Can We Successfully De-Escalate Axillary Surgery in Women Aged ≥ 70 Years with Ductal Carcinoma in Situ or Early-Stage Breast Cancer Undergoing Mastectomy?

Author(s):  
Regina Matar ◽  
Andrea V. Barrio ◽  
Varadan Sevilimedu ◽  
Tiana Le ◽  
Alexandra Heerdt ◽  
...  
2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12103-e12103
Author(s):  
Carolyn J. Kushner ◽  
Wei-Ting Hwang ◽  
Lawrence J. Solin ◽  
Neha Vapiwala

e12103 Background: Women with ductal carcinoma in situ (DCIS) or early stage breast cancer have a good prognosis after breast conservation treatment (BCT), and are at risk for second malignant neoplasms (SMNs). The long-term risk of SMNs is not well established and carries important public health implications. Methods: A total of 755 women with DCIS or stage I-II invasive breast cancer underwent breast-conserving surgery followed by definitive breast irradiation between 1995 and 2001. Systemic therapy (chemotherapy and/or hormonal therapy) was given to 73% of the patients. We have previously described patient demographics and 15-year oncologic outcomes in detail (Vapiwala, Cancer, 2017). The patient records were reviewed for development of SMNs. SMNs of any anatomic site (other than contralateral breast cancer and basal/squamous cell carcinoma of the skin) were included for analysis. The Kaplan-Meier method was used to determine the rate of SMNs over time. Median follow-up was 13.8 years. Results: The 5-, 10-, and 15-year rates of developing any SMN were 3.6% (95% CI 2.4-5.3%), 7.8% (95% CI 6.0-10.2%), and 12.7% (95% CI 10.2-15.8%). The most common SMNs were uterine (n=12), leukemia/lymphoma (n=11), melanoma (n=10), ovarian (n=9), and lung (n=7). Conclusions: Development of SMNs is a substantial risk for a protracted period of time following BCT. Clinical patterns of specific SMN histologies, locations and time course of development suggest potential opportunities for screening and treatment to guide patient survivorship clinics and protocols.


2016 ◽  
Vol 51 (7) ◽  
pp. 462-468 ◽  
Author(s):  
Floortje M. Knuttel ◽  
Bas H.M. van der Velden ◽  
Claudette E. Loo ◽  
Sjoerd G. Elias ◽  
Jelle Wesseling ◽  
...  

2017 ◽  
Vol 167 (1) ◽  
pp. 205-213 ◽  
Author(s):  
M. L. Gregorowitsch ◽  
H. J. G. D. van den Bongard ◽  
D. A. Young-Afat ◽  
J. P. Pignol ◽  
C. H. van Gils ◽  
...  

Author(s):  
G. S. Alieva ◽  
G. P. Korzhenkova ◽  
I. V. Kolyadina

Relevance: The systematization of radiological signs of microcarcinomas will increase the frequency of detection of the disease at an early stage and maximize the effectiveness of breast cancer treatment.Purpose: To assess the key radiological characteristics of early forms of breast cancer (invasive tumors up to 1.0 cm and ductal carcinoma in situ).Material and methods: The key radiological characteristics were studied in 110 patients with verified early forms of breast cancer: ductal carcinoma in situ (DCIS), invasive breast cancer up to 1 cm in size according to the morphological examination of the surgical material in the absence of signs of regional and distant metastasis — stage p T₁ₐ₋bN₀M₀.Results: The main radiological signs detected in mammography (MG) in early breast cancer were the nodular mass without microcalcifications — in 26 cases (23.9 %), the nodule and microcalcifications — in 35 cases (32.1 %), in 27 patients (24.8 %) — microcalcifications without a tumor node. In addition, in 17 cases (15.6 %) there was a violation of the architectonics or focal asymmetry, and in 4 patients (3.7 %) no signs of a malignant process were revealed at all with MG. The revealed changes in the breast in most patients (83 cases, 76.1 %) were interpreted as BIRADS 5, which indicates an extremely high probability of the presence of a malignant neoplasm. In 9 cases (8.3 %) after mammography, the diagnosis was interpreted as BIRADS 4, in 16 (14.7 %) cases the category BIRADS 0 was assigned, which required additional examination methods, and only in 1 patient (0.9 %) the revealed changes were interpreted as benign.Conclusions: Mammography performed in 92 patients (84.4 %), based on the assessment of radiological signs, to establish the BIRADS 4/5 category, which served as the basis for performing a biopsy and verifying the diagnosis. However, in 15 % there were diagnostic difficulties in interpreting the data, which confirms the data of the world literature on the complexity of the differential diagnosis of microcarcinomas. 


2020 ◽  
Vol 61 (3) ◽  
pp. 440-446 ◽  
Author(s):  
Ryoko Suzuki ◽  
Masahiro Yoshida ◽  
Masahiko Oguchi ◽  
Yasuo Yoshioka ◽  
Kenji Tokumasu ◽  
...  

Abstract Many patients with positive margins following breast-conserving surgery (BCS) undergo re-excisions that aim to remove residual disease from the breast, which brings a tremendous emotional burden in addition to financial consequences. We sought to determine whether re-excisions could be safely avoided without compromising local control and survival by using whole-breast radiation therapy (WBRT) with a tumor bed boost in patients with early-stage breast cancer with focally positive, tumor-exposed margins after BCS. All patients with ductal carcinoma in situ (DCIS) and/or invasive breast cancer (IBC) who had pathologically tumor-exposed margins following BCS, without re-excision and treated with WBRT with tumor bed boost between March 2005 and December 2011, were included. The radiotherapy consisted of WBRT at a dose of 50 Gy in 25 fractions, followed by a tumor bed boost with an additional dose of 16 Gy in eight fractions. A total of 125 patients fulfilled the eligibility criteria; of the 125 patients, 1 had bilateral breast cancer, resulting in 126 cases. Invasive disease was found in 102 (81%) cases and purely ductal carcinoma in situ (DCIS) disease in 24 (19%) cases. The 10-year ipsilateral breast tumor recurrence (IBTR) -free survival, progression-free survival (PFS), and 10-year overall survival (OS) rates were 95%, 92.5% and 96%, respectively. Patients with early-stage breast cancer who receive BCS and have focally positive, tumor-exposed margins can avoid re-excision by undergoing WBRT followed by a sufficient dose of tumor bed boost, without negatively impacting local control and survival.


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