patients and methods: A comparison was made between variables of breast cancers from 58 males and 155 females. A descriptive study, a bivariate analysis, and a multivariate analysis using logistic regression were performed.Results: No differences were found in staging. Significant differences were seen in age (p<0.0005), proportion of papillary carcinoma (p=0.038) and proportion of tumors with an associated intraductal component (p=0.002). There was a greater proportion of males expressing estrogen (p=0.038) and progesterone (p<0.0005) receptors in their tumors, with a significantly higher proliferation index (p<0.0005).Conclusions: Breast cancer in males should be considered a condition biologically different from female breast cancer as a result of factors related to the different hormonal influences, reflected mainly in immunohistochemical differences.Positive progesterone receptors and cell proliferation index: An independent association with breast cancer in males - Corrected ProofAntonio Piñero, Belén Ferri, Luis Polo, Manuel Canteras, Joaquín Sola, Juan Bermejo10.1016/j.breast.2010.01.001The Breast (2010)2010-02-01The Breast2010-02-01ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977610000044/abstract?rss=yesAbstract: The higher frequency of triple-negative and HER-2-positive tumors detected in younger patients has been suggested as an explanation for the more aggressive tumor types observed in this age group. However, estrogen receptor (ER)-positive tumors are the most frequent subtype of breast carcinomas identified, even in younger patients. In this retrospective study, the morphological and immunohistochemical profiles of ER-positive breast carcinomas from women 35 yrs and younger that were diagnosed between 1997 and 2007 were evaluated. From these cases, 213 were selected based on the availability of pathology reports and paraffin blocks. For comparison, 117 consecutive cases of breast carcinomas diagnosed in patients >60 yrs from 2006 were included. Paraffin-embedded tumors were stained for expression of ER, progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), Ki-67 antigen, epidermal growth factor receptor (EGFR), cytokeratin 5/6, p53, vimentin, CD117, and p63 using tissue microarrays. ER-positive carcinomas were diagnosed in 120 (56.1%) samples of the younger patient group and in 92 (78.6%) samples of the older patient group. Of these ER-positive carcinomas, 48 (40%) from the younger patient group presented the subtype luminal A, compared with 53 (57.6%) from the older patient group (p=0.01). Tumors from the younger patient group were also associated with increased vascular involvement, co-expression of HER-2, and decreased expression of CD117. These results highlight differences in expression markers and the pathology of ER-positive tumors detected in younger women, with a notable characteristic being co-expression of HER-2.Estrogen receptor-positive breast carcinomas in younger women are different from those of older women: A pathological and immunohistochemical study - Corrected ProofL.M. Bacchi, M. Corpa, P.P. Santos, C.E. Bacchi, F.M. Carvalho10.1016/j.breast.2010.01.002The Breast (2010)2010-02-01The Breast2010-02-01ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977609001805/abstract?rss=yesThere are epidemiologic data that tonsillectomy increase many types of cancer, including breast cancer. In the literature it is stated that the clinical and pathological features of breast cancer with a history of tonsillectomy are different from the others. This study investigates the clinical and pathological characteristics of breast cancer patients with a history of tonsillectomy.Clinical and pathological characteristics of breast cancer patients with history of tonsillectomy - Corrected ProofMetin Isik, Sercan Aksoy, Didem S. Dede, Omer Dizdar, Atilla Kara, Ibrahim Gullu, Yavuz Ozisik, Kadri Altundag10.1016/j.breast.2009.12.008The Breast (2010)2010-01-29The Breast2010-01-29LETTER TO THE EDITORhttp://www.thebreastonline.com/article/PIIS0960977609001775/abstract?rss=yesAbstract: The purpose of this study is evaluation of therapeutic impact of magnetic resonance imaging (MRI) in breast cancer patients that cannot be imaged adequately with traditional radiology: dense breasts, microcalcifications suspicious for carcinoma in situ or discordance between mammography and ultrasound. A review was performed of 493 patients’ records: determination of breast MRI effect on clinical management was made for the selected 70 cases by analysing pre-MRI and post-MRI therapeutic plans. Analysis of final pathology was useful to determine if the change in surgical plan prompted by MRI was appropriate. Breast MRI added clinical information in 52.9% of patients that resulted in 44.3% of management changes that were judged as appropriate in 83.9% of cases. Breast MRI provides additional useful information, but causes more extensive surgery (40%) with no proven prognostic benefit. MRI should be considered optional in the clinical staging of breast cancer and performed in selected cases.Role of magnetic resonance imaging in managing selected women with newly diagnosed breast cancer - Corrected ProofS. Scomersi, M. Urbani, M. Tonutti, F. Zanconati, M. Bortul10.1016/j.breast.2009.12.005The Breast (2010)2010-01-27The Breast2010-01-27ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977609001829/abstract?rss=yesAbstract: Adjuvant tamoxifen reduces relapses and prolongs survival in patients with oestrogen sensitive breast cancer. Development of resistance is however common. Tamoxifen can be given for a maximum of five years; although the risk of recurrences remains high after this period. This review examines nine randomised controlled trials including 28 632 women, which studied aromatase inhibitors (AIs) as an alternative to tamoxifen in three treatment settings: monotherapy (instead of tamoxifen), sequenced therapy (tamoxifen is switched to an AI) and extended therapy (following adjuvant tamoxifen). Disease free survival was significantly improved for monotherapy (HR 0.89, [95% CI 0.83–0.96] p = 0.002) and sequenced therapy (HR 0.72, [0.63–0.83] p < 0.00001). There was no difference in overall survival for monotherapy (HR 0.94, [0.82–1.08] p = 0.39) or extended therapy (HR 0.86 [0.79–1.16] p = 0.67). Importantly, overall survival was prolonged for patients who switched from tamoxifen to AI therapy (HR 0.78 95%CI 0.68–0.91, p = 0.001).Aromatase inhibitors versus tamoxifen as adjuvant hormonal therapy for oestrogen sensitive early breast cancer in post-menopausal women: Meta-analyses of monotherapy, sequenced therapy and extended therapy - Corrected ProofMette L. Josefsson, Samuel J. Leinster10.1016/j.breast.2009.12.010The Breast (2010)2010-01-25The Breast2010-01-25REVIEWhttp://www.thebreastonline.com/article/PIIS0960977609001817/abstract?rss=yesSeigneurin and colleagues showed a 37% increase in cancer detection (CD) and an even larger decrease in interval cancer (IC) between 1994–1999 and 2002–2004 in a French region (Isère) covered by a mammography screening program. Their interpretation, ie a nationwide shift from single to two-view mammography that occurred in-between the time periods compared, seems insufficiently supported by the data to be conclusive.Overestimation of the effect of moving from one to two-view mammography in France - Corrected ProofJean-Luc Bulliard, Fabio Levi10.1016/j.breast.2009.12.009The Breast (2010)2010-01-22The Breast2010-01-22LETTER TO THE EDITORhttp://www.thebreastonline.com/article/PIIS0960977609001738/abstract?rss=yesAbstract: Background: Postmenopausal women with osteoporosis/osteopenia are at increased risk of fracture. Aromatase inhibitors further increase bone loss in these patients. This study evaluates whether zoledronic acid prevents the bone loss expected when these patients initiate letrozole.Patients and methods: Postmenopausal women with estrogen and/or progesterone receptor-positive breast cancer and a bone mineral density (BMD) T-score <−2.0 were given letrozole 2.5mg/vitamin D 400 international units daily, calcium 500mg twice daily, and 4mg zoledronic acid every 6months. The BMD was assessed at baseline and 1year. The primary endpoint was the mean change in lumbar spine (LS) BMD at 1year.Results: Forty-six patients completed 1year of treatment. LS BMD increased by 2.66% (p=0.01), femoral neck (FN) by 4.81% (p=0.01), and any measured endpoint by 4.55% (p=0.0052).Conclusions: Zoledronic acid prevents bone loss in postmenopausal women with osteoporosis/osteopenia starting letrozole and is associated with improvements in BMD.Zoledronic acid for treatment of osteopenia and osteoporosis in women with primary breast cancer undergoing adjuvant aromatase inhibitor therapy - Corrected ProofStephanie L. Hines, Jeff A. Sloan, Pamela J. Atherton, Edith A. Perez, Shaker R. Dakhil, David B. Johnson, Pavan S. Reddy, Robert J. Dalton, Bassam I. Mattar, Charles L. Loprinzi10.1016/j.breast.2009.12.001The Breast (2010)2010-01-15The Breast2010-01-15ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977609001751/abstract?rss=yesAbstract: In our breast unit a significant proportion of core biopsies are performed freehand sometimes necessitating a repeat biopsy under image guidance. The aims of this study were to establish the proportion of patients undergoing freehand core biopsies who proceeded to a repeat procedure and to determine any factors associated with a missed freehand biopsy. Four hundred and ten core biopsies over 21months were included in the analysis. Demographic details, position and size of the lump, breast volume and lesion depth were recorded.Twenty-four percent freehand biopsies were repeated under ultrasound guidance. The histological classification of two-thirds of the repeat biopsies were upgraded, suggesting that the lesion had been previously missed. Multivariate analysis showed that missed freehand biopsies were strongly associated with deep lesions. If all lumps sited at a depth of 6mm or more were selected for US-guided core biopsy, the workload for the ultrasound department would increase by just less than a half and would have the effect of reducing the freehand biopsy miss rate by almost two-thirds.Core biopsies should be performed under ultrasound guidance. A freehand technique could be limited to superficial lesions. Depth is more predictive for a missed biopsy than lesion size or breast volume.Freehand versus ultrasound-guided core biopsies of the breast: reducing the burden of repeat biopsies in patients presenting to the breast clinic - Corrected ProofS.T. Ward, J.A. Shepherd, H. Khalil10.1016/j.breast.2009.12.003The Breast (2010)2010-01-15The Breast2010-01-15ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977609001799/abstract?rss=yesAbstract: Introduction: Triple assessment of breast lesions usually involves the use of core biopsy (CB) or fine needle aspiration cytology (FNAC). Punch Biopsy (PB) is a technique widely used by dermatologists and can be used in superficial breast lesions with dermal involvement. We studied the utilization of PB in a rapid diagnosis breast clinic.Method: We reviewed patients who underwent a PB over a seven and a half-year period from December 2001 to May 2009. The indications for biopsy and the contribution of PB to final diagnosis were studied.Results: The commonest indications were breast lump with skin involvement or ulceration (n = 27), suspected Paget's disease (n = 25), discolouration of breast skin (n = 23), and nodules in the breast skin or surgical scar (n = 18). Final diagnosis was benign in 80 patients and malignant in 20. In 74 patients with benign and 7 patients with malignant diagnoses, PB was the only source of histological diagnosis.Conclusion: PB is a valuable adjunct to conventional methods of tissue diagnosis such as CB and FNAC in both benign and malignant breast lesions.Punch biopsy: A useful adjunct in a rapid diagnosis breast clinic - Corrected ProofB.N. Modi, J.T. Machin, D. Ravichandran10.1016/j.breast.2009.12.007The Breast (2010)2010-01-13The Breast2010-01-13SHORT REPORThttp://www.thebreastonline.com/article/PIIS096097760900174X/abstract?rss=yesAbstract: Background: There are few studies examining breast cancer in women under the age of 40years, particularly in western European populations. Such tumours are reported to be more aggressive, possibly due to a different pathophysiology compared to older patients.Methods: We performed a retrospective review of all women less than 40years of age, diagnosed or treated with breast cancer, from June 2001 to June 2007 to assess pathophysiological factors that may influence clinical outcome and prognosis including patient demographics, clinical presentation, pre-operative investigations, surgical and pathological findings, treatment and outcome.Results: Fifty-eight women (mean age 34.9years, range 27–39years) were identified. One patient was excluded due to incomplete data; 98.2% (n=56) patients presented directly to our symptomatic clinic; 89.5% (n=51) patients had a palpable lump; 71.9% (n=41) patients had no family history. Mammography was less sensitive than ultrasound (64.3% vs. 82.4%) while fine needle aspiration cytology was 92.5% sensitive for malignancy. Twenty-nine (50.9%) patients underwent breast-conserving surgery (BCS) of which 7 proceeded subsequently to completion mastectomy due to involved margins. Twenty-six (45.6%) patients required total mastectomy primarily while 2 (3.5%) patients were treated palliatively due to metastatic disease. The mean tumour size (nearest resection margin) was 2.13cm (2.58mm) for BCS and 3.95cm (6.38mm) for mastectomy. From a total of 55 primary resections, 85.5% (n=47) of tumours were invasive ductal carcinoma; 57.4% (n=31) and 40.7% (n=22) were grade II and III tumours respectively. Lymphovascular invasion was identified in 50.9% (n=28) while 40.0% (n=22) were lymph node positive for metastatic disease. 76.8% (n=43), 39.3% (n=22) and 30.2% (n=16) were oestrogen, progesterone and human epidermal growth factor receptor-2 positive respectively. The mean Nottingham prognostic index was 4.37 (range 2.2–8.4). Neo-adjuvant and adjuvant chemotherapy was administered to 9.3% (n=5) and 80.0% (n=44) of surgically treated patients respectively while 76.4% (n=42) patients received adjuvant radiotherapy. 76.4% (n=42) of patients were treated with tamoxifen. Four patients received Herceptin® therapy. Statistically significant univariate factors adversely associated with overall survival were time from referral to out-patient department attendance (p=0.038), administration of neo-adjuvant treatment (p=0.019), surgical intervention (p<0.001), progesterone receptor positivity (p=0.018) and tumour recurrence (p<0.001). 86.0% (n=49) patients were alive at mean follow-up of 52months; 82.5% (n=47) remain disease free.Conclusion: Our study reports a low familial trait rate combined with a high proportion of hormonally active tumours less than grade III which suggests that breast cancer in this series of young women from Northern Ireland may be less aggressive and more hormonally responsive than anticipated.Breast cancer in women under 40years of age: A series of 57 cases from Northern Ireland - Corrected ProofB. McAree, M.E. O'Donnell, A. Spence, T.F. Lioe, D.T. McManus, R.A.J. Spence10.1016/j.breast.2009.12.002The Breast (2010)2010-01-11The Breast2010-01-11ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977609001763/abstract?rss=yesSummary: Various international comparisons of breast cancer survival have shown discrepancies which may reflect the impact of ethnicity or health care. Using databases from SEER 13 and from the Manila and Rizal Cancer Registries, age adjusted five-year absolute and relative survival estimates were computed and compared between Filipino-American breast cancer patients, Philippine residents and Caucasians in the US. Determinants of survival differences were examined using Cox proportional hazards modelling. Age adjusted five-year relative survival was almost identical in Filipino-Americans (89.1%) and Caucasians (87.7%), but much lower in the Philippine residents (58.4%). Large tumor size, lymph node involvement, distant metastasis, and the large proportion of women not receiving surgery explained a substantial portion of the excess mortality in Philippine residents. The moderate excess risk of Caucasians compared to Filipino-Americans was explained by age differences. Access to, utilization and affordability of cancer care facilities are important for reducing breast cancer deaths in developing countries.Breast cancer survival in different country settings: Comparisons between a Filipino resident population, Filipino-Americans and Caucasians - Corrected ProofMaria Theresa Redaniel, Adriano Laudico, Maria Rica Mirasol-Lumague, Adam Gondos, Gemma Leonora Uy, Cynthia Mapua, Hermann Brenner10.1016/j.breast.2009.12.004The Breast (2010)2010-01-08The Breast2010-01-08ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977609001702/abstract?rss=yesAbstract: Prospective data are limited on the course of anxiety and depression and their determinants in women with early breast cancer. These parameters were assessed before adjuvant radiotherapy (RT) and over 5 years follow-up.Of 2208 women recruited to the START QOL study, 35% reported clinically relevant levels of anxiety and/or depression pre-RT; there was no significant change in these proportions over time. However, 75% women with high baseline anxiety recorded further high scores over time whilst one in six had high scores at every follow-up point. Depression showed a similar pattern with lower frequencies at all time points; very few with initial normal scores developed clinically relevant anxiety or depression over time. Lower educational level predicted worse anxiety and depression over time; younger age predicted worse anxiety and chemotherapy predicted worse depression. Scores in the borderline or case range for anxiety or depression at baseline were both significantly associated with worse mood states over 5 years.These findings indicate the course of anxiety and depression in women with specific risk factors. This subgroup of patients requires greater clinical attention.The course of anxiety and depression over 5 years of follow-up and risk factors in women with early breast cancer: Results from the UK Standardisation of Radiotherapy Trials (START) - Corrected ProofPenelope Hopwood, Georges Sumo, Judith Mills, Joanne Haviland, Judith M. Bliss, on behalf of the START Trials Management Group10.1016/j.breast.2009.11.007The Breast (2009)2009-12-30The Breast2009-12-30ORIGINAL ARTICLEhttp://www.thebreastonline.com/article/PIIS0960977609001726/abstract?rss=yesAbstract: Approximately 180,000 women are diagnosed with breast cancer in the United States annually. The majority of these women are postmenopausal and have endocrine-sensitive tumors. Over the last four decades, multiple clinical trials have been conducted in efforts to establish and advance adjuvant endocrine therapies. We review the available evidence for adjuvant endocrine therapies and current recommendations for therapy in postmenopausal women. Although we have made substantial progress in the treatment of endocrine-sensitive breast cancer, future study will require incorporation of biological and translational questions with the goal of enhancing treatment benefits and minimizing toxicity.Adjuvant therapy for postmenopausal women with endocrine-sensitive breast cancer - Corrected ProofRachel A. Freedman, Eric P. Winer10.1016/j.breast.2009.11.009The Breast (2009)2009-12-25The Breast2009-12-25REVIEWhttp://www.thebreastonline.com/article/PIIS0960977605000883/abstract?rss=yesThis article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.WITHDRAWN: Breast cancer multi-disciplinary teams in England: Much achieved but still more to be done - Corrected ProofJ.M. Whelan, C.D.M. Griffith, T. Archer10.1016/j.breast.2005.04.003The Breast (2009)2009-02-12The Breast2009-02-12SHORT REPORThttp://www.thebreastonline.com/article/PIIS0960977602904583/abstract?rss=yesThe publisher regrets that this is an accidental duplication of an article that has already been published in The Breast, 12 (2003) 1–9, doi:10.1016/S0960-9776(02)00135-2. The duplicate article has therefore been withdrawn.WITHDRAWN: A qualitative study looking at the psychosocial implications of bilateral prophylactic mastectomy - Corrected ProofM. Bebbington Hatcher, L.J. Fallowfield10.1054/brst.2002.0458The Breast (2007)2007-05-31The Breast2007-05-31http://www.thebreastonline.com/article/PIIS0960977602904595/abstract?rss=yesThe publisher regrets that this is an accidental duplication of an article that has already been published in The Breast, 12 (2003) 58–62, doi:10.1016/S0960-9776(02)00136-4. The duplicate article has therefore been withdrawn.WITHDRAWN: Predicting multidrug resistance-related protein and P-glycoprotein expression with technetium-99m tetrofosmin mammoscintigraphy - Corrected ProofTse-Jia Liu, Yu-Chien Shiau, Shih-Chuan Tsai, Jhi-Joung Wang, Shung-Tai Ho, Albert Kao10.1054/brst.2002.0459The Breast (2007)2007-05-31The Breast2007-05-31http://www.thebreastonline.com/article/PIIS0960977602904698/abstract?rss=yesThe publisher regrets that this is an accidental duplication of an article that has already been published in The Breast, 12 (2003) 42–50, doi:10.1016/S0960-9776(02)00180-7. The duplicate article has therefore been withdrawn.WITHDRAWN: Combined epirubicin and vinorelbine as first-line therapy in metastatic breast cancer: a pilot study performed by the Danish Breast Cancer Cooperative Group - Corrected ProofB. Ejlertsen, I. Højris, S. Hansen, K. Møholt, B. Kristensen, H.T. Mouridsen, J. Andersen, C. Rose, M. Kjær10.1054/brst.2002.0469The Breast (2007)2007-05-31The Breast2007-05-31http://www.thebreastonline.com/article/PIIS0960977602904832/abstract?rss=yesThe publisher regrets that this is an accidental duplication of an article that has already been published in The Breast, 12 (2003) 1–9, doi:10.1016/S0960-9776(02)00214-X. The duplicate article has therefore been withdrawn.WITHDRAWN: Significance of serum vascular endothelial growth factor, insulin-like growth factor-I levels and nitric oxide activity in breast cancer patients - Corrected ProofUǧur Coşkun, Nazan Günel, Banu Sancak, Uǧur Günel, Erhan Onuk, Orhan Bayram, Erdal Yílmaz, Sakine Candan, Secil Ozkan10.1054/brst.2002.0483The Breast (2007)2007-05-31The Breast2007-05-31