Clinicopathological Characteristics of Mucinous Carcinoma of the Breast in Korea: Comparison with Invasive Ductal Carcinoma-Not Otherwise Specified

Clinicopathological characteristics and prognostic factors of mucinous carcinoma (MC) were compared with invasive ductal carcinoma-not otherwise specified (IDC-NOS). Clinicopathological characteristics and survivals of 104 MC patients were retrospectively reviewed and compared with those of 3,936 IDC-NOS. The median age at diagnosis was 45 yr in MC and 47 yr in IDC-NOS, respectively. The sensitivity of mammography and sonography for pure MC were 76.5% and 94.7%, respectively. MC showed favorable characteristics including less involvement of lymph node, lower stage, more expression of estrogen receptors, less HER-2 overexpression and differentiated grade, and better 10-yr disease-free survival (DFS) and overall survival (OS) (86.1% and 86.3%, respectively) than IDC-NOS (74.7% and 74.9%, respectively). Ten-year DFS of pure and mixed type was 90.2% and 68.8%, respectively. Nodal status and stage were statistically significant factors for survival. MC in Koreans showed similar features to Western populations except for a younger age of onset than in IDC-NOS. Since only pure MC showed better prognosis than IDC-NOS, it is important to differentiate mixed MC from pure MC. Middle-aged Korean women presenting breast symptoms should be examined carefully and evaluated with an appropriate diagnostic work-up because some patients present radiologically benign-like lesions.

Clinicopathologic Features and Outcomes of Metaplastic Breast Carcinoma: Comparison with Invasive Ductal Carcinoma of the Breast

PURPOSE: Metaplastic breast carcinoma (MBC) is rare. Its clinicopathologic features and prognosis are uncertain. The aim of this study was to evaluate the clinicopathologic characteristics and outcomes in comparison with invasive ductal carcinoma (IDC). MATERIALS AND METHODS: We reviewed the data of 29 patients with MBC and 4,851 patients with IDC, who received surgery at Yonsei University Severance Hospital between 1980 and 2008. Various clinicopathologic features, recurrence free, and overall survival were investigated and compared to each other. RESULTS: Stage IV cases at diagnosis were more common in MBC (10.3%) than in IDC (0.9%). The incidence rates of triple negative breast cancer (TNBC) were significantly higher in MBC (84.0%) than in IDC (20.1%). Larger tumors (>2 cm) and lower tendency of axillary metastasis were frequently observed in MBC. Only one of 24 preoperative core needle biopsies (CNB) correctly diagnosed MBC. There was no significant difference in survival between the two groups. CONCLUSION: MBC was characterized by a higher incidence of TNBC, larger tumor size, and lower tendency of axillary metastasis, and was difficult to diagnose with CNB. Although the incidence of stage IV disease at diagnosis was higher in MBC, the survival rates of stage I-III were comparable to those of IDC.

The Prognostic Significance of Survivin Expression in Breast Cancer / 한국유방암학회지

PURPOSE: Survivin is a member of the inhibitors of apoptosis family. It has recently comes into the limelight as a promising tumor marker, but many previous reports have shown controversial results regarding the significance and prognostic value of a survivin expression. In this study we determined the correlation between the survivin expression and the conventional prognostic markers and we also investigated the outcomes according to the localization of the survivin expression. METHODS: Tissue microarray (TMA) blocks were made with formalin-fixed paraffin-embedded tissues from 185 breast cancer patients and the immunohistochemical staining was done using an anti-survivin antibody. Among these, 157 patients were available for a survivin expression. The conventional clinicopathologic features and overall survival were correlated with the localization of the survivin expression. RESULTS: Survivin was expressed in 101 breast cancers (64.3%). A higher cytoplasmic survivin expression were noted in the older group (p=0.003), in the node-negative cancers (p=0.012), in the earlier tumor stages (p=0.012) and in the cancers that had not been treated with adjuvant chemotherapy (p=0.014). On the contrary, a higher nuclear survivin expression was inversely correlated with an estrogen expression (p=0.006) and a progesterone receptor (p=0.043) expression. In terms of survival, a cytoplasmic expression was associated with improved overall survival (p=0.01) but a nuclear survivin expression was correlated with unfavorable overall survival (p=0.002). A high cytoplasmic to nuclear ratio of survivin was associated with improved overall survival (p=0.001) conversely, increased nuclear to cytoplasmic survivin ratio was correlated with unfavorable overall survival (p<0.0001). Multivariate analysis revealed that nuclear survivin expression (p=0.001) and high nuclear to cytoplasmic survivin ratio (p=0.012) were independent predictor of overall survival. CONCLUSION: Survivin is frequently expressed in primary breast cancer. A cytoplasmic survivin expression is a good prognostic predictor for patients with axillary node negative early breast cancers and a nuclear survivin expression is a worse independent predictor of overall survival for patients with axillary node positive breast cancers.

Clinical Analysis of Medullary Carcinoma of the Breast / 한국유방암학회지

PURPOSE: Medullary carcinoma of the breast is a variant of breast cancer characterized by the histologic appearance of poorly differentiated cells surrounded by a prominent lymphoid stroma. Medullary carcinoma has been reported to carry a prognosis better than other invasive breast carcinomas, but it is frequently overdiagnosed due to the difficulty in diagnosis. The aim of this study was to assess the clinical manifestations and outcome of medullary carcinoma of the breast. METHODS: We reviewed the data of 91 patients diagnosed with medullary carcinoma and 3,743 patients with invasive ductal carcinoma, not otherwise specified (NOS) from January 1980 to December 2005 at Yonsei University Severance Hospital. The clinicopathologic features, disease free survival (DFS) and overall survival (OS) for patients with medullary carcinoma were compared with those of the NOS patients. RESULTS: With reviewing the pathologic slides, 69 (75.8%) patients had findings compatible with typical medullary carcinoma (TMC) and the remaining 22 (24.2%) patients were reclassified as atypical medullary carcinoma (AMC). Early stage cancer was more frequent at medullary carcinoma and lymph node positive cancer was less frequent at medullary carcinoma. The expression of ER/PR was positive in either the TMC (18.9%/16.2%) and AMC (15.0%/20.0%) as compared to the NOS (63.2%/57.2%), and the difference was significant (p<0.001). In contrast, the HER-2/neu expression rate was significantly higher in the TMC (47.4%) and AMC (45.5%) than in the NOS (28.3%, p=0.001). The 10-year disease free survival and 10-year overall survival of the atypical medullary carcinoma patients (67.8%, 77.8%) were in fact similar to the NOS carcinoma patients (68.3%, 74.7%). There was significant difference in 10-year disease free survival and 10-year overall survival between the TMC (77.8%, 86.0%) and NOS carcinoma (68.3%, 74.7%) patients (p=0.002, p=0.006). CONCLUSION: The clinical outcome of typical medullary carcinoma is favorable in spite of its aggressive pathologic features and it differs from atypical medullary carcinoma. For precise prediction of prognosis of medullary cancer, we should apply strict criteria for the diagnosis of subtype with medullary features.

Clinicopathological Characteristics of Male Breast Cancer

PURPOSE: To investigate clinicopathological characteristics and outcomes of male breast cancer (MBC). PATIENTS AND METHODS: We retrospectively analyzed the data of 20 MBC patients in comparison with female ductal carcinoma treated at Yonsei University Severance Hospital from July 1985 to May 2007. Clinicopathological features, treatment patterns, and survival were investigated. RESULTS: MBC consists of 0.38% of all breast cancers. The median age was 56 years. The median symptom duration was 10 months. The median tumor size was 1.7cm, 27.8% showed node metastasis, and 71.4% were estrogen receptor positive. All 20 cancers were arisen from ductal cells. No lobular carcinoma was found. The incidence of stages 0, I, II, and III in patients were 2, 10, 4, and 3, respectively. All patients underwent mastectomy. One with invasive cancer did not receive axillary node dissection and stage was not exactly evaluated. Adjuvant treatments were determined by pathologic parameters and stage. Clinicopathological parameters and survival rates of MBC were comparable to those of female ductal carcinoma. CONCLUSION: The onset age of MBC was 10 years older and symptom duration was longer than in female patients. No difference in outcomes between MBC and female ductal carcinoma suggests that the biology of MBC is not different from that of females. Therefore, education, an appropriate system for early detection, and adequate treatment are necessary for improving outcomes.

The Prognostic Factors for Tumor Metastasis to Bone from Breast Cancer and Survival for Breast Cancer Patients after Bone Metastasis / 한국유방암학회지

PURPOSE: Bone is the most common site of breast cancer metastasis. The aim of this study is to identify the subgroup of patients who have high risk of bone metastasis and we evaluate the prognostic factors of overall survival after bone relapse. METHODS: A total 2,785 of primary breast cancer patients who were treated from January 1980 to December 2001 were included in this analysis. All the patients received radical surgery at the time of diagnosis. We retrospectively collected the clinico-pathologic data (age, tumor size, axillary lymph node status, histologic grade, steroid hormone receptor status, and disease-free interval after primary surgery). Definitive radiologic evidence of bone metastases by plain X-ray or whole body bone scan during follow-up was defined as bone metastases. We analyzed the relationship between the clinicopatholgic factors and the risk of bone metastases and the overall survival after bone relapse. RESULTS: During follow-up, 256 patients (9.3%) experienced bone metastasis. By multivariate analysis using Cox's model, age less than 35 years (p<0.001, risk ratio [RR]; 2.467, 95% confidence interval [CI]; 1.619-3.759), large primary tumor more than 2 cm (p=0.005, RR; 1.911, 95% CI; 1.222-2.988), positive axillary node (p<0.001, RR; 2.798, 95% CI; 1.867-4.195), and a high histologic grade (p=0.046, RR; 1.631, 95% CI; 1.008-2.640) were significantly associated with frequent bone metastases. The 10 years survival rate after bone metastasis was 26.9%. Disease free interval less than 2 years (p<0.001, RR; 3.453, 95% CI; 2.382-5.005) and hormone receptor status (p=0.003, RR; 1.791, 95% CI; 1.218-2.635) were independently associated with poor overall survival after bone relapse. CONCLUSION: We concluded that a shorter disease-free interval after definitive surgery and hormonal receptor status of the primary tumor are independent prognostic factors of overall survival after bone metastasis. These results show that a tailored strategy is needed for the treatment of patients with bone metastases.

Clinicopathological Characteristics and Prognostic Factors of Papillary Carcinoma of the Breast / 한국유방암학회지

PURPOSE: Papillary carcinoma of the breast is a rare disease and accounts for 1-2% of all breast cancers. Because of its rarity, there have been no reports regarding prognostic factors of papillary carcinoma of the breast. The aim of this study was to review the clinicopathological factors and treatment modalities of papillary carcinoma of the breast and to evaluate the relationship between these factors and survival rates. METHODS: We retrospectively analyzed 31 patients diagnosed with papillary carcinoma of the breast from January 1986 to December 2005. RESULTS: The mean age of the patients was 53.5 yr. The most common symptom was a palpable mass (n=27). The mean size of a tumor was 3.5 cm and 41.9% of the patients were categorized as T2. Eighteen patients had node negative breast cancer. According to the TNM stage, there were 5, 5, 16 and 2 patients with stage 0, I, II and III disease, respectively. Expression of estrogen receptor and progesterone receptor were positive in 80.8% and 69.2% of the patients, respectively. Twenty-three patients underwent mastectomy and eight patients underwent breast-conserving surgery. Fourteen patients received chemotherapy, 20 patients received hormone therapy, and 10 patients received radiotherapy. The 10-yr disease-free survival rate and 10-yr overall survival rate were 74.9% and 86.1%, respectively. Axillary lymph node negative and an age under 50 yr were statistically significant factors in 5-yr disease-free survival and in 5-yr overall survival, respectively. CONCLUSION: Papillary carcinoma of the breast showed a favorable outcome. Lymph node status and age were statistically significant factors for survival rates. The tumor size and stage had a relation with the survival rate, although the relation was not statistically significant.

Ectopic Endometriosis of the Extra-pelvic Cavity

PURPOSE: Endometriosis is the heterotropic occurrence of island of endometrial glands and stroma outside of uterus. It common occurs in pelvic cavity, but rarely at the ectopic area of extra-pelvic cavity. The aim of this study was to evaluate the clinical characteristics of extrapelvic endometriosis in order to help diagnosis and treatment. METHODS: Between January 2001 and June 2007, 22 patients who underwent surgery and was diagnosed as ectopic endometriosis of extra-pelvic cavity at Bundang CHA hospital were retrospectively reviewed with medical records and a telephone interview. RESULTS: All cases were women in their reproductive age, with a median age of 33 years (range 24~49 years). 17 of 22 cases were endometriosis in the scarring tissue of prior caesarean section wound on abdomen. 1 case in vaginal orifice on episiotomy wound of perineum, 1 case in femoral ring area and 3 cases in appendix. All patients except endometriosis of appendix, were presented with mass, pain and symptoms almost associated with menstruation. 18 of 22 cases were suspected of having extra-pelvic endometriosis due to their specific clinical features, 4 cases were suspected of hernia and acute appendicitis. All patients were treated with surgery. None has revisited to clinics due to recurrence. CONCLUSION: Women who have mass or lump in surgical scar and symptoms associated with menstruation period should be suspected of having endometriosis. Endometriosis of surgical scaring tissue should be treated by wide local excision to prevent local recurrence.

Prognostic Value for the S-phase fraction in T1 T2, Node Negative Breast Cancer / 한국유방암학회지

PURPOSE: To evaluate the prognostic value of the S-phase fraction (SPF) and the correlation with other clinicopathologic factors in node negative breast cancer. METHODS: From 1995 to 1998, seventy one breast carcinoma tumors with T1-2N0M0 staging were prospectively sampled as fresh tumors for flow cytometric DNA analysis. We determined the nuclear DNA content, and the SPF was calculated from DNA histograms. We evaluated the relationship between the SPF and other clinicopathologic factors (age, tumor size, tumor grade and, steroid receptor status). The five year distant relapse free survival (DRFS) and overall survival (OS), according to the SPF, were determined. RESULTS: The SPF ranged from 0.1 to 50.9% (median: 13.4%). The SPF was dichotomized using the median value to divide patients into 38 patients (53.5%) having tumors with the low SPF and 33 patients (46.5%) having tumors with the high SPF. The patient's age and the tumor size were not significantly associated with the SPF. High SPF was associated with high tumor grade, but this did not reach statistical significance. There was a significant correlation between high SPF and estrogen receptor negativity; 34.4% of ER positive tumor had high SPF, whereas 58.3% of ER negative tumor had high SPF(p = 0.042). The mean follow up duration was 65.0 months (median: 62.3). Among 71 patients, there were 4 (5.6%) cases of local recurrence, 7 (9.9%) cases of systemic recurrence and 10 (14.1%) cases of disease related death. The patients with high SPF showed a poorer 5 years DRFS and OS than did the patients with low SPF (87.9% vs. 91.2%; 80.4% vs. 94.5%, respectively), but the difference had no statistical significance. CONCLUSION: The present data was insufficient to use SPF information for the selection of the type of adjuvant therapy, but SPF is a promising prognostic factor for node negative breast cancer. Further study with a sufficient number of patients is needed and this should lead to a better understanding of SPF in node negative breast cancer.

Bilateral Breast Cancer

Among the 1760 cases of carcinomas of the breast treated between 1981 and 1996, there were 31 cases of bilateral breast cancer. Of these, 7 were synchronous tumors and the remaining 24 patients had metachronous tumors : 41.7% of all patients had presented within 5 years since the first primary tumors were detected and 73.3% of all patients had presented within 10 years. The mean age of the synchronous bilateral cancers was 39.9 (26~55), and the mean age at the diagnosis of the first cancers in the metachronous cancers was 44.75 (31~70) years old. The location of the tumor was the same in 64% and 68% of the synchronous and metachronous cancers, respectively, that had an identified histology. The mean survival of metachronous group was 70.5 months and that of synchronous group was 114.7 months. However, there was no statistical significance between the mean survival times of the two groups (p>0.05). We recommend a careful check-up for the opposite breast at the time of primary cancer treatment, as well as well an organized follow-up program for all patients having undergone treatment for breast cancer. Further investigations are required to determine the incidence of and risk factors for second cancer development in the opposite breast.

Variable complementary combined radiologic imaging methods for breast diseases

Radiographic examination of the breast has been so improved that it became a routine complement to physicalexamination. From November 1, 1983 through Sept.30, 1984, 684 patient with complaints of various breast problemwere examined by low-dose film mammography at Yong Done Hospital, Yonesei University. Among them, a comparativestudies, independently conducted physical examination, 97 cases of film mammography, 35 cases of ultrasoundmammography, 16 cases of aspiration cytology, and 3 cases of galactography were performed for our pathologicallyproven 98 cases of breast disease. Combined and complementary studies for breast diseases were analyzed in 37proven cases and authors found that specificity of those combined immediate complementary study techniques forbreast disease were 94% under colose cooperation with surgeon in Yong Dong Hospital, Yonsei University.

A Pychosocial Support Program for Women with Primary Breast Carcinoma / 한국유방암학회지

PURPOSE: To our knowledge, there had been no evidence for the efficacy of psychosocial intervention among Korean breast cancer patients. The objective of this study was to determine the effect of a psychosocial group intervention in reducing psychologic distress and enhancing coping in this population. METHODS: The patient selection criteria were age younger than 70 years, undergoing any postoperative adjuvant therapy, and surgery undergone within the previous 3~6 months as of the start of the study. There were 30 patients that met this criteria. There was no wait-list control group because none of the eligible patients desired to stay in the wait-list control group. Therefore a one group pretest-posttest design was used. We conducted an 8-week, structured, psychosocial group intervention that used psychoeducational strategies combining education and psychological support. Subjects were assessed for psychological distress and coping by administering the Beck Depression Inventory (BDI) and the Ways of Coping Checklist-Revised (WCCL-R) at the baseline and at 8 weeks. RESULTS: Thirty patients participated and the results of 20 of these patients were used for the analysis as appropriate. The posttest results showed significantly lower scores than the pretest results for depression on the BDI (p<0.001), and for avoidance (p<0.001) and wishful thinking (p<0.001) on the WCCL-R. Additionally, the total score for coping on the WCCL-R showed a significant difference after the intervention (p=0.051). CONCLUSION: Despite some limitations, the results of this study suggest that short-term pshchosocial group intervention produces a significant improvement in the quality of life of patients with primary breast carcinoma in terms of managing depression and coping.

A Pychosocial Support Program for Women with Primary Breast Carcinoma / 한국유방암학회지

PURPOSE: To our knowledge, there had been no evidence for the efficacy of psychosocial intervention among Korean breast cancer patients. The objective of this study was to determine the effect of a psychosocial group intervention in reducing psychologic distress and enhancing coping in this population. METHODS: The patient selection criteria were age younger than 70 years, undergoing any postoperative adjuvant therapy, and surgery undergone within the previous 3~6 months as of the start of the study. There were 30 patients that met this criteria. There was no wait-list control group because none of the eligible patients desired to stay in the wait-list control group. Therefore a one group pretest-posttest design was used. We conducted an 8-week, structured, psychosocial group intervention that used psychoeducational strategies combining education and psychological support. Subjects were assessed for psychological distress and coping by administering the Beck Depression Inventory (BDI) and the Ways of Coping Checklist-Revised (WCCL-R) at the baseline and at 8 weeks. RESULTS: Thirty patients participated and the results of 20 of these patients were used for the analysis as appropriate. The posttest results showed significantly lower scores than the pretest results for depression on the BDI (p<0.001), and for avoidance (p<0.001) and wishful thinking (p<0.001) on the WCCL-R. Additionally, the total score for coping on the WCCL-R showed a significant difference after the intervention (p=0.051). CONCLUSION: Despite some limitations, the results of this study suggest that short-term pshchosocial group intervention produces a significant improvement in the quality of life of patients with primary breast carcinoma in terms of managing depression and coping.

A Pychosocial Support Program for Women with Primary Breast Carcinoma

PURPOSE: To our knowledge, there had been no evidence for the efficacy of psychosocial intervention among Korean breast cancer patients. The objective of this study was to determine the effect of a psychosocial group intervention in reducing psychologic distress and enhancing coping in this population. METHODS: The patient selection criteria were age younger than 70 years, undergoing any postoperative adjuvant therapy, and surgery undergone within the previous 3~6 months as of the start of the study. There were 30 patients that met this criteria. There was no wait-list control group because none of the eligible patients desired to stay in the wait-list control group. Therefore a one group pretest-posttest design was used. We conducted an 8-week, structured, psychosocial group intervention that used psychoeducational strategies combining education and psychological support. Subjects were assessed for psychological distress and coping by administering the Beck Depression Inventory (BDI) and the Ways of Coping Checklist-Revised (WCCL-R) at the baseline and at 8 weeks. RESULTS: Thirty patients participated and the results of 20 of these patients were used for the analysis as appropriate. The posttest results showed significantly lower scores than the pretest results for depression on the BDI (p<0.001), and for avoidance (p<0.001) and wishful thinking (p<0.001) on the WCCL-R. Additionally, the total score for coping on the WCCL-R showed a significant difference after the intervention (p=0.051). CONCLUSION: Despite some limitations, the results of this study suggest that short-term pshchosocial group intervention produces a significant improvement in the quality of life of patients with primary breast carcinoma in terms of managing depression and coping.

Carcinoma of the axillary breast

Axillary breast is one of the varieties of polymastia which is characterized by the presence of more than 2 breasts. It may cause symptoms during pregnancy, lactation, or in the premenopausal period. Unless there are obvious symptoms of lactation or the assistance of further imaging studies such as mammography and breast ultrasound, the diagnosis is often confused with subcutaneous lipoma. The incidence of axillary breast cancer is low but it should be investigated and treated properly in view of another breast cancer in the embryonic milk-line. In this paper we reviewed 4 cases of axillary breast cancer and documented some articles regarding aberrant breast and carcinoma arising from it. It is suggested that subcutaneous nodules of uncertain origin around the periphery of the breast should be viewed with suspicion and treated properly.

Prognostic Factors in Axillary Lymph Node Negative Breast Cancer / 한국유방암학회지

PURPOSE: With the increase of early breast cancer patients, the number of node negative breast cancer patients is also on the rise. However, reports show that there is a 20~30% recurrence in node negative breast cancer. Thus, we have attempted to determine the prognostic factors that may affect recurrence and relapse free survival. METHODS: From January, 1980, to June, 1999, 1110 node negative breast cancer patients who underwent curative surgery at the Severance Hospital, Yonsei University College of Medicine, were selected. A retrospective study was done to determine the effects of factors, such as operation method, age, size, type, histologic grade, intraductal components, ER, PR, c-erbB-2, number of lymph nodes removed, adjuvant chemotherapy, hormonal therapy and radiation therapy. RESULTS: The mean age was 47.2 years. The median follow- up period was 88 months. Recurrence occurred in 161 patients. Locoregional recurrence occurred in 64 patients, and systemic recurrence in 129 patients, while 32 patients had both. The 5 years overall survival rate was 93.3%. The rate of locoregional recurrence for a 10 year-period was significantly lower in the mastectomy group compared with that in the breast conservation therapy group (94.7% vs 79.6%, P=0.000). No other prognostic factors except the age affected in locoregional recurrence. There was less systemic recurrence in patients with the age greater than 35, with the histologic grade I, and with the intraductal components greater than 20%. Thus, 10-years distant relapse free survival rates were 87.4% vs 79.8% (P=0.039), 93.5% vs 85.5% (P=0.024), and 94.4% vs 82.0% (P=0.007), respectively. There was no statistical significance in the other prognostic factors that influence systemic recurrence. CONCLUSION: The patients' age was determined to be an independent prognostic value in the lymph node negative breast cancer. The histologic grade and intraductal components showed to have significance as prognostic factors for systemic recurrence.

Survival analysis for clinical researchers using personal computer

No abstract available.

Familial Breast Cancer

Familial or hereditary breast cancer has genetic heterogeneity and is transmitted vertically in an autosomal dominant fashion. About 5 to 10% of breast cancers are caused by the inheritance of mutations in dominant susceptibility genes. We retrospectively reviewed 50 breast cancer patients from 44 families. These patients had treated their breast cancer at the Department of Surgery, Yonsei University College of Medicine, from 1981 to 1996. There were no statistically significant differences between the familial breast cancers and the sporadic breast cancers in such clinicopathologic characteristics as major complaint, tumor location, tumor size, metastasis to axillary lymph nodes, stage distribution, histology distribution and hormone receptor status. For familial camcers, the mean survival was 125 months, the overal 5-year survival rate was 85%, and the overall 5-year disease-free survival rate was 70%.

The Importance of Clinical Breast Examination for Cancer Detection in Asymptomatic Women / 한국유방암학회지

Of 489 asymptomatic women who were referred to our institute from other screening clinics, 46 were eventually proven to be breast cancer patients, and this number equated to 8.1% of the 565 breast cancer patients treated in our institute during the period of January 1997 to December 1998. Among the 46 cancer patients of the initial 489 asymptomatic women, twenty-five(54.35%) were detected by mammogram alone, six(13.04%) by clinical breast examination(CBE) alone, and the remaining 15(32.61%) by both mammogram and CBE. In context with age, the mammographic sensitivity for cancer detection was 100% for women aged over 60, 91% for 50s, 78.9% for 40s, and 75% for 30s, and inversely correlated with the patient's age. Among the 25 cancers detected by mammogram alone, 18(72%) belonged to DCIS or stage|. In contrast, four(66.7%) of six cancers detected by CBE alone and nine(60%) of 15 cancers by both CBE and mammography were included in stage II a or II b. However, the total incidence of early cancers(stage 0 and I) was significantly higher in the screening group than in the symptomatic group(P<0.01). These results suggest that the role of mammography is important in the detection of cancers in their earlier stage and CBE is helpful in reducing false negative results in breast cancer screening. In conclusion, film mammography is the best tool for the detection of microcalcification and is useful for the detection of earlier lesions, but is not perfect for the detection of breast cancer particularly in young women. A careful CBE is an essential part of breast screening in order to reduce false-negative results.

An analysis of risk factors affecting operative morbidity and mortality in cirrhotic patients

No abstract available.