Infiltrating ductal carcinoma of the breast in South Australia. Sizes of primary lesions and histological evidence of axillary nodal metastases

There are few data available at the community level in Australia to indicate the stages of breast cancers at diagnosis, and whether there is a trend towards earlier detection. Therefore, the tumour diameters and extent of axillary nodal metastases in 434 cases of infiltrating ductal carcinoma, which were reported to the South Australian Central Cancer Registry during a three-year period, were analysed. Approximately 27% of tumours were 1.9 cm or less in diameter, about 48% were in the 2.0 cm to 3.9 cm range, and 25% had a diameter of 4.0 cm or greater. Almost half of the patients (48%) had axillary nodal metastases. The extent of nodal involvement was positively related to size of the primary lesion both in women under 50 years of age and in older women. It is intended that this information will be used in future analyses to discover trends over time in tumour size and nodal involvement at diagnosis.     

Case-survival rates for infiltrating ductal carcinomas by category of hospital at diagnosis in South Australia.

OBJECTIVE: To determine whether case-survival rates for infiltrating ductal carcinomas diagnosed in South Australia during 1980-1986 have varied by hospital of attendance at diagnosis. A null hypothesis was tested. DESIGN: All 2589 cases notified to the State Cancer Registry were included. The date of censoring for survival analyses was June 30, 1989. Multivariate analyses were undertaken adjusting for age at diagnosis, diameter of tumour, and extent of nodal involvement. RESULTS: After adjusting for differences in age, diameter and nodal status, there was not a significant difference in case outcome between large public hospitals, large private hospitals and smaller hospitals (P greater than 0.05). CONCLUSIONS: Although protocols for treatment of breast cancer are in a transitional phase and differences exist, case-survival rates have not shown a substantial variation by hospital of attendance at diagnosis.     

社会经济地位对安徽省成年女性乳腺癌筛查行为的影响

目的了解安徽省成年女性乳腺癌筛查行为现状及社会经济地位对女性乳腺癌筛查行为的影响。方法采取滚雪球抽样及方便抽样法,对安徽省1 897名18~70岁女性进行网络问卷调查。选取受教育水平、家庭年收入、职业类型综合衡量社会经济地位。采用主成分分析构建社会经济地位综合得分。结果安徽省成年女性的乳腺自我检查率、临床检查率和钼靶检查率分别为19.87%,13.65%和3.74%。安徽省成年女性的乳腺自我检查及乳腺临床检查均与受教育水平、家庭年收入、职业类型及社会经济地位综合得分呈正相关(P<0.01),而乳腺钼靶检查仅与教育水平、职业类型及社会经济地位综合得分呈正相关(P<0.05)。随社会经济地位的增高,安徽省成年女性的乳腺自我检查、临床检查及钼靶检查行为均显著增加(P<0.01)。社会经济地位中、高等女性实施乳腺自我检查的概率分别是社会经济地位低等女性的2.199、3.396倍,进行乳腺临床检查的概率分别是社会经济地位低等女性的1.994、2.921倍,进行乳腺钼靶检查的概率分别是社会经济地位低等女性的1.988、2.345倍。结论安徽省成年女性的乳腺癌筛查行为存在明显的社会经济地位差异,社会经济地位较低的女性是未来乳腺癌防控的重点人群。     

Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years.

OBJECTIVE: To evaluate the efficacy of annual mammography over and above annual physical examination of the breasts and the teaching of breast self-examination among women aged 50 to 59 on entry. DESIGN: Individually randomized controlled trial. SETTING: Fifteen urban centres in Canada with expertise in the diagnosis and treatment of breast cancer. PARTICIPANTS: Women with no history of breast cancer and no mammography in the previous 12 months were randomly assigned to undergo either annual mammography and physical examination (MP group) or annual physical examination only (PO group). The 39,405 women enrolled from January 1980 through March 1985 were followed for a mean of 8.3 years. DATA COLLECTION: Derived from the participants by initial and annual self-administered questionnaires, from the screening examinations, from the patients' physicians, from the provincial cancer registries and by record linkage to the Canadian National Mortality Data Base. Expert panels evaluated histologic and death data. MAIN OUTCOME MEASURES: Rates of referral from screening, rates of detection of breast cancer from screening and from community care, nodal status, tumour size and rates of death from all causes and from breast cancer. RESULTS: Over 85% of the women in each group attended the screening sessions after screen 1. The characteristics of the women in the two groups were similar. Compared with the Canadian population the participants were more likely to be married, have fewer children, have more education, be in a professional occupation, smoke less and have been born in North America. The rate of screen-detected breast cancer on first examination was 7.20 per 1000 in the MP group and 3.45 per 1000 in the PO group, more node-positive tumours were found in the MP group than in the PO group. At subsequent screens the detection rates were a little less than half the rates at screen 1. During years 2 through 5 the ratios of observed to expected cases of invasive breast cancer were 1.28 in the MP group and 1.18 in the PO group. Of the women with invasive breast cancer through to 7 years, 217 in the MP group and 184 in the PO group had no node involvement, 66 and 56 had one to three nodes involved, 32 and 34 had four or more nodes involved, and 55 and 46 had an unknown nodal status. There were 38 deaths from breast cancer in the MP group and 39 in the PO group. The ratio of the proportions of death from breast cancer in the MP group compared with those in the UC group was 0.97 (95% confidence interval 0.62 to 1.52). The survival rates were similar in the two groups. Women whose cancer had been detected by mammography alone had the highest survival rate. CONCLUSION: The study was internally valid, and there was no evidence of randomization bias. Screening with yearly mammography in addition to physical examination of the breasts detected considerably more node-negative, small tumours than screening with physical examination alone, but it had no impact on the rate of death from breast cancer up to 7 years' follow-up from entry.     

Determinants of case survival for cancers of the lung, colon, breast and cervix in South Australia

Survival rates for cancers of the lung, colon and female breast, and for invasive lesions of the cervix have been analysed according to age, place of residence, country of birth, socioeconomic status, and where applicable, by sex and histological type and were found to be negatively related to age. For patients with cancers of the colon and cervix, survival rates were lower in country residents than in those of metropolitan Adelaide. Low socioeconomic status was associated with a lower survival rate for patients with colonic cancers and female breast cancers; a similar trend was suggested for those with cancers of the cervix. Higher survival rates were found for patients with squamous cell carcinomas and adenocarcinomas of the lung, and mucinous tumours of the breast. Higher survival rates for patients with breast tumours were associated with small tumour size at diagnosis. In some overseas-born populations, survival rates for patients with lung cancers and cervical cancers were higher than those in the Australian-born population. This warrants further investigation.     

The prevention, detection, and management of breast cancer

The reduction in the incidence of contralateral breast cancer in women treated with adjuvant tamoxifen provided a model for prevention using endocrine agents. Oestrogen-receptor-positive cancer can be prevented with tamoxifen, but side effects limit its clinical utility, and the risk-benefit ratio is not sufficiently high to routinely recommend tamoxifen as a preventive agent. Agents being evaluated in prevention trials include raloxifene and the aromatase inhibitors; these are expected to be at least as effective as tamoxifen and to have fewer side effects. Core needle biopsy (providing histological information) and high-resolution breast ultrasound enhance preoperative assessment of breast cancer. Mammography remains the only screening test shown to reduce breast cancer deaths in randomised trials. Magnetic resonance imaging may have a role in screening women with inherited mutations of the breast cancer genes. Sentinel lymph node biopsy accurately assesses lymph node status and is associated with less morbidity than axillary dissection. Where the biopsy is negative (no histologic evidence of metastases), no further axillary treatment is necessary. Breast reconstruction after mastectomy can produce good cosmetic results, especially where autologous tissue is used. Myocutaneous flaps using latissimus dorsi or transverse rectus abdominus muscles are increasingly popular. Adjuvant trastuzumab therapy in patients whose tumours overexpress HER2 (growth factor receptor) can reduce recurrence rates and improve survival. Neoadjuvant endocrine therapy (as an initial treatment before surgery) is an underutilised treatment in postmenopausal women with oestrogen-receptor-positive large operable or locally advanced cancers. It makes more patients suitable for surgery and offers others the choice of breast conservation.     

Sensitivity of mammography and physical examination of the breast for detecting breast cancer.

Mammography and physical examination of the breast are evaluated as screening instruments for detecting breast cancer based on local biopsy data obtained from women enrolled in a national breast cancer screening program. One hundren thirteen cancers (15.5%) of women who underwent biopsy) were detected. The individual sensitivities of mammography and physical examination for detecting breast cancer are 62% and 24%, respectively. The sensitivity of the two methods combined is 75% (85 of 113). Thirty-seven cancers were in situ or minimally invasive (less than or equal to 1 cm in greatest dimension). Eighty-one percent (30 of 37) of these small cancers were detected by screening, and they comprised 35% (30 of 85) of all cancers detected by mammography, physical examination, or both. Improved survival is anticipated due to this high rate of discovery of small cancers.     

Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years.

OBJECTIVES: To evaluate the efficacy of the combination of annual screening with mammography, physical examination of the breasts and the teaching of breast self-examination in reducing the rate of death from breast cancer among women aged 40 to 49 years on entry. DESIGN: Individually randomized controlled trial. SETTING: Fifteen urban centres in Canada with expertise in the diagnosis and treatment of breast cancer. PARTICIPANTS: Women with no history of breast cancer and no mammography in the previous 12 months were randomly assigned to undergo either annual mammography and physical examination (MP group) or usual care after an initial physical examination (UC group). The 50,430 women enrolled from January 1980 through March 1985 were followed for a mean of 8.5 years. DATA COLLECTION: Derived from the participants by initial and annual self-administered questionnaires, from the screening examinations, from the patients' physicians, from the provincial cancer registries and by record linkage to the Canadian National Mortality Data Base. Expert panels evaluated histologic and death data. MAIN OUTCOME MEASURES: Rates of referral from screening, rates of detection of breast cancer from screening and from community care, nodal status, tumour size, and rates of death from all causes and from breast cancer. RESULTS: Over 90% of the women in each group attended the screening sessions or returned the annual questionnaires, or both, over years 2 to 5. The characteristics of the women in the two groups were similar. Compared with the Canadian population, the participants were more likely to be married, have fewer children, have more education, be in a professional occupation, smoke less and have been born in North America. The rate of screen-detected breast cancer on first examination was 3.89 per 1000 in the MP group and 2.46 per 1000 in the UC group; more node-positive tumours were found in the MP group than in the UC group. During years 2 through 5 the ratios of observed to expected cases of invasive breast cancer were 1.26 in the MP group and 1.02 in the UC group. Of the women with invasive breast cancer through to 7 years, 191 and 157 women in the MP and UC groups respectively had no node involvement, 55 and 43 had one to three nodes involved, 47 and 23 had four or more nodes involved, and 38 and 49 had an unknown nodal status. There were 38 deaths from breast cancer in the MP group and 28 in the UC group. The ratio of the proportions of death from breast cancer in the MP group compared with those in the UC group was 1.36 (95% confidence interval 0.84 to 2.21). The survival rates were similar in the two groups. The highest survival rate occurred among women whose cancer had been detected by mammography alone. CONCLUSION: The study was internally valid, and there was no evidence of randomization bias. Screening with yearly mammography and physical examination of the breasts detected considerably more node-negative, small tumours than usual care, but it had no impact on the rate of death from breast cancer up to 7 years' follow-up from entry.     

The effect of mammographic screening on invasive breast cancer in Western Australia

OBJECTIVE: To determine whether mammographic screening has affected the presentation of invasive breast cancer in Western Australia. DESIGN: Population-based reviews of the presentation of all invasive breast cancers diagnosed in Western Australia in 1989 and 1994. SETTING: Western Australia (population 1.8 million). Active recruitment of women aged 50-69 years for mammographic screening began in 1989. MAIN OUTCOME MEASURES: Size and stage of invasive breast cancers at diagnosis. RESULTS: From 1989 to 1994, the age-standardised incidence rose from 109 to 123 per 100,000 woman-years, based on 584 and 750 cases, respectively. The proportion of all invasive breast cancers detected as a result of a mammogram increased from 9.2% in 1989 to 34.5% in 1994. Among the cases where relevant information was recorded, the proportion of "impalpable" tumours increased from 7.7% in 1989 to 27.6% in 1994, and the average size of palpable tumours fell. There was an unexpected increase in the proportion of tumors that were negative on assays for oestrogen and progesterone receptors. CONCLUSIONS: A relatively simple and inexpensive clinical review has boosted confidence that the outlay of public monies required to establish and conduct screening in Australia appears likely to yield the reductions in mortality from breast cancer that would be predicted on the basis of the earlier controlled trials of mammography.     

Breast cancer by stage of disease at diagnosis, central Oklahoma

We describe factors associated with an initial diagnosis of stage IV breast cancer to identify segments of Oklahoma's population that need earlier screening. We obtained data from the Central Oklahoma chapter of Susan G. Komen for the Cure and from the Oklahoma Central Cancer Registry. All analyses were cross-sectional and ecologic. The distributions of breast cancer stage at diagnosis for ten central Oklahoma counties were analyzed with respect to age group, race/ethnicity, insurance status, family income, and the percent of women who reported [not] receiving a mammogram in the previous twelve months. The percentage of African American women diagnosed with stage IV disease (7.8%) was nearly double that in white (4.2%) and other races (4.1%; p < 0.01). After controlling for confounding variables, the proportion of women diagnosed with breast cancer at stage IV was still higher among African American than among white females (p < 0.01) and females aged 65+ years (p = 0.02). The availability of breast cancer screening services should be increased among African American women in central Oklahoma.     

Screening Mammography Program of British Columbia: pattern of use and health care system costs

BACKGROUND: The use of mammography for screening asymptomatic women has increased dramatically in the past decade. This report describes the changes that have occurred in the use of bilateral mammography in British Columbia since the provincial breast cancer screening program began in 1988. METHODS: Using province-wide databases from both the breast cancer screening program and the provincial health insurance plan in BC, the authors determined the number and costs of bilateral mammography services for women aged 40 years or older between Apr. 1, 1986, and Mar. 31, 1997. Unilateral mammography was excluded because it is used for investigating symptomatic disease and screening abnormalities, and for follow-up of women who have undergone mastectomy for cancer. RESULTS: As the provincial breast cancer screening program expanded from 1 site in 1988 to 23 in 1997, it provided an increasing proportion of the bilateral mammographic examinations carried out each year in BC. In fiscal year 1996/97, 65% of bilateral mammographic examinations were performed through the screening program. The cost per examination within the screening program dropped as volume increased. Thirty percent more bilateral mammography examinations were done in 1996/97 than in 1991/92, but health care system expenditures for these services increased by only 4% during the same period. In calendar year 1996, 21% of new breast cancers were diagnosed as a result of a screening program visit. INTERPRETATION: Substantial increases in health care expenditures have been avoided by shifting bilateral mammography services to the provincial screening program, which has a lower cost per screening visit.     

Mammography screening: a current controversy

Breast cancer is the most commonly occurring cancer in women in the United States and the second leading cause of cancer deaths. Over the past several decades, there has been a concerted effort to detect and diagnose breast cancer in women at early stages using mammography, and a simultaneous increase in lawsuits filed against physicians for a delay in the diagnosis of the disease. Even though mammography screening has become a standard of care for middle-aged and older women, recent questions have been raised about the efficacy of breast cancer screening. After carefully reviewing the literature on this subject, I conclude that routine screening mammography in women older than 50 is an effective means of identifying early breast cancers and significantly reduces mortality.     

磁共振成像在乳腺癌中的应用

乳腺癌是女性常见的恶性肿瘤之一,病死率较高。磁共振成像(MRI)具有极好的软组织分辨率和无辐射特点,对乳腺检查具有独到的优势。MRI对乳腺癌的诊断、手术方案的制订及鉴别复发有重要作用,能监测到原位癌、多灶性癌,可用于高危人群的普查。现就乳腺癌MRI影像表现及MRI技术在乳腺癌诊断和治疗中的作用予以综述,旨在促进其推广和应用。     

Breast cancer diagnosis by screening mammography: early results of the Central Sydney Area Health Service Breast X-ray Programme

The Central Sydney Area Health Service (CSAHS) Breast X-ray Programme is a pilot mammography screening project for breast cancer detection funded by the NSW Government. Screening by two-view mammography is carried out in a mobile van and is offered free to women aged over 45 years living in the CSAHS region, the inner western suburbs of Sydney. In the first 18 months of operation from March 1988, 7193 women were screened: 99 women underwent excision biopsy and 53 cancers were diagnosed. This is an overall detection rate of seven cancers per thousand women screened. Sixty per cent of the cancers were impalpable to the examining surgeon; 19% of all cancers were shown to have axillary node metastasis at the time of diagnosis. These results compare well with those of the major European screening studies.     

The need to improve informed consent for breast cancer patients

Many of the more than 182,000 women who will be newly diagnosed with breast cancer this year will not have access to all the information they need to make the surgical and treatment choices that are most appropriate for them. Research clearly shows that lumpectomy and other breast-conserving surgeries are just as safe as mastectomy for most women with early stage disease, and yet approximately half will undergo the more disfiguring procedures. Choices about breast implants and autologous tissue reconstruction are based, at best, on a few published studies that provide limited information about the long-term safety of these procedures. Many healthy women who have strong family histories of breast cancer consider prophylactic mastectomies, and their decisions are also based on very limited information, because there are few studies showing the effectiveness of that procedure. This paper delineates how limited information and biased recommendations can undermine breast cancer patients' ability to make informed choices.     

农村妇女宫颈癌和乳腺癌筛查的实践与探讨

目的通过对农村妇女宫颈癌和乳腺癌的筛查实践,探讨宫颈癌和乳腺癌联合筛查的模式及效果。方法 2009年—2011年襄垣县妇幼保健院对该县适龄农村妇女开展宫颈癌和乳腺癌筛查。结果此次筛查共完成27 517名妇女的宫颈癌筛查,6 122名妇女的乳腺癌筛查,其中宫颈上皮内瘤变Ⅱ级(CINⅡ)及以上病变的患病率为0.49%,早诊率为91.2%。乳腺良性肿瘤33例(0.53%);乳腺癌2例(0.03%),早诊率为50。%结论宫颈癌检查有筛查基础,筛查及早诊、早治效果明显。乳腺癌筛查仍需规范,须加强技术培训,提高筛查水平。筛查体系和技术队伍建设是基层妇女保健服务的保证,对农村妇女同时进行宫颈癌、乳腺癌联合筛查优于单一项目筛查。     

Inequalities in Use of Antenatal Care and Its ServiceComponents in India

Objectives: This study was performed to evaluate the use of individual components of antenatal care (ANC) services by pregnant women across India in addition to counting of ANC visits and then analyze differences according to state, socioeconomic condition, and access to health care services.Methods: The study used a nationally representative sample of 36,850 women from the National Family Health Survey (2005–2006) of India. Outcome measurements were medication, number of ANC visits, and components of ANC, including physical examination and measurements, laboratory examination, and advice about pregnancy. Differences in these outcomes according to 29 states, socioeconomic conditions, and access to health care services were examined. Independent associations between outcome measures and social and health care factors were analyzed.Results: The percentages of women who used ANC at least once and four times or more were 81.5% (ranges by states: 38.0 –99.9%) and 46.1% (15.2–97.9%), respectively. Among those who used ANC four times or more, 86.4% (54.2–98.9%) received a blood examination, and 85.8% (70.3–96.3%) were advised to deliver in a hospital. Greater wealth (OR=3.38; 95%CI 2.58–4.42) and higher education level (OR=3.19; 95%CI 2.49–4.14) were associated with receiving a blood examination during ANC. Rural residence was negatively associated with using ANC four times or more (OR=0.64; 95%CI 0.59–0.67) and receiving a blood examination (OR=0.67; 95%CI 0.59–0.76). Those who received ANC at community health centers were less likely to receive a blood pressure examination, blood and urine examination, and advice to deliver in a hospital compared with those who received ANC at public hospitals.Conclusion: This study showed substantial inequalities in use of ANC and service components of ANC received in India across geographic areas, socioeconomic conditions, and levels of access to health care services. In addition to reducing socioeconomic inequalities, it is necessary to provide quality services to those with limited access to health care services.     

农村地区妇女“两癌筛查”项目实施中的问题与对策

宫颈癌与乳腺癌是我国妇女高发的恶性肿瘤，严重影响妇女健康。为降低宫颈癌与乳腺癌的发病率和死亡率，我国从2009年开始积极实施与推广“两癌筛查”项目，并于2016年全面铺开。本文基于对湖南省某市农村地区2016-2017年“两癌筛查”项目实施情况的实地调研，总结项目实施中的问题为：部分农村妇女缺乏“两癌”知识和社会支持，地理交通因素、筛查时间场所安排、对医疗机构的不信任影响妇女参与筛查，部分地区缺乏筛查氛围。提出采取村医参与发动、多重手段反复宣传刺激、当场告知筛查结果和及时回报后续结果、避免推荐非必要的后续服务等对策，以期为该项工作的开展发挥推动作用。     

A review on metastatic breast cancer in Iran

Metastatic breast cancer is a disease of early breast cancer that usually occurs several years after the early breast cancer. Breast cancer is the most common cancer among Iranian women. According to the new statistics in Iran 6 160 breast cancers are diagnosed in the country each year and 1 063 cases lead to death. In this paper, epidemiology, diagnosis and treatment have been investigated. In this study, case-control clinical trials and open studies with adequate data were collected. Due to the higher risk of age group 40-49 years and the advent of advanced breast cancer in Iranian women, the early diagnosis and determination of the exact size of the tumor before surgery is important in choosing a therapy plan. The decision on the therapy of invasive breast cancer depends on several factors such as cancer stage, tumor size and type, pathological and cytological status of the tumor, the patient's opinion, the presence or absence of estrogen and progesterone receptors in the cytoplasm of tumor cells and so on.     

Mammography: a surgeon''s experience.

Most reports advocating mammography have been written by radiologists rather than by clinicians who are frequently confronted by women with breast complaints. The value of mammography in managing patients with breast problems was studied by reviewing its role in 1026 breast consultations; there were 129 patients with cancer. Mammography was performed in 95 patients. The procedure hastened the diagnosis of one comedocarcinoma, and in another patient was suspicious 3 years before she presented with a locally advanced lesion. It missed six cancers. In seven patients it recognized clinically obvious cancers, though in one of these it had given negative results 10 months before the patient presented with a lesion 15 cm in diameter. It also falsely suggested the possibility of cancer in 28 women. In the other 52 patients the clinical diagnosis of a benign condition was usually fairly evident. The morbidity caused by mammography does not seem to have been widely appreciated, no doubt because of the hope that clinically unrecognized cancers would be found by it. Most breast problems can be diagnosed without mammography.