The Breast : official journal of the European Society of Mastology
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The purpose of the study was to assess the role of preoperative breast magnetic resonance imaging (MRI) as a complementary tool to routine imaging methods in the management of women affected by invasive breast carcinoma. Mammograms, sonograms and biopsy results of 121 breasts in 118 women affected by invasive breast carcinoma, who underwent pre-surgical breast MR, were re-examined to identify patients theoretically eligible for conservative surgery instead of radical mastectomy. Surgery effectively performed was evaluated to identify cases for which MRI determined a change in management. ⋯ In the evaluation of single breasts, MRI resulted in true-positive in 22 out of 29 breasts (75.9%), false-positive in 7 out of 29 breasts (24.1%), leading to over-treatment in women whose treatment was changed from conservative surgery to radical mastectomy. MRI sensitivity in the detection of additional foci not seen on conventional imaging was 57.4%, overall sensitivity 87.4%, sensitivity for invasive cancers 93.1%, while for ductal carcinoma in situ it was 58.8%. In conclusion, breast MRI determines a significant change in the management of patients affected by invasive breast carcinoma, particularly in patients eligible for conservative surgery after standard breast examination.
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Comparative Study
A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction.
The cosmetic and psychological outcomes of patients who underwent reconstructive surgery, conservative surgery or simple mastectomy for breast cancer between 1995 and 2002 were compared. ⋯ Good perception of cosmetic outcome is associated with good psychological adjustment. There is no cosmetic advantage of one type of reconstruction over another. Reconstruction patients have a better body image compared with other treatment groups but there are no other psychological advantages of one type of treatment over another.
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Estrogen receptor (ER) status can predict the efficacy of endocrine therapy. However, the predictive significance of the progesterone receptor (PgR) is controversial in an adjuvant setting. Records of 758 ER+ breast cancer patients who received adjuvant tamoxifen (TAM) for 3-5 years were reviewed to evaluate the predictive value of PgR for TAM treatment in ER+/PgR+ and ER+/PgR- groups. ⋯ In contrast, the ER+/PgR- group had a worse prognosis in the >or=60 stratum with regard to both DFS (P=0.0484) and OS (P=0.0009). The results suggest that PgR status might be a predictive factor of benefit to be gained from adjuvant TAM for older ER+ patients with regard to DFS and OS. This should take into account older ER+/PgR- patients who tend to be resistant to TAM.
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Aromatase inhibitors (AIs) are widely used as an adjuvant endocrine treatment in postmenopausal women with early-stage breast cancer. Clinical trials have assessed 5 years of AI therapy, either as an alternative to tamoxifen for primary adjuvant therapy of breast cancer, or after 5 years of adjuvant tamoxifen. Treatment of 2-3 years' duration after 2-3 years of tamoxifen has also been studied. ⋯ Arthralgia and arthritis have seldom been rigorously differentiated in clinical trials of AIs. Assessment of inflammatory and rheumatologic markers, as well as detailed evaluation of patient symptoms using appropriate quality-of-life instruments, may be warranted in order to understand both the symptoms and the etiology of the arthralgia syndrome. Treatment options for arthralgia (primarily non-steroidal anti-inflammatory drugs) are currently inadequate, but areas of active research include high-dose vitamin D and new-targeted therapies to inhibit bone loss.
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Nationwide breast cancer screening with mammography is well-established in many western countries. Many studies have shown its benefit in mortality reduction. However, breast cancer screening in Asia has been slow to implement, as it was perceived that the breast cancer incidence was low and the parenchyma of Asian women was difficult to assess mammographically. ⋯ Breast cancer screening has become an important and relevant health problem. However, apart from biological differences between western and Asian women, cultural and economic considerations need to be addressed. This paper looks at the various issues pertaining to the feasibility and relevance of population-based screening in the Asia/Pacific region.