1
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Keating N, Cevik J, Hopkins D, Lippey J. Malignant upgrade rate and associated clinicopathologic predictors for concordant intraductal papilloma without atypia: A systematic review and meta-analysis. J Surg Oncol 2024; 129:1025-1033. [PMID: 38305061 DOI: 10.1002/jso.27592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
Previously reported upgrade rates for benign breast intraductal papilloma (IDP) are widely variable. However, many previous studies have failed to consider radiologic-pathologic discordance of lesions. This review aims to synthesize malignant upgrade data for benign, concordant IDP at surgical excision. Thirteen studies were included in our meta-analysis. The pooled estimate for percentage underestimation of carcinoma was 1.4% (95% CI: 0.8%-2.0%). We conclude that these lesions can be safely managed by active surveillance.
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Affiliation(s)
- Niamh Keating
- Department of Breast Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jevan Cevik
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Hopkins
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jocelyn Lippey
- Department of Breast Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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2
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Lippey J, Keogh L, Campbell I, Mann GB, Forrest LE. Impact of a risk based breast screening decision aid on understanding, acceptance and decision making. NPJ Breast Cancer 2023; 9:65. [PMID: 37553371 PMCID: PMC10409718 DOI: 10.1038/s41523-023-00569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/21/2023] [Indexed: 08/10/2023] Open
Abstract
Internationally, population breast cancer screening is moving towards a risk-stratified approach and requires engagement and acceptance from current and future screening clients. A decision aid ( www.defineau.org ) was developed based on women's views, values, and knowledge regarding risk-stratified breast cancer screening. This study aims to evaluate the impact of the decision aid on women's knowledge, risk perception, acceptance of risk assessment and change of screening frequency, and decision-making. Here we report the results of a pre and post-survey in which women who are clients of BreastScreen Victoria were invited to complete an online questionnaire before and after viewing the decision aid. 3200 potential participants were invited, 242 responded with 127 participants completing both surveys. After reviewing the decision aid there was a significant change in knowledge, acceptance of risk-stratified breast cancer screening and of decreased frequency screening for lower risk. High levels of acceptance of risk stratification, genetic testing and broad support for tailored screening persisted pre and post review. The DEFINE decision aid has a positive impact on acceptance of lower frequency screening, a major barrier to the success of a risk-stratified program and may contribute to facilitating change to the population breast screening program in Australia.
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Affiliation(s)
- Jocelyn Lippey
- Sir Peter MacCallum Department of Oncology, Melbourne, Australia
- University of Melbourne, Department of Surgery, Melbourne, Australia
- St. Vincent's Hospital, Department of Surgery, Fitzroy, Australia
| | - Louise Keogh
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, Australia
| | - Ian Campbell
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Gregory Bruce Mann
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Breast Service, The Royal Melbourne Hospital, Melbourne, Australia
| | - Laura Elenor Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.
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3
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Lippey J, Keogh L, Campbell I, Mann GB, Forrest L. “Linking Risk With Screening” – The Impact Of An Online Decision Aid For Risk-Stratified Breast Screening On Understanding, Acceptance And Decision-Making. Breast 2023. [DOI: 10.1016/j.breast.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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4
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Braue K, Baker C, Lippey J. Internal mammary node involvement in patients with axilla-negative early breast cancer: a narrative review. ANZ J Surg 2023; 93:59-64. [PMID: 35997283 DOI: 10.1111/ans.17982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Abstract
Early breast cancer staging involves radiological and pathological evaluation of the tumour and regional lymph nodes. The internal mammary nodes (IMN) are an important site of possible metastasis and influence disease stage and prognosis. However, the recommendation for routine IMN assessment remains unclear. Internal mammary sentinel lymph node biopsy (SLNB) is associated with increased morbidity and an unknown survival benefit. Furthermore, the IMN are traditionally thought to be involved only synchronous with, or following, axillary node (AXN) metastasis. The aim of this review is to determine the prevalence of IMN metastasis in patients with axilla-negative early breast cancer. A narrative review of studies assessing IMN metastasis was performed. The literature search was completed using the database Medline (Ovid). Twenty-two retrospective studies were identified. The studies included data from SLNB, US, MRI, PET/CT and opportunistic biopsy during free-flap reconstruction (FFR). The prevalence of isolated IMN metastasis ranged from 1.2% to 17.9%.
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Affiliation(s)
- Kaela Braue
- St Vincent's Hospital Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline Baker
- Breast Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jocelyn Lippey
- Breast Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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5
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Stafford L, Sinclair M, Gerber K, Christobel Saunders, Ives A, Peate M, Lippey J, Umstad MP, Little R. Experiences of health professionals treating women diagnosed with cancer during pregnancy and proposals for service improvement. Breast 2022; 63:71-76. [PMID: 35334241 PMCID: PMC8942836 DOI: 10.1016/j.breast.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To examine the experiences, needs, and perceptions of health professionals(HPs) treating women diagnosed with cancer during pregnancy(gestational cancer, GC). Methods Interviews were undertaken with Australian HPs who had treated women diagnosed with GC over the previous five years. HPs were recruited via social media, and professional and community networks. Questions focussed upon HPs’ confidence caring for these women, whether current guidelines/training met their needs, psychological impacts of care provision, and service gaps. Interview data were analysed thematically. Results Twenty-seven HPs were interviewed; most were oncology HPs(22/27) with experience caring for women with gestational breast cancer and 13 had a breast-specific clinical focus (e.g. breast surgeon). Many were currently treating women with GC(48%) or had in the last 6–12 months(29.6%). Four themes were identified: A clinically complex case, Managing multi-disciplinary care, Centralised resources for health professionals, and Liaison, information and shared experiences for women. HPs found this population personally challenging to treat. They reported initial uncertainty regarding treatment due to infrequent exposure to GC, limited resources/information, and the need to collaborate with services with which they did not usually engage. Solutions offered include centralised resources, clinical liaison/care coordinators, and connecting women with GC with peer support. Conclusions HPs perceived women with GC as a vulnerable, complex population and experienced challenges providing comprehensive care; particularly when treatment was delivered at geographically separated hospitals. Systemic changes are needed to optimise comprehensive care for these women. Their insights can guide the development of more integrated cancer and obstetric care, and better 10.13039/100004314HP support. Women with cancer diagnosed in pregnancy require complex, coordinated, multidisciplinary care. Clinicians consider these women vulnerable with needs that are hard to meet using standard care. Systemic changes like co-locating services and integrating supportive care are needed. Access to centralised, coordinated, up-to-date evidence-based guidelines is required. Formalised ways to connect women with cancer in pregnancy with peer support would help.
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6
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Lippey J, Keogh L, Campbell I, Mann GB, Forrest L. Development and pilot testing of an online decision aid for women considering risk-stratified breast screening. J Community Genet 2022; 13:137-141. [DOI: 10.1007/s12687-021-00571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 12/11/2021] [Indexed: 11/27/2022] Open
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7
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Hatton A, Heriot N, Zalcberg J, Ayton D, Evans J, Roder D, Chua BH, Hersch J, Lippey J, Fox J, Saunders C, Mann GB, Synnot J, Bell RJ. Factors involved in treatment decision making for women diagnosed with ductal carcinoma in situ: A qualitative study. Breast 2021; 60:123-130. [PMID: 34624754 PMCID: PMC8503564 DOI: 10.1016/j.breast.2021.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Whilst some of the diversity in management of women with ductal carcinoma in situ (DCIS) may be explained by tumour characteristics, the role of patient preference and the factors underlying those preferences have been less frequently examined. We have used a descriptive qualitative study to explore treatment decisions for a group of Australian women diagnosed with DCIS through mammographic screening. Semi-structured telephone interviews were performed with 16 women diagnosed with DCIS between January 2012 and December 2018, recruited through the LifePool dataset (a subset of BreastScreen participants who have agreed to participate in research). Content analysis using deductive coding identified three themes: participants did not have a clear understanding of their diagnosis or prognosis; reported involvement in decision making about management varied; specific factors including the psychosexual impact of mastectomy and perceptions of radiotherapy, could act as barriers or facilitators to specific decisions about treatment. The treatment the women received was not simply determined by the characteristics of their disease. Interaction with the managing clinician was pivotal, however many other factors played a part in individual decisions. Recognising that decisions are not purely a function of disease characteristics is important for both women with DCIS and the clinicians who care for them.
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Affiliation(s)
- Amy Hatton
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Natalie Heriot
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - John Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia; Medical Oncology Unit, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, 3004, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | | | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - Boon H Chua
- Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Jolyn Hersch
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Jocelyn Lippey
- Department of Surgery University of Melbourne, Australia
| | - Jane Fox
- Department of Surgery Monash University, Monash Health Clayton Road Clayton Victoria, Australia
| | - Christobel Saunders
- Department of Surgery, School of Medicine, University of Western Australia, Australia
| | - G Bruce Mann
- Department of Surgery University of Melbourne, Australia
| | - Jane Synnot
- Consumer Representative Breast Cancer Network Australia, Australia
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
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8
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Stafford L, Sinclair M, Gerber K, Collins L, Newman L, Saunders C, Ives A, Mason KD, Peate M, Lippey J, Umstad MP, Shanahan K, Little R. Cancer during pregnancy: A qualitative study of healthcare experiences of Australian women. Eur J Cancer Care (Engl) 2021; 30:e13425. [PMID: 33569843 DOI: 10.1111/ecc.13425] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/30/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To identify features enhancing the quality of healthcare experiences for women with gestational cancer, and explore the impact of the heterogeneous Australian healthcare system on those experiences. METHODS Semi-structured, qualitative interviews were conducted with women diagnosed with any cancer during pregnancy in the last five years. Recruitment occurred during 2018-2019 via social media and professional, clinical and community networks. Questions related to women's experiences of their healthcare, wellbeing and psychosocial needs. Interviews were analysed thematically. RESULTS Study participants (n = 23) received treatment in the private sector (n = 10), public sector (n = 8), or both (n = 5). Five interview themes were found: Control over healthcare; Trust in clinicians, hospitals and systems; Coordination of care; An uncommon diagnosis; Holistic, future-oriented care. Women were most likely to have had a positive healthcare experience when (a)care was well-coordinated and adjusted to meet their unique needs/challenges, and (b)women perceived their care went beyond their immediate medical needs and encompassed future psychosocial wellbeing, including preparation for postpartum challenges. CONCLUSION Existing 'usual care' in the public and/or private sector for both the pregnancy and the cancer is insufficient to meet these women's needs. Prioritising psychological wellbeing including psychosocial needs, and communication and planning around fertility and postnatal challenges are essential for this population.
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Affiliation(s)
- Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, VIC, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Michelle Sinclair
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, VIC, Australia
| | - Katrin Gerber
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.,Melbourne Ageing Research Collaboration, National Ageing Research Institute, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Leah Collins
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, VIC, Australia
| | - Louise Newman
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Christobel Saunders
- Medical School, The University of Western Australia, Perth, WA, Australia.,Fiona Stanley and St John of God Subiaco Hospitals, Subiaco, WA, Australia
| | - Angela Ives
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Kylie D Mason
- Parkville Integrated Haematology Service, Victorian Comprehensive Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia
| | - Jocelyn Lippey
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia.,Department of Surgery, St. Vincent's Hospital, Fitzroy, VIC, Australia.,Department of Surgery, The Northern Hospital, Epping, VIC, Australia
| | - Mark P Umstad
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia.,Department of Maternal-Fetal Medicine, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Kerry Shanahan
- Breast Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ruth Little
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, VIC, Australia
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9
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Chae RP, Tsao SCH, Baker CB, Lippey J. Progressive silicone lymphadenopathy post mastectomy and implant reconstruction for breast cancer. BMJ Case Rep 2021; 14:14/2/e237711. [PMID: 33563690 PMCID: PMC7875285 DOI: 10.1136/bcr-2020-237711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 56-year-old woman with a 12-year history of recurrent triple-negative invasive carcinoma of the breast presented with progressive enlargement of lymph nodes in the setting of established rupture of the ipsilateral silicone breast implant. Although this was proven to be benign on cytology, its progressive nature led to repeated core biopsies for histology, which were necessary given the high-risk nature of triple-negative breast cancer and the multiple proven previous recurrences. The histology demonstrated features of silicone deposits without evidence of malignancy. This case demonstrates the dilemma in surveillance of high-risk patients with breast cancer who have had previous silicone lymphadenopathy.
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Affiliation(s)
- Raphael Park Chae
- Breast Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jocelyn Lippey
- Breast Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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10
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Chao M, Jassal S, Baker C, Tacey M, Law M, Loh S, Cheng M, Yong C, Zantuck N, Bevington E, Hyett A, Guerrieri M, Cokelek M, Brown B, Chipman M, Chew G, Yeo B, Lippey J, Neoh D, Lamoury G, Spillane A, Foley C, Kechagioglou P, Rolfo M, Foroudi F. OC-0330: Neoadjuvant breast radiotherapy for one stage mastectomy and autologous breast reconstruction. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Lippey J, Keogh L, Mann G, Campbell I, Forrest L. OP3 Are Victorian women interested in risk stratified breast screening? Breast 2020. [DOI: 10.1016/j.breast.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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12
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Lippey J, Keogh LA, Mann GB, Campbell IG, Forrest LE. "A Natural Progression": Australian Women's Attitudes About an Individualized Breast Screening Model. Cancer Prev Res (Phila) 2019; 12:383-390. [PMID: 31003994 DOI: 10.1158/1940-6207.capr-18-0443] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/01/2019] [Accepted: 04/09/2019] [Indexed: 11/16/2022]
Abstract
Individualized screening is our logical next step to improve population breast cancer screening in Australia. To explore breast screening participants' views of the current program in Victoria, Australia, examine their openness to change, and attitudes toward an individualized screening model, this qualitative work was performed from a population-based breast screening cohort. This work was designed to inform the development of a decision aid to facilitate women's decisions about participating in individualized screening, and to elicit Australian consumer perspectives on the international movement toward individualized breast screening. A total of 52 women participated in one of four focus groups, and were experienced with screening with 90% of participants having had more than three mammograms. Focus group discussion was facilitated following three main themes: (i) experience of breast screening; (ii) breast cancer risk perception, and (iii) views on individualized screening. Participants had strong, positive, emotional ties to breast screening in its current structure but were supportive, with some reservations, of the idea of individualized screening. There was good understanding about the factors contributing to personalized risk and a wide range of opinions about the inclusion of genetic testing with genetic testing being considered a foreign and evolving domain. Individualized breast screening that takes account of risk factors such as mammographic density, lifestyle, and genetic factors would be acceptable to a population of women who are invested in the current system. The communication and implementation of a new program would be critical to its acceptance and potential success. Reservations may be had in regards to uptake of genetic testing, motivations behind the change, and management of the women allocated to a lower risk category.
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Affiliation(s)
- Jocelyn Lippey
- Department of Surgery, University of Melbourne, Melbourne, Australia. .,St. Vincent's Hospital, Victoria, Australia
| | - Louise A Keogh
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - G Bruce Mann
- Department of Surgery, University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Victoria, Australia
| | - Ian G Campbell
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Laura E Forrest
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
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13
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Ronald M, Emery L, Lippey J, King M, Saunders C. A retrospective examination of Ductal carcinoma in situ (DCIS) treatment pathways to assist with the development of a decision support tool. Breast 2017. [DOI: 10.1016/s0960-9776(17)30187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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Lippey J, Spillane A, Saunders C. Not all ductal carcinoma in situ is created equal: can we avoid surgery for low-risk ductal carcinoma in situ? ANZ J Surg 2017; 86:859-860. [PMID: 27784140 DOI: 10.1111/ans.13659] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jocelyn Lippey
- Breast Unit, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Spillane
- Department of Surgery, Poche Centre, Sydney, New South Wales, Australia
| | - Christobel Saunders
- Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Perth, Western Australia, Australia
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15
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Lippey J, Bousounis R, Behrenbruch C, McKay B, Spillane J, Henderson MA, Speakman D, Gyorki DE. Intralesional PV-10 for in-transit melanoma-A single-center experience. J Surg Oncol 2016; 114:380-4. [PMID: 27237868 DOI: 10.1002/jso.24311] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with in-transit melanoma metastasis have longer median survival than patients with distant metastatic disease. Furthermore, local disease control is an important endpoint for symptom management. The treatment of unresectable loco-regional recurrence or in-transit disease has been historically managed with a combination of treatments including surgery, radiotherapy, isolated limb infusion or perfusion as well as systemic therapies. Intralesional PV-10 has been used at Peter MacCallum Cancer Centre since 2010, and the current report presents a retrospective analysis of patient outcomes, reporting the response rates, durability of responses, and observed toxicities. METHODS Records were analyzed retrieving details of 19 patients treated with PV-10 over a 4-year period from 2010 to 2014. Medical records were reviewed for these patients and data extracted. RESULTS Nineteen patients with in-transit melanoma were treated with intralesional PV-10 between 2010 and 2014. Disease control (complete or partial response or disease stability) was achieved in 68% of patients with 26% having a complete response. This was achieved with minimal associated toxicity. CONCLUSIONS PV-10 is an effective, durable, well-tolerated treatment tool with an acceptable side effect profile for the management of unresectable in-transit melanoma. J. Surg. Oncol. 2016;114:380-384. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jocelyn Lippey
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Rhiannon Bousounis
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Cori Behrenbruch
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Bartholomew McKay
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - John Spillane
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Michael A Henderson
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Victoria, Australia
| | - David Speakman
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Victoria, Australia
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16
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Gannan E, Khoo J, Nightingale S, Suhardja TS, Lippey J, Keane H, Tan KJ, Clouston D, Gorelik A, Mann GB. Management of Early Node-Positive Breast Cancer in Australia: A Multicentre Study. Breast J 2016; 22:413-9. [PMID: 27095381 DOI: 10.1111/tbj.12595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
To examine practice patterns for breast cancer patients with limited sentinel node (SN) disease in light of the ACOSOG Z0011 results. Retrospective analysis of patients with T1-2 breast cancer and positive sentinel lymph node biopsy (SLNB) admitted between January 2009 and December 2012. Patient demographics, tumor characteristics, and treatments were recorded. Eight hundred positive SLNBs were identified. A total of 452 (56.5%) proceeded to completion axillary lymph node dissection (cALND). cALND rate decreased from 65.1% to 49.7% from 2009-2010 to 2011-2012. cALND was performed for micrometastasis or isolated tumor cells in 39.3% in 2009-2010 and 22.2% in 2011-2012, whereas for macrometastases the rates were 83.1% and 68.6%, respectively. cALND rates diminished for both Z0011-eligible and -ineligible patients. The ACOSOG Z0011 trial presentation and publication coincided with a reduction in cALND for breast cancer with limited nodal disease. There appears equipoise regarding management of macrometastatic SN disease.
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Affiliation(s)
- Emma Gannan
- The Breast Service, The Royal Melbourne Hospital & The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jeremy Khoo
- Focus Pathology, East Melbourne, Victoria, Australia
| | - Sophie Nightingale
- Department of Surgery, The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | | | - Jocelyn Lippey
- Department of Surgery, The Austin Hospital, Heidelberg, Victoria, Australia
| | - Holly Keane
- Department of Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kian Jin Tan
- Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Alexandra Gorelik
- Melbourne EpiCentre, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Gregory Bruce Mann
- The Breast Service, The Royal Melbourne Hospital & The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
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17
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Affiliation(s)
- Cori Behrenbruch
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jocelyn Lippey
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - John Spillane
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Henderson
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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