[Surgery or not on an atypical breast lesion? Taking anxiety into account in shared decision support from a prospective cohort of 300 patients]. / Opérer ou non une lésion atypique du sein ? Prise en compte de l'anxiété dans l'aide à la décision partagée à partir d'une cohorte prospective de 300 patientes.

INTRODUCTION: Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions (ABL)". Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process. METHODS: Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care. RESULTS: One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, P<0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%). CONCLUSION: Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.

[Cancers detected at over-reading: analysis of data from the Loire-Atlantic breast cancer screening program, 2003-2005 (update)]. / Cancers détectés par le deuxième lecteur: analyse des données de la campagne de dépistage du cancer du sein en Loire-Atlantique, 2003-2005 (nouveau cahier des charges).

Systematic over-reading of screening mammograms increases the number of cancers detected. Published results will vary based on the particularities of different programs. A feature of the revised French program is that over-reading is limited to ACR BI-RADS 1 and 2 mammograms. In the Loire-Atlantic region, 8.7% of detected cancers between 2003-2005 were detected at over-reading. We have reviewed our database to analyze the features of these cancers detected only by the second reviewer during this period and search for causes of non-detection by the initial reviewer. Cancers detected only by the second reviewer were generally small. Breast parenchyma was mainly type 1 or 2 of the BI-RADS classification. In our study, 60% of these cancers initially missed were considered as "detection errors" because there were not detected by the initial reviewer whereas 40% were considered as "interpretation errors" because they were detected by the initial reviewer but interpreted as benign.

[Surgical management of non-palpable breast lesions in ambulatory care]. / La prise en charge chirurgicale des lésions mammaires non palpables en ambulatoire.

OBJECTIVE: The aim of our study was to assess if surgery for non-palpable breast lesions could be compatible with a walk-in case hospitalization setting. METHOD: We retrospectively compared 75 patients with a traditional hospital stay to 68 patients with a walking case hospitalization. Overall 143 patients were treated during 1997. Studied parameters were: the quality of the surgical results, the duration of the hospital stay and the post operatives complications. Statistical analysis was realized using the chi 2 test. RESULTS: There was no difference between the studied populations according to the quality of surgical results either the post operatives complications. CONCLUSION: Surgery for non palpable breast lesions can be performed during a one day surgery. The reduction of the duration of the hospital stay decrease the cost of health care system. We should follow the evaluation of the walking case hospitalization for the breast cancer surgery especially when an axillary lymphadenectomy have to be performed.