Cosmetic Outcomes and Quality of Life in Thai Women Post Breast Conserving Therapy for Breast Cancer

Purpose: To evaluate the correlation between cosmetic outcome (CO), body image, and quality of life in postbreast-conserving therapy (BCT) women. Materials and Methods: This cross-sectional study concerned one-yearpost-completed BCT Thai women. The data included subjective and objective CO with a questionnaire coveringdemographic and clinical data, anti-hormonal treatment status, Eastern Cooperative Oncology Group (ECOG)performance status, Self-Reported Cosmetic Outcomes (SRCO), Self-Reported Breast Symmetry (SRBS), BodyImage Scale (BIS), and the Functional Assessment of Cancer Therapy with Breast Cancer subscale (FACT-B).Participants had breast photographs taken for the evaluation of objective cosmetic outcome (OCO) after breastcancer conservation treatment. The relationship between CO and FACT-B was tested using Spearman’s rankcorrelation Results: A total 127 participants volunteered for the study. The participant characteristics were age52(±9), Buddhist 87%, married 65%, body mass index 25.0(±4.6), breast cup size A-C 91%, college educated60%, employed 66%, ECOG 0-1 95%, tumor size less than or equal to 2 cm 55%, no lymph node metastasis98%, and taking tamoxifen 57%. Two percent of the participants regretted their decision to undergo BCT. TheSRCO was excellent in 2%, good in 68%, fair in 30%, and poor in 0%. For SRBS, rates were 17%, 58%, 24%and 1% for excellent, good, fair and poor cosmetic outcomes, respectively. The BCCT scores were excellent 24%,good 39%, fair 32%, and poor 6%. The median total QOL score of the participants was 130 (93-144). There wasno significant correlation between CO and FACT-B scores. Conclusions: The significance of CO for FACT-B inThai women with breast cancer could not be assessed in detail because of a very low level of correlation. Theresults may be due to the effects of cultural background.     

Postmenopausal Hormone Therapy is Associated with in Situ Breast Cancer Risk

Background: The relationship between postmenopausal hormone therapy (HT) and invasive breast cancerhas been extensively investigated, but that with breast carcinoma in situ (BCIS) has received relatively littleattention. The aim of our present study was to review and summarize the evidence provided by longitudinalstudies on the association between postmenopausal HT use and BCIS risk. Methods: A comprehensive literaturesearch for articles published up to May 2012 was performed. Prior to performing a meta-analysis, the studies wereevaluated for publication bias and heterogeneity. Relative risk (RR) or odds ratio (OR) values were calculatedusing 14 reports (8 case–control studies and 6 cohort studies), published between 1986 and 2012. Results: Therewas evidence of an association between ever postmenopausal estrogen use and BCIS based on a random-effectsmodel (RR = 1.25, 95% confidence interval (CI) = 1.01, 1.55). However, we found no strong evidence of anassociation between ever postmenopausal estrogen combined with progesterone use and BCIS using a randomeffectsmodel (RR = 1.55, 95% CI = 0.95, 2.51). Furthermore, our analysis showed a strong association between“> 5 years duration” of estrogen or estrogen combined with progesterone use and BCIS. Furthermore, currentuse of any HT is associated with increased risk of BCIS in cohort studies. Additional well-designed large studiesare now required to validate this association in different populations.     

生物靶向治疗在乳腺癌中应用的最新进展

生物靶向治疗是以乳腺癌发生发展相关的分子为靶 ,进行拮抗治疗。笔者综述了针对肿瘤血管生成、生长因子或生长因子受体、细胞凋亡、细胞内信号传导的新药物的研究现状及末来的研究思路。     

乳腺癌长期辅助性三苯氧胺治疗

对６３例激素受体阳性乳腺癌长期辅助性三苯氧胺治疗的疗效、安全性及预防乳腺第二原发癌的作用回顾性分析。可评仨者６１例。总的５年生存率、无瘤生存率分别为６５．６％和５４．５％。小于５０岁、５０岁及以上，绝经前、后，腋淋巴结阳性及阴性者５年生存率分别为５５．７％、７７．８％，５０．３％、７９．１％，６３．６％和８０．０％（各组Ｐ＜０．０５）。１例子宫内膜呈不典型性增生，１例发生对侧乳腺第二原发癌（１．６％）。表明长期辅助性三苯氧胺治疗能提高５年生存率，安全可靠，可预防乳腺第二原发癌，但应警惕子宫内膜癌发生。     

乳腺癌内分泌治疗的共识与争议

三苯氧胺已经被推荐作为所有激素受体阳性乳腺癌患者术后辅助内分泌治疗的标准药物…但三苯氧胺"金标准"已经受到来自第三代芳香化酶抑制剂(阿那曲唑)和LHRH类似物(诺雷德)的挑战.在进展期乳腺癌的一线治疗中,确立了氟隆在绝经后复发转移性乳腺癌一线治疗的地位.但在内分泌治疗药物选择、应用期限以及与化疗的联合等方面仍存在众多争议.     

早期乳腺癌保乳手术56例近期疗效分析

目的探讨早期乳腺癌保乳治疗的近期疗效及美容效果。方法回顾分析56例0～Ⅱ期原发性乳腺癌施行区段、局部扩大切除并腋窝淋巴结清扫,手术后辅以综合治疗的临床资料。结果手术后随访10～48个月,平均随访21个月;患者本人对保留乳房的满意率100%,十分满意者为93%;无局部复发、远处转移和死亡病例。结论0～Ⅱ期乳腺癌实施保乳治疗,近期疗效、美容效果满意,远期效果有待长期随访观察。     

自杀基因治疗乳腺癌的研究进展

自杀基因疗法是近年乳腺癌基因治疗研究的热点之一。这类基因所编码的酶能将无细胞毒性或低细胞毒性的前体药转化成细胞毒性代谢产物 ,经靶向性转导或靶向性转录 ,选择性地杀伤肿瘤细胞。简要介绍该疗法的机理以及基因治疗载体、靶向性治疗和联合基因治疗的新进展     

可手术乳腺癌的综合治疗

乳腺癌的综合治疗在提高乳腺癌患者的远期生存率 ,改善生活质量中的地位越来越受到重视。介绍了初治可手术乳腺癌的综合治疗策略研究的现状     

乳腺癌保乳治疗的临床研究体会

回顾乳腺癌保乳治疗的演变，结合206例实践及学习体会，从病例选择，手术要点，放疗及其它辅助治疗，前哨淋巴结活检，保乳美容评估等方面，探讨保乳综合治疗模式。     

Breast compression in mammography: How much is enough?

The amount of breast compression that is applied during mammography potentially influences image quality and the discomfort experienced. The aim of this study was to determine the relationship between applied compression force, breast thickness, reported discomfort and image quality. Participants were women attending routine breast screening by mammography at BreastScreen New South Wales Central and Eastern Sydney. During the mammographic procedure, an ‘extra’ craniocaudal (CC) film was taken at a reduced level of compression ranging from 10 to 30 Newtons. Breast thickness measurements were recorded for both the normal and the extra CC film. Details of discomfort experienced, cup size, menstrual status, existing breast pain and breast problems were also recorded. Radiologists were asked to compare the image quality of the normal and manipulated film. The results indicated that 24% of women did not experience a difference in thickness when the compression was reduced. This is an important new finding because the aim of breast compression is to reduce breast thickness. If breast thickness is not reduced when compression force is applied then discomfort is increased with no benefit in image quality. This has implications for mammographic practice when determining how much breast compression is sufficient. Radiologists found a decrease in contrast resolution within the fatty area of the breast between the normal and the extra CC film, confirming a decrease in image quality due to insufficient applied compression force.     

乳腺癌肺转移的综合治疗

目的 :分析乳腺癌肺转移综合治疗的疗效及影响生存的预后因素。方法 :65例乳腺癌肺转移患者采用化疗、放疗、内分泌和综合治疗 ,分单一方法治疗组和综合治疗组 ,疗效评价按WHO标准 ,生存率按寿命表法计算。结果 :单一方法治疗组总有效率为 4 6.9% ,综合治疗组总有效率为 72 .7% ,经统计学处理 ,P <0 .0 5 ;两组患者的中位生存期相近 ;内分泌治疗未能提高总有效率。结论 :乳腺癌肺转移综合治疗近期疗效明显优于单一方法治疗 ,但不能延长患者生存期     

乳腺癌综合治疗后随访策略探讨

[目的]探讨乳腺癌综合治疗后合理的随访间隔时间、必需的检查项目及有效的随访方式。[方法]对140例乳腺癌综合治疗后患者行每3个月1次随访,共2年,记录每次随访方式及结果。探讨年龄、职业、手术方式、病期等因素与随访率的关系。[结果]患者年龄、手术方式、内分泌治疗情况与随访率无显著相关性。教育程度、职业、临床分期与随访率有显著相关性(P<0.05)。[结论]应宣教让患者理解随访的重要性,提高随访率,并选择合理检查项目及时间间隔。     

Optimal Breast Density Characterization Using a Three-Dimensional Automated Breast Densitometry System

Dense breasts are a risk factor for breast cancer. Assessment of breast density is important and radiologist-dependent. We objectively measured mammographic density using the three-dimensional automatic mammographic density measurement device Volpara™ and examined the criteria for combined use of ultrasonography (US). Of 1227 patients who underwent primary breast cancer surgery between January 2019 and April 2021 at our hospital, 441 were included. A case series study was conducted based on patient age, diagnostic accuracy, effects of mammography (MMG) combined with US, size of invasion, and calcifications. The mean density of both breasts according to the Volpara Density Grade (VDG) was 0–3.4% in 2 patients, 3.5–7.4% in 55 patients, 7.5–15.4% in 173 patients, and ≥15.5% in 211 patients. Breast density tended to be higher in younger patients. Diagnostic accuracy of MMG tended to decrease with increasing breast density. US detection rates were not associated with VDG on MMG and were favorable at all densities. The risk of a non-detected result was high in patients without malignant suspicious calcifications. Supplementary use of US for patients without suspicious calcifications on MMG and high breast density, particularly ≥25.5%, could improve the breast cancer detection rate.     

Outcomes of Triple-Negative Versus Non-Triple-Negative Breast Cancers Managed with Breast-Conserving Therapy

Background: Triple negative breast cancer is associated with aggressive behavior and high risk of local andregional failure. Aggressive surgical intervention is considered suitable. This makes role of breast conservingtherapy (BCT) debatable in these patients. The objective of this study was to compare outcome of BCT for triplenegative versus non-triple negative breast cancer. Materials and Methods: Medical records of patients whounderwent breast conserving therapy from 1999 to 2009 at Shaukat Khanum Cancer Hospital and had completereceptor status information were extracted. Patients were divided into triple negative breast cancer (TNBC) andnon-TNBC. Patient characteristics, medical treatment modalities and adverse events were compared. Expectedfive year locoregional recurrence free, disease free and overall survival was calculated. The Cox proportionalhazard model was used to identify independent predictors of outcome. Results: A total of 194 patients with TNBCand 443 with non-TNBC were compared. Significant difference was present for age at presentation (p<0.0001),family history (p=0.005), grade (p<0.0001) and use of hormonal therapy (p<0.0001). The number of locoregionalfailures, distant failures and mortalities were not significantly different. No significant difference was present in5 year locoregional recurrence free (96% vs 92%, p=0.3), disease free (75% vs 74%, p=0.7) and overall survival(78% vs 83%, p=0.2). On multivariate analysis, tumor size, nodal involvement and hormonal treatment wereindependent predictors of negative events. Conclusions: Breast conserving therapy has comparable outcomesfor triple negative and non-triple negative breast cancers.     

Breast cancer screening

Radiographic imaging of the breast began in the early years of the twentieth century. Continuous advances in film quality, energy sources, targets, grids, and filters have all contributed to superior image resolution. Federal quality standards now regulate screening mammography, and mass screening for breast cancer has become widely accepted in the United States. Wider application of screening has resulted in a dramatic apparent increase in incidence rates of breast cancer; a large proportion of this increase is in ductal carcinoma in situ. During the past 30 years, nine prospective, randomized trials to evaluate the ability of screening mammography to reduce mortality from breast cancer have been completed. These trials show a 30% reduction in mortality for women ages 50–69 years, but the benefit to women aged 40–49 years remains uncertain. This uncertainty is largely attributable to the lack of properly designed and conducted studies to evaluate screening efficacy in younger women. Although there is no biological reason to predict poor screening performance in the younger age groups, the sensitivity of screening mammography is lower in younger women. Additional data suggest that screening intervals longer than 12 months are ineffective in women younger than 50 years. With shorter screening intervals, the cost associated with screening mammography is comparable to other life-saving measures widely applied in the population. New breast imaging techniques hold promise for superior image quality, but they remain investigational as tools for mass screening. Until primary prevention of breast cancer is a reality, mass screening remains available to reduce mortality from breast cancer.     

乳腺隐匿性病灶的诊断

目的：研究乳腺隐匿性病灶的诊断方法。方法：对8000例乳腺病患者行乳腺钼靶摄像，乳腺红外线检查及乳腺超声检查，对可疑病变进行定位病检。结果：乳腺钼靶摄像发现142例可疑病灶，经定位病检证实乳腺癌44例。结论：乳腺钼靶摄像检查及对可疑病灶定位病检是诊断早期乳腺癌的好方法。     

乳腺癌化疗和内分泌治疗是否应当联合使用

在乳腺癌治疗中，化疗和内分泌治疗是否可以联合应用一直是大家关注及争论的热点。该文分别从术后辅助治疗和复发转移后解救治疗两个方面，回顾国际大规模临床试验的结果，结合当前乳腺癌治疗的指导原则和作者的经验，认为乳腺癌化疗和内分泌治疗应当合理地序贯应用，而不是同时联合应用。     

乳腺癌分子靶向治疗现状

近年来,乳腺癌的分子靶向治疗取得了长足的发展.曲妥珠单抗联合化疗已成为Her-2阳性乳腺癌患者的标准一线治疗.全文从抗Her-2治疗药物-PI3K/AKT/mTOR通路中的抑制剂,抗血管生成治疗药物,针对BR-CA1/2突变的PARP抑制剂,细胞周期蛋白依赖性激酶4和6(CDK4/6)抑制剂几个方面就当前乳腺癌分子靶向治疗现状作一综述.     

炎性乳腺癌综合治疗的探讨

目的：探讨炎性乳腺癌的临床特点、治疗经验及预后因素？方法：对我院1987～2002年收治的48例炎性乳腺癌的临床资料进行回顾性分析,按TNM分期,Ⅲb期37例,Ⅳ期11例,无特定的组织学类型,48例患者均接受综合治疗。结果：全组平均生存期34个月,2年生存率46、9％,5年生存率34．4％,Ⅲb期生存5年者11例,Ⅲb期1年内死亡者有7例,Ⅳ期中3例1年内死亡。结论：炎性乳腺癌恶性程度高,预后极差。其乳房皮肤红斑范围、术前对化疗药物的敏感性、腋窝淋巴结转移状况和局部血管受累情况以及分期等与预后有关,主张采用新辅助化疗-手术或局部放疗-辅助化疗的综合方法进行治疗。