Ductal carcinoma in situ of the breast: influence of age on diagnostic, therapeutic, and prognostic features. Retrospective study of 812 patients.

BACKGROUND: The objective of this retrospective study was to identify prognostic, diagnostic, and therapeutic disparities between younger (≤ 40 years) and older (> 40 years) women with ductal carcinoma in situ (DCIS) of the breast. METHODS: From 1971 to 2001, all patients treated for DCIS at Institut Bergonié were included in our analyses. Follow-up data was collected over 10 years. We used univariate and multivariate analyses to investigate patient-, disease-, and treatment-related factors predictive of diagnostic, histological, therapeutic, and prognostic DCIS criteria. RESULTS: A total of 812 patients were eligible including 731 women aged >40 years and 81 women ≤40 years. Younger women with DCIS were more likely to receive a mastectomy and less likely to receive radiotherapy. Young age and initial surgical treatment (lumpectomy and especially nonfree margins) were revealed as predictive of recurrence in multivariate analyses. CONCLUSIONS: Young age represents a recurrence risk independent of histological and clinical characteristics of the tumor. Initial treatment, especially for nonfree margins, is also a predictive factor. Appropriate initial surgery with particularly wide margins appears essential for the treatment of young women with DCIS.

Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations.

We retrospectively analysed mammographies of 909 ductal carcinoma in situ (DCIS) (1980-1999) and compared our results to those of literature. Microcalcifications were present in 75% of the cases, and soft-tissue abnormalities in 27% cases with association with calcifications in 14% of cases. Palpable masses were found in 12% of the cases and nipple discharge was present in 12% of the cases. The radiographic-pathologic correlation allowed to suspect the DCIS "aggressiveness" on radiologic signs. Granular, linear, branching and/or galactophoric topography of the microcalcifications were correlated with necrosis, grade 3, comedocarcinoma type. A number of microcalcifications higher than 20 was correlated with necrosis and grade 3. Mammographic size was correlated to histologic size. Masses were correlated with grade 1. A diagnosis strategy can be proposed with a multidisciplinar approach.

[Patients' attraction to complementary and alternative medicine (CAM): a reality which physicians can neither ignore nor deny]. / L'attrait pour les médecines complémentaires et alternatives en cancérologie: une réalité que les médecins ne peuvent ni ignorer, ni réfuter.

Use of complementary and alternative medicine (CAM) is very frequent in cancer patients. The reasons of this attraction are very complex. Cultural context, psychological and functional status of the patients (anxiety, depression, more physical symptoms) emerge as significative predictors. Dissatisfaction with conventional medicine, lack of holism (inadequate information regarding diet, nutrition, exercise and ignorance of social and spiritual dimensions) are important motivations for turning to CAM. To optimise the patient-physician relationship and to avoid a propensity to ineproved treatments, accurate and adequate communication is necessary.

[Interests of applied anthropology to oncology]. / Les apports de l'anthropologie appliquée au champ de la cancérologie.

From now on the introduction of social and human sciences studies in the field of oncology has not always been conclusive. This article aims to analyze the bounds that border the meeting and the understanding between physicians, patients and anthropologists. It also treats the problems due to the introduction of applied anthropology in the field of oncology and points up the interests and practical contributions that this disciplinary bring and could bring.

Do anxiety, body image, social support and coping strategies predict survival in breast cancer? A ten-year follow-up study.

A longitudinal study enrolled 75 women with primary breast cancer. Before the confirmation of diagnosis, authors measured trait-anxiety and body satisfaction. Three weeks after diagnosis, coping strategies and state-anxiety were evaluated. The number of days of survival was measured 10 years after diagnosis. In Cox proportional-hazards models adjusting for severity of disease and age, high social support and low state-anxiety predicted an increased risk of death from breast cancer. A significant increased risk of death in women with low scores on the Body Image Questionnaire appeared only in the univariate model.

[Psychological aspects of cancer Information dedicated to patients and relatives]. / Vivre pendant et après un cancer. Information à l'usage des personnes malades et de leurs proches.

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives, the SOR SAVOIR PATIENT program (SSP). The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French cancer centres, the National League against Cancer, The National Cancer Institute, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals, the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The information and dialogue handbook SOR SAVOIR PATIENT Vivre pendant et après un cancer reporting on the psychological aspects of cancer was worked out and published on the Web in 2005. The guide aims to provide cancer patients with support and advice about the psychological impact of the disease. It provides information on the possible personal consequences of the disease and treatments, in every domain: psychological, emotional, interpersonal, familial or professional. Patients are also advised of the emotional challenges associated with cancer, of the support they may expect at every stage of the disease, from diagnosis to treatment, and of psychological outcome after the disease is over. The document also provides healthcare professionals with a valuable, concise source of validated information on the psychological aspects of cancer, thus facilitating communication between carers and patients. Information provided in the present article has been selected from the information and dialogue handbook SOR SAVOIR PATIENT Vivre pendant et après un cancer. The document addresses the issue of the psychological support made available to the patients during and after the disease. The SOR SAVOIR PATIENT guide can be downloaded from the FNCLCC website at: http://www.fnclcc.fr

[SOR SAVOIR PATIENT Cancer and fatigue. Information dedicated to cancer patients and relatives]. / SOR SAVOIR PATIENT Fatigue et cancer. Information à l'usage des personnes malades et de leurs proches.

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives,the SOR SAVOIR PATIENT program. The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French regional cancer centres, the National League against Cancer, The National Cancer Institute, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals,the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The handbookSOR SAVOIR PATIENT Cancer and Fatigue is an adapted version of different publications regarding fatigue in oncology. It is meant to provide a basis for the explanationof the disease and to facilitate discussions with the healthcare team. It is available from the FNCLCC (101, rue de Tolbiac, 75013 Paris, Tel. (0033) 1, 01 76 64 78 00,www.fnclcc.fr). This document has been validated at the end of 2005 and published in January 2006. SOR SAVOIR PATIENT guides are systematically updated when new research becomes available. This article is extract from the handbook SOR SAVOIR PATIENT Cancer and Fatigue and concerns the causes and effects of fatigue and how to cope with fatigue. This information allow patients to better understand the causes and effects of fatigue, how to cope fatigue...which represent important patient information needs. This article is meant to inform patients and relatives about the disease and its treatments. It also offers health professionals a synthetic evidence-based patient information source which facilitates discussions with the patient.

[Patients and physicians: cross representations anthropological study of the construction of individuality in radiation therapy]. / Soignant contaminé et malade imaginé: étude anthropologique de la construction de l'individualité en radiothérapie.

The methods of anthropology allow us to understand group dynamics by bringing to light a web of linked causalities in order to describe human and social relationships. The density and dimension of the relationship with a patient have direct repercussions on professional motivation. But this proximity has its drawbacks. The process of identification to patients is inevitable and the fear of "contamination" is not medical but symbolic: it is expressed in the difficulty of appreciating the distance, the difference between the "other" (the patient) and the self (the physician). Health professionals have therefore to find a delicate compromise between proximity and strategies of distance. The temptation is therefore great, of considering the patient only through his pathology. This "imagined patient" allows the clinician to define the frames structuring his relation to the patient. But at the same time, this creates a loss of identity for the patient. In this context, the relation between patient and clinician should be based primarily on a necessary individual acknowledgement of the patient who expresses it in a re appropriation of his illness. Thus he sets himself as an actor of the therapeutic relation and no longer as an object of clinical care.

[Parcours de femmes 2001, a French survey on the management and needs of women with breast and gynecological cancer: what's new after 8 years?]. / Parcours de femmes 2001.

The aim of the survey Parcours de Femmes 2001 was to evaluate at a national level, the overall management of patients with breast or gynecological cancers and to determine their needs. Eligible patients had either received at least 3 months of treatment or had completed treatment less than 1 year before the study. from February to November 2001, 2 839 questionnaires were distributed ; 1 870 were returned (66% response rate); 87% of patients had breast cancer and 76% de novo cancer (primary management). Overall, 92% of women received information/explanations with an acceptable quality. Information of patients clearly improved during last years but insufficiencies persist for two points : adverse events of treatments and disease progression, especially for recurrent patients. Fatigue (78%), anxiety (66%) and chemotherapy adverse events were the most frequent problems and were well managed by caregivers, except for fatigue due to diagnostic and treatment difficulties. Problems relating to daily life (48% of patients reported difficulty in doing housework), material and social life were poorly identified and remained largely unmanaged. Information given to female cancer patients must be improved particularly in relapsed patients. Psychosocial management requires a more holistic approach through new channels together with the coordination of existing structures.

[Standards, Options and Recommendations for the management of ductal carcinoma in situ of the breast (DCIS): update 2004]. / Recommandations pour la pratique clinique: Standards, Options et Recommandations 2004 pour la prise en charge des carcinomes canalaires in situ du sein (rapport abrégé).

The " Standards, Options and Recommendations " (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objectives : To update the Standards, Options and Recommendations clinical practice guidelines for the management of ductal carcinoma in situ of the breast (DCIS). Methods : The working group identified the questions requiring up-dating from the previous guideline. Medline(r) and Embase(r) were searched using specific search strategies from year 1996 to year 2003. In addition several Internet sites were searched in October 2002. Results : Clinical guidelines have been defined for the management of diagnosis, treatment, follow-up, and treatment of recurrence of DCIS. The issue of hormone replacement therapy has also been addressed in the context of DCIS.