[Breast cancer : individualized risk assessment for tailor-made screening]

Breast cancer is the leading cause of neoplastic death in women around the world. In the era of personalized medicine, legitimately awaited by our patients, the future of breast cancer screening will depend on an individual-based risk assessment, making it possible to better adapt the age of onset, frequency and the type of examinations useful for this screening. This article reviews the three broad categories of highest risk factors available to establish a risk score appropriate for each patient.

[Primary and secondary prevention for women at high risk for breast cancer]

Many factors determine a woman's risk of breast cancer; some genetic are related to family history, others are based on personal factors such reproductive and medical history. A high-risk woman must benefit of a specific screening regimen including breast examination, mammography, ultrasonography and contrast material-enhanced magnetic resonance. But she can also benefit of chemo prevention or/and risk-reducing surgery such bilateral prophylactic salpingo-oophorectomy and bilateral prophylactic mastectomy.

[Hormone therapy for breast cancer]

Following Beatson's publications in 1896, various modalities of endocrine therapy applied to breast cancer have been developed. Endocrine treatment has greatly contributed to the improvement of the disease's prognosis. Tamoxifen has established itself as a first choice adjuvant therapy for patients with tumors expressing hormone receptors. Over the last decade, third generation aromatase inhibitors have demonstrated their efficacy amongst menopausal patients, alone or in combination with tamoxifen. Efficacy of these medications is dependent on patient's compliance. This article proposes a synthesis of the main knowledges available in the field of breast cancer endocrine therapy.

[Bilateral prophylactic mastectomy for women at very high risk for breast cancer: beyond the technique]

Bilateral prophylactic mastectomy is the most efficient risk management strategy for women at very high risk for breast cancer. Different methods can be used. The implementation of such a strategy must respond to the request of a well informed patient.

[Sentinel lymph node biopsy and axillary reverse mapping: a tailoring axillary staging in breast cancer]

The status of the axillary lymph nodes is one of the most important prognostic factors in women with early stage breast cancer. Histologic examination of removed lymph nodes is the most accurate method for assessing spread of disease to these nodes. Axillary lymph node dissection (ALND) remains the standard approach for women who have clinically palpable axillary nodes. The benefits of ALND include its impact on disease control (axillary recurrence and survival), its prognostic value, and its role in treatment selection. However, the anatomic disruption caused by ALND may result in lymphedema, nerve injury, and shoulder dysfunction, which compromise functionality and quality of life. For patients who have clinically negative axillary lymph nodes, sentinel lymph node (SLN) biopsy offers a less morbid method to determine if there are positive nodes, in which case axillary node dissection would be necessary. Patients who are SLN-positive should undergo complete ALND. Axillary reverse mapping (ARM) is a recent improvement of ALND which, like the biopsy of the GS, would reduce morbidity.

[Microsurgical breast reconstruction: for whom and how?]

Breast reconstruction is now an integral part of breast cancer treatment. There are several different procedures that make use of flaps or prostheses, or a combination of the two. Which of these procedures is indicated depends on the sequelae of the initial treatment and the patient's wishes and morphology. However, the constraints caused by the prosthetic material and the now regular use of microsurgical techniques have greatly favoured the purely autologous options. The different surgical techniques and their respective advantages and disadvantages will be described, before considering the timing of the various stages of the procedure. We will also give a summary of our experience with free flaps.

[Management and follow-up of a consecutive series of 411 surgically treated breast cancer patients]

This study reports a consecutive serie of 427 breast neoplasms (411 patients) diagnosed and treated in our department between 1994 and 2004. Patients' records were prospectively collected including personnal medical history and the major elements of the diagnostic and the therapeutic protocol applied. 12 patients (3%) had to be excluded due to incomplete follow-up data. With a median follow-up of 8 years, a 4.5% loco-regional relapse rate is noted while 11% of patients recurred at distant sites and 9% died of their disease progression. These statistics are comparable to those published by prominant breast cancer centers. Amongst the 16% of deaths (67/411 Pts), 54% are due to breast cancer progression. The results are discussed with the aim to upgrade the diagnostic and the therapeutic protocols offered to our patients.

[Adherence to long-term medication: the particular case of the adjuvant endocrine therapy for breast cancer]

The aim of adjuvant hormone therapy for breast cancer is to reach, in daily practice, an efficacy similar to that obtained in clinical trials. In spite of the demonstrated efficacy of hormone therapy, compliance represents a major challenge and a multidimensional problem. A better understanding of the reasons underlying non-compliance would help identify the patients at higher risk and would permit the implementation of strategies to improve compliance to adjuvant hormone therapy. With this in mind, we undertook a review of the recent literature on the topic (Pub Med 2003-2009).

Prospective Evaluation of Pre and Postoperative Lymphoscintigraphy in Axillary Reverse Mapping (ARM) for Breast Cancer Patients

BackgroundThe sentinel lymph node (SLN) procedure, has been used successfully to detect lymphatic involvement. The expected reduction in morbidity and improvement in the quality of life of patients remains uncertain. In spite of this minimal invasive technique, 40 to 50 % of axilla are explored by classic axillary dissection. The aim of axillary reverse mapping (ARM) is to preserve the main lymphatic chain in relation to lymphatic arm drainage during an axillary dissection, reducing the rate of lymphedema.ObjectivesThe objective of this study is to describe a prospective comparison of pre and post axillary dissection (AD) lymphoscintigraphy, in 15 consecutive breast cancer patients.MethodsIsotope InjectionThe morning of surgery, all patients underwent isotope injection in the ipsilateral hand. Each patients received a single injection of 60 MBq (vol 0.2 ml) into the first interdigital space. The preoperative lymphoscintigraphy was performed 45 min after injection, in surgical position. An average of 2 nodes were visible in the axilla. The postoperative lymphoscintigraphy was planned before starting adjuvant treatment.Surgical TechniqueAfter having performed the lumpectomy or the mastectomy, the surgeon began the AD. The first important step was the identification of the second intercostals brachial nerve. While reserving the nerve, the dissection was carried out from medial to lateral, below the nerve. The gamma probe was then used in order to identify the first radioactive node draining the upper limb. This node was localized in the lateral pillar of the axilla. The ARM nodes were carefully preserved during the dissection with retractors placed over them to protect from inadvertent damage. After completion of AD, the axillary content was examined ex-vivo to identify at least ten nodes within the surgical specimen.ResultsThe mean age is 62.4 years (range 40-81). For all 15 patients, the mean number of axillary nodes removed by means of AD was 10.7 (range 7–14). Of all patients, 3 (87%) had metastatic involvement in the AD with an average of 1.3 (range 1– 2) nodes involved.A lymphoscintigraphic mapping concordance between pre and post, was found in 13 out 15 patients (87%).ConclusionsIsotopic ARM allows identification of radioactive nodes in the axilla in 91% of cases.The very good correlation between pre and postoperative mapping suggests a persistence of the normal LAD, and lets hope for a risk reduction of lymphodema after AD.A longterm follow up is needed to confirm these very promising preliminary results.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1025.

Current management of lobular in situ neoplasia

Although the term of lobular neoplasia was first proposed in 1978 and the term Lobular In situ Neoplasia (LIN) has been incorporated in the current World Health Organisation (WHO) classification to cover both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), the clinical significance and the natural history of lobular neoplasia is far from being fully understood. Furthermore problems and confusion still remain surrounding (1) the most appropriate terminology and classification for these lesions, (2) the best course of long-term management after diagnosis.This article summarizes the opinions on LCIS management of a group of Belgian experts.

The lateral and dorsal neurons of Drosophila melanogaster: new insights about their morphology and function

This chapter summarizes our present knowledge about the master clock of the fruit fly at the neuronal level. The clock is organized in distinct groups of interconnected pacemaker neurons with different functions. All of these neurons appear to communicate with one another in order to produce the species-specific activity rhythm, which is organized in morning (M) and evening (E) activity bouts. These two activity components are differentially influenced by distinct groups of pacemaker neurons reminiscent of the Pittendrigh-Daan dual oscillator model. In the original work (Grima et al. 2004; Stoleru et al. 2004), the ventrolateral (LN(v)) and dorsolateral (LN(d)) plus some dorsal groups (DN) of clock neurons have been defined as M and E cells, respectively. We further specify that the clock neurons belong to the M and E oscillators and define a more complex picture of the Drosophila brain clock.

High-power diode-pumped AlGaAs surface-emitting laser

We report the development and characterization of an efficient diode-pumped surface-emitting semiconductor laser operating at approximately 870 nm. By using a semiconductor Bragg reflector stack/multiple GaAs quantum well structure, mounted within a conventional laser cavity, we achieved single transverse mode laser output powers of 153 mW. Self-tuning over a 15-nm spectral range has been obtained.

[Defecation disorders. Characteristics of manometric studies and rehabilitation]

The authors review the literature and their personal experience about the systematic exploration of defecation disorders by anorectal manometry and colpocystodefecography. They stress the importance of combining functional and morphological evaluation, in order to avoid inappropriate surgery. Concerning anorectal manometry, the determination of the smallest volume of rectal distention inducing a complete relaxation of the internal anal sphincter was found more useful than the maximal tolerable volume in the exploration of defecation disorders. Finally, the authors report the results of biofeedback conditioning prescribed in 30 patients (27 women, 3 men, mean age: 55 years) with defecation disorders (terminal constipation in 21, fecal incontinence in 9 patients). Several characteristics of anorectal manometry and of defecography were significantly improved after biofeedback conditioning.