Breast conservation for early stage breast cancer

Approximately 80 percent of women with breast cancer are candidates for breast conservation, but national statistics suggest that more than half of the women treated in the United States of America continue to be treated with mastectomy. This therapeutic option is grossly underutilized in the West Indies. The results of many large scale multi-institutional clinical trials have demonstrated the equivalence of "Breast Conserving Therapy" (conservative surgery and post operative radiation) with mastectomy. The aim of the conservative approach is to eradicate disease, reduce local recurrence at the primary site with minimal complications, and without a negative impact on quality of life or survival, while achieving acceptable cosmesis. Factors influencing patient selection, recent clinical trials, optimal surgical and radiation techniques and potential morbidity associated with breast conservation therapy will be discussed. Adjuvant therapy (cytotoxic chemotherapy and/or hormone therapy), recommendations for follow up care and the management of complications and recurrence will be reviewed.(AU)

Carcinosarcoma of the breast

Two cases of carcinosarcoma of the female breast are described. Previously reported cases are tabulated. The histogenesis of the tumours is discussed ad the relative frequency of squamous epithelial differentiation and osteogenic stromal differentiation is commented on (AU)

Triple biopsy technique in cancer of the breast

Cancer of the breast should be treated by radical mastectomy only when there is reasonable expectation of cure. It is now possible to assess prognosis more logically if clinically operable patients are regarded in terms of the "triple biopsy", criteria for which operation are discussed. It is suggested that evidence of microscopic metastases to the apex of the axilla or to the internal mammary chain denotes inoperability and that in such instances radiotherapy has more to offer than radical surgery. The clinical experience with breast cancer as encountered at the University College Hospital of the West Indies for the past six years is reviewed and compared with that reported from other centres in America and Europe. Areas are indicated where local improvements are necessary. A strong plea is made for the urgent provision of better facilities and trained personnel for modern radiotherapy - surely Jamaica's most important medical need at this time (AU)