The Breast Journal最新文献

{"title":"Proceedings of the international consensus conference on breast cancer risk, genetics, & risk management, April, 2007.","authors":"Gordon F Schwartz, Kevin S Hughes, Henry T Lynch, Carol J Fabian, Ian S Fentiman, Mark E Robson, Susan M Domchek, Lynn C Hartmann, Roland Holland, David J Winchester, Benjamin O Anderson, Banu K Arun, Harry Bartelink, Philip Bernard, Bernardo Bonanni, Blake Cady, Krishna B Clough, Stephen A Feig, Sylvia H Heywang-Köbrunner, Anthony Howell, Claudine Isaacs, Daniel B Kopans, Robert E Mansel, Shahla Masood, Juan P Palazzo, Peter I Pressman, Lawrence J Solin, Michael Untch","doi":"10.1111/j.1524-4741.2008.00665.x","DOIUrl":"https://doi.org/10.1111/j.1524-4741.2008.00665.x","url":null,"abstract":"Abstract:  A consensus conference including thirty experts was held in April, 2007, to discuss risk factors for breast cancer and their management. Four categories of risk were outlined, from breast cancer “average” through “very high” risk, the latter including individuals with high penetrance BRCA1/2 gene mutations. Guidelines for management of patients in each of these categories were discussed, with the major portion of the conference being devoted to individuals with BRCA1/2 mutations. Prevalence of these mutations in the general populations was estimated to be 1 in 250–500 individuals, with an increased prevalence in Ashkenazic Jews and other founder groups. Risk reduction strategies for these individuals include surveillance, with or without chemoprevention drugs, or surgical procedures to remove the organs at risk, i.e., bilateral mastectomy and/or bilateral salpingo‐oophorectomy. These risk reduction strategies were evaluated fully, and recommendations were made for the care of patients in each of the risk categories. These guidelines for patient care were approved by the entire group of experts.","PeriodicalId":501151,"journal":{"name":"The Breast Journal","volume":" ","pages":"4-16"},"PeriodicalIF":2.1,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1524-4741.2008.00665.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39989306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of breast conservation rates: reasons for mastectomy at a comprehensive cancer center.","authors":"M Catherine Lee,&nbsp;Kendra Rogers,&nbsp;Kent Griffith,&nbsp;Kathleen A Diehl,&nbsp;Tara M Breslin,&nbsp;Vincent M Cimmino,&nbsp;Alfred E Chang,&nbsp;Lisa A Newman,&nbsp;Michael S Sabel","doi":"10.1111/j.1524-4741.2008.00668.x","DOIUrl":"https://doi.org/10.1111/j.1524-4741.2008.00668.x","url":null,"abstract":"<p><p>Bias in referral patterns and variations in multi-disciplinary management may impact breast conservation therapy (BCT) rates between hospitals. Retrospective studies of BCT rates are limited by their inability to differentiate indicated mastectomies versus those chosen by the patient. Our prospective breast cancer data base was queried for patients with invasive breast cancer who underwent surgical therapy at the University of Michigan over a 3-year period. Demographics, stage and histology were recorded along with the reason mastectomy was performed, categorized as \"by need\" (contraindication to BCT) or \"by choice.\" Multivariate analysis was used to identify factors significantly associated with mastectomy by choice. BCT was associated with tumor size, histology and nodal status, but not older age, either by choice or by need. Of the 34% of patients initially felt to be poor candidates for BCT, it was absolutely contraindicated in 44%, while 56% were thought to have a tumor-to-breast size ratio too large for successful BCT. Of this latter group, 80% underwent neo-adjuvant chemotherapy in an attempt to downstage the primary tumor and perform BCT, which was successful in over half the patients. For the patients initially thought to be good candidates for BCT, only 15% chose to undergo mastectomy, while 5% eventually required mastectomy due to failed attempts to achieve negative margins. Overall, the BCT rate was 63%, however without the use of neo-adjuvant chemotherapy, the BCT rate would have been only 53%. At a tertiary referral center, BCT rates are driven more by contraindications than patient choice, and may be heavily skewed towards mastectomy due to referral patterns. In addition to tumor factors such as stage and histology, BCT rate can be dramatically impacted by neo-adjuvant chemotherapy or genetic counseling. Examining BCT rates alone as a measure of quality, therefore, is not an appropriate standard across institutions serving diverse populations.</p>","PeriodicalId":501151,"journal":{"name":"The Breast Journal","volume":" ","pages":"34-40"},"PeriodicalIF":2.1,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1524-4741.2008.00668.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39989309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the suggested guidelines for breast cancer risk, genetics, and risk assessment: the critical need for educating practicing physicians.","authors":"Shahla Masood","doi":"10.1111/j.1524-4741.2008.00684.x","DOIUrl":"https://doi.org/10.1111/j.1524-4741.2008.00684.x","url":null,"abstract":"","PeriodicalId":501151,"journal":{"name":"The Breast Journal","volume":" ","pages":"1-3"},"PeriodicalIF":2.1,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1524-4741.2008.00684.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39989305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National surgical patterns of care for primary surgery and axillary staging of phyllodes tumors.","authors":"Norleena Poynter Gullett,&nbsp;Monica Rizzo,&nbsp;Peter A S Johnstone","doi":"10.1111/j.1524-4741.2008.00669.x","DOIUrl":"https://doi.org/10.1111/j.1524-4741.2008.00669.x","url":null,"abstract":"<p><p>Phyllodes tumors (PT) are rare and unique in their suspected stromal and epithelial origin, and their propensity to recur despite surgical resection. Current surgical treatment of PT does not include sampling of regional lymph nodes (LNs) as malignant PT infrequently spread to LNs. We hypothesize that, because of substantial experience with common epithelial lesions of the breast, surgeons are more prone to sample LNs in PT patients. We reviewed national surgical patterns of care of axillary LN sampling for PT using the Surveillance Epidemiology & End Results (SEER) registry. SEER data for LN evaluation are available from 1988. The public-access SEER data-base was queried for patients presenting over all 17 registries between 1988 and 2003 with PT of the breast. Data were collated by type of surgery and number of LNs examined, and further analyzed by tumor size of the primary lesion where available; 1,035 cases of PT were identified for the 16-year period. Patients had a median age of 50 (range 12-96). Of the specimens with SEER grade listed, 117 were well-differentiated, 186 moderately differentiated, 79 poorly differentiated, and 132 undifferentiated; 612 (59.1%) cases had specific surgical procedures reported: 191 partial, 251 simple, 5 subcutaneous, 154 modified radical, and 6 radical mastectomies, with 5 mastectomies (NOS) documented. The remainder of cases had surgery that was coded as \"undocumented\" or unknown. When surveyed by LNs examined, 25.5% of patients (n=264) underwent some degree of regional lymphadenectomy; the median number of LNs examined in these patients was 7 (range 1-37). Of all PT patients, 9.0% of patients underwent axillary sampling of 10 LN or more. Only nine patients (3.4%) had positive LNs. When assessing axillary sampling rate by tumor size, smaller lesions were less likely to undergo sampling than larger lesions (19.3% for lesions <2 cm, 20.5% for lesions 2-4.9 cm, 27.9% for 5-9.9 cm); although this was nonsignificant. In spite of the lack of supporting data for LN examination axillary staging continues to be performed for many cases of PT.</p>","PeriodicalId":501151,"journal":{"name":"The Breast Journal","volume":" ","pages":"41-4"},"PeriodicalIF":2.1,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1524-4741.2008.00669.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39989283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer in the elderly: retrospective study on diagnosis and treatment according to national guidelines.","authors":"Marije E Hamaker,&nbsp;W H Schreurs,&nbsp;Jeroen M Uppelschoten,&nbsp;Carolien H Smorenburg","doi":"10.1111/j.1524-4741.2008.00667.x","DOIUrl":"https://doi.org/10.1111/j.1524-4741.2008.00667.x","url":null,"abstract":"<p><p>We set out to investigate the level of accordance of diagnosis and treatment of elderly breast cancer patients with national guidelines and to study predictors of deviation. Data on patient and tumor variables were collected from charts of 166 patients aged 70 years and older, diagnosed at our hospital in 2002-2004. Diagnostic work-up and treatment were compared with guidelines and reasons for deviation were recorded; 122 (74%) patients were diagnosed and treated in accordance with guidelines. Diagnosis was incomplete in 19 patients (11%). Surgery, radiotherapy, and hormonal therapy were withheld in 19 (11%), 11 (7%), and 9 (5%) patients, respectively. Guideline deviation was motivated in 18 patients (11%) (comorbidity n=11, patients' preferences n=5, age n=2), unmotivated in 18 (11%), and undeliberate in 8 (5%). Our study demonstrates that deviation from guidelines in elderly breast cancer patients mainly occurs due to a deliberate adjustment to patient's comorbidity and preference.</p>","PeriodicalId":501151,"journal":{"name":"The Breast Journal","volume":" ","pages":"26-33"},"PeriodicalIF":2.1,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1524-4741.2008.00667.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39989307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Breast Journal regrettably is retracting a manuscript entitled, \" Dolasetron decreases postoperative nausea and vomiting after breast surgery\".","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":501151,"journal":{"name":"The Breast Journal","volume":" ","pages":"164"},"PeriodicalIF":2.1,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25759033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}