Evaluating population-based breast cancer surgical practice in real time with a web-based synoptic operative reporting system.

BACKGROUND: A Web-based synoptic operative reporting system (WebSMR) incorporates implicit guidelines and real-time feedback of a surgeon's practice compared with provincial data. This study compares rates of total mastectomy (TM) between the overall provincial and WebSMR patients and examines decision-making factors in WebSMR patients. METHODS: Patients treated for invasive breast cancer (2007 to 2011) were identified from WebSMR and the Alberta Cancer Registry. Reports include surgery type and reasons for TM. RESULTS: Among 5,787 patients in WebSMR (2007 to 2011), TM rate decreased from 48% to 42% (P < .001). In 2011, the provincial cancer registry recorded a 56% TM rate compared to 42% in WebSMR patients. Patient preference accounted for 36% in the latter group. CONCLUSIONS: In WebSMR patients, TM rates were lower than the overall provincial rate and decreased significantly during the study period. Reasons are unclear, but guidelines and real-time feedback likely plays a role.

A 10-year (1999 ~ 2008) retrospective multi-center study of breast cancer surgical management in various geographic areas of China.

PURPOSE: To study the change of surgical treatments for breast cancer in China over the recent 10 years and the relationship between such a changes and social economical development. METHODS: The data were extracted from the 10-year database of female primary breast cancer at 7 tertiary hospitals from various geographic areas in China. The Chi-square Cochran-Armitage trend test was used to measure the difference. RESULTS: Over the 10 year period, mastectomy showed a decline trend while breast conserving surgeries increased. The modified radical mastectomy was the primarily surgical treatment. Among various types of mastectomies, modified radical mastectomy was increasing while Halsted radical mastectomy had shown a decrease trend; no significant changes were observed for the simple mastectomy. Halsted radical mastectomy and breast conserving surgery were used in a higher proportion in high economic areas than low economic areas, while the modified radical mastectomy has been underused in hospitals from high economic areas. CONCLUSIONS: Modified radical mastectomy was the overall most common choice of operation in China. Breast conserving surgery has been less popular but had been showing an increasing trend. Halsted radical mastectomy has still been in use but showing a decrease these years. Surgeries were not adherent to guidelines completely and needed further effective training.

Experiencia en el tratamiento de los sarcomas de novo: en la glándula mamaria / Experience in the treatment of the novo sarcomas: in the mammary gland

El objetivo del presente trabajo es conocer la incidencia y la experiencia en el tratamiento de los sarcomas primitivos de la glándula mamaria, en nuestro Instituto. Se analizaron retrospectivamente, las historias de las pacientes con el diagnóstico de neoplasia maligna de la mama, ingresadas al Servicio de Patología Mamaria del Instituto de Oncología Dr. Miguel Pérez Carreño entre diciembre de 1998 y diciembre de 2003, revisándose un total de 856 historias, de donde se extrajeron sólo 6 casos de sarcomas primitivos de la mama, lo que representó un total de 0,74 por ciento. El 100 por ciento de los casos se presentó en el sexo femenino, y con lesiones mayores de 5 cm de diámetro. En ninguno de los casos se presentaron adenopatías axilares clínicamente sospechosas. La edad de presentación osciló entre los 13 y los 60 años, con una media de 36 años. El estadio predominante al momento del diagnóstico fue el III-B (50 por ciento). El tratamiento en la mayoría de los casos consistió en la mastectomía simple, radioterapia y quimioterapia adyuvante. Se presentaron un total de seis sarcomas primitivos de la mama, distribuidos así: 3 angiosarcomas, 1 neurofibrosarcoma, 1 fibrohistiocitoma, 1 tumor neuroectodérmico primitivo. El tratamiento realizado se basó en la mastectomía simple sin disección axilar, y el tratamiento adyuvante con radioterapia y quimioterapia. La sobrevida global osciló entre 10 y 60 meses

Angiosarcoma de la glándula mamaria: presentación de un caso y revisión de la literatura / Angiosarcoma of the mammary gland: presentation a case and review of the literature

Los tumores no epiteliales de la mama comprenden menos del 4 por ciento de las neoplasias malignas. Los sarcomas primarios de la mama representan menos del 1 por ciento. EL angiosarcoma es la neoplasia maligna de origen estromal más frecuente de la mama, representando el 0,05 por ciento de las neoplasias malignas primarias de la mama. Presentamos el caso de una paciente de 22 años quien presentó un nódulo en mama izquierda de crecimiento rápido. Se le práctico mastectomía parcial izquierda sin biopsia intraoperatoria, en otro hospital. Un mes después biopsia definitiva reporta angiosarcoma bien diferenciado, por lo cual, es referida al Servicio de Patología Mamaria del Instituto de Oncología "Dr. Miguel Pérez Carreño". Al examen físico de ingreso se evidencia tumor de 10 cm x 7 cm de diámetro que ocupa los cuadrantes superiores y región centro mamaria de la mama izquierda, axila libre. Mamográficante se describe mama izquierda con imágenes nodulares de alta densidad, sin microcalsificaciones. Resto del examen físico sin alteraciones . Se les práctico mastectomía simple izquierda, y posteriormente recibe tratamiento adyuvante con radioterapia y quimioterapia. Este caso se trae dado lo infrecuente de esta patología

Patterns of treatment for ductal carcinoma in situ of the breast in Louisiana, 1988-1999.

Data from numerous studies show that lumpectomy (breast-conserving therapy) plus radiation therapy provides survival equivalent to that following mastectomy (either modified radical or radical mastectomy) for patients with ductal carcinoma in situ (DCIS). According to the data from the National Cancer Data Base and the Surveillance Epidemiology End Results (SEER) Program, use of lumpectomy among female DCIS patients has increased dramatically over the last decade. This study examined population-based trends in treatment for DCIS among Louisiana women and compared the trends with the SEER data. Our data revealed that the percentage of the DCIS patients who received a lumpectomy increased from 34.3% in 1988-1991 to 53.7% in 1996-1999 in Louisiana (p<0.05) while DCIS patients who received a modified radical mastectomy decreased from 51.7% to 26.1% (p<0.05). Increasing use of lumpectomy was seen across all races, age groups, rural/urban areas, and poverty-level areas. Utilization of lumpectomy was about the same for white and African-American women but varied by age group, rural/urban area, and poverty level. Female DCIS patients residing in rural areas or high poverty level areas were less likely to receive a lumpectomy than those residing in urban or affluent areas. Among the patients who had a lumpectomy, 34.4% received post-lumpectomy radiotherapy in the first study period (1988-1991) and 49.7% in the last study period (1996-1999). In Louisiana, utilization of post-lumpectomy radiotherapy decreased with advancing age. Despite the increase in use of lumpectomy, its utilization remained approximately 10% lower than in the SEER areas throughout the study period. A similar deficit was observed for post-lumpectomy radiation therapy.

Sarcoma de la mama: casuística de 14 años en el Hospital Oncológico Padre Machado / Sarcoma of the breast: 14 years review in the Hospital Oncológico Padre Machado

Conocer el número de casos de sarcomas primarios de la mama evaluados en el Hospital Oncológico "Padre Machado" durante los últimos catorce años. Revisar la literatura mundial referente a sarcomas primarios de mama. Se revisaron las historias clínicas, así como las biopsias de las pacientes con dignóstico histopatológico de sarcoma de la mama, evaluadas por el Servicio de patología Mamaria. Se revisaron las láminas de biopsias y se realizaron estudios inmunohistoquímicos. Desde 1988 hasta el año 2001 se diagnosticaron, siete pacientes con sarcoma primario de mama, con edades comprendidas entre los 23 y los 92 años. En todos los casos el tratamiento fue quirúrgico, seguido de radioterapia más quimioterapia sólo en dos casos. En dos pacientes no se pudo tener seguimiento, tres recayeron y de las cinco con seguimiento sólo una se encuentra libre de enfermedad. A todos los casos se les realizó estudios de inmunohistoquímica. Se diagnosticaron 4 fibrosarcomas, 2 angiosarcomas y un fibrohistiocitoma maligno. Los sarcomas primrios de mama son un conjunto de entidades heterogéneas de tumores que se originan del tejido masenquimático sin componente bifásico. Representan menos de 1 por ciento de los cánceres mamarios y menos del 5 por ciento de los sarcomas de tejidos blandos. El tratamiento de elección es quirúrgico con resección local amplia versus mastectomía total. El uso de radioterapia y quimioterapia adyuvante resulta de extrapolación de experiencias en sarcomas de otras áreas

Surgical treatment of early-stage breast cancer in the Department of Defense Healthcare System.

BACKGROUND: The choice between breast-conserving surgery and modified radical mastectomy in the treatment of women with early stage breast cancer in the Department of Defense Healthcare System may be influenced by demographic factors. STUDY DESIGN: The Department of Defense Automated Central Tumor Registry (ACTUR) was queried for women diagnosed with American Joint Committee on Cancer Stage I or II invasive breast carcinoma from January 1, 1986, to December 31, 1996. Univariate analysis and multivariate analysis were applied to the study variables. Year of diagnosis, age at diagnosis, tumor size, type of hospital, geographic region, and local availability of radiation therapy were evaluated with respect to the type of surgical treatment performed. Surgical treatment was either breast conservation therapy (BCT) or modified radical mastectomy. RESULTS: After excluding women for whom the data were incomplete (n = 308), 7,815 women were identified who met study criteria. There was a progressive increase in the use of BCT to treat tumors of all sizes from 16% to 47% over the 11 years of the study (p < 0.0001). BCT was more frequently used for smaller tumors (< 2cm), with an odds ratio of 2.46 (2.20-2.76, 95% CI). In 1996, 54% of women with T1 (< 2 cm) tumors were treated with BCT. Women treated with BCT were nearly the same age as those undergoing modified radical mastectomy (55.5 years versus 56.8 years, p < 0.0001). BCT was used at a slightly greater rate in medical centers than in community hospitals (31% versus 28%, p < 0.0001). Use of BCT varied among geographic regions from a low of 24% in the southwestern USA to a peak of 36% in the Northeast and 40% in hospitals outside of the continental United States (p < 0.0001). Local availability of radiation therapy did not influence choice of treatment. CONCLUSIONS: The use of BCT to treat early stage invasive breast carcinoma in the Department of Defense Healthcare System is increasing. But BCT is used less often to treat larger tumors. Regional differences in the use of BCT persist, even after controlling for other factors. Patient age and type of hospital (community versus academic center) appear to exert little influence on the choice of treatment. Local availability of radiation therapy did not seem to influence the choice of treatment. Our data suggest that efforts to promote the use of BCT should target the central and southwestern USA. Use of BCT should also be emphasized for women with larger tumors (> 2 cm).

Treating early-stage breast cancer: hospital characteristics associated with breast-conserving surgery.

Despite growing acceptance of the fact that women with early-stage breast cancer have similar outcomes with lumpectomy plus radiation as with mastectomy, many studies have revealed the uneven adoption of such breast-conserving surgery. Discharge data from the Hospital Cost and Utilization Project, representing multiple payers, locations, and hospital types, demonstrate increasing trends in breast-conserving surgery as a proportion of breast cancer surgeries from 1981 to 1987. Women with axillary node involvement were less likely to have a lumpectomy, even though consensus recommendations do not preclude this form of treatment when local metastases are present. Non-White race, urban hospital location, and hospital teaching were associated with an increased likelihood of having breast-conserving surgery.

Radiotherapy in the curative treatment of breast cancer: current status and future trends. An opinion sample of radiation oncologists active in breast cancer research.

A questionnaire regarding the current practice of breast cancer radiotherapy and possible future trends in this field was filled out by 13 radiation oncologists active in breast cancer research. In the opinion of this small group, radiotherapy is presently included in the initial treatment of the large majority of early breast cancers, particularly in the framework of breast-conserving therapy, which is currently used in > 50% of these patients. Indications for post-mastectomy irradiation vary greatly among respondents, as do attitudes toward the potentially negative aspects of adjuvant radiotherapy. Most respondents feel that their future practices will be significantly influenced by an increase in screen-detected cancers, the aging of the population, the increasing influence of medical oncologists, participation in clinical trials, and increased patient participation in treatment decisions. An increase is foreseen in the use of breast-conserving approaches, radiotherapy, and systemic therapies, and a decrease in the use of both total mastectomy and axillary dissection. Most respondents feel that there will be a modest decrease in the percentage of conservatively operated patients receiving radiotherapy. A future role is seen for neo-adjuvant chemotherapy, at least in well-defined subgroups, increasing the number of patients offered breast-conserving approaches. Most respondents expect that irradiation of lymph nodal areas will gain new credibility and be used more often. No majority opinion could be elicited regarding ways of improving the therapeutic ratio in breast cancer radiotherapy.

[Reduction of functional inoperability in patients with breast cancer]. / Snizhenie funktsional'noi neoperabel'nosti u bol'nykh rakom molochnoi zhelezy.

The somatic condition of patients with breast cancer was assessed. Preoperative correction and intraoperative control owing to which 90 percent of the patients could radically be operated on were considered. Only 5 percent of the elderly patients were operated on palliatively in view of the correction failure. Thus as a result of the goal-oriented preoperative preparation none of the patients with breast cancer was dented surgery according to functional contraindications. The elderly age was not related to the surgery denial or its scope restriction.