Quality of life among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy

Purpose Besides the quality of the aesthetic results, the quality of life after surgery is one of the most important criteria when reviewing different operation methods, especially in oncologic diseases. This study was performed to evaluate the difference in the health-related quality of life following breast conserving surgery and autologous breast reconstruction after mastectomy. Patients and methods Hundred and forty-four breast cancer patients were included in this study. Sixty seven patients underwent breast conserving surgery followed by radiotherapy. In 77 patients a mastectomy was performed with immediate or late reconstruction. To evaluate the health-related quality of life we used the SF-36 self-administered questionnaire. Results A significant difference was found in quality of life in the subscale “physical functioning” showing better results in the breast reconstruction group (P = 0.01). No significant difference was found in the other subscales, but there was a tendency to a better “emotional role” among the breast reconstruction patients. Conclusion Our study demonstrated that autologous tissue breast reconstruction in breast cancer patients did not affect adversely the health-related quality of life compared to breast conserving therapy when the quality of life is assessed by the standardized questionnaire SF-36. In particular, the physical function is not reported to be significantly influenced negatively by the more extensive surgical therapy. The authors declare that there are no considerations or conflict of interest patients gave informed consent for this study.     

Lymph circulation in the breast after radiotherapy and breast conservation

The aim of this study was to investigate the breast lymph circulation and skin blood circulation after radiotherapy and breast conservation. In 23 patients who had undergone lumpectomy for breast cancer (mean age 58 years, range 44-75) and 12 patients with lumpectomy for benign lesions (mean age 51 years, range 33-72), lymph circulation in the breast was measured by 99mTc-nanocolloid clearance and skin circulation by Laser Doppler Fluxmetry (LDF). Measurements were made 2-5 years after radiotherapy (50 Gy) in the former group and at a corresponding time in the latter. The lymph circulation was measured 2 cm above and medial or lateral to the areolar border in the quadrant not operated on for carcinoma. Skin circulation was measured at corresponding sites. The lymph circulation expressed as the ratio of 99mTc-nanocolloid clearance in the operated irradiated to that in the non-operated (radiation 2-4 Gy) breast was 2.33 (2.66) (median, interquartile range) (p value 0.01) and the skin circulation ratio over the corresponding area was 0.92 (0.21). Corresponding ratios in the non-radiotherapy group were 2.07 (1.96) (p value 0.03) and 1.04 (0.18) respectively. Compared with the control breast (i.e., the non-operated non-irradiated breast), there was a 4-fold increase in lymph flow in the operated, irradiated breast, a 2.5-fold increase in the contralateral non-operated (2-4 Gy) breast and a 1.5-fold increase in the operated non-irradiated breast. Radiotherapy after breast conservation surgery leads to increased long-term changes in basal lymph circulation and smaller increases in lymph flow in the contralateral breast receiving 2-4 Gy and after surgery. If maximal lymph transport capacity is unchanged, edema may be more likely in this circumstance of reduced lymphatic transport reserve.     

Risk factor analysis for breast cellulitis complicating breast conservation therapy.

Women who undergo breast conservation therapy for early-stage breast cancer can develop breast cellulitis, a complication for which risk factors are undefined. A matched case-control investigation was conducted to identify risk factors for the development of breast cellulitis among patients who have undergone breast conservation therapy. Patients comprised 17 patients with cases of breast cellulitis diagnosed after partial mastectomies that had been performed from 1992 through 1997 and 34 control patients who were matched to case-patients by date of breast lumpectomy and by primary surgeon. Statistical analyses indicated the following factors were associated with breast cellulitis: drainage of a hematoma (P=.010); postoperative ecchymosis (P=.021); lymphedema (odds ratio [OR], 10. 154; 95% confidence interval [CI], 1.348-208.860); resected breast tissue volume (OR, 1.456; 95% CI, 1.035-2.168); and previous number of breast seroma aspirations (OR, 3.445; 95% CI, 1.036-19.771). This is the first matched case-control study to identify risk factors for the development of breast cellulitis after breast conservation therapy.     

Tuberculosis of the breast misdiagnosed as breast cancer

The authors report 15 patients with tuberculosis of the breast initially misdiagnosed as breast cancers. Criteria of differentiation of breast tuberculosis were: incidence (Tbc: cancer = 1: 245), lacking in constant site of involvement, possible concomitant involvement of other organs, eg. lung tuberculosis, youth of the patient, multi-para and history of breast feeding, in isolated cases, co-existence of tuberculosis and cancer is not impossible. The authors stress meticulous care in evaluating the history, symptoms, signs and supplementary examinations. Needle biopsy and pathology are indicated.     

数字乳腺断层摄影在乳腺良恶性结节鉴别中的价值

目的与乳腺超声检查结果对比,评估数字乳腺断层X线摄影(DBT)鉴别乳腺良、恶性结节的效能。 方法回顾性分析2019年1月至2020年6月于南昌大学第二附属医院进行乳腺结节手术的患者资料,分别计算DBT及超声诊断乳腺良恶性结节的灵敏度、特异度及准确度,采用ROC分析评价DBT及超声结果与病理结果的一致性,并对二者进行比较。 结果DBT与超声对乳腺良恶性结节诊断的灵敏度分别为88.46%、75.00%,特异度为91.43%、94.29%,准确度为91.95%、82.76%,AUC为89.0%、81.8%。DBT诊断乳腺结节的准确度、灵敏度及曲线下面积均高于超声检查,特异度略低于超声检查。 结论DBT在乳腺结节良恶性的鉴别中具有较高的诊断效能,有利于乳腺癌的筛查及诊断,其效能不亚于乳腺超声。     

Prevention of breast cancer

With the advent of screening and the increased incidence of breast cancer, concern for the prevention of breast cancer has become forefront in today's society. Determining individual risk is the key to prescribing prevention. Prevention of breast cancer is still under clinical investigation with only one drug, tamoxifen, showing benefit in high risk patients. This paper reviews the possible sites for prevention of neoplastic transformation via biomarkers in a breast cell as well as the investigational drugs and their potential use in the chemoprevention of breast cancer.     

Lump detection is enhanced in silicone breast models simulating postmenopausal breast tissue

We varied the softness and nodularity of silicone breast models to assess the effects of age-related breast tissue characteristics on lump detection. In two sets of six silicone breast models manufactured to simulate premenopausal and postmenopausal breast tissue, respectively, 82 internal medicine attending and housestaff physicians more readily detected lumps among models simulating older breast tissue. The proportion of models with one or more false-positive findings was higher among models simulating postmenopausal breast tissue. We conclude that age-related changes in breast tissue most likely contribute to the higher sensitivity of clinical breast examination in older women.     

PTEN mutation spectrum in breast cancers and breast hyperplasia

Purpose  

Phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is one of the most frequently mutated human tumor suppressor genes. The present study aims to investigate the role of PTEN mutation in breast carcinogenesis by analyzing PTEN mutation spectrum and the protein expression in breast cancers, adjacent hyperplastic lesions, benign breast lesions and normal breast tissues.     

Kaposi's sarcoma of the breast

Kaposi's sarcoma of the breast is extremely rare. We report a case of a patient with AIDS presenting with Kaposi's sarcoma localized to the breast and review another published case of a patient with AIDS and disseminated cutaneous Kaposi's sarcoma with breast involvement. Although rare, the diagnosis should be considered in patients with breast lumps.     

Aromatase and breast cancer susceptibility

Based on experimental and epidemiological evidence it is hypothesized that estrogen increases breast cancer risk by increasing mitotic activity in breast epithelial cells. Aromatase is crucial to the biosynthesis of estrogens and may therefore play a role in breast cancer development. Supporting data for an etiological role of aromatase in breast tumor biology are several-fold. First, the association between weight and postmenopausal breast cancer risk may be mediated by aromatase. Secondly, a pilot study found a higher aromatase expression in normal breast adipose tissue from breast cancer cases as opposed to healthy women. Thirdly, experimental data in animals suggest that aromatase activity predisposes mammary tissue to preneoplastic and neoplastic changes. In a multiethnic cohort study conducted in Los Angeles and on Hawaii we investigated (i) whether the plasma estrone to androstenedione (E1/A) ratio in different ethnic groups was associated with ethnic differences in breast cancer incidence, and (ii) whether genetic variation in the CYP19 gene encoding the P450 aromatase protein was associated with breast cancer risk. The age- and weight-adjusted ethnic specific E1/A ratios x 100 among women without oophorectomy were 7.92 in African-Americans, 8.22 in Japanese, 10.73 in Latinas and 9.29 in non-Latina Whites (P=0.09). The high E1/A ratio in Latina women was not associated with a high breast cancer incidence; in fact Latina women had the lowest breast cancer incidence in the cohort observed so far. We found no consistent association of an intronic (TTTA)n repeat polymorphism with breast cancer risk in different ethnic groups. This polymorphism was not associated with differences in the plasma E1/A ratio in a way that would predict its functional relevance. We describe a newly identified TTC deletion in intron 5 of the CYP19 gene that is associated with the (TTTA)n repeat polymorphism. Neither this polymorphism, nor a polymorphism at codon 264 in exon VII of the CYP19 gene, was associated with breast cancer. We did not identify any genetic variation in exon VIII in 54 African-American subjects. We identified rare genetic variants of unknown functional relevance in the promoter 1.4 of the CYP19 gene in 3 out of 24 Latina women. Further investigation into the role of aromatase in breast cancer etiology is important, given that the potential use of aromatase inhibitors as breast cancer chemopreventives depends on these results.     

Screening for breast cancer

There is very good evidence that screening for breast cancer reduces mortality in women older than 50 years and suggestive but inconsistent evidence that screening is effective in reducing long-term mortality in women younger than 50 years. The probability that an average-risk woman will be diagnosed with breast cancer in the coming 10 years is about 130 in 10,000 for a 40-year-old woman, 230 in 10,000 for a 55-year-old woman, and 280 in 10,000 for a 65-year-old woman. The chance of dying from breast cancer diagnosed in the coming 10 years is about 90 in 10,000, 123 in 10,000, and 120 in 10,000 for women age 40, 55, and 65, respectively. Mathematical models based on data from controlled trials of screening programs indicate that screening annually for 10 years with breast physical examination will decrease the probability of death from breast cancer by about 25 in 10,000 for women in the three age groups and increase life expectancy by about 20 days. Adding annual mammography will decrease the probability of death from breast cancer an additional 25 in 10,000 and increase life expectancy an additional 20 days. The actual reductions in mortality observed in controlled trials are slightly lower. If women are screened annually for 10 years with breast physical examination and mammography, the chance for a false-positive result over the 10-year period is approximately 2500 in 10,000. On the population level, if 25% of women age 40 to 75 are screened annually with both examinations, deaths from breast cancer would be decreased by about 4000 in the year 2000. Net annual costs would be approximately $1.3 billion. Recommending a screening strategy requires weighing the benefits against the risks and costs.     

Extramedullary plasmacytoma of the breast simulating breast cancer

A patient with a palpable mass in the breast suggestive of carcinoma underwent radical modified mastectomy. Surprisingly, histology of the tumor revealed an extramedullary plasmacytoma. Further diagnostic work up showed no evidence of underlying multiple myeloma. Among neoplastic lesions of the breast, although rare, malignancy of mesenchymal or lymphoproliferative origin should always be considered.     

Oestrogen-regulated 24-kDa protein — a marker for breast carcinoma in benign breast tissue

Summary A monoclonal antibody (mAb) raised to an oestrogen-induced protein (24-kDa protein) has been suggested as a marker of women at risk of developing breast cancer. Patients with benign breast biopsies who have not developed breast cancer (benign control groups) were compared to women who had malignant breast biopsies. The benign tissue components from each group were studied. Subsequently, women with benign breast biopsies who have not developed malignancy were compared to women with benign breast biopsies who later went on to develop breast cancer. The study was carried out on formalin-fixed paraffin-embedded tissue sections. Comparison between tissue from the benign control groups and from women with breast cancer demonstrated the cytoplasmic staining in apocrine metaplasia of benign controls to be more pronounced. No staining differences were apparent between benign biopsies of patients who have not developed breast cancer and benign biopsies of those who have. We conclude that diminished expression in apocrine metaplasia of mAb to 24-kDa protein may indicate the presence of breast cancer but we have been unable to establish the role of 24-kDa protein as a marker for cancer risk.This work was supported by the Welcome Foundation Trust and the Cancer Research Campaign     

Mondor's disease in the breast

Mondor's disease, superficial thrombophebitis of the breast, is an uncommon self-limiting condition. Surgical procedures and trauma were the common known causes. The objective of this study was to evaluate the incidence of Mondor's disease in different breast operations in lower risk of breast cancer area over a 6-year period and to identify its causes, clinical features, related surgical factors and associated breast cancer. Eighty-four cases of Mondor's disease were obtained from 9657 new patients in the breast clinic of Kaohsiung Medical University Hospital between January 1991 and December 1996. The incidence per year was close (0.84%-0.96%) although the number has been increasing each year. In 23 cases, no definite cause was diagnosed, whereas in 61 cases, the disorder was secondary because the pathogenesis could be discerned. The identified causes included forty-three cases caused by breast surgery, two cases associated with breast cancer and sixteen cases with other benign causes. Although the incidence did not differ significantly between breast surgery (0.95%) and non-surgical causes (0.79%), the highest incidence, 1.52%, occurred when excision through circumareolar incision and tunnel procedure for cosmesis (25 cases in 1634 excisions) were used, and the lowest 0.69% when excisions through direct incision (14 cases in 2004 excisions) were performed. (P < 0.05) The other incidence rates were 1.56% in breast conserving surgery which is higher than 0.37% following mastectomy. The incidence of the disease was higher (4.28%) when the distance of the breast lesion was more than 3 cm from the areolar edge, compared to 1.20% for the 2 cm group and 0.32% for the 1 cm group (P < 0.05) in tunnel procedures. The incidence of Mondor's disease during breast surgery was not significantly different in different breast quardrants. Although Mondor's disease is a benign, self-limiting condition, a high incidence developed in the excision biopsy through circumareolar incision with tunnel procedure when the distance from the breast lesion to the areolar edge was more than 3 cm. To prevent this complication, the tunnel procedure in breast biopsy should be avoided. The incidence of Mondor's disease associated with breast cancer was low (2.4%) in the lower-incidence breast cancer area from this series, but awareness of the condition is recommended.     

The usefulness of monthly breast self-examination for the early detection of breast cancer

At present, the influence of BSE on mortality reduction from breast cancer is not yet clear. Within a larger case-control study in 195 cases and 390 controls, BSE practice, factors influencing BSE-frequency and the impact of BSE on tumor size as well as on the number of positive lymph-nodes have been investigated. 44% of women practised BSE monthly. Factors significantly positively correlated with BSE were older age, higher education, prior breast biopsy, participation in cervical cancer screening and regular physical breast examination. In comparison to non-users, BSE users had a relative risk for breast cancer more than 3 cm in tumor size of 0.65 (0.35-1.21). The relative risk of BSE-users for breast cancer with more than 3 positive lymph-nodes at the time of diagnosis amounted to 0.62 (0.33-1.18).     

Two sisters with breast tuberculosis

Breast tuberculosis is a rare form of extrapulmonary tuberculosis. Two sisters diagnosed with mammary tuberculosis and having a family history concerning pulmonary tuberculosis in other siblings were presented in this study; and thereby breast tuberculosis was discussed by evaluating similar cases of breast tuberculosis published in our country. The ultrasonography examinations of the cases (26/F, 27/F) with history of mass, enlargement, pain and discharge complaints were reported as being consistent with fibrotic mastopathy and inflammation. Patients having the diagnosis of breast tuberculosis after the excisional biopsy were undergone HRZE treatment. After the antituberculosis regimen, a complete resolution of the lesion in the breast was observed in our first case which had concurrent pulmonary tuberculosis. The lesion of our second subject who had isolated mammary tuberculosis showed marked improvement. Our cases are still being followed up without any complaints. In conclusion, breast tuberculosis should become a part of differential diagnosis of breast diseases in populations with high incidence of tuberculosis as our country.     

Adiponectin and breast cancer risk

Adiponectin, an adipocyte-secreted hormone, is closely and inversely associated with insulin resistance and was recently found to be inversely and independently associated with endometrial cancer. Because insulin resistance in the setting of obesity has also been associated with the development of breast cancer, we have hypothesized that decreased adiponectin levels might underlie the association between breast cancer and obesity/insulin resistance. We evaluated the association of adiponectin with the occurrence of breast cancer in a case-control study comprising 174 women with newly diagnosed, histologically confirmed breast cancer and 167 controls. We found an inverse, fairly strong, and statistically significant association of serum adiponectin with breast cancer (odds ratio, 0.84; 95% confidence interval, 0.71-0.99). Importantly, despite a fairly robust inverse association of adiponectin with breast cancer risk among postmenopausal women (odds ratio, 0.82; 95% confidence interval, 0.67-1.00), no such significant association between adiponectin and breast cancer was found among premenopausal women. The observed associations were independent of possible effects of major components of the IGF system, leptin, body mass index, sociodemographic variables, and known risk factors for breast cancer. Future studies are needed to prove causality and provide further insights into both the mechanisms underlying the actions of this hormone and its potential role in breast cancer.     

Tuberculosis of the breast

Tuberculosis of the breast is a rare malady. The clinician may confuse tuberculosis of the breast with either carcinoma or breast abscess. In the past 30 years at the First Teaching Hospital attached to Xi'an Medical University, only 23 patients reported herein had documented tuberculosis of the breast. Tuberculosis of the breast is a disease of younger women between 20 and 40 years of age. Mammary tuberculosis may be primary or secondary. There are three recognized modes of spread of the tubercle bacillus to the breast: hematogenous, lymphatic spread, and direct extension. There are three recognized types of mammary tuberculosis: nodular, diffuse, and sclerosing type. The diagnosis of mammary tuberculosis is difficult. The most reliable diagnostic studies include bacteriologic cultures of aspirate, histologic examination of tissue, and guinea pig inoculation. The differential diagnosis includes with carcinoma, acute or chronic mastitis with abscess. The treatment of tuberculous mastitis requires a combination of surgery and antituberculous drugs.     

Progress in breast cancer chemoprevention

Over the past years there have been significant advances in breast cancer treatment and early detection. For the first time, a decrease in cancer mortality has been observed. Recently, much progress has been made in the understanding of carcinogenesis partly due to available new technologies to detect early molecular changes in the tissue. The knowledge of breast cancer carcinogenesis has provided possible opportunities to prevent breast cancer. Currently, several clinical breast cancer prevention trials are ongoing. This paper reviews issues related to breast cancer chemoprevention including identification of high risk cohorts, endpoint biomarkers, current and new chemopreventive agents as well as models to evaluate these agents.