Breast Disease - Volume 12, issue 1

Authors: Cance, William G.

Article Type: Introduction

DOI: 10.3233/BD-2001-12101

Citation: Breast Disease, vol. 12, no. 1, pp. 1-1, 2001

Authors: Rhei, Esther | Nixon, Asa J. | Iglehart, J. Dirk

Article Type: Research Article

Abstract: Within the past decade, scientists have reported the discovery of potent genes that predispose to major cancers, including breast, ovarian, and colorectal cancer. The discovery of human cancer susceptibility genes is important for fundamental research into the cause of cancer. In addition, these discoveries will certainly have profound implications for the prevention and diagnosis of breast cancer. However, it is not yet clear whether and to what extent cancer susceptibility genes will alter the treatment of cancer. While breast cancer is an important malignant disease in women, it is hoped that knowledge gained from the management of this common disease …will provide a template for the approach to other malignancies, caused by hereditary factors. In this paper, we will review the state of knowledge about genes that predispose to breast cancer. Our focus will be to summarize the available information, addressing how genetic factors may alter the initial approach to cancer in the breast. We will concentrate on the surgical management of early breast cancer. Issues include the use of limited surgery with radiation (breast conservation), the approach to the opposite breast, and prophylactic mastectomy in patients at high risk. Show more

DOI: 10.3233/BD-2001-12102

Citation: Breast Disease, vol. 12, no. 1, pp. 3-12, 2001

Authors: Edwards, Michael J. | Mahoney, Mary C.

Article Type: Research Article

DOI: 10.3233/BD-2001-12103

Citation: Breast Disease, vol. 12, no. 1, pp. 13-21, 2001

Authors: Winchester, David J.

Article Type: Research Article

DOI: 10.3233/BD-2001-12104

Citation: Breast Disease, vol. 12, no. 1, pp. 23-33, 2001

Authors: Johnson, Anita T. | Henry-Tillman, Ronda | Klimberg, V. Suzanne

Article Type: Research Article

DOI: 10.3233/BD-2001-12105

Citation: Breast Disease, vol. 12, no. 1, pp. 35-41, 2001

Authors: Harlow, Seth P. | Krag, David N.

Article Type: Research Article

Abstract: Sentinel lymph node biopsy techniques have evolved in a short period of time to become a highly accurate method for the pathologic staging of clinically node-negative breast cancers. Multiple single and multi-institutional studies have confirmed a high accuracy of pathologic staging (95–100%) with reasonable false-negative rates (0–15%). The use of vital blue dyes, radioactive isotopes, or a combination of the two are the most commonly employed techniques used for this procedure. Currently, two large prospective randomized Phase III clinical trials supported by the National Cancer Institute are underway, which will define the effectiveness of these techniques as compared to standard axillary dissection …in regards to regional disease control and patient survival. Show more

DOI: 10.3233/BD-2001-12106

Citation: Breast Disease, vol. 12, no. 1, pp. 43-55, 2001

Authors: Ollila, David W. | Carey, Lisa A. | Sartor, Carolyn I.

Article Type: Research Article

DOI: 10.3233/BD-2001-12107

Citation: Breast Disease, vol. 12, no. 1, pp. 57-67, 2001

Authors: Kuerer, Henry M. | Singletary, S. Eva

Article Type: Research Article

Abstract: The use of neoadjuvant chemotherapy has its origins in the management of inoperable locally advanced breast cancer. Several important recent trials have demonstrated that neoadjuvant chemotherapy can increase the resectability rate of primary breast cancer, can allow more patients to successfully undergo breast conservation surgery, and does not confer a survival disadvantage compared with standard, adjuvant chemotherapy. These findings indicate that neoadjuvant chemotherapy is the preferred initial treatment for patients with locally advanced or inflammatory breast carcinoma. Neoadjuvant chemotherapy may also be appropriate in some women with earlier-stage disease. If a patient is predicted to derive little advantage from …chemotherapy in the adjuvant setting, it is equally unlikely that an advantage will be seen with neoadjuvant chemotherapy. However, if a woman desires conservative breast surgery and her primary tumor size precludes this approach, neoadjuvant chemotherapy should be offered regardless of clinical disease stage. Careful initial patient assessment and close monitoring of response to neoadjuvant chemotherapy through physical assessment and imaging studies of the primary tumor and nodal metastases are critical in planning breast conservation surgery and have been shown to minimize the risk of local-regional recurrence. The clinical and pathologic response of the primary breast tumor to neoadjuvant chemotherapy appears to be a surrogate marker for the response of occult micrometastases and therefore patient outcome. The most exciting aspect of neoadjuvant chemotherapy in the multidisciplinary management of breast cancer is that neoadjuvant chemotherapy allows for the potential rapid evaluation of promising novel cancer therapies in patients who are predicted to do poorly on the basis of their minimal response to standard cytotoxic regimens. This remains a fertile area for ongoing and future trials of neoadjuvant chemotherapy. By using neoadjuvant chemotherapy, not only can we advance the field of breast cancer research but we may also offer our individual patients an early chance for potentially curative therapy. Show more

DOI: 10.3233/BD-2001-12108

Citation: Breast Disease, vol. 12, no. 1, pp. 69-81, 2001

Authors: Schnaper, Lauren A. | Hughes, Kevin S.

Article Type: Research Article

Abstract: The growing aging population of the U.S. will lead to an absolute and proportional increase in elderly women with breast cancer. While the underlying biologic characteristics of the disease will not likely change, the health status and life expectancy of the patients will improve. Our decisions regarding therapy must take into account not just the disease we are treating, but the characteristics of the host as well.

DOI: 10.3233/BD-2001-12109

Citation: Breast Disease, vol. 12, no. 1, pp. 83-93, 2001

Authors: Smith, Barbara L.

Article Type: Research Article

Abstract: Surgical procedures performed for diagnosis and treatment of breast disease have become progressively less invasive. As an increasing proportion of breast surgery is performed on an outpatient basis, identification and management of postoperative problems have become a collaborative effort involving the surgeon, the patient, home care services and medical office staff. Although this shift to outpatient care has created a number of challenges, complication rates are no higher when breast procedures are performed on an outpatient or short-stay basis. Perioperative, short-term and long-term complications, including wound complications, injuries to adjacent structures, lymphedema, and pain syndromes are discussed.

DOI: 10.3233/BD-2001-12110

Citation: Breast Disease, vol. 12, no. 1, pp. 95-101, 2001

Authors: Brinkmann, Erika | Morrow, Monica

Article Type: Research Article

Abstract: An individual woman's level of risk for the development of invasive breast cancer can be accurately estimated using the Gail model. This model is not appropriate for use in women with prior breast cancer (invasive or in situ) or a family history suggestive of a genetic predisposition. Tamoxifen is an option for breast cancer risk reduction. The magnitude of benefit varies based on the factors that increase a woman's level of risk, but benefit has been seen in all risk subgroups that have been studied. The risks associated with tamoxifen for prevention vary with menopausal status. In premenopausal women, there …are no life threatening toxicities, and quality-of-life issues predominate. In postmenopausal women, the increased risk of endometrial cancer and venous thrombosis mandate a careful assessment of the presence of other risk factors for these conditions prior to considering tamoxifen for prevention. At present, prevention options for the high-risk woman include surveillance, tamoxifen for five years, participation in the STAR trial (if postmenopausal), and bilateral prophylactic mastectomy Show more

DOI: 10.3233/BD-2001-12111

Citation: Breast Disease, vol. 12, no. 1, pp. 103-112, 2001

Authors: Hultman, C. Scott | Bostwick III, John

Article Type: Research Article

DOI: 10.3233/BD-2001-12112

Citation: Breast Disease, vol. 12, no. 1, pp. 113-130, 2001

Authors: Sabel, Michael S. | Edge, Stephen B.

Article Type: Research Article

Abstract: Recent trends in the management of early breast cancer have moved toward breast conservation, without a loss in disease-free intervals or overall survival. The in situ ablation of breast tumors without the need for lumpectomy is the next logical extension of this trend. Advances in stereotactic guided localization, ultrasound and magnetic resonance imaging (MRI) technology has markedly improved our ability to visualize, biopsy and possibly treat breast tumors. With these technologies, probes for delivery of energy for ablating tumors and for monitoring the effect can be placed precisely within breast tumors. Several methods are available to destroy tumors in situ, based …on thermal destruction of tumor with either heat or cold. Cryoablation is performed using a liquid-nitrogen cooled needle. Heating techniques include delivery of the heat through probes placed in the lesion to conduct radiofrequency irradiation or laser light energy. Two techniques, focused ultrasound and focused microwave thermotherapy, are truly non-invasive in that they do not involve any skin puncture. In addition to the incentive of eliminating lumpectomy from the treatment paradigm for early stage breast cancer, and the potential cosmetic advantages, in situ ablation may also provide an immunological benefit by providing a source of antigens for the development of a systemic anti-tumor immune response. The augmentation of this response may provide an advantage to in situ ablation in terms of recurrence and survival rates. Show more

DOI: 10.3233/BD-2001-12113

Citation: Breast Disease, vol. 12, no. 1, pp. 131-140, 2001

Authors: Simmons, Rache M.

Article Type: Research Article

Abstract: Dramatic changes have taken place in the field of breast surgery within the past ten years. Much of the change in practice is due to the advent of less invasive surgical procedures and increased technology such as the evolution of sentinel node biopsies. Many surgeons choose to undergo additional postgraduate training to gain an increased proficiency in the diagnosis and surgical treatment of benign and malignant disorders of the breast.

DOI: 10.3233/BD-2001-12114

Citation: Breast Disease, vol. 12, no. 1, pp. 141-144, 2001

Authors: Kern, Kenneth A.

Article Type: Research Article

Abstract: The delayed diagnosis of breast cancer is a leading source of error in clinical practice, and an important cause of medical malpractice claims for surgeons and other clinicians. If clinical situations frequently leading to the delayed diagnosis of breast cancer could be predicted, misdiagnosis could be avoided more easily. Therefore, a policy of risk prevention should focus on understanding which group of patients fall into a high-risk profile for diagnostic errors, and why physicians commonly commit errors when evaluating these specific patients. Drawing on multiple sources of medical malpractice information, a profile of high-risk for misdiagnosis was created and analyzed. …We have identified a “Triad of Error” for misdiagnosed breast cancer, involving (1) young patients, with (2) self-discovered breast masses, and (3) negative mammograms. The “Triad of Error” accounts for the majority of cases of misdiagnosed breast cancer. An understanding by surgeons and other clinicians of the clinical, biological, and technical basis for the “Triad of Error”, and how these factors interact to produce misdiagnoses, should lead to more rapid diagnosis of breast cancer, and fewer medical liability claims. The surgeon plays a central role in preventing the delayed diagnosis of breast cancer by interrupting this cycle of diagnostic error, through the use of tissue sampling techniques that rapidly establish a definitive diagnosis of breast abnormalities. Show more

DOI: 10.3233/BD-2001-12115

Citation: Breast Disease, vol. 12, no. 1, pp. 145-158, 2001