Training lay health workers to promote post-treatment breast cancer surveillance in African American breast cancer survivors: development and implementation of a curriculum.

BACKGROUND: African American breast cancer survivors are less adherent to guidelines for post-treatment breast cancer surveillance compared to White survivors. Survivors in Spirit (SIS) is an intervention that addresses this problem through lay health workers (LHWs). METHODS: African American women were trained as LHWs using a structured curriculum. Trainees' intervention knowledge was assessed before and after training. RESULTS: There was a substantial increase in the mean percentage of correct items from pre- to post-test for the trainees as a group. CONCLUSIONS: LHWs can be effectively prepared to conduct interventions focusing on the complexities of breast cancer recurrence and surveillance.

Breast cancer in men: prognostic factors, treatment patterns, and outcome.

PURPOSE: The aim of this study was to review the clinical presentation and to evaluate prognostic factors, treatment modalities, outcome, and second malignancy in male breast cancer patients. A chart review was conducted of all men treated for breast cancer between January 1991 and December 2007. Cox proportional hazards regression model and Kaplan-Meier curve were used to determine prognostic factors and plot survival probabilities. Invasive carcinoma was diagnosed in 22 patients and ductal carcinoma in situ in 7 patients. With mortality as the endpoint, tumor size indicated hazard ratio (HR) of 1.5 for each 1-cm increase in tumor size (p = .03). Overall stage and increased age were associated with increased risk of mortality (HR = 2.1, p = .055; HR = 1.09 for a 1-year increase in age, p = .08, respectively). Adjuvant radiation therapy yielded an HR of 0.1 (p = .058), indicating a favorable association with the survival. Advanced age, higher stage, and increasing tumor size were unfavorable to survival in male breast carcinoma. The benefit of adjuvant radiation therapy should be addressed in future collaborative studies.

Idiopathic granulomatous lobular mastitis.

Idiopathic granulomatous lobular mastitis (IGLM) is a rare breast condition with prominent skin findings. It is typically seen in young parous women. Painful breast masses, draining sinuses, scarring, and breast atrophy are the main clinical manifestations. IGLM can resemble a variety of other inflammatory and neoplastic processes of the breast. It is thought to result from obstruction and rupture of breast lobules. Extravasated breast secretions then induce an inflammatory reaction. Corynebacteria have also been implicated in the pathogenesis. Treatment is surgical, but systemic corticosteroids, methotrexate, and antibiotics also play a role.

MammoSite multilumen catheter: dosimetry considerations.

PURPOSE: To explore the dosimetric advantages of the new MammoSite multilumen (ML) balloon for breast brachytherapy treatment compared to conventional single lumen (SL) device plan. MATERIALS AND METHODS: Patients deemed appropriate for accelerated partial breast irradiation (APBI) were implanted with the MammoSite ML balloon. Two plans were generated in each patient for the same target coverage (PTV_EVAL) and dose to normal structures were plotted. The first plan used only the central single lumen with single-dwell position (SL), and the second plan (ML) was generated using the other lumens of the device. Dose distributions of the SL and ML plans were compared. RESULTS: For the same PTV_EVAL, the ML balloon improved dose coverage at the tip and base of the applicator compared to SL plan. The skin and rib doses were reduced using the ML plan versus SL plan for the same PTV_EVAL in-patient 2, where the skin-balloon distance was 7 mm and the rib-balloon distance was <1 cm. For patient 1, the skin and rib distances were greater than 1 cm and the ML plan did not further minimize the dose to normal structures. CONCLUSION: In our initial experience, dosimetric goals can be better achieved using the ML MammoSite balloon when normal structures (skin and ribs) are close to PTV_EVAL with a distance of <7 mm and rib distance of <1 cm. The multiple lumen of ML balloon can optimize dose and reduce excessive dose to rib and skin and therefore minimize the long-term toxicities of rib discomfort, skin fibrosis and fat necrosis.

Intraoperative placement of MammoSite for breast brachytherapy treatment and seroma incidence.

PURPOSE: To identify possible risk factors for development of clinically significant seroma (CSS) (seroma requiring intervention) and to report on incidence of infection after intraoperative placement of MammoSite for breast brachytherapy. METHODS AND MATERIALS: Fifty-eight postmenopausal patients with early stage breast cancer and no nodal metastases, treated with partial breast irradiation using the MammoSite catheter from June 2003 to November 2007 were analyzed retrospectively for CSS predictive factors and incidence of infection. After a lumpectomy, a MammoSite catheter was placed by intraoperative open-cavity technique (OCT). All the patients received wound care and prophylactic antibiotics. A dose of 3400 cGy was prescribed at 1cm from the surface of the balloon and was delivered at 340 cGy twice daily 6h apart for 5 days. The patients with seroma who underwent intervention were considered to have CSS. On the basis of the characteristics and symptoms associated with seroma, interventions, such as aspiration, core biopsy, or re-excision of the lumpectomy cavity were performed either to relieve symptoms or to rule out a local recurrence. RESULTS: Fifty-seven of the 58 patients were eligible for analysis. One patient, who died 4 weeks after treatment from unrelated causes, was excluded from final analysis. All the patients were postmenopausal, with a median age of 71 years (range, 53-88 years). Eighteen of the 57 patients (31.5%) had CSS; 9 of them had re-excision of the lumpectomy cavity. Pathology in all revealed evidence of fat necrosis, chronic inflammatory cells, and fibrosis. There was no evidence of tumor recurrence in any of these patients. Technical and nontechnical parameters were analyzed to determine possible risk factors for CSS, and none were found to be statistically significant. No patient developed acute postprocedural infection. CONCLUSIONS: Meticulous wound care and postoperative antibiotics prevented acute infection. Infection was not a contributing factor for seroma formation in these patients. Placement of the MammoSite catheter by OCT did not increase the risk of CSS development, in postmenopausal breast cancer patients.

Staining of endotracheal tube with isosulfan blue dye after sentinel node mapping: a case report.

Sentinel node mapping is successfully performed for the detection of cancer and nodal metastasis. There is a reported complication rate of 1.5%, most being mild allergic reactions, with a few rare reported cases of anaphylaxis. Isosulfan blue has been found to routinely create a modest artifactual desaturation via pulse oximetry, as well as a transient skin discoloration that may last for several hours to weeks. It causes discoloration of urine and has been detected in other body secretions, none of which have been found to be of clinical significance. This is a case report involving a 61-year-old woman who underwent sentinel node mapping and axillary dissection for breast adenocarcinoma. On postoperative extubation, the endotracheal tube was noted to be stained dark blue with isosulfan dye. This unusual complication is unreported to date and is likely the result of systemic absorption of the dye.