Technical aspects of immediate breast reconstruction with implants: five year follow-up.

We describe the technical aspects of 249 patients who had immediate breast reconstruction with implants and a follow-up of at least five years. The type of reconstruction was permanent expander prostheses (n=208), permanent prostheses (n=32), and temporary expander prostheses (n=9). The median total number of operations required to complete the reconstruction was 3 (range 1-6) with nipple-reconstruction included. Thirty-two patients developed local complications (13%) and three had systemic complications (1%). Eighteen implants were lost, so the failure rate of reconstruction was 7%. The technique of immediate breast reconstruction with implants is associated with a low overall morbidity. This, combined with earlier reported psychological advantages, no increased risk of cancer relapse, and reasonable cost, indicates the importance of immediate reconstruction with implants in the treatment of breast cancer.     

Technical aspects of immediate breast reconstruction with implants: Five year follow-up

We describe the technical aspects of 249 patients who had immediate breast reconstruction with implants and a follow-up of at least five years. The type of reconstruction was permanent expander prostheses (n=208), permanent prostheses (n=32), and temporary expander prostheses (n=9). The median total number of operations required to complete the reconstruction was 3 (range 1–6) with nipple-reconstruction included. Thirty-two patients developed local complications (13%) and three had systemic complications (1%). Eighteen implants were lost, so the failure rate of reconstruction was 7%. The technique of immediate breast reconstruction with implants is associated with a low overall morbidity. This, combined with earlier reported psychological advantages, no increased risk of cancer relapse, and reasonable cost, indicates the importance of immediate reconstruction with implants in the treatment of breast cancer.     

Bilateral breast cancer

A second primary breast cancer in the opposite breast can be either synchronous or metachronous. The majority are metachronous. A woman who has had breast cancer has a fivefold increase in risk for a second breast cancer. Additional risk factors include multifocal cancer, lobular carcinoma in situ, and an original cancer at an early age with long survival. Lobular carcinoma in situ is predominantly a marker for the subsequent development of a second primary breast cancer. The incidence of synchronous bilateral cancer is approximately 1% to 2% and that of metachronous cancer 5% to 6%. The cancer can be invasive or noninvasive. Mammography has increased the number of synchronous cancers found but not the overall incidence. The incidence of invasive cancer detected by random biopsy of the opposite breast is not high enough to justify routine adoption of this procedure. The remaining breast must be followed for the remainder of the patient's life by physical examination and annual mammography. The treatment of the secondary primary breast cancer should be that appropriate for the stage of the disease. The prognosis for the woman with a second primary breast cancer is quite favorable and is dependent on the stage of both the first and the second cancer.     

Screening for breast cancer.

Mammography is of real assistance to the surgeon in evaluating breast problems not associated with a breast mass. Use of mammography in the detection of early breast cancer in breast demonstration projects has brought forth the time honored value judgement of benefit vs risk. This report introduces an additional aspect in the consideration of benefit vs risk, the interval cancer. From the demonstration project at KUMC, 326 biopsies were performed and 65 proved to be cancer. However, 24 additional women developed cancer before their next recommended screening date. This reduces the accuracy of mammography and physical examination by trained nurses in screening for breast cancer to 73%.     

乳癌根治术后同期假体置埋隆乳术

目的　报告乳癌根治术后 ,应用硅凝胶乳房假体同期置埋隆乳。方法　对手术的方法选择及实施 ,切除物体积与假体型号的关系 ,术后注意事项等问题进行探讨。结果　随访感到手术后乳房多项外在指标均较满意。结论　该方法比应用各种自体组织隆乳大为简化 ,并免除手术分期进行带来的问题。     

Clinical options for women at high risk for breast cancer

Women at hereditary risk of breast cancer face a difficult clinical decision. Each of the options available to them has unique advantages and disadvantages that are summarized in Table 9. Many components enter a high-risk woman's decision: her objective risk of breast cancer; clinical features, such as the consistency of breast tissue and resultant ease of examination; breast density on mammography; personal characteristics, including her experience with cancer within her family; her role and [table: see text] responsibilities within her own nuclear family; her values and goals; her experiences with the medical system; and her subjective assessment of risk. It is generally believed that women significantly overestimate their risk of breast cancer. Thus, it is vital that a woman at risk have access to a genetic counselor who can provide accurate assessment of her risk. Women should be encouraged to take time to understand their risk level and the advantages and disadvantages of the options before them.     

Follow-up recommendations for benign breast biopsies

Histologically proven benign breast disease increases a woman's relative risk for subsequent cancer development. Yet follow-up guidelines for mammogram and clinical breast examination after a benign breast biopsy are lacking. Our objective was to determine if increased surveillance is indicated following a benign breast biopsy. Following institutional review board approval, a retrospective database review was conducted of prospectively gathered patients who had a benign breast biopsy (core or excisional) for an abnormality detected on mammogram, ultrasound, or clinical breast examination. Follow-up, for all subjects, was a clinical breast examination and mammogram or ultrasound at 6 months, 1 year, and 2 years after benign breast biopsy by a breast surgeon. End points were the need for additional biopsies or cancer detection. Statistical analysis was performed using chi-squared analysis. From January 2000 to July 2003, 156 patients age 18-86 years had a benign breast biopsy. During the 2 year follow-up, 20 patients (13%) required a subsequent biopsy. No significant difference was observed in mean age, race, menarche, menopause, parity, age at first live birth, use of oral contraceptives, history of prior biopsy, or the pathology of the initial lesion between those who needed a subsequent biopsy and those who did not. Seven excisional biopsies were performed (one at 6 months, four at 1 year, and two at 2 years follow-up) for growth of the benign breast biopsy lesion, and pathology remained concordant with the original diagnosis. Thirteen biopsies were done for new findings on mammogram or ultrasound. Three of these (1.9%) yielded a cancer diagnosis (one at 6 months, one at 1 year, and one at 2 years follow-up). No new lesions were identified on follow-up by clinical breast examination alone. Increased surveillance following a benign breast biopsy is necessary because of the increased need for subsequent biopsy or risk of cancer development. This should include imaging (mammography or ultrasound) and a clinical breast examination 6 months, 1 year, and 2 years after a benign breast biopsy.     

番禺区大石街农村妇女乳腺癌患病率及乳腺癌预防知信行调查分析

目的：通过对番禺区大石街农村妇女的乳腺癌患病率及乳腺癌预防知信行的调查结果,分析番禺区农村妇女乳腺癌预防的现状及存在问题,为有关机构及部门如何制定对策,预防农村妇女乳腺癌的发生发展提供参考依据。方法采用随机整群抽样法,通过乳腺检查及乳腺癌预防知信行问卷调查的方式,调查番禺区大石街1428名农村妇女乳腺癌患病率及乳腺癌预防的知信行现状,回收有效问卷1420份。结果受调查者对乳腺癌的12项危险因素平均知晓率为42.25%,乳腺癌的5项征兆的平均知晓率为41.06%;对乳腺癌预防的3项态度调查,同意及非常同意的平均占89.74%,不一定及不同意的平均占10.26%;乳腺彩超或X线检查中从未检查的13.73%,定期检查的18.31%,乳腺自检中从未自检的37.75%、定期自检的仅0.99%;乳腺癌患病率为0.14%,其他乳腺疾病以乳腺增生和乳腺囊肿为主,患病率依次为29.44%、6.55%。结论番禺区大石街农村妇女对乳腺癌预防基本知识的知晓率低,约10%对乳腺癌预防持消极态度,乳腺定期检查率低,乳腺癌及其他乳腺疾病患病率较高。社区卫生服务机构及其主管部门应针对存在问题制定对策,有效防控农村妇女乳腺癌的发生发展。     

Pathologies of the male breast

The majority of breast lesions in men are benign. Gynaecomastia is a very common condition in which hormonal changes cause male breasts to enlarge. Three radiological patterns of gynaecomastia have been described: nodular, dendritic, and diffuse glandular pattern. The main differential diagnosis is lipomastia, which is when adipose tissue deposits are found in the subcutaneous tissue. Male breast cancer is rare. The main risk factors are pathologies that cause hormonal imbalances, a history of chest irradiation, and a family history of breast cancer (particularly in families carrying a mutation of the gene BRCA2). Mammography usually shows a mass with no calcifications. Sonography is useful to investigate local disease spread, and for detecting any enlarged axillary lymph nodes. MRI is not currently indicated to investigate male breast cancer. Very often, the clinical examination alone is enough to distinguish benign lesions from malignant lesions. Imaging must not be automatically carried out, but rather it should be used when the diagnosis is clinically uncertain or when patients present risk factors for breast cancer, as well as for guiding biopsies and for assessing disease spread.     

Perceived risk and adherence to breast cancer screening guidelines among women with a familial history of breast cancer: A review of the literature

ObjectivesA small positive association has been consistently demonstrated between perceived breast cancer risk and mammography use. Evidence specific to women with familial breast cancer risk has not been previously reviewed.MethodsA literature search was conducted. 186 studies were identified for abstract/full-text review, of which 10 articles were included. Manual searching identified 10 additional articles. Twenty articles examining the association between perceived breast cancer risk and adherence to mammography, clinical breast examination (CBE) or breast self-examination (BSE) guidelines among women with familial breast cancer risk were reviewed. Studies were classified according to screening modality, categorized by finding and ordered by year of publication. Studies assessing mammography were further classified according to the applied method of measuring perceived risk.ResultsOur review found a weak positive association between higher perceived risk and adherence to mammography guidelines among women with familial breast cancer risk. Consistent associations between perceived risk and adherence to CBE and BSE guidelines were not observed.ConclusionsOur ability to understand the relationship between perceived breast cancer risk and adherence to breast screening guidelines is limited, because most previous research is cross-sectional. Future studies with prospective methodologies that use consistent measurement methods and are adequately powered are warranted.     

多模态乳腺肿瘤图像特征提取与分级诊断的研究进展

乳腺癌是女性最常见的恶性肿瘤之一。影像学检查是诊断乳腺肿瘤的重要方法,其主要包括超声、钼靶、核磁共振成像（MRI）检查等。单一医学影像技术存在诸多的局限性,使用多种影像学技术联合诊断能提高分级诊断效率。临床亟需一个高度智能的乳腺肿瘤诊断系统,有望帮助临床医生提高整体诊断效率,降低漏诊误诊率。而图像特征提取是乳腺肿瘤诊断系统研制中的第一步,也是最关键的一步。本文回顾了超声、钼靶和MRI之间联合使用对乳腺癌进行分级诊断的研究方法,就多模态乳腺肿瘤图像特征提取与分级诊断的研究进展进行综述。     

Metastatic bone disease secondary to breast cancer: an all too common cause of low back pain

Breast cancer is currently the most common form of cancer in women and will eventually affect 12 percent of the female population. Since 40% of patients with breast cancer develop musculoskeletal symptoms secondary to metastatic bone disease, the likelihood of patients presenting to chiropractic settings with this disorder is relatively high. The need for further imaging is stressed in the patient with a history of breast cancer and whose physical examination and plain film radiographs are inconclusive or suspicious. In these cases metastasis is the diagnosis until proven otherwise. To illustrate the physical examination and radiographic findings of metastatic bone disease secondary to breast cancer the case of a 46-year-old woman presenting to a chiropractic office for examination is presented. A brief discussion highlighting the incidence, prevalence, risk factors and management of the disease follows. A review of the distribution pattern of metastasis, with special emphasis on the major sites of skeletal metastasis, is presented. The need for referral for further imaging, when examination findings and radiographic results are suspicious or inconclusive, is stressed.     

Trial of early detection of breast cancer by mass screening in Miyagi Prefecture

Mass screening for breast cancer which was commenced by Miyagi Cancer Society in 1977 has been carried out on 94953 examinees. The main activities comprise itinerant screening in the communities and group screening at the workplaces. In addition to two types of mass screening, examination was also performed at the detection center. The overall breast cancer detection rate was 0.12% in mass screening. In contrast it was 3.1% at the center. Early breast cancer, however, was more frequently found in mass screening than at the center examination. The cytologic studies of nipple discharge were performed on 14314 subjects as first screening. Positive finding was seen in 5 (0.005%). In high risk group, which also underwent mammography at first screening, the detection rate was higher than that among general examinees. Method for effective procedures for detecting early breast cancer are now under study.     

Management of breast carcinoma identified intraoperatively during reduction mammaplasty

Before reduction mammaplasty, patients should be assessed for breast cancer risk and evaluated with physical examination and mammography. Patients determined to be at increased risk should be informed of the possibility of occult breast carcinoma and the potential treatment options. Intraoperative discovery of an occult carcinoma may allow for breast conservation therapy under certain circumstances if an appropriate biopsy sample is taken from the tumor and if clear margins are obtained.     

Feasibility of screening for breast cancer.

The feasibility of screening for breast cancer by clinical examination and X-ray mammography has been studied. The results suggest that a breast screening programme is safe from dangers of irradiation and can be conducted by non-medical staff. The response of women at risk suggests that the service is acceptable to the general public. The hospital service could deal with the additional surgical work.     

Nutrition and breast cancer

The major risk factors for breast cancer are hormone-related, and the only well-established diet-related risk factors for breast cancer are obesity and alcohol consumption. Obesity increases breast cancer risk in postmenopausal women by around 30%, probably by increasing serum concentrations of bioavailable oestradiol. Moderate alcohol intakes increase breast cancer risk by about 7% per alcoholic drink per day, perhaps also by increasing oestrogen levels. Populations with high fat intakes generally have high rates of breast cancer, but studies of individual women have not confirmed an association of high fat diets with breast cancer risk. Phyto-oestrogens can affect hormone metabolism, but data on phyto-oestrogen consumption and breast cancer risk are inconsistent. Nutrition might affect breast cancer risk by altering levels of growth factors such as insulin-like growth factor-I. Current dietary advice should be to avoid obesity, limit alcohol intake, and maintain a varied diet.     

Chronic haematoma as a late complication of cosmetic breast augmentation

To our knowledge, a chronic expanding haematoma has not been reported in a patient who received silicone gel breast prostheses for augmentation and never before at an interval as long as 12 years, as in our case. There have been occasional reports of chronic haematoma as complication of implantation of silicone breast prostheses after mastectomy for cancer, presenting 2.5-8 years later.     

The primary mammoplasty in patients with breast cancer

The novel technique of the primary mammoplasty for patients with the breast cancer T1 - 2N0-1M0 was worked out. The submammar skin flap preservation provides the more natural breast form and make the breast modeling technically easier for the surgeon. The method can be applied solitary or in combination with breast prostheses. Of the 23 patients, operated on, 4 had postoperative complications. The long-term follow up revealed no tumor recurrence in these patients.     

Women's acceptance of MRI in breast cancer surveillance because of a familial or genetic predisposition

Magnetic resonance imaging (MRI) of the breasts is a promising screening modality for early detection in women at increased breast cancer risk. We investigated the subjective experiences with MRI and the preferences for MRI, mammography or clinical breast examination in 178 high-risk women adhering to a breast cancer surveillance programme. MRI was reported to cause limited discomfort. About 44% preferred MRI as a screening test (mammography: 14%). MRI provided the most reassurance of breast cancer being absent in case of a favourable test result. MRI seems to be acceptable as a screening test for women at increased breast cancer risk and is preferred by them over mammography.     

Management of women at high risk for breast cancer: new imaging beyond mammography

The management of women with an increased lifetime risk of breast cancer is a difficult task. This is especially true for women with a documented mutation in a breast cancer susceptibility gene (BRCA), and also for those who tested negative for a mutation, but have a family history that is suggestive of familial breast cancer. Primary prevention by prophylactic mastectomy has been shown to reduce breast cancer incidence in these women, but this intervention is still not considered a "first-line" option in the majority of guidelines. Instead, secondary prevention (intensified surveillance) is recommended. However, due to the early onset of familial breast cancer, screening must start at a substantially younger age than in women at average risk. This, together with the fact that familial breast cancers may differ from sporadic cancers in many aspects, will have a significant impact on the design and on the success rates of surveillance protocols. This article describes the different management options that exist for women at increased genetic risk and provides a survey of the current evidence regarding mammographic and non-mammographic imaging techniques. The conclusion is that mammographic screening, with or without concomitant ultrasound and clinical breast examination, is probably not sufficient to ensure an early diagnosis of familial breast cancer. If MRI is integrated in surveillance programs, early diagnosis seems to be possible. Still, the efficacy of screening even with MRI is unclear in terms of morbidity and mortality, and this lack of evidence must be communicated to women at high genetic risk.