35岁以下女性乳腺癌临床分析

目的探讨青年女性乳腺癌的诊断和最佳治疗方法.方法回顾性分析了1985年1月至1999年10月收治的67例青年女性乳腺癌的临床资料.结果在67例患者中,62例行乳腺癌根治术、改良根治术及乳房单纯切除术,4例行肿瘤局部切除术,1例行保留乳房的乳癌根治术.术后完成正规CMF或CAF方案化疗者31例,非正规CMF或CAF方案化疗者29例.14例患者行内分泌治疗.3例患者于术后3月至2年时出现局部复发,38例患者在随访1月至8年时出现肺、骨、肝及脑转移.全组患者3年、5年生存率分别为67%、50%.结论青年女性乳腺癌的诊断主要依赖于医患双方的警惕,乳房钼靶X线摄影帮助有限,应重视并规范辅助化疗,术后放疗可明显降低局部复发.     

Nuclear DNA content in mammary carcinomas in women aged 35 or younger

Nuclear DNA content was studied in cytologic preparations obtained from 50 patients aged 35 or less with primary mammary carcinoma. As many as 90% of the tumors were aneuploid, i.e., exhibited DNA profile types III and IV. The cytologic diagnosis was confirmed by histologic examination in 46 patients. The majority of these tumors, 83%, were invasive ductal carcinomas, while medullary carcinomas constituted 13% of the surgical material. As judged from their DNA profiles, most mammary carcinomas in this age group would be tumors of high malignancy potential. This does not seem, however, to influence the prognosis of young women with breast cancer as much as would be expected, possibly because of a better-functioning immune surveillance system in this age group.     

Ovarian cancer in younger vs older women: a population-based analysis

To compare the clinico-pathologic prognostic factors and survival of younger vs older women diagnosed with epithelial ovarian cancer. Demographic, clinico-pathologic, treatment, and surgery information were obtained from patients with ovarian cancer from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001 and analysed using Kaplan-Meier estimates. Of 28 165 patients, 400 were <30 years (very young), 11 601 were 30-60 (young), and 16 164 were >60 (older) years of age. Of the very young, young, and older patients, 261 (65.3%), 4664 (40.2%), and 3643 (22.5%) had stage I-II disease, respectively (P<0.001). Across all stages, very young women had a significant survival advantage over the young and older groups with 5-year disease-specific survival estimates at 78.8% vs 58.8 and 35.3%, respectively (P<0.001). This survival difference between the age groups persists even after adjusting for race, stage, grade, and surgical treatment. Reproductive age (16-40 years) women with stage I-II epithelial ovarian cancer who received uterine-sparing procedures had similar survivals compared to those who underwent standard surgery (93.3% vs 91.5%, P=0.26). Younger women with epithelial ovarian cancer have a survival advantage compared to older patients.     

Cervical cancer mortality is increasing in Spanish women younger than 50

Spanish women seem to have low cervical cancer mortality rates and some studies suggest the trend is stationary; however, this fact remains unclear because a great number of uterine cancer cases are classified as site unspecified. The main goal in this paper is to study mortality trends due to cancer of the cervix in young Spanish women. The percentage of uterus cancer deaths recorded as site unspecified has fallen from 90% in 1965 to 25% in 1995. Mortality by cervical cancer decreases in women aged 25-49 born before 1939-1948 and increases in women born later. This result is shown in each 5-year age group and seems independent from the percentage of unspecified site uterine cancer. In conclusion, Spanish women aged under 50 are suffering an increase in cervix uteri mortality rates; this rise can be related with behavioural changes occurring from 1970-1975 on.     

Cervical cancer in the Netherlands 1989-1998: Decrease of squamous cell carcinoma in older women, increase of adenocarcinoma in younger women

Cervical cancer is a preventable disease, occurring in relatively young women. In the Netherlands, population-based cervical screening aims at women aged 30-60 years. We performed a population-based study of the incidence of invasive cervical cancer in the Netherlands to evaluate trends, with emphasis on age at time of diagnosis. Histologic diagnosis was retrieved from the Netherlands Cancer Registry for all women residing in the Netherlands with invasive cervical cancer between January 1, 1989, and December 31, 1998. In this 10-year period, the incidence rate of squamous cell carcinoma decreased significantly from 7.1/100,000 to 6.1/100,000 (p < 0.001), with the greatest decrease in women aged 60-74 (-5.5%). While the overall incidence rate of adenocarcinoma remained stable, it increased in women aged 15-29 (+15.8%) and in women aged 30-44 (+2.5%), though the number of cases was small. For squamous cell carcinoma, the incidence of stage II at diagnosis decreased most (-2.7%). There was no change in stage at diagnosis for adenocarcinoma. Most cases of cervical cancer, 60.5%, were detected between ages 30 and 60 years, i.e., the Dutch screening age interval. Cervical cancer in women below age 30 contributed 5.0% to the total incidence, with 3.0% occurring between ages 27 and 29. Thus, screening for cervical cancer in the Netherlands is associated with a decrease in the incidence of squamous cell carcinoma and adenocarcinoma incidence appears to be increasing in younger women.     

Oral contraceptives and prognosis of breast cancer in women aged 35 to 50

Among 193 breast cancer patients aged 35-50 years, there was no appreciable difference in the extent of disease at diagnosis between 53 oral contraceptive (OC) users and 140 OC non-users. There was no overall significant difference between OC users and non-users for either the disease-free interval (P = .81), metastatic period (P = .41), or survival (P = .79), either alone or when adjusted for stage or family history. The survival rate of OC users of more than 2 years was similar to the survival rate of those of shorter duration (P = .36). Patients who began the use of OC 10 years or more before diagnosis showed no statistical difference from those beginning more recently (P = .69). Recent OC users within a year of diagnosis had a survival rate similar to that of other users who stopped the pills at least 1 year prior to diagnosis (P = .14). Our data suggest no adverse effects of OC use on the prognosis of breast cancer, regardless of duration of use, latency or recency period.     

Breast cancer risk assessment in women aged 70 and older

Although the benefit of screening mammography for women over 69 has not been established, it is generally agreed that screening recommendations for older women should be individualized based on health status and breast cancer risk. However, statistical models to assess breast cancer risk have not been previously evaluated in this age group. In this study, the original Gail model and three more recent models that include mammographic breast density as a risk factor were applied to a cohort of 19,779 Vermont women aged 70 and older. Women were followed for an average of 7.1 years and 821 developed breast cancer. The predictive accuracy of each risk model was measured by its c-statistic and associations between individual risk factors and breast cancer risk were assessed by Cox regression. C-statistics were 0.54 (95% CI = 0.52–0.56) for the Gail model, 0.54 (95% CI = 0.51–0.56) for the Tice modification of the Gail model, 0.55 (95% CI = 0.53–0.58) for a model developed by Barlow and 0.55 (95% CI = 0.53–0.58) for a Vermont model. These results indicate that the models are not useful for assessing risk in women aged 70 and older. Several risk factors in the models were not significantly associated with outcome in the cohort, while others were significantly related to outcome but had smaller relative risks than estimated by the models. Age-related attenuation of the effects of some risk factors makes the prediction of breast cancer in older women particularly difficult.     

Mammography use among women aged 35 to 75 years

The aim of the study was to evaluate mammography use and indications (diagnosis or screening) among 19,253 women aged 35 to 75 attending a health screening centre. The data were collected by a self-administered questionnaire completed after by an interview with a nurse. Mammography use is frequent in women attending a health screening centre, even before the age of 50: 79.1% had undergone at least one mammography during their life and for 47.3% a screen had been performed within the last three years. Nevertheless mammography was only used by 65.2% of the women aged 50-69 years, target age group of the screening programme. A logistic regression model adjusting for multiple variables was used to examine factors associated with women who underwent a screen within the last three years. Women more likely to be screened were aged 50-69 (vs age 35-49: OR=3.1), used regular gynaecological care (OR=4.5), had a family history of breast cancer (OR=1.45), had in their district a breast cancer screening campaign (OR=1.93). The study indicated that women under 50 years of age with a family history of breast cancer and women aged 70 and over were under-screened. When a campaign for breast cancer screening was organised in the district the screening rates were higher in the target population (71,4% vs 60,1%) although only 64% of the women reported having attended. Current recommendations for breast cancer screening should be reviewed in the light of these results.     

The relationship of selected variables to breast cancer detection behaviors in women 35 and older

The purpose of this study was to identify the relationship between selected variables and the practice of breast self-examination (BSE), mammography, and professional breast examination (PBE). In addition, the relationship between the behaviors was examined using a probability sample of 322 women ages 35 and older. The women were contacted by telephone via random digit dialing, and data were collected through mailed questionnaires. Results supported a relationship between BSE and attitudinal variables of health motivation, social influence, susceptibility, barriers, confidence, and knowledge (R2 = 0.29). Additionally, the variables of knowledge, social influence, and health motivation related to compliance with mammography, and the variable of health motivation related to compliance with PBE.     

35岁以下年轻女性乳房良性肿物的隐匿切除

目的：探讨年轻女性乳房良性肿物隐匿切口切除的临床效果。方法：回顾性分析2002年3月～2006年2月我院以隐匿切口手术切除的283例35岁以下女性乳房良性肿物的临床资料。结果：283例患者乳房肿物全部采用隐匿切口切除。其中采用乳晕切口251例，乳房下皱襞切口23例，腋前皱襞切口9例。术后病理报告均为良性病变。所有病例切口全部Ⅰ期愈合，切口瘢痕不明显，隐蔽性好。结论：经隐匿切口切除年轻女性乳房良性肿物操作可行，术后疤痕隐蔽，既达到治疗目的，又具美学效果，值得推广。     

Method of detection of new contralateral primary breast cancer in younger versus older women

BACKGROUND: Surveillance for contralateral primary breast cancer after a diagnosis of unilateral breast cancer typically consists of yearly mammography and physical examinations at 3-6 month intervals. Mammography is known to be less sensitive in younger, dense breasts. It is unknown at this time how well mammography performs in young patients to detect a new contralateral primary breast cancer. PATIENTS AND METHODS: Patients with contralateral breast cancer diagnosed between 1980 and 2004 were identified from the British Columbia Cancer Agency's Breast Cancer Outcomes Unit database in Vancouver. Characteristics of the tumor at baseline and the contralateral tumor were recorded as well as the method of detection of the contralateral breast cancer. A subset of patients was identified based on the age at which they were diagnosed with their initial primary cancer: < 40 years (group A) and 55-59 years (group B). chi2 and independent-sample t tests were used for between-group comparisons. RESULTS: Older patients were significantly more likely to have their second primary tumor detected by routine follow-up mammography compared with the younger cohort (P < 0.001). Older patients were also more likely to have estrogen receptor-positive, lower grade second primary tumors, and there was a trend toward smaller tumors. Tumors detected by mammography were more likely to be lower grade, estrogen receptor positive, and smaller. CONCLUSION: Older patients were more likely to have a contralateral breast cancer detected by conventional mammography, whereas younger patients tended to have cancer detected by physical examinations or by self-diagnosis. Better imaging techniques are required to detect new contralateral primary breast cancer in younger patients.     

Assessment of treatment factors and clinical outcomes in cervical cancer in older women compared to women under 65 years old

Objective

This study aims to understand the treatment patterns and clinical outcomes of older women with cervical cancer compared to younger women.

Lung cancer in men aged 40 or younger

Twenty-nine cases of lung cancer occurring in men aged 40 or less were examined at autopsy. Histologic types of cancer and metastatic patterns in this group of patients were similar to those seen in middle-aged or elderly patients except for a lower occurrence of lymphatic spread in the younger group.     

Healthcare satisfaction in older and younger patients with cancer

ObjectiveAlthough older patients represent the most rapidly growing segment of the oncology population, clinical care is guided by very little data on patient-reported outcomes, particularly satisfaction with healthcare. Using a large cancer center registry, we sought to describe factors associated with satisfaction with care for older and younger oncology patients.MethodsData were collected through the University of North Carolina Health Registry Cancer Survivorship Cohort. Satisfaction was measured with the Patient Satisfaction Questionnaire Short Form. Quality of life (QOL) measures included were the Promis Global short form and the Functional Assessment of Cancer Therapy General (FACT-G).ResultsA total of 2385 patients were included. 460 (20%) were aged 70 and above (older group). Older patients reported significantly higher levels of satisfaction in domains of time spent with doctor (scores 3.84 versus 3.73 p = 0.03) and financial aspects (scores 4.03 versus 3.44 p < 0.001) compared to younger patients. In multivariable analysis, higher QOL scores and higher self-reported ECOG performance status were associated with higher satisfaction scores. African American race was associated with lower satisfaction scores in all age groups. QOL was more closely correlated with satisfaction in older patients compared to younger patients.ConclusionsOlder patients with cancer report higher levels of satisfaction with care, in part due to lesser financial burden of care. Better QOL is associated with satisfaction with care in older patients. Use of patient-reported outcomes such as patient satisfaction may help improve patient-centered geriatric oncology care.