The Breast : official journal of the European Society of Mastology
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The study examines the management and outcomes of women with early invasive breast cancer treated in rural and metropolitan centres over a nine-year observation period. A prospective audit of the treatment and outcomes of 2081 women with early breast cancer who underwent potentially curative surgery between 1997 and 2006 in metropolitan Canberra or in the surrounding rural region was completed. Overall, there was good agreement between published guidelines and the treatment received by the women in the study. ⋯ There were differences in both the care provided and treatment outcomes between women treated in rural centres and women treated in metropolitan centres. However, the increased non-cancer related mortality in women treated in rural centres suggests an increased medical comorbidity in this group. Initiatives supporting rural-based surgeons to adopt new procedures such as sentinel node biopsy may help to optimise rural breast cancer treatment.
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My personal journey into breast cancer advocacy resulted from a diagnosis of low grade DCIS. I joined with others throughout the world in turning adversity into advocacy to support endeavors which further public and professional education, political change and scientific research. This path took me from a mere one woman networking effort to addressing national panels of experts in Washington, D. ⋯ My family also supported my mission and the potential impact that advocacy could make on both a personal and community level. So I follow in the footsteps of other tenacious advocates and always keep in mind the singular focus of improving standards for quality breast care now and in the future. This paper describes the ever-changing face of advocacy from my viewpoint as a breast cancer survivor.
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Review
The relationship between quality and cost during the perioperative breast cancer episode of care.
The relationship between quality and cost of care for breast cancer surgery was investigated by literature review. The guidelines, policy statements, quality measures (QM) and target goals for performance described by professional organizations were also reviewed. ⋯ Other components of care, such as post-mastectomy reconstruction, demonstrate a direct relationship between quality and cost. Recognition of the variability of performance of QM's with an inverse quality and cost relationship has the potential to lower breast cancer population healthcare expenditures, if average performance for those QM can be improved.
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Hypofractionated whole breast radiation therapy following breast conserving surgery (BCS) has been used in many institutions for several decades. Four randomized trials with 5-10-year follow-up, have demonstrated equivalent local control, cosmetic and normal tissue outcomes between 50 Gy in 25 fractions and various hypofractionated RT prescriptions employing 13-16 fractions. Indirect evidence suggests that hypofractionated RT may also be safe and effective for regional nodal RT. In the face of equivalent outcomes, patient convenience and health care utilization benefits, hypofractionated RT should be the new 'standard' following BCS.
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Randomized Controlled Trial Multicenter Study
Update of the BIG 1-98 Trial: where do we stand?
There is accumulating data on the clinical benefit of aromatase inhibitors in the adjuvant treatment of early-stage breast cancer in postmenopausal women. The Breast International Group (BIG) 1-98 study is a randomized, phase 3, double-blind trial comparing four adjuvant endocrine treatments of 5 years duration in postmenopausal women with hormone-receptor-positive breast cancer: letrozole or tamoxifen monotherapy, sequential treatment with tamoxifen followed by letrozole, or vice versa. This article summarizes data presented at the 2009 St. Gallen early breast cancer conference: an update on the monotherapy arms of the BIG 1-98 study, and results from the sequential treatment arms. Implications for daily practice from BIG 1-98 and from other adjuvant trials will be discussed. ⋯ The BIG 1-98 study update with median follow up of 76 months confirms a significant reduction in the risk of breast cancer recurrence and a trend towards improved overall survival with letrozole as compared to tamoxifen, and no unexpected safety concerns with letrozole. Adjuvant endocrine treatment should preferentially be initiated with letrozole. For patients unable to continue letrozole, switching to tamoxifen appears to be an acceptable alternative.