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Abstract
Dr. Bernard Fisher (1918-2019) was an early proponent of evidence-based medicine using the mechanism of prospective, multicenter, randomized clinical trials to test biological and clinical hypotheses. In this article, I trace how his early scientific work in striving to understand the nature of cancer metastasis through animal experiments led to a new, testable, clinical hypothesis: that surgery to remove only the tumor and a small amount of tissue around it was as effective as the more disfiguring operations that were then the standard treatment. Fisher's work with the National Surgical Adjuvant Breast and Bowel Project (NSABP) using large, randomized clinical trials to demonstrate the veracity of this hypothesis led to a new paradigm in which the emphasis was placed on how systemic therapies used at an early stage of disease could effectively eradicate breast cancer for many patients. This new therapeutic approach led to the successful development of new treatments, many of which are widely used today. Ultimately, the new paradigm led to successfully preventing breast cancer in women who were at high risk for the disease but who had not yet been diagnosed with the disease. Throughout his entire career, Fisher championed the use of large prospective, randomized clinical trials despite criticism from many in the medical community who strongly criticized his use of randomization as a mechanism for testing clinical hypotheses. The approach he and the NSABP employed is still considered to be the highest standard of evidence in conducting clinical studies.
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Affiliation(s)
- Stewart Anderson
- University of Pittsburgh Graduate School of Public Health - Biostatistics, Pittsburgh, PA, USA
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Late Recurrence in Breast Cancer: To Run after the Oxen or to Try to Close the Barn? Cancers (Basel) 2021; 13:cancers13092026. [PMID: 33922205 PMCID: PMC8122713 DOI: 10.3390/cancers13092026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/10/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary The initial treatment of early breast cancer has achieved important clinical results over time. However, late recurrences after many years of disease-free survival remain an open question, which has recently attracted the attention of a few researchers. The authors of this commentary suggest that the approach emerging from scientific meetings regarding this subject is marred by the lack of attention to recent clinical and laboratory data. The role of tumor dormancy and the dynamics of disease recurrence are presented here and a more general reflection on therapeutic approaches to cancer is proposed. Abstract The problem of late recurrence in breast cancer has recently gained attention and was also addressed in an international workshop held in Toronto (ON, Canada), in which several aspects of the question were examined. This Commentary offers a few considerations, which may be useful for the ongoing investigations. A few premises are discussed: (a) clinical recurrences, especially the late ones, imply periods of tumor dormancy; (b) a structured pattern of distant metastases appearance is detectable in both early and late follow-up times; (c) the current general paradigm underlying neoplastic treatments, i.e., that killing all cancer cells is the only way to control the disease, which is strictly sprouting from the somatic mutation theory, should be re-considered. Finally, a few research approaches are suggested.
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Walstra CJEF, Schipper RJ, Poodt IGM, Maaskant-Braat AJG, Luiten EJT, Vrancken Peeters MJTFD, Smidt ML, Degreef E, Voogd AC, Nieuwenhuijzen GAP. Multifocality in ipsilateral breast tumor recurrence - A study in ablative specimens. Eur J Surg Oncol 2020; 46:1471-1476. [PMID: 32402507 DOI: 10.1016/j.ejso.2020.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/24/2020] [Accepted: 04/17/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The incidence and clinical significance of multifocality in ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) are unclear. With growing interest in repeat BCT, this information has become of importance. This study aimed to gain insight in the incidence of multifocality in IBTR, to identify patient- and tumor-related predicting factors and to investigate the prognostic significance of multifocality. METHODS Two hundred and fifteen patients were included in this analysis. All had an IBTR after BCT and were treated by salvage mastectomy and appropriate adjuvant therapy. Predictive tumor- and patient-related factors for multifocality in IBTR were identified using X2 test and univariate logistic regression analyses. Prognostic outcomes were calculated using Kaplan Meier analysis and compared using the log rank test. RESULTS Multifocality was present in 50 (22.9%) of IBTR mastectomy specimens. Axillary positivity in IBTR was significantly associated with multifocality in IBTR. Chest wall re-recurrences occurred more often after multifocal IBTR (14% versus 7% after unifocal IBTR, p = 0.120). Regional re-recurrences did not differ significantly between unifocal and multifocal IBTR (8% vs. 6%, p = 0.773). Distant metastasis after salvage surgery occurred more frequently after multifocal IBTR (15% vs. 24%, p = 0.122). Overall survival was 132 months after unifocal IBTR and 112 months after multifocal IBTR (p = 0.197). CONCLUSION The prevalence of multifocality in IBTR is higher than in primary breast cancer. Axillary positivity in IBTR was associated with a multifocal IBTR. Chest wall re-recurrences and distant metastasis were, although not statistically significant, more prevalent after multifocal IBTR.
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Affiliation(s)
| | | | - Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands
| | | | | | | | - Marjolein L Smidt
- Department of Surgery, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands
| | - Ellen Degreef
- Department of Pathology, Catharina Hospital Eindhoven, the Netherlands
| | - Adri C Voogd
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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Lee-Felker SA, Tekchandani L, Thomas M, Gupta E, Andrews-Tang D, Roth A, Sayre J, Rahbar G. Newly Diagnosed Breast Cancer: Comparison of Contrast-enhanced Spectral Mammography and Breast MR Imaging in the Evaluation of Extent of Disease. Radiology 2017; 285:389-400. [DOI: 10.1148/radiol.2017161592] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stephanie A. Lee-Felker
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 165-53, Los Angeles, CA 90095 (S.A.L.F.); Department of Radiological Sciences, Santa Ana-Tustin Radiology Medical Group, Santa Ana, Calif (L.T.); Department of Radiological Sciences, Olive View-UCLA Medical Center, Los Angeles, Calif (M.T., D.A.T., A.R., E.G., G.R.); and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, Calif (J.S.)
| | - Leena Tekchandani
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 165-53, Los Angeles, CA 90095 (S.A.L.F.); Department of Radiological Sciences, Santa Ana-Tustin Radiology Medical Group, Santa Ana, Calif (L.T.); Department of Radiological Sciences, Olive View-UCLA Medical Center, Los Angeles, Calif (M.T., D.A.T., A.R., E.G., G.R.); and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, Calif (J.S.)
| | - Mariam Thomas
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 165-53, Los Angeles, CA 90095 (S.A.L.F.); Department of Radiological Sciences, Santa Ana-Tustin Radiology Medical Group, Santa Ana, Calif (L.T.); Department of Radiological Sciences, Olive View-UCLA Medical Center, Los Angeles, Calif (M.T., D.A.T., A.R., E.G., G.R.); and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, Calif (J.S.)
| | - Esha Gupta
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 165-53, Los Angeles, CA 90095 (S.A.L.F.); Department of Radiological Sciences, Santa Ana-Tustin Radiology Medical Group, Santa Ana, Calif (L.T.); Department of Radiological Sciences, Olive View-UCLA Medical Center, Los Angeles, Calif (M.T., D.A.T., A.R., E.G., G.R.); and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, Calif (J.S.)
| | - Denise Andrews-Tang
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 165-53, Los Angeles, CA 90095 (S.A.L.F.); Department of Radiological Sciences, Santa Ana-Tustin Radiology Medical Group, Santa Ana, Calif (L.T.); Department of Radiological Sciences, Olive View-UCLA Medical Center, Los Angeles, Calif (M.T., D.A.T., A.R., E.G., G.R.); and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, Calif (J.S.)
| | - Antoinette Roth
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 165-53, Los Angeles, CA 90095 (S.A.L.F.); Department of Radiological Sciences, Santa Ana-Tustin Radiology Medical Group, Santa Ana, Calif (L.T.); Department of Radiological Sciences, Olive View-UCLA Medical Center, Los Angeles, Calif (M.T., D.A.T., A.R., E.G., G.R.); and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, Calif (J.S.)
| | - James Sayre
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 165-53, Los Angeles, CA 90095 (S.A.L.F.); Department of Radiological Sciences, Santa Ana-Tustin Radiology Medical Group, Santa Ana, Calif (L.T.); Department of Radiological Sciences, Olive View-UCLA Medical Center, Los Angeles, Calif (M.T., D.A.T., A.R., E.G., G.R.); and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, Calif (J.S.)
| | - Guita Rahbar
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 165-53, Los Angeles, CA 90095 (S.A.L.F.); Department of Radiological Sciences, Santa Ana-Tustin Radiology Medical Group, Santa Ana, Calif (L.T.); Department of Radiological Sciences, Olive View-UCLA Medical Center, Los Angeles, Calif (M.T., D.A.T., A.R., E.G., G.R.); and Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, Calif (J.S.)
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Management of the Axilla. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wang SY, Long JB, Killelea BK, Evans SB, Roberts KB, Silber A, Gross CP. Preoperative Breast Magnetic Resonance Imaging and Contralateral Breast Cancer Occurrence Among Older Women With Breast Cancer. J Clin Oncol 2015; 34:321-8. [PMID: 26628465 DOI: 10.1200/jco.2015.62.9741] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Preoperative magnetic resonance imaging (MRI) detects occult contralateral breast cancers (CBCs) in women with breast cancer, but the impact of detection on long-term CBC events is unclear. We examined whether MRI use decreases the occurrence of CBCs and the detection of stages II to IV disease among women who develop a CBC. PATIENTS AND METHODS Analyzing the SEER-Medicare database, we assessed overall, synchronous (< 6 months after primary cancer diagnosis), and subsequent (ie, metachronous) stage-specific CBC occurrences in women who were diagnosed with stages I and II breast cancer during 2004-2009 and who were observed through 2011. RESULTS Among 38,971 women with breast cancer, 6,377 (16.4%) received preoperative MRI. After propensity score matching, and compared with women who did not undergo MRI, preoperative MRI use was significantly associated with a higher synchronous CBC detection rate (126.4 v 42.9 per 1,000 person-years, respectively; hazard ratio, 2.85; P < .001) but a lower subsequent CBC detection rate (3.3 v 4.5 per 1,000 person-years, respectively; hazard ratio, 0.68; P = .002). However, the 5-year cumulative incidence of CBC remained significantly higher among women undergoing MRI compared with those not undergoing MRI (7.2% v 4.0%, respectively; P < .001). The analyses of projected CBC events for 10,000 patients who receive MRI indicated that, after a 5-year follow-up, MRI use would detect an additional 192 in situ CBCs (95% CI, 125 to 279) and 120 stage I CBCs (95% CI, 62 to 193) but would not have a significant impact on stages II to IV CBC occurrences (∼ 6; 95% CI, -21 to 47). CONCLUSION An increased synchronous CBC detection rate, attributable to MRI, was not offset by a decrease of subsequent CBC occurrence among older women with early-stage breast cancer, suggesting that preoperative MRI in women with breast cancer may lead to overdiagnosis.
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Affiliation(s)
- Shi-Yi Wang
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT.
| | - Jessica B Long
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
| | - Brigid K Killelea
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
| | - Suzanne B Evans
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
| | - Kenneth B Roberts
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
| | - Andrea Silber
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
| | - Cary P Gross
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
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Neri A, Marrelli D, Megha T, Bettarini F, Tacchini D, De Franco L, Roviello F. "Clinical significance of multifocal and multicentric breast cancers and choice of surgical treatment: a retrospective study on a series of 1158 cases". BMC Surg 2015; 15:1. [PMID: 25586679 PMCID: PMC4324662 DOI: 10.1186/1471-2482-15-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 01/07/2015] [Indexed: 12/18/2022] Open
Abstract
Background The biological and clinical significance of multifocal and multicentric (MF/MC) breast cancers and the choice of appropriate surgical treatment for these tumors are still debated. Methods 1158 women operated on for a stage I-III breast cancer were included in this retrospective study; clinical and pathological data were obtained from the institutional database of the Department of Oncology of the University of Siena, Italy. The impact of MF/MC breast cancers on patterns of recurrence and breast cancer specific survival (BCSS) was investigated in relation to the type of surgical treatment. Results MF and MC cancers were present in 131 cases (11.3%) and 60 cases (5.2%) respectively and were more frequently treated with mastectomy (55 MF and 60 MC cancers, 81.2%) than with breast conserving surgery (36 MF cancers, 18.9%; p < 0.001). MF and MC breast cancers were associated with a worse prognosis with a BCSS of 154 months compared to 204 months of unicentric cancers (p < 0.001). In multivariate analysis, MF/MC cancers were independent prognostic factors for BCSS together with higher number of metastatic axillary nodes, absence of estrogen receptors and high proliferative activity. MF and MC cancers were related to a significantly shorter BCSS in patients submitted to mastectomy as well as those submitted to breast conserving surgery. Relapse at any site was higher in the subgroup of MF and MC cancers but the incidence of loco-regional and distant recurrences did not differ between patients treated with mastectomy or breast conserving surgery. Conclusions Our results indicate that MF/MC cancers have a negative impact on prognosis and are related to higher loregional and distant relapse independently from the type of surgery performed. Adjuvant therapies did not modify the poorer outcome, but in patients receiving adjuvant anthacyclines, the differences with unicentric tumors were reduced. Our data support the hypothesis that MF/MC tumors may have a worse biological behavior and that the presence of multiple foci should be considered in planning adjuvant treatments.
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Affiliation(s)
- Alessandro Neri
- Unit of Surgical Oncology, Department of Oncology of the University Hospital of Siena, Siena, Italy.
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Orentlicher D. Abortion and compelled physician speech. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:9-21. [PMID: 25846035 DOI: 10.1111/jlme.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading.
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Affiliation(s)
- David Orentlicher
- Samuel R. Rosen Professor and Co-Director at the Hall Center for Law and Health, Indiana University Robert H. McKinney School of Law, and an Adjunct Professor of Medicine at the Indiana University School of Medicine
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McAuliffe PF, Danoff S, Shapiro SD, Davidson NE. Treatment for Breast Cancer: Is Time Really of the Essence? ACTA ACUST UNITED AC 2013; 105:80-2. [DOI: 10.1093/jnci/djs524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schott AF, Hayes DF. Reply to J. Perlmutter et al and D. Yee et al. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.45.3589] [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] Open
Affiliation(s)
- Anne F. Schott
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Daniel F. Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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Jochelson MS, Dershaw DD, Sung JS, Heerdt AS, Thornton C, Moskowitz CS, Ferrara J, Morris EA. Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology 2012; 266:743-51. [PMID: 23220903 DOI: 10.1148/radiol.12121084] [Citation(s) in RCA: 266] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine feasibility of performing bilateral dual-energy (DE) contrast agent-enhanced (CE) digital mammography and to evaluate its performance compared with conventional digital mammography and breast magnetic resonance (MR) imaging in women with known breast cancer. MATERIALS AND METHODS This study was approved by the institutional review board and was HIPAA compliant. Written informed consent was obtained. Patient accrual began in March 2010 and ended in August 2011. Mean patient age was 49.6 years (range, 25-74 years). Feasibility was evaluated in 10 women with newly diagnosed breast cancer who were injected with 1.5 mL per kilogram of body weight of iohexol and imaged between 2.5 and 10 minutes after injection. Once feasibility was confirmed, 52 women with newly diagnosed cancer who had undergone breast MR imaging gave consent to undergo DE CE digital mammography. Positive findings were confirmed with pathologic findings. RESULTS Feasibility was confirmed with no adverse events. Visualization of tumor enhancement was independent of timing after contrast agent injection for up to 10 minutes. MR imaging and DE CE digital mammography both depicted 50 (96%) of 52 index tumors; conventional mammography depicted 42 (81%). Lesions depicted by using DE CE digital mammography ranged from 4 to 67 mm in size (median, 17 mm). DE CE digital mammography depicted 14 (56%) of 25 additional ipsilateral cancers compared with 22 (88%) of 25 for MR imaging. There were two false-positive findings with DE CE digital mammography and 13 false-positive findings with MR imaging. There was one contralateral cancer, which was not evident with either modality. CONCLUSION Bilateral DE CE digital mammography was feasible and easily accomplished. It was used to detect known primary tumors at a rate comparable to that of MR imaging and higher than that of conventional digital mammography. DE CE digital mammography had a lower sensitivity for detecting additional ipsilateral cancers than did MR imaging, but the specificity was higher. © RSNA, 2012.
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Affiliation(s)
- Maxine S Jochelson
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
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Kapoor NS, Chung A, Huynh K, Giuliano AE. Preliminary Results: Double Lumpectomies for Multicentric Breast Carcinoma. Am Surg 2012. [DOI: 10.1177/000313481207801226] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The standard operation for patients with multicentric breast cancer is total mastectomy. The safety of breast-conserving surgery (BCS) for these patients is unknown but interest in BCS has recently resurfaced as a result of the detection of occult second malignancies by breast magnetic resonance imaging (MRI). We report a small number of patients who chose to undergo “double lumpectomies,” defined as two separate segmental mastectomies for primary cancers in different quadrants of the same breast. Patients with multicentric breast cancer surgically managed with double lumpectomies at our institute were identified retrospectively. Clinicopathologic features are described and outcomes reported. Seven patients underwent double lumpectomies for multicentric carcinoma. Median age was 69 years (range, 61 to 80 years). In five patients, MRI identified ipsilateral second malignancies. All patients had two foci of invasive carcinoma, all tumors expressed estrogen receptor, and none showed HER-2 overexpression. Tumor sizes ranged from 0.7 to 2.9 cm. Six patients had histologically distinct tumors in the same breast: five had one invasive lobular carcinoma (ILC) and one invasive ductal carcinoma (IDC), and one had classic ILC in one quadrant and pleomorphic ILC in another. One patient had two foci of IDC in separate quadrants. All patients had sentinel lymph node biopsies and none had nodal metastasis. Median follow-up was 26 months (range, 18 to 85 months). No patient developed locoregional recurrence. This small series suggests that “double lumpectomy” may be considered for multicentric invasive breast carcinoma in carefully selected patients with favorable tumors who desire breast conservation.
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Affiliation(s)
- Nimmi S. Kapoor
- John Wayne Cancer Institute, Santa Monica, California
- Cedars Sinai Medical Center, Beverly Hills, California
| | - Alice Chung
- Cedars Sinai Medical Center, Beverly Hills, California
| | - Kelly Huynh
- Cedars Sinai Medical Center, Beverly Hills, California
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Rosenkranz K. Multiple Ipsilateral Breast Cancers: Current Strategies for Surgical Management. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0075-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Garcia-Etienne CA, Tomatis M, Heil J, Friedrichs K, Kreienberg R, Denk A, Kiechle M, Lorenz-Salehi F, Kimmig R, Emons G, Danaei M, Heyl V, Heindrichs U, Rageth CJ, Janni W, Marotti L, del Turco MR, Ponti A. Mastectomy trends for early-stage breast cancer: a report from the EUSOMA multi-institutional European database. Eur J Cancer 2012; 48:1947-56. [PMID: 22483323 DOI: 10.1016/j.ejca.2012.03.008] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 02/23/2012] [Accepted: 03/03/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Recent single-institution reports have shown increased mastectomy rates during the last decade. Further studies aiming to determine if these reports could be reflecting a national trend in the United States of America (US) have shown conflicting results. We report these trends from a multi-institutional European database. PATIENTS AND METHODS Our source of data was the eusomaDB, a central data warehouse of prospectively collected information of the European Society of Breast Cancer Specialists (EUSOMA). We identified patients with newly diagnosed unilateral early-stage breast cancer (stages 0, I or II) to examine rates and trends in surgical treatment. RESULTS A total of 15,369 early-stage breast cancer cases underwent surgery in 13 Breast Units from 2003 to 2010. Breast conservation was successful in 11,263 cases (73.3%). Adjusted trend by year showed a statistically significant decrease in mastectomy rates from 2005 to 2010 (p = 0.003) with a progressive reduction of 4.24% per year. A multivariate model showed a statistically significant association of the following factors with mastectomy: age < 40 or ≥ 70 years, pTis, pT1mi, positive axillary nodes, lobular histology, tumour grade II and III, negative progesterone receptors and multiple lesions. CONCLUSION Our study demonstrates that a high proportion of patients with newly diagnosed unilateral early-stage breast cancer from the eusomaDB underwent breast-conserving surgery. It also shows a significant trend of decreasing mastectomy rates from 2005 to 2010. Moreover, our study suggests mastectomy rates in the population from the eusomaDB are lower than those reported in the US.
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Affiliation(s)
- Carlos A Garcia-Etienne
- Breast Unit, Humanitas Cancer Center, Milan, Rozzano, Italy; EUSOMA Data Centre, Turin, Italy
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Costa A. E1. What the past is telling us about the future. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)00201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ciatto S, Bernardi D. Is Preoperative Staging with Breast MRI Causing Overtreatment with Mastectomies? WOMENS HEALTH 2012; 8:119-22. [DOI: 10.2217/whe.11.92] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Stefano Ciatto
- UO Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Trento, Italy and Corte Cà Brusà 1G, 37067 Valeggio sul Mincio (VR), Italy, Tel.: +39 348 654 0748,
| | - Daniela Bernardi
- Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Trento, Italy
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