Epidemiology of Second Non-breast Primary Cancers among Survivors of Breast Cancer: A Korean Population–Based Study by the SMARTSHIP Group / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to evaluate the incidence and prognosis of second non-breast primary cancer (SNBPC) among Korean survivors of breast cancer. @*Materials and Methods@#Data from the Korean National Health Insurance Service were searched to identify women who received curative surgery for initial breast cancer (IBC) between 2003 and 2008 (n=64,340). Among them, patients with the following characteristics were excluded: other cancer diagnosis before IBC (n=10,866), radiotherapy before IBC (n=349), absence of data on sex or age (n=371), or male (n=248). Accordingly, data of 52,506 women until December 2017 were analyzed. SNBPC was defined as a newly diagnosed SNBPC that occurred 5 years or more after IBC diagnosis. @*Results@#The median follow-up time of all patients was 12.13 years. SNBPC was developed in 3,084 (5.87%) women after a median of 7.61 years following IBC diagnosis. The 10-year incidence of SNBPC was 5.78% (95% confidence interval [CI], 5.56 to 6.00). Higher SNBPC incidence was found in survivors with the following factors: old age at IBC diagnosis, low household income, and receiving combined chemotherapy with endocrine therapy, whereas receiving radiotherapy was related to a lower incidence of SNBPC (hazard ratio, 0.89; p < 0.01). Among the patients with SNBPC, the 5-year survival rate was 62.28% (95% CI, 65.53 to 69.02). @*Conclusion@#Approximately 5% of breast cancer survivors developed SNBPC within 10 years after IBC diagnosis. The risk of SNBPC was associated with patient’s age at IBC diagnosis, income level, and a receipt of systemic treatments.

Survey of the Application of the Korean Clinical Practice Recommendations on Breast Cancer Treatment: The Utility of the Korean Breast Cancer Society Guidelines / 한국유방암학회지

This survey was performed to analyze the usability of the third edition of the Korean breast cancer clinical practice guidelines (KBCCPG) in clinical practice. We made a questionnaire composed of 18 general and 82 specific questions regarding benign breast disease (B; 1 question); non-invasive disease (N; 12 questions); early-stage disease (E; 26 questions); advanced disease (A; 24 questions); and metastatic (M) breast cancer-related problems (19 questions). A total of 100 questionnaires, with a link to an online survey, were delivered via e-mail to over 700 members of the Korean Breast Cancer Society (KBCS), and associated academy members, over 20 days between 26th February and 16th May 2010. Out of 270 respondents who read the e-mail, 96 answered the questionnaire. Participants included 87 surgical oncologists, 5 radiation oncologists, 2 oncoplastic surgeons, 1 pathologist, and 1 medical oncologist. The third KBCCPG were perceived as differing from the second guidelines in terms of the level of clinical evidence required before choosing a recommendation. For the progress of the KBCCPG, the guideline committee should try to reinforce all courses of guideline development with several elements including data from clinical trials of Korean breast cancer patients, securing a multidisciplinary approach, developing consistent and reasonable processes for each step of the revision of the guidelines, induction of liberal scientific and ethical discussion about all issues with all KBCS members. The cost-effectiveness of healthcare and the logical development of the KBCCPG would also be ensured. Timely updates of the clinical guidelines for breast cancer treatment are essential to facilitate optimal decision-making in daily practice, and to ensure adequate patient feedback.

Endoscopy-assisted Breast Conserving Surgery for Breast Cancer: A Preliminary Clinical Experience / 한국유방암학회지

PURPOSE: Breast conserving surgery (BCS) has replaced modified radical mastectomy as the standard treatment for early breast cancer. However, even though the original shape of the breast is preserved, the significant scarring after BCS detracts from the natural appearance of the breast. Endoscopy-assisted breast surgery can be performed with small incisions that become inconspicuous after surgery. We report herein on our preliminary clinical experience for the aesthetic and treatment results of endoscopy-assisted BCS (EA-BCS). METHODS: We retrospectively analyzed 22 consecutive patients who underwent EA-BCS between June 2006 and February 2008. The skin incisions were made at the periareolar and axillary sites. We performed a dye- and/or radioisotope-guided sentinel lymph node biopsy (SLNB), and we dissected the axillary lymph nodes (level I and II), and excised tissue under endoscopic assistance. We carried out frozen section biopsies to rule out tumor invasion on the resection margins. The following information was obtained: the clinical and histopathological characteristics, the operative procedures, the surgical outcomes, the cosmetic evaluation, and the patients' satisfaction. RESULTS: The average age of the patients was 52.0 years (range, 32-74 years). The mean tumor size was 2.2 cm (range, 0.7-5.5 cm). All the patients underwent EA-BCS and SLNB. The postoperative complications were as follows: lymphedema in two patients, wound infection in three patients, and a total mastectomy due to positive margins on the final biopsy report in one patient. No locoregional recurrence was observed on the follow-up study (mean, 24.0 months). There were good to excellent aesthetic results for 95% of the evaluated cases. Almost all the patients were satisfied with the outcome of surgery. CONCLUSION: EA-BCS was a feasible and effective procedure for treating patients with breast cancer and it achieved good aesthetic results with reducing the surgical scarring. However, further study with more patients and long-term follow-up is needed.

Volume Replacement with Polyglactin 910 Mesh for Breast Reconstruction after Endoscopy-Assisted Breast Conserving Surgery for Treating Early Breast Cancer: the Early Results / 한국유방암학회지

PURPOSE: We introduce a new technique using a Vicryl(R) mesh made with Polyglactin 910 for breast reconstruction after performing endoscopy-assisted breast conserving surgery. METHODS: From July 2006 to July 2008, we performed endoscopiy-assisted breast surgery in 30 patients with early breast cancer. (Thirty [fourteen] patients [who] underwent endoscopy-assisted breast conserving surgery). Of the total patients, 14 underwent reconstruction procedure (volume replacement with the use of a Vicryl(R) mesh) and 16 underwent reconstuction without Vicryl(R) mesh. We were evaluated for their quality of life (QOL), the surgery-related complications and the cosmetic outcomes. Three patients were excluded from the study; two patients required mesh removal due to infection and the other patient had a total mastectomy performed due to a positive resection margin. RESULTS: The median age of the patient was 49.4 year (range 36-60 year) and all of the patients had a diagnosis of early breast cancer (less than stage IIb). In general, the patients were satisfied with the outcome for their QOL. The patients were especially satisfied with the cosmetic outcome. The patients' satisfaction increased with longer follow-up, as compared to that for the shorter intervals. At 10 months after surgery, there was encapsulated granulation tissue within a collection of tissue fluid, as seen on ultrasonography. At 20 months after surgery, the skin and breast shape both recovered. CONCLUSION: The results of this study showed that for relatively short follow-up period, breast reconstruction with using Polyglactin 910 mesh, which is made from oxidized regenerated cellulose, resulted in satisfactory cosmetic results and a good quality of life after breast conservative surgery.