Limited M1 Disease: A Significant Prognostic Factor for Stage IV Breast Cancer

Purpose

The prognosis of patients with breast cancer presenting with distant metastasis can vary depending on disease extent. This study evaluates a definition of limited M1 disease in association with survival in a cohort of women presenting with metastatic breast cancer.

Methods

The study cohort comprised 692 women referred to the BC Cancer Agency between 1996 and 2005 with M1 breast cancer at presentation. Limited M1 disease was defined as <5 metastatic lesions confined to one anatomic subsite. Extensive M1 disease was defined as ??5 lesions or disease in more than one subsite. Clinicopathologic and treatment characteristics and overall survival (OS) were compared between subjects with limited (n?=?233) versus extensive (n?=?459) M1 disease. Multivariable analysis was performed by Cox regression modeling.

Results

Median follow-up time was 1.9?years. Five-year Kaplan-Meier OS was significantly higher in patients with limited compared to extensive M1 disease (29.7 vs. 13.1?%, p?p?Conclusions Limited M1 disease, defined as <5 metastatic lesions confined to one anatomic subsite, is a relevant favorable prognostic factor in patients with stage IV breast cancer. This definition may be used in conjunction with other clinicopathologic factors to select patients for more aggressive systemic and locoregional treatments.     

Health promotion in local government: A British experience

Historically, the development of health promotion work in Britaincentred largely upon the activities of elected local authorities.From the mid-nineteenth century onwards, these authorities wereprimarily responsible both for major interventions in the physicalenvironment, such as improved housing and sanitation, and forthe development of community-based preventive and primary careservices, such as ante-natal care, health-visiting and districtnursing. The importance attached to such work was underlinedby the statutory requirement that local authorities should appointa Medical Officer of Health who could not be dismissed withoutspecific Ministerial approval. Yet in recent decades, this long-standingtradition has been undermined, with both public health doctorsand the community health services being displaced from theirhistorical local authority base and placed instead within thethe National Health Service, where they are substantially outnumberedby their hospital-based colleagues. As a result, a major politicaland administrative focus for developing public health approacheshas largely disappeared. This loss of a health focus has become a matter of concern toa growing number of local authorities in Britain; a concernwhich reflects their public health tradition and newer policyissues and approaches which began to affect British local authoritiesfrom the late 1970s onwards. This paper considers the exampleof one such authority, the London Borough of Greenwich, wherethe author was employed during the early 1980s. In particular,it examines the political and practical problems faced whenattempting a systematic review of the authority's role and potentialfor promoting health through its policies on housing. In thelight of this experience, some tentative suggestions are madeabout the kinds of structures which will be needed if localauthorities are to revitalise their public health traditionin a political and economic climate hostile even to existinglevels of State intervention.