The Breast : official journal of the European Society of Mastology
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Axillary management has evolved from routine axillary lymph node dissection (ALND) for most patients to a selective approach based on the assessment of the sentinel node (SN). Validation of this approach for staging the axilla is based on observational studies and multiple randomized trials with near general consensus that in case of negative SN completion ALND is not required and if the SN contained metastatic disease, a completion ALND is recommended. ⋯ The presentation and publication of the American College of Surgeons Oncology Group (ACOSOG) Z0011 study has provoked controversy around the world regarding the extent to which this is a practice-changing study. The aim of this review was to critically re-appraise Z0011 results and assess available evidence which should be used to support the decision of which SN positive breast cancer patient needs an ALND.
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Breast cancer is the most commonly diagnosed cancer in women worldwide and characterized its by molecular and clinical heterogeneity. Gene expression profiling studies have classified breast cancers into five subtypes: luminal A, luminal B, HER-2 overexpressing, basal-like, and normal breast-like. Although clinical differences between subtypes have been well described in the literature, etiologic heterogeneity have not been fully studied. The aim of this study was to assess the associations between several hormonal and nonhormonal risk factors and molecular subtypes of breast cancer. ⋯ Reproductive and hormonal characteristics (breastfeeding, parity, age at first full-term birth, hormone replacement therapy) were associated with luminal subtype, compared to non-luminal breast cancer, as consistent with previous studies. Obesity and overweight increased the risk of triple negative subtype, particularly in premenopausal women. Older age and use of hormone replacement therapy were related to the risk of HER-2 overexpressing breast cancer. Our data suggest a significant heterogeneity in association of traditional breast cancer risk factors and tumor subtypes.
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The purpose of this study was to evaluate for differences in occurrence and severity ratings of sleep disturbance, fatigue, and decreased energy in women who reported breast pain prior to surgery for breast cancer. Of the 390 women who completed self-report measures for each symptom, 28.2% reported pain in their breast prior to surgery. ⋯ Findings from this study suggest that sleep disturbance, fatigue, and decreased levels of energy are significant problems for women prior to breast cancer surgery. Future studies need to evaluate for specific characteristics that place women at greater risk for these symptoms as well as the mechanisms that underlie these symptoms.