The breast journal
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Among women around the globe, breast cancer is both the most common cancer and the leading cause of cancer-related death. Women in economically disadvantaged countries have a lower incidence of breast cancer, but poorer survival rates for the disease relative to women in affluent countries. Evidence suggests that breast cancer mortality can be reduced if resources are applied to the problem in a systematic way. ⋯ Because advanced breast cancer has the poorest survival rate and is the most resource intensive to treat, measures to reduce the stage at diagnosis are likely to have the greatest overall benefit in terms of both survival and costs. Women should have access to diagnosis and treatment if efforts are undertaken to improve early detection of breast cancer. The panels' findings outline specific steps for prioritizing the use of limited resources to decrease the impact of breast cancer around the globe.
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Axillary nodal status is the most significant prognosticator for predicting survival and guiding adjuvant therapy in breast cancer patients. Sentinel lymph node biopsy (SLNB) represents a minimally invasive procedure with low morbidity for staging axillary nodal status. In this article we review and report our experiences in patients with early breast cancer who underwent SLNB at the Revlon/UCLA Breast Center. ⋯ Immediate postoperative complications were uncommon and delayed complications completely absent. Because of the high detection rate, accurate staging, and minimal morbidity, SLNB should be offered as a choice to women with small breast cancers and clinically negative nodes. Because positive LVI and negative ER/PR status are highly predictive of pathologically positive SLNs in small breast cancers, women whose cancers meet these criteria should be advised preoperatively about their risk of having a positive SLN and may benefit from intraoperative assessment (frozen section and/or touch preparation) of their SLNs.
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Comparative Study
Effects of screening mammography on the comparative survival rates of African American, white, and Hispanic beneficiaries of a comprehensive health care system.
This study reviewed mammographic screening related to breast carcinoma diagnosis and treatment between 1987 and 1997 at Brooke Army Medical Center, San Antonio, TX. Epidemiologic data from the Department of Defense Automated Central Tumor Registry were merged with data from patients' medical records and responses of the patients or their families to a mailed survey. The cases of 907 women grouped by race-white, African American, and Hispanic-were analyzed. ⋯ Whites were diagnosed with breast carcinoma, on average, at 57 years of age-11 years later than African Americans (average age 46 years) and 7 years later than Hispanic women (average age 50 years). As a diagnostic tool, screening mammography was used to discover breast cancer in 36% of white women, 33% of Hispanics, and 22% of African Americans. Further research is recommended to examine the use of mammography among various racial/ethnic groups.