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Xiao L, Greer D. Linked Argumentation Graphs for Multidisciplinary Decision Support. Healthcare (Basel) 2023; 11:healthcare11040585. [PMID: 36833121 PMCID: PMC9956294 DOI: 10.3390/healthcare11040585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
Multidisciplinary clinical decision-making has become increasingly important for complex diseases, such as cancers, as medicine has become very specialized. Multiagent systems (MASs) provide a suitable framework to support multidisciplinary decisions. In the past years, a number of agent-oriented approaches have been developed on the basis of argumentation models. However, very limited work has focused, thus far, on systematic support for argumentation in communication among multiple agents spanning various decision sites and holding varying beliefs. There is a need for an appropriate argumentation scheme and identification of recurring styles or patterns of multiagent argument linking to enable versatile multidisciplinary decision applications. We propose, in this paper, a method of linked argumentation graphs and three types of patterns corresponding to scenarios of agents changing the minds of others (argumentation) and their own (belief revision): the collaboration pattern, the negotiation pattern, and the persuasion pattern. This approach is demonstrated using a case study of breast cancer and lifelong recommendations, as the survival rates of diagnosed cancer patients are rising and comorbidity is the norm.
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Affiliation(s)
- Liang Xiao
- School of Computer Science, Hubei University of Technology, Wuhan 430068, China
- Correspondence:
| | - Des Greer
- School of Electronics, Electrical Engineering and Computer Science, Queen’s University Belfast, Belfast BT7 1NN, UK
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Xiao L, Zhou H, Fox J. Towards a systematic approach for argumentation, recommendation, and explanation in clinical decision support. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:10445-10473. [PMID: 36032002 DOI: 10.3934/mbe.2022489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In clinical decision support, argumentation plays a key role while alternative reasons may be available to explain a given set of signs and symptoms, or alternative plans to treat a diagnosed disease. In literature, this key notion usually has closed boundary across approaches and lacks of openness and interoperability in Clinical Decision Support Systems (CDSSs) been built. In this paper, we propose a systematic approach for the representation of argumentation, their interpretation towards recommendation, and finally explanation in clinical decision support. A generic argumentation and recommendation scheme lays the foundation of the approach. On the basis of this, argumentation rules are represented using Resource Description Framework (RDF) for clinical guidelines, a rule engine developed for their interpretation, and recommendation rules represented using Semantic Web Rule Language (SWRL). A pair of proof knowledge graphs are made available in an integrated clinical decision environment to explain the argumentation and recommendation rationale, so that decision makers are informed of not just what are recommended but also why. A case study of triple assessment, a common procedure in the National Health Service of UK for women suspected of breast cancer, is used to demonstrate the feasibility of the approach. In conducting hypothesis testing, we evaluate the metrics of accuracy, variation, adherence, time, satisfaction, confidence, learning, and integration of the prototype CDSS developed for the case study in comparison with a conventional CDSS and also human clinicians without CDSS. The results are presented and discussed.
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Affiliation(s)
- Liang Xiao
- School of Computer Science, Hubei University of Technology, Wuhan, China
| | - Hao Zhou
- Network & Informatization Center, Wuhan Polytechnic University, Wuhan, China
| | - John Fox
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
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Deandrea S, Sardanelli F, Calabrese M, Ferré F, Vainieri M, Sestini E, Caumo F, Saguatti G, Bucchi L, Cataliotti L. Provision of follow-up care for women with a history of breast cancer following the 2016 position paper by the Italian Group for Mammographic Screening and the Italian College of Breast Radiologists by SIRM: a survey of Senonetwork Italian breast centres. Radiol Med 2022; 127:484-489. [PMID: 35347582 PMCID: PMC8960092 DOI: 10.1007/s11547-022-01485-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/10/2022] [Indexed: 11/06/2022]
Abstract
Introduction In 2016, the Italian Group for Mammography Screening and the Italian College of Breast Radiologists by the Italian Society of Medical and Interventional Radiology recommended that screening programmes and specialist breast centres actively invite women with a history of breast cancer to follow-up imaging. Objective A survey of breast centres associated with Senonetwork, the Italian network of breast cancer services, has offered the opportunity to assess the implementation of this recommendation. Methods A national, cross-sectional, voluntary, online survey was developed, pre-tested, and administered during the months July–October 2020. Five of the 73 questionnaire items concerned breast cancer follow-up. Results The response rate was 82/128 (65%). Of the 82 respondent centres, 69 (84%) were involved in a screening programme. Fifty-six (68%) reported the presence of a programme of active invitation to breast cancer follow-up targeted at patients living in their catchment area, with a significant north-to-south gradient. Four centres (5%) reported that the screening programme was responsible for actively initiating follow-up during the 10-year period since diagnosis. Only after 10 years did the proportion increase moderately. Conclusion Screening programmes have still a marginal role in active breast cancer follow-up.
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Affiliation(s)
- Silvia Deandrea
- Environmental Health Unit, Agency for Health Protection, Pavia, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università Degli Studi di Milano, San Donato Milanese, Italy
| | - Massimo Calabrese
- UOC Radiologia Senologica, IRCCS-Policlinico San Martino, Genoa, Italy
| | - Francesca Ferré
- Management and Health Laboratory, Department EMbeDS, Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Milena Vainieri
- Management and Health Laboratory, Department EMbeDS, Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy
| | | | - Francesca Caumo
- Department of Breast Radiology, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | | | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy.
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Singh M, Maheu C, Brady T, Farah R. Centres de diagnostic rapide du cancer et conséquences psychologiques : une analyse systématique. Can Oncol Nurs J 2017; 27:356-364. [PMID: 31148778 DOI: 10.5737/23688076274356364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mina Singh
- Professeure agrégée, École des sciences infirmières, Faculté des sciences de la santé, Université York, Toronto (Ontario)
| | - Christine Maheu
- Professeure agrégée, École des sciences infirmières Ingram, Faculté de médecine, Université McGill, Montréal (Québec) H3A 2A7
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Singh M, Maheu C, Brady T, Farah R. The psychological impact of the rapid diagnostic centres in cancer screening: A systematic review. Can Oncol Nurs J 2017; 27:348-355. [PMID: 31148761 DOI: 10.5737/23688076274348355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this review is to assess the state of the literature and identify implications for nursing practice and future research on the psychological impact of rapid diagnostic centres (RDC) for women related to breast cancer. A systematic literature review was conducted on the topic and six studies were identified for data extraction and analysis. There is evidence that RDCs decrease short-term anxiety in women undergoing further cancer tests after cancer screening, and who receive a benign diagnosis. There is limited available research on the impact of anxiety on women who receive a diagnosis of cancer in RDCs, but some evidence showed that this sub-group had higher depression in the long term. Nurses need to be aware of the different needs of women undergoing further cancer screening tests after a cancer diagnosis and receiving these results in the same day.
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Affiliation(s)
- Mina Singh
- Associate Professor, School of Nursing, Faculty of Health, York University, Toronto, ON
| | - Christine Maheu
- Associate Professor, Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC
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Bucchi L, Belli P, Benelli E, Bernardi D, Brancato B, Calabrese M, Carbonaro LA, Caumo F, Cavallo-Marincola B, Clauser P, Fedato C, Frigerio A, Galli V, Giordano L, Golinelli P, Mariscotti G, Martincich L, Montemezzi S, Morrone D, Naldoni C, Paduos A, Panizza P, Pediconi F, Querci F, Rizzo A, Saguatti G, Tagliafico A, Trimboli RM, Zuiani C, Sardanelli F. Recommendations for breast imaging follow-up of women with a previous history of breast cancer: position paper from the Italian Group for Mammography Screening (GISMa) and the Italian College of Breast Radiologists (ICBR) by SIRM. LA RADIOLOGIA MEDICA 2016; 121:891-896. [PMID: 27601142 PMCID: PMC5102938 DOI: 10.1007/s11547-016-0676-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/16/2016] [Indexed: 10/25/2022]
Abstract
Women who were previously treated for breast cancer (BC) are an important particular subgroup of women at intermediate BC risk. Their breast follow-up should be planned taking in consideration a 1.0-1.5 % annual rate of loco-regional recurrences and new ipsilateral or contralateral BCs during 15-20 years, and be based on a regional/district invitation system. This activity should be carried out by a Department of Radiology integrating screening and diagnostics in the context of a Breast Unit. We recommend the adoption of protocols dedicated to women previously treated for BC, with a clear definition of responsibilities, methods for invitation, site(s) of visits, methods for clinical and radiological evaluation, follow-up duration, role and function of family doctors and specialists. These women will be invited to get a mammogram in dedicated sessions starting from the year after the end of treatment. The planned follow-up duration will be at least 10 years and will be defined on the basis of patient's age and preferences, taking into consideration organizational matters. Special agreements can be defined in the case of women who have their follow-up planned at other qualified centers. Dedicated screening sessions should include: evaluation of familial/personal history (if previously not done) for identifying high-risk conditions which could indicate a different screening strategy; immediate evaluation of mammograms by one or, when possible, two breast radiologists with possible addition of supplemental mammographic views, digital breast tomosynthesis, clinical breast examination, breast ultrasound; and prompt planning of possible further workup. Results of these screening sessions should be set apart from those of general female population screening and presented in dedicated reports. The following research issues are suggested: further risk stratification and effectiveness of follow-up protocols differentiated also for BC pathologic subtype and molecular classification, and evaluation of different models of survivorship care, also in terms of cost-effectiveness.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, via Piero Maroncelli, 40, 47014, Meldola, Forlì, Italy
| | - Paolo Belli
- Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 0168, Rome, Italy
| | - Eva Benelli
- Zadig Scientific Communication Agency, via Arezzo 21, 00161, Rome, Italy
| | - Daniela Bernardi
- Dipartimento di Radiologia, U.O. Senologia Clinica e Screening Mammografico, APSS, Centro per i Servizi Sanitari, Pal. C, viale Verona, 38123, Trento, Italy
| | - Beniamino Brancato
- Struttura Complessa di Senologia Clinica, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Massimo Calabrese
- UOC Senologia Diagnostica, IRCCS AOU San Martino-IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Luca A Carbonaro
- Unit of Radiology, Research Hospital (IRCCS) Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Francesca Caumo
- UOSD Breast Unit ULSS20, Piazza Lambranzi 1, 37142, Verona, Italy
| | - Beatrice Cavallo-Marincola
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto I, Sapienza Università di Roma, Viale Regina Elena 324, 00161, Rome, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, 1090, Verona, Austria
- Institute of Radiology, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy
| | - Chiara Fedato
- Regional Screening Coordinating Centre, Veneto Region, Venice, Italy
| | - Alfonso Frigerio
- Regional Reference Centre for Breast Cancer Screening, Turin, Italy
| | - Vania Galli
- Mammography Screening Centre, Local Health Authority, Modena, Italy
| | - Livia Giordano
- Epidemiology Unit, Centre for Cancer Prevention, Turin, Italy
| | - Paola Golinelli
- Medical Physics Service, Local Health Authority, Modena, Italy
| | - Giovanna Mariscotti
- Dipartimento di Diagnostica per Immagini, Radiologia 1U, Università di Torino, A. O. U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Turin, Italy
| | - Laura Martincich
- U.O. Radiodiagnostica, Candiolo Cancer Institute-FPO, IRCCS, Str. Prov. 142, km 3.95, I, 10060, Candiolo, Turin, Italy
| | - Stefania Montemezzi
- DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, P.le A. Stefani 1, 37126, Verona, Italy
| | - Doralba Morrone
- Struttura Complessa di Senologia Clinica, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Carlo Naldoni
- Department of Health, Emilia-Romagna Region, Bologna, Italy
| | - Adriana Paduos
- Epidemiology Unit, Centre for Cancer Prevention, Turin, Italy
| | - Pietro Panizza
- U.O. Radiologia Senologica, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Federica Pediconi
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto I, Sapienza Università di Roma, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fiammetta Querci
- Department of Prevention, Screening Centre, Local Health Authority, Sassari, Italy
| | - Antonio Rizzo
- Pathology Department, Local Health Authority, Asolo, Italy
| | | | - Alberto Tagliafico
- Department of Experimental Medicine, DIMES, Institute of Anatomy, University of Genova, Via de Toni 14, 16132, Genoa, Italy
| | - Rubina M Trimboli
- Unit of Radiology, Research Hospital (IRCCS) Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Chiara Zuiani
- Institute of Radiology, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, Research Hospital (IRCCS) Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
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Smith GJ, Hodges E, Markham H, Zhang S, Cutress RI. Evaluation of the Metasin assay for intraoperative assessment of sentinel lymph node metastases in breast cancer. J Clin Pathol 2016; 70:134-139. [PMID: 27406050 DOI: 10.1136/jclinpath-2016-203728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 11/04/2022]
Abstract
AIMS Sentinel lymph node (SLN) biopsy is the preferred surgical technique for staging the axilla in clinically node-negative breast cancer. Accurate intraoperative staging allows for the immediate performance of an axillary clearance in node-positive patients. We assessed the Metasin assay for the intraoperative analysis of SLNs in a prospective evaluation of 250 consecutive patients undergoing intraoperative SLN analysis at the Breast Unit, University Hospital, Southampton, UK. METHODS Metasin uses a quantitative reverse transcription PCR to detect two markers of metastasis: cytokeratin 19 (CK19) an epithelial marker and mammaglobin (MGB) a breast specific marker. Metasin results were compared with the results from routine paraffin block histopathology. RESULTS Metasin was robust, with a failure rate of <1%, and demonstrated excellent accuracy and reproducibility. The average turnaround time for the Metasin assay was 42 min, the largest variable being the number of nodes assayed. A total of 533 SLNs were evaluated with 75 patients testing positive for MGB and/or CK19. Based on the analysis of individual SLNs, the overall concordance between Metasin and histology was 92.3% (sensitivity 88.7%, specificity 92.9%). When adjusted for tissue allocation bias, the concordance was 93.8% (sensitivity 89.8%, specificity 94.6%). In this evaluation, 57/250 patients (23%) proceeded to axillary clearance based on Metasin results and were considered spared a second operative procedure. CONCLUSIONS Metasin has proven to be an accurate, reproducible and reliable laboratory test. The analysis time is acceptable for intraoperative use, and in comparison to routine histology demonstrates acceptable concordance, sensitivity and specificity.
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Affiliation(s)
- G J Smith
- Department of Molecular Pathology, University Hospital Southampton, Southampton, UK
| | - E Hodges
- Department of Immunology & Molecular Pathology, University Hospital Southampton, Southampton, UK
| | - H Markham
- University Hospital Southampton, Cellular Pathology, Southampton, UK
| | - S Zhang
- Department of Molecular Pathology, University Hospital Southampton, Southampton, UK
| | - R I Cutress
- University of Southampton, Cancer Sciences, Faculty of Medicine and University Hospital Southampton, Southampton Breast Unit, Southampton, UK
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Yoon JH, Kim MJ, Kim EK, Moon HJ. Imaging surveillance of patients with breast cancer after primary treatment: current recommendations. Korean J Radiol 2015; 16:219-28. [PMID: 25741186 PMCID: PMC4347260 DOI: 10.3348/kjr.2015.16.2.219] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 11/24/2014] [Indexed: 11/29/2022] Open
Abstract
Women who have been treated for breast cancer are at risk for second breast cancers, such as ipsilateral recurrence or contralateral metachronous breast cancer. As the number of breast cancer survivors increases, interest in patient management and surveillance after treatment has also increased. However, post-treatment surveillance programs for patients with breast cancer have not been firmly established. In this review, we focus on the imaging modalities that have been used in post-treatment surveillance for patients with breast cancer, such as mammography, ultrasonography, magnetic resonance imaging, and positron emission tomography, the effectiveness of each modality for detecting recurrence, and how they can be applied to manage patients.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
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Masood S, Rosa M, Kraemer DF, Smotherman C, Mohammadi A. Comparative cost-effectiveness of fine needle aspiration biopsy versus image-guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of affordable care act: A changing landscape. Diagn Cytopathol 2015; 43:605-12. [DOI: 10.1002/dc.23270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/20/2015] [Accepted: 02/04/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Shahla Masood
- Department of Pathology and Laboratory Medicine; University of Florida; Jacksonville Florida
| | - Marilin Rosa
- Department of Pathology and Laboratory Medicine; University of Florida; Jacksonville Florida
| | - Dale F. Kraemer
- Center for Health Equity and Quality Research, University of Florida; Jacksonville Florida
- Department of Neurology; University of Florida; Jacksonville Florida
| | - Carmen Smotherman
- Center for Health Equity and Quality Research, University of Florida; Jacksonville Florida
| | - Amir Mohammadi
- Department of Pathology and Laboratory Medicine; University of Florida; Jacksonville Florida
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Kreienberg R, Albert US, Follmann M, Kopp IB, Kühn T, Wöckel A. Interdisciplinary GoR level III Guidelines for the Diagnosis, Therapy and Follow-up Care of Breast Cancer: Short version - AWMF Registry No.: 032-045OL AWMF-Register-Nummer: 032-045OL - Kurzversion 3.0, Juli 2012. Geburtshilfe Frauenheilkd 2013; 73:556-583. [PMID: 24771925 PMCID: PMC3963234 DOI: 10.1055/s-0032-1328689] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - U.-S. Albert
- Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik
für Gynäkologie, Gynäkologische Endokrinologie und Onkologie,
Marburg
| | - M. Follmann
- Deutsche Krebsgesellschaft e. V., Bereich Leitlinien,
Berlin
| | - I. B. Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, c/o
Philipps-Universität, Marburg
| | - T. Kühn
- Klinikum Esslingen, Klinik für Frauenheilkunde und Geburtshilfe,
Esslingen
| | - A. Wöckel
- Universitätsklinikum Ulm, Klinik für Frauenheilkunde und Geburtshilfe,
Ulm
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Chae BJ, Bae JS, Song BJ, Jung SS. Multidisciplinary team approach in breast cancer: a nationwide survey in Korea. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:340-6. [PMID: 22708095 PMCID: PMC3373983 DOI: 10.4174/jkss.2012.82.6.340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/03/2012] [Accepted: 03/26/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE This assesses the current workings of multidisciplinary team (MDT) meetings across Korea through surgeons' reports and their current commitments to MDT meetings pertaining to breast cancer, and to determine any perceived areas of potential improvement. METHODS A questionnaire was sent out to 307 members of The Korean Breast Cancer Society (KBCS) who worked at comprehensive or university medical centers in Korea. The mailing lists of the KBCS members were obtained with the approval of the society. From December 2008 to February 2009, the survey was distributed by surface and electronic mail, with an initial mailing followed by another distribution to non-responders eight weeks later. RESULTS Sixty-five individuals (21.2%) returned the completed survey. Of these, 38 responders (62.3%) participated in MDT meetings. Most (97.4%) breast health specialists regarded MDT meetings as an effective method for treatment planning. Most responders (94.7%) reported that the MDT leader was a breast surgeon. CONCLUSION The MDT approach is perceived as an effective method for breast cancer treatment planning and is a feature in most major centers in Korea. Further work is needed to ensure that the MDT approach operates as intended and that all breast cancer patients have access to an MDT.
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Affiliation(s)
- Byung Joo Chae
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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13
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Taylor K, O'Keeffe S, Britton PD, Wallis MG, Treece GM, Housden J, Parashar D, Bond S, Sinnatamby R. Ultrasound elastography as an adjuvant to conventional ultrasound in the preoperative assessment of axillary lymph nodes in suspected breast cancer: a pilot study. Clin Radiol 2011; 66:1064-71. [PMID: 21835398 DOI: 10.1016/j.crad.2011.05.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 04/27/2011] [Accepted: 05/13/2011] [Indexed: 12/21/2022]
Abstract
AIMS To compare the performance of ultrasound elastography with conventional ultrasound in the assessment of axillary lymph nodes in suspected breast cancer and whether ultrasound elastography as an adjunct to conventional ultrasound can increase the sensitivity of conventional ultrasound used alone. MATERIALS AND METHODS Fifty symptomatic women with a sonographic suspicion for breast cancer underwent ultrasound elastography of the ipsilateral axilla concurrent with conventional ultrasound being performed as part of triple assessment. Elastograms were visually scored, strain measurements calculated and node area and perimeter measurements taken. Theoretical biopsy cut points were selected. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated and receiver operating characteristic (ROC) analysis was performed and compared for elastograms and conventional ultrasound images with surgical histology as the reference standard. RESULTS The mean age of the women was 57 years. Twenty-nine out of 50 of the nodes were histologically negative on surgical histology and 21 were positive. The sensitivity, specificity, PPV, and NPV for conventional ultrasound were 76, 78, 70, and 81%, respectively; 90, 86, 83, and 93%, respectively, for visual ultrasound elastography; and for strain scoring, 100, 48, 58 and 100%, respectively. There was no significant difference between any of the node measurements CONCLUSIONS Initial experience with ultrasound elastography of axillary lymph nodes, showed that it is more sensitive than conventional ultrasound in detecting abnormal nodes in the axilla in cases of suspected breast cancer. The specificity remained acceptable and ultrasound elastography used as an adjunct to conventional ultrasound has the potential to improve the performance of conventional ultrasound alone.
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Affiliation(s)
- K Taylor
- Department of Radiology, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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14
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Kontos M, Roy P, Rizos D, Hamed H. An evidence based strategy for follow up after breast conserving treatment for breast cancer. J Surg Oncol 2011; 104:223-7. [PMID: 21370233 DOI: 10.1002/jso.21747] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 08/13/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Follow up for breast cancer patients aims at the timely detection of loco-regional recurrences and contralateral breast cancers (LRR). This study investigates the annual risk of LRR after breast conserving treatment (BCT) and the potential value of mammographic surveillance and/or routine clinical examination. METHODS Data on 650 women who underwent BCT were obtained and LRR was divided into parenchymal and non-parenchymal. LRR-free and cumulative LRR-free rates were calculated. In patients where recurrence was diagnosed at a routine clinic visit and had negative mammography ("clinical detection only" group) were also separately examined. RESULTS Median follow up was 115 months, range 9-196. Seventy-three patients had parenchymal and 16 nodal recurrence. The median probability of LRR was 1.4% and of parenchymal LRR was 1.32% per year, remaining constant for up to 168 months. The 16 patients in the "clinical detection only" group relapsed mainly during the first 2 years (annual risk 0.77% and 0.80%, respectively). CONCLUSIONS This study shows that the risk of parenchymal LRR remains constant for at least 14 years and is significant enough to warrant routine long-term follow up mammography. Routine clinical examination contributes significantly to the detection of LRR only for the first 2 years.
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Affiliation(s)
- Michael Kontos
- Breast Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
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15
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Houssami N, Abraham LA, Miglioretti DL, Sickles EA, Kerlikowske K, Buist DSM, Geller BM, Muss HB, Irwig L. Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer. JAMA 2011; 305:790-9. [PMID: 21343578 PMCID: PMC3799940 DOI: 10.1001/jama.2011.188] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Women with a personal history of breast cancer (PHBC) are at risk of developing another breast cancer and are recommended for screening mammography. Few high-quality data exist on screening performance in PHBC women. OBJECTIVE To examine the accuracy and outcomes of mammography screening in PHBC women relative to screening of similar women without PHBC. DESIGN AND SETTING Cohort of PHBC women, mammogram matched to non-PHBC women, screened through facilities (1996-2007) affiliated with the Breast Cancer Surveillance Consortium. PARTICIPANTS There were 58,870 screening mammograms in 19,078 women with a history of early-stage (in situ or stage I-II invasive) breast cancer and 58,870 matched (breast density, age group, mammography year, and registry) screening mammograms in 55,315 non-PHBC women. MAIN OUTCOME MEASURES Mammography accuracy based on final assessment, cancer detection rate, interval cancer rate, and stage at diagnosis. RESULTS Within 1 year after screening, 655 cancers were observed in PHBC women (499 invasive, 156 in situ) and 342 cancers (285 invasive, 57 in situ) in non-PHBC women. Screening accuracy and outcomes in PHBC relative to non-PHBC women were cancer rates of 10.5 per 1000 screens (95% CI, 9.7-11.3) vs 5.8 per 1000 screens (95% CI, 5.2-6.4), cancer detection rate of 6.8 per 1000 screens (95% CI, 6.2-7.5) vs 4.4 per 1000 screens (95% CI, 3.9-5.0), interval cancer rate of 3.6 per 1000 screens (95% CI, 3.2-4.1) vs 1.4 per 1000 screens (95% CI, 1.1-1.7), sensitivity 65.4% (95% CI, 61.5%-69.0%) vs 76.5% (95% CI, 71.7%-80.7%), specificity 98.3% (95% CI, 98.2%-98.4%) vs 99.0% (95% CI, 98.9%-99.1%), abnormal mammogram results in 2.3% (95% CI, 2.2%-2.5%) vs 1.4% (95% CI, 1.3%-1.5%) (all comparisons P < .001). Screening sensitivity in PHBC women was higher for detection of in situ cancer (78.7%; 95% CI, 71.4%-84.5%) than invasive cancer (61.1%; 95% CI, 56.6%-65.4%), P < .001; lower in the initial 5 years (60.2%; 95% CI, 54.7%-65.5%) than after 5 years from first cancer (70.8%; 95% CI, 65.4%-75.6%), P = .006; and was similar for detection of ipsilateral cancer (66.3%; 95% CI, 60.3%-71.8%) and contralateral cancer (66.1%; 95% CI, 60.9%-70.9%), P = .96. Screen-detected and interval cancers in women with and without PHBC were predominantly early stage. CONCLUSION Mammography screening in PHBC women detects early-stage second breast cancers but has lower sensitivity and higher interval cancer rate, despite more evaluation and higher underlying cancer rate, relative to that in non-PHBC women.
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Affiliation(s)
- Nehmat Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
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16
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Snook KL, Layer GT, Jackson PA, de Vries CS, Shousha S, Sinnett HD, Nigar E, Singhal H, Chia Y, Cunnick G, Kissin MW. Multicentre evaluation of intraoperative molecular analysis of sentinel lymph nodes in breast carcinoma. Br J Surg 2010; 98:527-35. [DOI: 10.1002/bjs.7347] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2010] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Ideally, intraoperative sentinel lymph node (SLN) analysis in breast cancer should be automated, have high concordance with extensive histopathology, and be applicable in any hospital setting. A prospective multicentre evaluation of the one-step nucleic acid amplification (OSNA) automated molecular diagnostic system of SLN analysis was undertaken.
Methods
Intraoperative examination of SLNs from 204 patients with breast cancer was performed by OSNA at four sites in the UK. Half of each SLN was assessed by OSNA (for cytokeratin 19 mRNA) and the remaining half was paraffin embedded for intensive histological examination at ten levels. Discordant cases were reanalysed by further molecular biological techniques and by additional histological examination of all remaining nodal material to ascertain whether the discordance was due to an uneven distribution of metastases, known as tissue allocation bias (TAB).
Results
After exclusion of samples affected by TAB, the overall concordance rate for OSNA versus histopathology was 96·0 per cent, with a sensitivity of 91·7 per cent and a specificity of 96·9 per cent. The median time to process a single SLN was 32 (range 22–97) min, and that for two nodes 42 (30–73) min.
Conclusion
OSNA enables accurate automated intraoperative diagnosis and can be used successfully in different UK hospitals. When the SLN is shown to be positive, the patient can undergo immediate axillary clearance under the same anaesthetic rather than having a delayed second procedure.
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Affiliation(s)
| | - K L Snook
- Breast Unit, Royal Surrey County Hospital, Guildford, UK
- Postgraduate Medical School, University of Surrey, Guildford, UK
| | - G T Layer
- Breast Unit, Royal Surrey County Hospital, Guildford, UK
- Postgraduate Medical School, University of Surrey, Guildford, UK
| | - P A Jackson
- Histopathology Department, Royal Surrey County Hospital, Guildford, UK
| | - C S de Vries
- Postgraduate Medical School, University of Surrey, Guildford, UK
| | - S Shousha
- Histopathology Department, Charing Cross Hospital, London, UK
| | - H D Sinnett
- Breast Unit, Charing Cross Hospital, London, UK
| | - E Nigar
- Pathology Department, Northwick Park Hospital, Harrow, UK
| | - H Singhal
- Breast Unit, Northwick Park Hospital, Harrow, UK
| | - Y Chia
- Pathology Department, Wycombe Hospital, High Wycombe, UK
| | - G Cunnick
- Breast Unit, Wycombe Hospital, High Wycombe, UK
| | - M W Kissin
- Breast Unit, Royal Surrey County Hospital, Guildford, UK
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Chirgwin J, Craike M, Gray C, Watty K, Mileshkin L, Livingston PM. Does multidisciplinary care enhance the management of advanced breast cancer?: evaluation of advanced breast cancer multidisciplinary team meetings. J Oncol Pract 2010; 6:294-300. [PMID: 21358959 PMCID: PMC2988663 DOI: 10.1200/jop.2010.000017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2010] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To assess the contribution of the advanced breast cancer (ABC) multidisciplinary team meetings (MDMs) to patient care and clinical outcomes. METHODS Members of ABC MDMs at two health services completed questionnaires in November 2007. The questionnaire asked about the performance of the MDMs and their contribution to improvement in patient care in five domains: medical management, psychosocial care, palliative care, care in the community, and benefits for team members. A final section covered the perceived value and importance of the MDM in patient management. Descriptive statistics (frequencies, mean, and standard deviation) were used to summarize the performance, improvement, and importance scores. RESULTS A total of 27 multidisciplinary team members (73%) completed the questionnaire. The MDM performed best in medical management (mean performance score out of 5 [M] = 3.78) and palliative care (M = 3.77). These were also the areas that were most improved through the MDM. Benefits to team members and care in the community (both M = 3.05) ranked lowest by both measures. The MDM provided the most benefit for patient management in the areas of "awareness of services available" (M = 4.32), "efficiency of referrals" (M = 4.27) and "supportive care for patients" (M = 4.27). "Awareness of services available," "psychological care for patients," and "continuity of care" were considered the most important (M = 4.64). CONCLUSION The study provides evidence that MDMs make an important contribution to the logistical and medical management of patients with advanced breast cancer.
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Affiliation(s)
- Jacquie Chirgwin
- Eastern Health, Box Hill; Centre for Behavioural Research in Cancer, The Cancer Council Victoria; Deakin University, Melbourne; Peter MacCallum Cancer Centre, Victoria, Australia
| | - Melinda Craike
- Eastern Health, Box Hill; Centre for Behavioural Research in Cancer, The Cancer Council Victoria; Deakin University, Melbourne; Peter MacCallum Cancer Centre, Victoria, Australia
| | - Christine Gray
- Eastern Health, Box Hill; Centre for Behavioural Research in Cancer, The Cancer Council Victoria; Deakin University, Melbourne; Peter MacCallum Cancer Centre, Victoria, Australia
| | - Kathy Watty
- Eastern Health, Box Hill; Centre for Behavioural Research in Cancer, The Cancer Council Victoria; Deakin University, Melbourne; Peter MacCallum Cancer Centre, Victoria, Australia
| | - Linda Mileshkin
- Eastern Health, Box Hill; Centre for Behavioural Research in Cancer, The Cancer Council Victoria; Deakin University, Melbourne; Peter MacCallum Cancer Centre, Victoria, Australia
| | - Patricia M. Livingston
- Eastern Health, Box Hill; Centre for Behavioural Research in Cancer, The Cancer Council Victoria; Deakin University, Melbourne; Peter MacCallum Cancer Centre, Victoria, Australia
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18
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Parkin E, Hindocha S, Subar D, Mehrban I, Walls J. An Initial Experience with Rapid Microwave Processing in the One-Stop Breast Clinic. World J Surg 2010; 34:3036-41. [DOI: 10.1007/s00268-010-0747-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Risk stratification as a means of reducing the burden of follow-up after completion of initial treatment for breast cancer. Surgeon 2010; 9:61-4. [PMID: 21342668 DOI: 10.1016/j.surge.2010.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 06/29/2010] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Little evidence exists regarding the optimum frequency or duration of follow-up for patients with breast cancer. The aim of this study was to assess the effectiveness of a risk-stratified follow-up programme. METHODS Patients treated surgically for primary breast cancer from January 2000 to September 2006 were recorded on a BASO database. Follow-up was stratified according to risk of relapse as determined by the Nottingham Prognostic Index (NPI). Patients were assigned to high, moderate or low risk groups. The date of recurrence, time from primary diagnosis and site of relapse were obtained from the database. Review of case notes was used to confirm the method of detection. RESULTS 1303 women had surgery for primary breast cancer in the study period. Median follow-up was 40 months. Overall survival rate was 96.9% (90.4% high, 97.3% moderate, 99.5% low). Disease free survival was 94.1% (84.1% high, 94.7% moderate, 98.1% low). Seventy-seven recurrences were detected with 39 (51%) in the high risk group, 27 (35%) in the moderate risk group and 11 (14%) in the low risk group. Detection rate at a scheduled appointment was 0.27% overall (low risk 0.14%, moderate risk 0.27%, high risk 0.45%). CONCLUSIONS NPI correlates with risk of recurrent disease. Scheduled follow-up yielded few recurrences, suggesting early discharge with open access to clinics could be a safe alternative. This type of follow-up may reduce demand on specialist clinics without significantly affecting patient care or overall survival.
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20
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Liau SS, Cariati M, Noble D, Wilson C, Wishart GC. Audit of local recurrence following breast conservation surgery with 5-mm target margin and hypofractionated 40-Gray breast radiotherapy for invasive breast cancer. Ann R Coll Surg Engl 2010; 92:562-8. [PMID: 20522309 DOI: 10.1308/003588410x12699663903476] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The risk of ipsilateral breast tumour recurrence (IBTR) following breast conservation surgery (BCS) for invasive breast cancer (IBC) and radiotherapy is dependent on patient-, tumour- and treatment-related variables. In the Cambridge Breast Unit, breast conserving surgery has been performed with a target radial margin of 5 mm for IBC, in combination with 40-Gy hypofractionated (15 fractions) breast radiotherapy, since 1999. PATIENTS AND METHODS An audit was performed of cases treated between 1999 and 2004. A total of 563 patients underwent BCS for invasive breast cancer with 90.4% receiving radiotherapy (RT) and 60.4% of patients receiving boost RT (3 fractions of 3-Gy). RESULTS After a median follow-up of 58 months, five of the 563 (0.9%) patients developed IBTR. The 5-year actuarial IBTR rate was 1.1%. In terms of distant disease recurrence (DDR), 29 of the 563 (5.2%) had DDR during follow-up, giving a 5-year actuarial DDR rate of 5.4%. The 5-year breast cancer specific survival was 95%, with the poorer NPI groups having worse breast cancer specific survival (Log-rank, P<0.0001). More importantly, patients with IBTR had a shorter breast cancer-specific survival than those who were IBTR-free (Log-rank, P<0.0001). CONCLUSIONS Our treatment regimen, combining BCS with a 5-mm target margin and hypofractionated 40-Gy RT, results in an extremely low rate of IBTR, and compares favourably with the target IBTR rate of <5% defined by the Association of Breast Surgeons (ABS) at BASO guidelines.
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Affiliation(s)
- Siong-Seng Liau
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, UK
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21
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Are mastectomy resection margins of clinical relevance? A systematic review. Breast 2009; 19:14-22. [PMID: 19932025 DOI: 10.1016/j.breast.2009.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/09/2009] [Accepted: 10/17/2009] [Indexed: 11/22/2022] Open
Abstract
Although some guidelines support the use of post-mastectomy radiotherapy where the resection margin is involved or close, the scientific basis of this practice is not established. This systematic review explores the relationship between margin status and subsequent relapse. Pooled data from 22 studies (18,863 women) identified an involved post-mastectomy margin in 2.5%, a close margin in 8.0% and muscle or fascia invasion in 7.2% of patients. In a meta-analysis of five studies of non-inflammatory breast cancer without radiotherapy, local recurrence was increased by an involved or close margin (relative risk 2.6; P<0.00001). The effect of muscle or fascia invasion was of borderline significance (relative risk 1.7; P=0.04). In two separate meta-analyses, risk of relapse was related to margin status in women with inflammatory breast cancer (relative risk 3.1; P<0.0001) but not in those undergoing skin-sparing mastectomy (relative risk 2.1; P=0.16).
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22
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Kontos M, Allen D, Trafalis DT, Jones G, Garmo H, Holmberg L, Hamed H. Follow-up may not be beneficial after treatment of grade 1 breast cancer. Br J Surg 2009; 96:999-1004. [PMID: 19644972 PMCID: PMC7970719 DOI: 10.1002/bjs.6669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2009] [Indexed: 11/12/2022]
Abstract
BACKGROUND Identification of women treated for breast cancer who have a low risk of locoregional recurrence or contralateral breast cancer, and who can be discharged safely from follow-up, would lower costs without compromising prognosis. This study investigated the risk of locoregional recurrence and contralateral breast cancer in women treated for grade 1 breast cancer. METHODS Some 1143 women who had surgery for breast cancer were followed, and the rate of locoregional recurrence or contralateral breast cancer was determined. The risk was compared to the tumour grade. RESULTS At a mean follow-up of 9.1 years, 10-year estimates of the cumulative risk of locoregional recurrence or contralateral breast cancer for grade 1, 2 and 3 breast cancer were 0.03 (95 per cent confidence interval (c.i.) 0.01 to 0.08), 0.12 (0.09 to 0.15) and 0.16 (0.13 to 0.20) respectively. Grade 1 tumours had a risk of locoregional recurrence or contralateral breast cancer of 285 (95 per cent c.i. 93 to 670) per 100,000 person-years. CONCLUSION Women treated for grade 1 breast cancer could be discharged from follow-up after completion of the primary treatment, without compromising their quality of care.
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Affiliation(s)
- M Kontos
- Breast Unit, Guy's Hospital, London, UK.
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23
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Greenwood-Haigh L. Mammographic surveillance in the follow up of early primary breast cancer in England: A cross-sectional survey. Radiography (Lond) 2009. [DOI: 10.1016/j.radi.2008.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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24
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Montgomery DA, Krupa K, Cooke TG. Locoregional relapse after breast cancer: most relapses occur late and are not clinically detected. Breast J 2009; 15:163-7. [PMID: 19292802 DOI: 10.1111/j.1524-4741.2009.00691.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There remains controversy over follow-up after breast cancer. The National Institute for Clinical Excellence (NICE) in the United Kingdom recommends 2-3 years of follow-up for the detection of locoregional relapse. Guidelines in North America advocate much longer follow up periods. Clinicians in the UK have been reluctant to implement the NICE guidelines. Previous studies report that the rate of relapse peaks in the first 3-5 years before falling off. In this study, a retrospective analysis of rate of relapse and method of detection in 198 patients treated with conservation surgery between 1995 and 2001 has been undertaken. Median follow-up was 5.9 years. Rate of relapse is essentially constant for 10 years, with most relapses occurring after 3 years. The majority of relapse in this cohort is detected by means other than routine clinical examination, with only 16.66% of relapse detected this way. The guidelines for follow-up in the UK need revision. If follow-up is to be provided, this needs to continue for at least 10 years, if not beyond. This study casts doubt on the value of routine clinical examination.
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Affiliation(s)
- David A Montgomery
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom.
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25
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Wishart GC, Greenberg DC, Chou P, Brown CH, Duffy S, Purushotham AD. Treatment and survival in breast cancer in the Eastern Region of England. Ann Oncol 2009; 21:291-296. [PMID: 19502647 DOI: 10.1093/annonc/mdp301] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The reasons for variation in survival in breast cancer are multifactorial. METHODS From 1999 to 2003, the vital status of 9051 cases of invasive breast cancer was identified in the Eastern Region of England. Survival analysis was by Cox proportional hazards regression. Data were analysed separately for patients aged <70 years and those older due to differences in treatment policies. RESULTS Overall 5-year survival was 78%. In patients aged <70 years, significant differences in survival lost their formal significance after adjustment for detection mode and node status, although this remained close to statistical significance with some residual differences between relative hazards. There was significant negative ecological correlation between proportion with nodes positive or not examined and 9-year survival rates. Patients with estrogen receptor (ER) status unknown were at significantly higher risk of dying than ER-positive patients. There was a clear trend of increasing hazard of dying with increasing deprivation. Survival differences in women aged > or =70 years were related to whether surgery was included as part of treatment. CONCLUSION This variation in treatment and survival may be attributed to lack of information, in particular nodal and ER status, thereby impacting on staging and prescription of adjuvant therapy.
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Affiliation(s)
- G C Wishart
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge
| | - D C Greenberg
- Eastern Cancer Registration and Information Centre Unit C, Cambridge
| | - P Chou
- Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, London
| | - C H Brown
- Eastern Cancer Registration and Information Centre Unit C, Cambridge
| | - S Duffy
- Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, London
| | - A D Purushotham
- King's College London and Guy's and St Thomas' National Health Service Foundation Trust, Guy's Hospital, London, UK.
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Britton P, Duffy SW, Sinnatamby R, Wallis MG, Barter S, Gaskarth M, O'Neill A, Caldas C, Brenton JD, Forouhi P, Wishart GC. One-stop diagnostic breast clinics: how often are breast cancers missed? Br J Cancer 2009; 100:1873-8. [PMID: 19455145 PMCID: PMC2714235 DOI: 10.1038/sj.bjc.6605082] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to estimate the number of patients discharged from a symptomatic breast clinic who subsequently develop breast cancer and to determine how many of these cancers had been ‘missed’ at initial assessment. Over a 3-year period, 7004 patients were discharged with a nonmalignant diagnosis. Twenty-nine patients were subsequently diagnosed with breast cancer over the next 36 months. This equates to a symptomatic ‘interval’ cancer rate of 4.1 per 1000 women in the 36 months after initial assessment (0.9 per 1000 women within 12 months, 2.6 per 1000 women within 24 months). The lowest sensitivity of initial assessment was seen in patients of 40–49 years of age, and these patients present the greatest imaging and diagnostic challenge. Following multidisciplinary review, a consensus was reached on whether a cancer had been missed or not. No delay occurred in 10 patients (35%) and probably no delay in 7 patients (24%). Possible delay occurred in three patients (10%) and definite delay in diagnosis (i.e., a ‘missed’ cancer) occurred in only nine patients (31%). The overall diagnostic accuracy of ‘triple’ assessment is 99.6% and the ‘missed’ cancer rate is 1.7 per 1000 women discharged.
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Affiliation(s)
- P Britton
- Department of Radiology, Cambridge Breast Unit, Box 97, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 2QQ, UK.
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Maxwell AJ, Evans AJ, Carpenter R, Dobson HM, Kearins O, Clements K, Lawrence G, Bishop HM. Follow-up for screen-detected ductal carcinoma in situ: results of a survey of UK centres participating in the Sloane project. Eur J Surg Oncol 2009; 35:1055-9. [PMID: 19414235 DOI: 10.1016/j.ejso.2009.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 03/23/2009] [Accepted: 04/01/2009] [Indexed: 11/30/2022] Open
Abstract
AIMS To investigate the variations in follow-up practice for screen-detected ductal carcinoma in situ (DCIS) in the UK. METHODS A questionnaire enquiring about follow-up practice and the perceived value of clinical follow-up after surgery for screen-detected DCIS was sent to the 74 UK screening centres participating in the Sloane Project. RESULTS Responses were received from 66 hospitals serving 54 screening centres. These demonstrate wide variations in practice. Clinical follow-up duration ranges from 1 year to indefinite, with the frequency of visits from three-monthly to annually. Formal mammographic follow-up duration ranges from none to indefinite. Mammographic frequency ranges from 1 to 2 years. Follow-up varies according to factors such as size and grade of disease and margin status in 23 units and according to whether adjuvant therapy is given in 23. Seven hospitals perform mammography of reconstructed breasts. Thirty-one centres consider clinical follow-up of DCIS to be of value or limited value whereas 28 consider it to be of little or no value. CONCLUSIONS There is no consensus with regard to the duration and frequency of follow-up for screen-detected DCIS, the contribution of predictive and treatment factors, the use of mammography of the reconstructed breast or the perceived value of clinical follow-up. Published guidelines show no consensus. Multidisciplinary teams involved in the care of women with screen-detected non-invasive cancer should contribute to audits such as the Sloane Project in order to determine the most effective and efficient ways to treat and follow up these patients.
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Affiliation(s)
- A J Maxwell
- Bolton Breast Unit, Royal Bolton Hospital, Minerva Road, Bolton BL4 0JR, UK.
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28
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MacDermid E, Hooton G, MacDonald M, McKay G, Grose D, Mohammed N, Porteous C. Improving patient survival with the colorectal cancer multi-disciplinary team. Colorectal Dis 2009; 11:291-5. [PMID: 18477019 DOI: 10.1111/j.1463-1318.2008.01580.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE There is little information on the impact of the colorectal multi-disciplinary team (MDT) in the United Kingdom. Our single operator presented his patients before and after the inception of an MDT meeting in June 2002. The aim of this study was to assess the effect of this on his patients' survival, and trends in the use of adjuvant chemotherapy. METHOD Data were collected on all patients (n = 310) undergoing colectomy for colorectal cancer by one surgeon. Excluding patients with Dukes A stage, the pre-MDT cohort from January 1997 to May 2002 was 176 and the post-MDT cohort from June 2002 to December 2005 was 134. Three-year survival rates were calculated using Kaplan-Meier life table analysis. Prognostic factors were analysed using Cox-proportional hazard regression, and chemotherapy data analysed using the chi-squared test. Independent prognostic indicators of chemotherapy prescription were examined using binary logistic testing. RESULTS MDT status was shown to be an independent predictor of survival on hazard regression analysis (P = 0.044). A significantly greater number of patients were prescribed adjuvant chemotherapy in the post-MDT cohort (P = 0.0002). MDT status was shown to be a significant prognostic indicator of chemotherapy prescription (P < 0.0001). Three-year survival for Dukes C patients was 58% in the pre-MDT group, and 66% in the post-MDT group (P = 0.023). CONCLUSION There was a significant increase in patients undergoing adjuvant postoperative chemotherapy after the inception of the MDT. This was associated with a significant survival benefit in patients with Dukes C disease. The data suggest that the MDT process has resulted in an increase in the prescription of adjuvant chemotherapy, with 3-year survival being greater after its inception.
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Affiliation(s)
- E MacDermid
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK.
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29
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Dixon JM, Montgomery DA. Extended follow-up of breast cancer patients in clinic wastes time for both patients and doctors: the case for. Breast Cancer Res 2008; 10 Suppl 4:S7. [PMID: 19128445 PMCID: PMC2614833 DOI: 10.1186/bcr2167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Michael Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
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Todd J, Scally A, Dodwell D, Horgan K, Topping A. A randomised controlled trial of two programmes of shoulder exercise following axillary node dissection for invasive breast cancer. Physiotherapy 2008. [DOI: 10.1016/j.physio.2008.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Potter S, Govindarajulu S, Shere M, Braddon F, Turner J, Sahu AK, Cawthorn SJ. Does limiting long-term follow-up for breast cancer allow all referrals to be seen in 2 weeks? Ann R Coll Surg Engl 2008; 90:381-5. [PMID: 18634731 DOI: 10.1308/003588408x301181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The UK National Institute for Health and Clinical Excellence (NICE) recommends that breast cancer follow-up should be limited to 2-3 years stating this will 'release resources' making it 'possible for all women with breast symptoms to be seen within 2 weeks'. In 2000, breast cancer follow-up services in North Bristol were redesigned to reflect evidence-based best practice. The aim of this paper is to assess the impact of this policy on numbers of follow-ups, clinic capacity and waiting times. PATIENTS AND METHODS Data regarding the numbers of new and follow-up patients seen in breast clinic between January 2000 and December 2005 were collected from the hospital Patient Administration System. New patients were categorised as either 'routine' or 'urgent' according to '2-week wait' rule guidelines. Median waiting times were calculated for each group and nominal appointment times assigned in an attempt to assess the effect of any changes on clinic capacity. RESULTS The number of follow-ups decreased by 33% as a result of the new policy. Numbers of referrals over the same period, however, increased by 14%. Routine referrals declined, but there was a 27% increase in '2-week wait' patients. Waiting times for routine appointments initially decreased in response to reduced follow-up, but then rose as the number of '2-week wait' referrals increased. CONCLUSIONS Reducing long-term follow-up is a simple and effective method of increasing clinic capacity but its effects are inadequate and transient in the face of increasing service demand. Additional innovative and creative strategies will be required if all breast patients are to be seen within 2 weeks.
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Affiliation(s)
- S Potter
- Breast Care Centre, Frenchay Hospital, Bristol, UK.
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Australian breast cancer specialists' involvement in multidisciplinary treatment planning meetings. Breast 2008; 17:335-40. [DOI: 10.1016/j.breast.2008.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 09/24/2007] [Accepted: 02/29/2008] [Indexed: 11/18/2022] Open
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Second breast cancers in a Tuscan case series: characteristics, prognosis, and predictors of survival. Br J Cancer 2008; 99:539-44. [PMID: 18628762 PMCID: PMC2527814 DOI: 10.1038/sj.bjc.6604481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Little is known about long-term outcomes following a second breast cancer diagnosis. We describe the epidemiology, characteristics and prognosis of second breast cancers in an Italian cohort. We identified women with two breast cancer diagnoses from 24 278 histology records at a Tuscan breast cancer service between 1980 and 2005, and determined their survival status. Disease-specific survival from second diagnosis was examined using Cox regression analyses. Second cancers were identified in 1044 women with a median age of 60 years. In all 455 were ipsilateral relapses and 589 were contralateral cancers. Median time between first and second diagnosis was 63.4 months. The majority of second cancers was small invasive or in situ tumours. Estimated 10-year survival from a second cancer diagnosis was 78%. Survival was poorest when the second cancer was large (HR=2.26) or node-positive (HR=3.43), when the time between the two diagnoses was <5 years (HR=1.45), or when the diagnosis was in an earlier epoch (HR=2.20). Second tumours were more likely to be large or node-positive if the first breast cancer had these features. Prognosis following a second breast cancer in this cohort was generally good. However, large or node-positive second tumours, and shorter intervals between diagnoses were indicators of poorer survival.
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Besana-Ciani I, Greenall MJ. The importance of margins status after breast conservative surgery and radiotherapy in node positive patients: a follow-up of 10-15 years. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2008; 5:13. [PMID: 18498621 PMCID: PMC2409360 DOI: 10.1186/1477-7800-5-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 05/22/2008] [Indexed: 12/02/2022]
Abstract
Background Margin status is the main factor determining local recurrence (LR) after wide excision and radiotherapy for breast cancer. The aim of the study is to evaluate if positive margins are as great a risk factor for LR in node-positive as in node-negative patients, since the major risk in the former group is dissemination and whether there is a correlation between nodal status and margins in relation to prognosis. Methods 773 patients underwent WLE and radiotherapy between 1988 and 1992 and were followed-up (> 10 years) to determine LR rates according to margin and nodal status. Margins were assessed by cavity-shave biopsies and the axilla was staged by sampling or clearance. Results 461 patients were node negative and 312 node positive. In the node-negative group 415 patients had negative margins and 46 positive: LR after > 10 years was 12 % and 28 % respectively. Among the 312 patients in the node positive group, 267 were margin negative and 45 positive; the LR rate was 12 % and 18 % respectively. In the node negative-group there was a statistically significant difference between the positive and the negative margins with higher relapse rate and lower overall survival (p < 0.001), whereas in the node-positive group the equivalent comparison didn't show any statistical difference. Conclusion Although re-excision should be always recommended, in node-negative patients positive margins are associated with a statistically higher LR rate and lower overall survival while in node-positive disease margins might be of less importance in determining prognosis as dissemination is more likely to occur.
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Bhatt N, Cotter MM. Breast cancer pathology reporting: an audit to compare standards with minimum datasets in a district general hospital. Breast J 2008; 14:118-9. [PMID: 18186880 DOI: 10.1111/j.1524-4741.2007.00537.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Consensus and Controversy in Breast Reconstruction a Review of Current Opinion and Practice. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Follow-up in breast cancer: does routine clinical examination improve outcome? A systematic review of the literature. Br J Cancer 2007; 97:1632-41. [PMID: 18000508 PMCID: PMC2360278 DOI: 10.1038/sj.bjc.6604065] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Multiple guidelines exist for the follow-up of breast cancer, with no agreement on frequency or duration. The contribution of routine clinical examination for the detection of potentially treatable relapse, and the impact this has on survival, is unknown. In this study, we systematically review the literature to establish the proportion of potentially treatable locoregional relapses and new contralateral breast cancers detected by clinical examination, mammography and patient self-examination. We analyse whether method of detection of relapse influences outcome. The methods used were systematic review of the literature. MEDLINE, EMBASE, CancerLit, Web of Sciences and EBM reviews were the data sources for the systematic review. All studies with information on proportion of relapses detected by clinical examination, mammography and self-examination were included. A total of 30-40% of potentially treatable relapses are detected by patient self-examination. In studies published before 2000, 15% of such relapse is mammographically detected with 46% detected by routine clinical examination. In those published after 2000, 40% are mammographically detected with 15% detected on routine clinical examination. Patients with ipsilateral breast relapse detected clinically appear to do less well than those with relapse detected by self-examination or mammography. Routine clinical surveillance is responsible for detection of fewer potentially treatable relapses in more modern cohorts as experience with mammography increases. There is no evidence to suggest that clinical examination confers a survival advantage compared with other methods of detection. The data in this analysis suggest that a review of the guidelines on follow-up after breast cancer should be undertaken.
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Benediktsson KP, Perbeck L. Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg Oncol 2007; 34:143-8. [PMID: 17709228 DOI: 10.1016/j.ejso.2007.06.010] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Accepted: 06/28/2007] [Indexed: 10/22/2022] Open
Abstract
AIM Validation of the oncological safety of nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants (NSM) and of the outcome in patients with locoregional recurrences (LRRs) after this procedure. METHODS Two-hundred and sixteen patients, mean age of 52.8 (29-81) years with primary unilateral breast cancer, not suitable for partial mastectomy because of large (>3cm) or multifocal carcinoma, underwent NSM, a single procedure lasting about 1h 30min, between December 1988 and September 1994. Lymph node metastases were found in 40.3% of the patients, and 47 patients received radiotherapy (RT) postoperatively. All patients were monitored for at least 11.6 years or as long as they lived. Median follow-up was 13 years. The end-points were locoregional recurrence (LRR) or distant metastases (DM) as first events, disease-free survival (DFS) and overall survival (OS). RESULTS Specificity at frozen section from sub-areolar tissues was 98.5%. LRR occurred in 52 patients and DM in 44 patients. DFS was 51.3% and OS was 76.4%. The frequency of LRR was 8.5% among irradiated and 28.4% among non-irradiated patients (p=0.025). These results compare well with results after conventional mastectomy in other trials. All patients were monitored for at least 6 years after the occurrence of LRR, finding 5 years freedom from further LRR or DM of 60% and OS of 82%. CONCLUSIONS NSM is an oncologically safe procedure and could be offered to most patients with breast cancer unsuitable for sector resection only. RT effectively lowers the frequency of LRR. The occurrence of LRR after this operation does not significantly affect OS.
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Affiliation(s)
- K P Benediktsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden.
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Baildam A, Bishop H, Boland G, Dalglish M, Davies L, Fatah F, Gooch H, Harcourt D, Martin L, Rainsbury D, Rayter Z, Sheppard C, Smith J, Weiler-Mithoff E, Winstanley J, Church J. Oncoplastic breast surgery – A guide to good practice. Eur J Surg Oncol 2007; 33 Suppl 1:S1-23. [PMID: 17604938 DOI: 10.1016/j.ejso.2007.04.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Montgomery DA, Krupa K, Jack WJL, Kerr GR, Kunkler IH, Thomas J, Dixon JM. Changing pattern of the detection of locoregional relapse in breast cancer: the Edinburgh experience. Br J Cancer 2007; 96:1802-7. [PMID: 17533401 PMCID: PMC2359955 DOI: 10.1038/sj.bjc.6603815] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 04/25/2007] [Accepted: 05/01/2007] [Indexed: 11/14/2022] Open
Abstract
The guidelines for follow-up of breast cancer patients concentrate on the first 3-5 years, with either reduced frequency of visits or discharge after this. They also recommend mammography, but no evidence exists to inform frequency. We analyse treatable relapses in our unit from 1312 patients with early stage breast cancer treated by breast conserving surgery (BCS) and postoperative radiotherapy between 1991 and 1998 to assess appropriateness of the guidelines. A total of 110 treatable relapses were analysed. Treatable relapse developed at 1-1.5% per year throughout follow-up. Forty-eight relapses were in ipsilateral breast, 25 ipsilateral axilla, 35 contralateral breast, 2 both breasts simultaneously. Thirty-seven relapses (33.5%) were symptomatic, 56 (51%) mammographically detected, 15 (13.5%) clinically detected, 2 (2%) diagnosed incidentally. Mammography detected 5.37 relapses per 1000 mammograms. Patients with symptomatic or mammographically detected ipsilateral breast relapse had significantly longer survival from original diagnosis (P=0.0002) and from recurrence (P=0.0014) compared with clinically detected. Treatable relapse occurs at a constant rate for at least 10 years. Clinical examination detects a minority (13.5%). Relapse diagnosed clinically is associated with poorer outcome. Long-term follow-up based on regular mammography is warranted for all patients treated by BCS.
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Affiliation(s)
- D A Montgomery
- Clinical Research Fellow, University Department of Surgery, Level 2, Queen Elizabeth Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, Scotland, UK.
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Montgomery DA, Krupa K, Cooke TG. Alternative methods of follow up in breast cancer: a systematic review of the literature. Br J Cancer 2007; 96:1625-32. [PMID: 17486134 PMCID: PMC2359932 DOI: 10.1038/sj.bjc.6603771] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Regular clinical follow up after breast cancer is a common practice. Evidence from retrospective reviews casts doubt on the efficacy of this practice and the various guidelines for follow up show little concordance. Our aim was to investigate what alternative follow-up methods (including reduced frequency of visits) have been subjected to controlled trial and to establish what evidence exists from controlled trials to advise the guidelines. The study involved systematic review of the literature using MEDLINE, Embase, CancerLit, Web of Sciences and EBM reviews as data sources. Methods included reviewing all randomised controlled trials comparing different follow-up frequencies or comparing an alternative method with clinical follow up after breast cancer. All outcome measures addressed in the trials were analysed. Two trials compared frequency of traditional follow up. Five trials assessed alternative methods. All were of inadequate power or duration to establish ideal frequency of clinic visits or safety of alternative follow-up methods. Alternative follow up had no detrimental effect on satisfaction or outcome. Few trials have been conducted, all of which are underpowered to establish safety of reducing or replacing clinic visits. Alternative methods of follow up are acceptable to patients and may be associated with other benefits. Larger trials are required.
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Affiliation(s)
- D A Montgomery
- University Department of Surgery, Level 2, Queen Elizabeth Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK.
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Lavelle K, Todd C, Moran A, Howell A, Bundred N, Campbell M. Non-standard management of breast cancer increases with age in the UK: a population based cohort of women > or =65 years. Br J Cancer 2007; 96:1197-203. [PMID: 17387342 PMCID: PMC2360138 DOI: 10.1038/sj.bjc.6603709] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 02/28/2007] [Accepted: 02/28/2007] [Indexed: 12/01/2022] Open
Abstract
Evidence suggests that compared to younger women, older women are less likely to receive standard management for breast cancer. Whether this disparity persists once differences in tumour characteristics have been adjusted for has not been investigated in the UK. A retrospective cohort study involving case note review was undertaken, based on the North Western Cancer Registry database of women aged > or =65 years, resident in Greater Manchester with invasive breast cancer registered over a 1-year period (n=480). Adjusting for tumour characteristics associated with age by logistic regression analyses, older women were less likely to receive standard management than younger women for all indicators investigated. Compared to women aged 65-69 years, women aged > or =80 years with operable (stage 1-3a) breast cancer have increased odds of not receiving triple assessment (OR=5.5, 95% confidence interval (CI): 2.1-14.5), not receiving primary surgery (OR=43.0, 95% CI: 9.7-191.3), not undergoing axillary node surgery (OR=27.6, 95% CI: 5.6-135.9) and not undergoing tests for steroid receptors (OR=3.0, 95% CI: 1.7-5.5). Women aged 75-79 years have increased odds of not receiving radiotherapy following breast-conserving surgery compared to women aged 65-69 years (OR=11.0, 95% CI: 2.0-61.6). These results demonstrate that older women in the UK are less likely to receive standard management for breast cancer, compared to younger women and this disparity cannot be explained by differences in tumour characteristics.
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Affiliation(s)
- K Lavelle
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Toomey DP, Cahill RA, Birido N, Jeffers M, Loftus B, McInerney D, Rothwell J, Geraghty JG. Rapid assessment breast clinics – Evolution through audit. Eur J Cancer 2006; 42:2961-7. [PMID: 16956758 DOI: 10.1016/j.ejca.2006.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 06/15/2006] [Accepted: 06/29/2006] [Indexed: 10/24/2022]
Abstract
This observational, cohort study aimed to examine the potential utility of Rapid Assessment Breast Clinics (RABC) beyond cancer detection at presentation. One thousand four hundred and twenty nine women were studied over an 18 month period. 154 (10.7%) had breast cancer - 87.7% of whom were seen expediently with 92.9% being diagnosed at one attendance. One hundred and forty three (10%) of those with a benign diagnosis were found by routine questioning to have significant familial risk separate to their reason for referral. Despite careful triage, considerable contamination of appointment allotment occurred with many who were correctly triaged as non-urgent being seen 'urgently'. One hundred and seventy six attendees (12.3%) had neither the symptom that triggered referral, nor breast lump, nipple discharge nor family history of breast cancer, while 283 (19.8%) had no objective clinical or radiological abnormality. Although RABC reliably categorise malignant versus non-malignant diagnoses despite cluttering by low risk women, a significant proportion of non-cancer patients still require address of future risk rather than reassurance of their present status alone.
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Affiliation(s)
- D P Toomey
- Department of Surgery, Tallaght Breast Unit, Adelaide and Meath Hospitals incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland
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de Roos MAJ, de Bock GH, Baas PC, de Munck L, Wiggers T, de Vries J. Compliance with guidelines is related to better local recurrence-free survival in ductal carcinoma in situ. Br J Cancer 2005; 93:1122-7. [PMID: 16234825 PMCID: PMC2361497 DOI: 10.1038/sj.bjc.6602815] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The aim was to study the effect of compliance with guidelines on local recurrence (LR)-free survival in patients treated for ductal carcinoma in situ (DCIS). From January 1992 to December 2003, 251 consecutive patients had been treated for DCIS in two hospitals in the North Netherlands. Every case in this two-hospital sample was reviewed in retrospect for its clinical and pathological parameters. It was determined whether treatment had been carried out according to clinical guidelines, and outcomes in follow-up were assessed. In addition, all patients treated for DCIS in this region (n=1389) were studied regarding clinical parameters, in order to determine whether the two-hospital sample was representative of the entire region. In the two-hospital sample, 31.4% (n=79) of the patients had not been treated according to the guidelines. Positive margins were associated with LR (hazard ratio (HR)=4.790, 95% confidence interval (CI) 1.696–13.531). Breast-conserving surgery and deviation from the guidelines were independent predictors of LR (HR=7.842, 95% CI 2.126–28.926; HR=2.778, 95% CI 0.982–6.781, respectively). Although the guidelines changed over time, time was not a significant factor in predicting LRs (HR=1.254, 95% CI 0.272–5.776 for time period 1992–1995 and HR=1.976, 95% CI 0.526–7.421 for time period 1996–1999). Clinical guidelines for the treatment of patients with DCIS have been developed and updated from existing literature and best evidence. Compliance with the guidelines was an independent predictor of disease-free survival. These findings support the application of guidelines in the treatment of DCIS.
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Affiliation(s)
- M A J de Roos
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.
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