Psychosocial impact of breast cancer surgeries in Chinese patients and their spouses

BACKGROUND AND PURPOSE: This pilot study assesses the psychosocial impact of different modalities of breast cancer surgery in Chinese patients and their husbands. METHODS: Thirty-six patients who underwent conservative breast therapy (BCT) for breast cancer were compared with 36 women who underwent total mastectomy (TM) on four aspects of psychosocial adjustment. They were matched in pairs in terms of stage of disease, age and time since surgery. Where available, their husbands were also consented for similar assessment. RESULTS: Women who underwent BCT showed a significantly better response to their body and sexual image than those who underwent TM. This difference did not translate into any significant difference in terms of emotional and symptomatic aspects, daily activities, or fear of recurrences. The husbands of patients in the TM group showed significantly more emotional and symptomatic distress and greater change in the perception of their wives' body and sexual images. CONCLUSION: This is the first of such study conducted in a Chinese population. The lack of differences in certain psychosocial aspects may indicate a generally good adjustment in the TM patients after their surgery. It may also relate to the fact that volunteers for the study were themselves representative only of the patient population who adapted well to the surgery, and those patients who were emotionally distressed tended to decline to participate. Psychosocial disruption in the patients' families is reflected in our study where patients' husbands in the TM group were significantly more disturbed. However, due to the limited number of patients studied, the findings are not yet conclusive and require further studies for confirmation.     

Psychosocial impact of newly diagnosed advanced breast cancer

The purpose of this study was to delineate the key emotional concerns of women newly diagnosed with recurrent or metastatic breast cancer. Sixty-six women diagnosed with metastatic breast cancer within the previous 6 months, receiving treatment at the Medical Oncology Departments of two metropolitan teaching hospitals, completed measures of HADS, IES, CARES-SF and Memorial Symptom Assessment Scale, and participated in a semi-structured interview. There were high levels of psychological morbidity, 56.7% of women younger than 55 years qualifying as "cases" on the HADS, compared with 34.5% of women aged over 55 years. The total HADS score was significantly correlated with the Global and Physical Subscales of the MSAS and CARES. Women younger than 55 years had significantly higher levels of intrusive and avoidant symptoms than women over 55 years. Women also reported high numbers of physical symptoms. Key themes which emerged during the interviews were: difficulties in communicating with doctors, perceived delay in diagnosis, the emotional impact, concerns about the family, feelings about why the cancer developed, other life stress and trauma, and use of non-prescribed treatments.     

Psychosocial factors in the development and progression of breast cancer

The factors responsible for the genesis of breast cancer remain unclear. Emerging, although controversial, evidence suggests that factors related to life-style, such as dietary fat or alcohol intake, or exposure to various forms of stressors, are associated with mammary tumorigenesis. The possible role of life-style factors in breast cancer is important in light of the fact that mortality to this disease is increasing in most countries and that development of curative therapies for breast cancer has not been forthcoming. Thus, determining the role of life-style factors in the onset and progression of breast cancer, particularly among individuals genetically vulnerable to breast cancer or women with breast cancer in remission, is critical to prevent this disease. We will review the three main hypotheses which have been suggested to link psychosocial factors to the etiology of cancer, emphasizing data obtained through animal models. Interpretation of the existing data suggests that the number of stressful life-events does not predict vulnerability to develop breast cancer or survival from it; a certain level of stress appears to protect from malignancies. The crucial factor affecting tumor growth is the interaction among stress, an individual's personality, and available psychosocial support, and the effect of this interaction on an individual's ability to cope with stress. In addition, other risk factors for breast cancer known to be closely associated with psychosocial factors, namely dietary fat and alcohol consumption, may interact with the effects of psychosocial factors on breast cancer.     

乳腺癌高危因素和预后的研究进展

乳腺癌的发病率逐年上升,远处转移是导致患者不良预后的主要原因。目前关于乳腺癌预后相关危险因素已成为研究的一个热点,因此准确判断乳腺癌高危因素有利于指导临床治疗、判断预后及临床疗效评价。     

radixin在乳腺癌组织中的表达及其与预后的相关性

目的:观察radixin蛋白表达与乳腺癌临床病理参数的相关性及临床意义。方法:收集散发性乳腺癌标本278例,乳腺纤维腺瘤组织46例,应用SP免疫组化法检测radixin蛋白的表达情况,并分析与乳腺癌患者临床病理参数的相关性。结果:乳腺癌中radixin蛋白表达阳性率为73.7%（205/278）,乳腺纤维腺瘤中radixin蛋白表达阳性率为32.6%（15/46）,与乳腺纤维腺瘤组织比较,radixin蛋白阳性表达率显著高于乳腺纤维腺瘤组织（P＜0.000 1）。在乳腺癌组织中,radixin蛋白表达与患者TNM分期、HER-2表达正相关,在临床分期高、HER-2表达阳性的组织中,radixin蛋白表达阳性率明显增加（P=0.023,P=0.007）。radixin蛋白表达与患者年龄、绝经状态、淋巴结转移、肿瘤大小、p53蛋白表达均未见相关性。生存分析发现,radixin蛋白表达与乳腺癌患者总体生存期无关,radixin阳性表达的乳腺癌患者,RFS时间明显缩短（P＜0.05）。结论:乳腺癌组织中radixin蛋白高表达与患者临床分期、HER-2表达和临床预后相关。     

三阴性乳腺癌的临床病理特点及预后分析研究

目的:探讨三阴性乳腺癌患者临床病理特点、生存率以及影响预后的因素。方法:回顾性分析30例三阴性乳腺癌患者的资料,分析其临床病理特点、免疫组化指标和各种治疗方式对生存率的影响。结果:全组30例患者均为女性,占同期收治乳腺癌患者的5.7%,中位年龄50岁(39-76岁)。其中,浸润性导管癌21例(70.0%),单纯癌4例(13.3%),髓样癌2例(6.7%),管状腺癌2例(6.7%),导管内癌1例(3.3%)。Ⅰ期患者5例(16.7%),Ⅱ期15例(50.0%),Ⅲ期8例(26.7%),Ⅳ期2例(6.7%)。核分级1级4例(13.3%),2级11例(36.7%),3级15例(50.0%)。伴有脉管瘤栓10例(33.3%),伴有神经浸润5例(16.7%)。中位生存时间3.8年(1.6-7.5年)。单因素分析结果显示,影响总生存的因素为肿瘤大小、淋巴结状态、临床分期、脉管瘤栓和神经浸润。多因素分析结果显示,肿瘤大小和淋巴结状态是影响预后的独立因素。3年总生存率65.7%。结论:三阴性乳腺癌发病率较低,组织学分级较高,多为浸润性导管癌,易较早出现复发和转移。影响生存率的因素为肿瘤大小、淋巴结状态、临床分期、脉管瘤栓和神经浸润,其中影响预后的独立因素是肿瘤大小和淋巴结状态。     

CD24 polymorphisms in breast cancer: impact on prognosis and risk

Overexpression of CD24 has a negative impact on breast cancer prognosis. We have recently reported that the CD24 codon 57 Val/Val genotype (rs52812045) is associated with pathologic complete response after neoadjuvant chemotherapy for primary breast cancer and correlates with intratumoral lymphocyte infiltrates. This study was performed to investigate the influence of CD24 polymorphisms on breast cancer prognosis and risk. A total of 2,514 patients and 4,858 controls recruited as part of the MARIE study, a population-based case–control study, were genotyped for two CD24 polymorphisms (rs52812045, rs3838646) using TaqMan custom genotyping assays. Associations with overall and breast cancer-specific survival were assessed using uni- and multivariable Cox regression models stratified by age at diagnosis and adjusted for prognostic factors. Conditional logistic regression analysis adjusted for major risk factors was used to estimate multivariable odds ratios for risk of putative allele carriers compared to wildtype carriers. CD24 Ala/Val was significantly associated with breast cancer prognosis [Val/Val hazard ratio (HR)_adjusted = 1.52; 95 % confidence interval (CI): 1.00–2.30, p = 0.05 and HR_adjusted = 1.83; 95 % CI: 1.10–3.05, p = 0.018 for all-cause and breast cancer-specific mortality, respectively). The association was significant only in patients with a BMI <25 and in those who received adjuvant chemotherapy. None of the CD24 alleles was associated with breast cancer risk. These results provide further evidence of the CD24 Val/Val genotype influencing outcome in primary breast cancer. Together with previous data of CD24 overexpression as a poor prognostic marker, the findings underline the biological importance of CD24 for breast cancer.     

三阴性乳腺癌的临床病理特点及预后分析研究

目的：探讨三阴性乳腺癌患者临床病理特点、生存率以及影响预后的因素。方法：回顾性分析30例三阴性乳腺癌患者的资料,分析其临床病理特点、免疫组化指标和各种治疗方式对生存率的影响。结果：全组30例患者均为女性,占同期收治乳腺癌患者的5.7%,中位年龄50岁（39-76岁）。其中,浸润性导管癌21例（70.0%）,单纯癌4例（13.3%）,髓样癌2例（6.7%）,管状腺癌2例（6.7%）,导管内癌1例（3.3%）。Ⅰ期患者5例（16.7%）,Ⅱ期15例（50.0%）,Ⅲ期8例（26.7%）,Ⅳ期2例（6.7%）。核分级1级4例（13.3%）,2级11例（36.7%）,3级15例（50.0%）。伴有脉管瘤栓10例（33.3%）,伴有神经浸润5例（16.7%）。中位生存时间3.8年（1.6-7.5年）。单因素分析结果显示,影响总生存的因素为肿瘤大小、淋巴结状态、临床分期、脉管瘤栓和神经浸润。多因素分析结果显示,肿瘤大小和淋巴结状态是影响预后的独立因素。3年总生存率65.7%。结论：三阴性乳腺癌发病率较低,组织学分级较高,多为浸润性导管癌,易较早出现复发和转移。影响生存率的因素为肿瘤大小、淋巴结状态、临床分期、脉管瘤栓和神经浸润,其中影响预后的独立因素是肿瘤大小和淋巴结状态。     

New factors of possible prognostic value in breast cancer]

Over the past 10 years, we have witnessed a variety of potential prognostic factors of breast cancer including proliferative rate, ploidy, growth factor receptors, oncogenes and cathepsin D production. Some of these variables seem to predict the prognosis of the patients but the available data are conflicting and call for carefully conducted quality-control studies to analyze intra- and interlaboratory variations. In this review, we provided a framework from which prognostic factor information can be used directly to make treatment decisions.     

Psychosocial aspects of breast cancer

In the past year, there have been timely and important reports on psychosocial aspects of breast cancer screening. Noteworthy papers have also been published on the psychologic sequelae of mastectomy compared with breast conservation, quality-of-life-adjusted survival analysis with breast cancer adjuvant therapy, and the relative importance to patients with metastatic breast cancer of quality-of-life dimensions.     

Pre-operative tumour marker levels in patients with breast cancer and their prognosis

The serum levels of carcino-embryonic antigen, tissue polypeptide antigen (TPA), breast carcinoma antigen 15-3 and mucin-like carcinoma-associated antigen were measured pre-operatively in 99 patients with breast cancer receiving no adjuvant hormonal or chemotherapy and in 64 patients with benign breast tumours. Using the 95th percentile of the marker levels in patients with benign breast tumours as the cut-off level, marker levels in patients with breast cancer were related to prognosis. In the follow-up period of 6-36 months (mean = 17.9 months), 20 out of the 99 patients developed metastases. Only 4 out of these 20 patients had elevated pre-operative levels of one or more of the markers. One out of these 4 patients was misclassified having metastatic disease at the time of the operation. On the other hand, in a total of 28 patients the pre-operative levels of one or more markers were noted to be elevated; 26 of the patients remained disease-free at the time of follow-up.     

肺癌发病的社会心理因素研究

目的　探讨与肺癌发病有关的社会心理因素 ,为进一步前瞻性研究打下基础。方法　选 118例经病理确诊 ,卡氏评分≥ 6 0分的肺癌患者为病例组 ,根据 1∶1配对原则 ,即与病例组相同性别、相同民族、相同职业、相同居住地点、年龄相差± 3岁、无身心疾患的健康人作为对照组。使用杨德森、张亚宁编制的“生活事件量表 (LES)”、肖水源编制的“社会支持评定量表”和Bond编制的“防御机制问卷 (DSQ)”分别对两组对象的生活事件、社会支持和防御机制进行问卷调查。结果　单因素分析中病例组吸烟、睡眠不足、饮酒、吃饭常伴烟酒、常吃腌制食品、生活无规律与对照组有统计学差异 (P <0 .0 5 ) ,生活事件评分、社会支持评分与对照组无统计学差异 ,但负性事件总分高于对照组 ,防御方式中不成熟因子与对照组有统计学差异 (P <0 .0 5 ) ;多因素分析中吸烟、睡眠不足进入癌症发病的 1∶1配对多元Logistic模型。结论　社会心理因素与肺癌发病有一定关系 ,防御方式中的不成熟因子为肺癌发病的社会心理因素 ,吸烟、睡眠不足、饮酒、吃饭常伴烟酒、常吃腌制食品、生活无规律为肺癌发病的危险因素。     

The impact of bilateral breast cancer on the prognosis of breast cancer: a comparative study with unilateral breast cancer

BACKGROUND: The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. We assessed the impact of synchronous and metachronous bilateral breast cancer on the prognosis compared with unilateral breast cancer. METHODS: Between January 1, 1960 and December 31, 2001, 1,214 women were treated for primary operable breast cancers. Thirteen (1.1%) had synchronous bilateral breast cancer; 33 (2.7%) had a metachronous contralateral breast cancer. We compared age at operation, menopausal status, clinical stage, tumor size and histology, lymph node status, hormone receptor status, and use of adjuvant chemotherapy or hormone therapy, and we analyzed the impact of these factors on recurrence and survival in the 46 patients with bilateral breast cancer and the 1,168 patients with unilateral breast cancer. RESULTS: The 5-and 10-year disease-free survival rates, respectively, were 65% and 65% in metachronous cases, 85.7% and 64.3% in synchronous cases, and 77.9% and 72.1% in unilateral cases. There was no significant difference in overall survival among the three groups. On multivariate analysis, metachronous bilaterality, tumor size, lymph node status and adjuvant hormone therapy were each independent risk factors for recurrence, whereas bilaterality of breast cancer did not influence overall survival. CONCLUSIONS: Our data suggest that metachronous bilateral breast cancer is associated with shorter disease-free survival than synchronous bilateral or unilateral breast cancer, although overall survival does not differ among the 3 groups. Patients with metachronous bilateral breast cancer should be followed particularly closely in order to detect recurrence early and maximize quality of life.