Changes in Benign to Malignant Ratio of Surgically Treated Breast Diseases in a District Hospital

The benign to malignant ratio (BMR) of open surgical biopsies is often used to monitor the efficacy of diagnostic workup of breast lesions. Avoiding the unnecessary removal of benign lesions is of recognized importance. Histopathology archives of the Department of Pathology of the Bács-Kiskun County Hospital were retrieved for breast lesions and the BMR of surgical specimens was determined for each year between the period of 1965-1996. The introduction of mammography and especially fine-needle aspiration cytology was paralleled by a reduction in the benign to malignant ratio from 1.7 to 0.7. Only the introduction of breast aspiration cytology seemed to have a significant effect on the BMR, but the more adequate diagnostic approach to breast lesions (mostly palpable in their nature) was in part masqueraded by the late shift in attitude of both surgeons and patients towards breast lumps. This is why the BMR can give a basic information on preoperative diagnostic workup of breast lesions, but in itself it is not able to monitor them.

Quality of life after breast conservation or mastectomy: a systematic review

BACKGROUND

For early breast cancer, survival after breast conservation is similar to that after mastectomy. Some women may not have a clear preference and wish to have further information about quality of life experienced after the alternative treatments. This paper describes a systematic review of randomized trials on mastectomy versus breast conservation for which there are data on quality of life or psychosocial outcomes.

METHODS

Literature was reviewed to find all randomized controlled trials comparing breast conservation to mastectomy, with quality of life or psychological effects as an outcome. Studies were then critically appraised by two reviewers independently and any disagreements about their quality and results resolved by discussion.

RESULTS

A total of six randomized trials met our inclusion criteria. In general, they are of poor quality. Women who had breast conservation had a more favourable body image of themselves than those who had mastectomy in all five studies in which it was examined. The evidence was statistically inconclusive for all the other dimensions measured, namely perceptions of psychological health, sexual health, physical health, fear of the future and global quality of life. Radiotherapy may be a determinant of poorer psychological health and body image.

CONCLUSIONS

Apart from body image, it is unclear whether breast conservation or mastectomy results in better psychosocial outcomes. Moreover, the studies were done before evidence was available to inform women about the equivalence of survival with these alternative treatments. Therefore there is inadequate information available to help many women decide about their choice of treatment in the future. Preference trials should be conducted, using standardized quality-of-life measures, in which women who are uncertain about which treatment to choose are randomized to breast conservation or mastectomy.

Ductal carcinoma in situ. Part I: Definition and diagnosis

The frequency of diagnosis of ductal carcinoma in situ (DCIS) has increased in Australia, largely because of the national screening programme. Ductal carcinoma in situ presents a dilemma because of problems with its diagnosis and variations in reporting pathological and radiological findings, making it difficult to define optimal treatment and communicate information in a way that helps the patient understand the problems and make decisions. There is considerable inter-observer variation, particularly in differentiating low-grade DCIS from ductal hyperplasia, with or without atypia, but pathologists who participate in regular pathological review sessions vary less in their opinions. Mammography remains the main investigative tool for DCIS and the American College of Radiology has recommended standardized reports. A team approach is required for the removal and diagnosis of possible DCIS. Although the team may be best co-located in the one facility, this is not practical in many community hospital settings which lack on-site radiology and pathology services. The decision about how much breast tissue to remove will need to be made for each patient and depends on the size of the microcalcification and how suspicious the mammogram is for DCIS. We recommend the use of synoptic reports for DCIS, and we document the minimum factors that should be reported by pathologists. The evaluation and management of DCIS by a multidisciplinary team will allow the patient access to information required to make often difficult treatment decisions. In this paper, we review the literature about the natural history, pathology, cytology and radiology of DCIS and document the 20 critical steps required for the diagnosis of impalpable, mammographic microcalcifications suspected to be DCIS.

Surgical treatment of breast cancer in New South Wales 1991, 1992

BACKGROUND

The purpose of this study was to examine existing data on women diagnosed with breast cancer in New South Wales in 1991 and 1992 and to describe surgical treatments received on an inpatient basis.

METHODS

Analyses were based on the linkage of two databases: the New South Wales Central Cancer Registry and the New South Wales Health Department's Inpatient Statistics Collection. Data were limited to women who were resident and treated in New South Wales. Main analyses were restricted to definitive surgical procedures.

RESULTS

Thirty-six per cent of women treated surgically for breast cancer in 1991 had breast-conserving therapy. This had increased to 39% in 1992. There were substantial geographical variations in the use of breast-conserving therapy in New South Wales which could not be explained by patient characteristics. Age, degree of spread at diagnosis, and area health service/ health region were all found to have an independent association with the probability of having a mastectomy.

CONCLUSIONS

Women with a localized degree of spread living in non-metropolitan areas (Health Regions) were almost twice as likely to have a mastectomy as compared with similar women who were resident in metropolitan areas (Area Health Services). The concentration of radiotherapy services may have contributed to the urban/rural variation in breast-conserving therapy in New South Wales, but it is also likely that some of the variations that were observed may be a reflection of the failure of clinicians to use best current practice.