scholarly journals BREAST CONSERVING SURGERY AWARENESS AND ACCEPTANCE AMONG FEMALE NURSES IN IRRUA SPECIALIST TEACHING HOSPITAL

2021 ◽  
Vol 2 (2) ◽  
pp. 138-152
Author(s):  
A. A. Okomayin ◽  
D. Brotobor ◽  
A. E. Onyeanusi ◽  
I. B. Alili
Keyword(s):  
Breast Cancer ◽  
Expert Opinion ◽  
Nursing Practice ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
Categorical Variables ◽  
P Value ◽  
Surgical Removal ◽  
Good Representation ◽  
Female Nurses

Introduction: Breast Conserving Surgery (BCS) is oncologically safe for eligible patients with breast cancer and has enormous physical and psychological benefits. Despite this, the mastectomy rate in many centres is still very high. Nurses are frontline staff in healthcare settings and have great contact with the patients. The level of their awareness would have a great impact on patients eligible for breast conservation seeking expert opinion. This study explored the awareness, perception and acceptance of BCS among female nurses in a rural Nigeria tertiary hospital. Methodology: A quasi-structured self-questionnaire was distributed to 235 nurses using a convenient sampling method. The responses on 219 adequately filled questionnaires were entered into an IBM SPSS Statistics Data Document (version 21.0) for analysis. Categorical variables were presented in counts and percentages. Association between the acceptance of BCS versus its awareness, equivalence to TM and years of nursing practice were tested using Chi-square probability test and a p-value of <0.05 was considered statistically significant. Result: The 219 participants had a good representation of junior and senior nurses among whom 80.4% were at least 45 years old and 82.2% were married. The nurses were mostly general nursing practitioners (76.7%) and 49.3% of the nurses had practised for a duration not less than 10 years of age. The 126 (57.5%) nurses, who described BCS as the surgical removal of a cancerous breast lump short of mastectomy, were considered to be aware of BCS irrespective of their understanding of complementary treatment modalities, eligibilities, comparative advantages to TM and certainty of its oncologic safety. The lack of ready access to radiotherapy centres (54.3%) and delay/overcrowding of these facilities (42.5%) were recognised respectively as major local challenges to BCS practices. The equivalence of BCS to TM was affirmed in 44.3% of the nurses and 35.6% had participated in managing breast cancer patients using the conservative surgical approach. 57.1% were willing to accept BCS or recommend it for an eligible friend or relative and no statistically significant association was observed among those who accepted BCS when matched with the level of awareness or the duration of nursing practice. A higher and significant level of acceptance of BCS was noted among those aware of its oncologic equivalence to TM (p-value = 0.000) Conclusion: This study demonstrated gaps in knowledge of BCS among nurses who are stakeholders in assisting patients make the right decision. This knowledge gap in the perception of BCS will interfere with the ability of the nurse to adequately counsel patients in need of their expert opinion. The awareness of the oncologic equivalence of BCS to TM increased its acceptance significantly. An increase in public awareness and education of nurses is required to improve the acceptance rate of BCS in our practice. Caregivers should also devise effective means of communication to encourage eligible patients for breast conservation

Axillary Metastasis with Occult Primary Breast Cancer

2017 ◽  
Author(s):  
Anne Kuritzky ◽  
Laila Khazai ◽  
Roberto Diaz ◽  
Christine Laronga
Keyword(s):  
Breast Cancer ◽  
Primary Breast Cancer ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Clinical Trial Data ◽  
Breast Conserving Surgery ◽  
Endocrine Treatment ◽  
Axillary Lymph ◽  
Axillary Metastasis ◽  
Cancer Breast

The identification of an axillary metastasis in the absence of a primary breast cancer can pose a diagnostic and therapeutic dilemma. The clinician should first use more sensitive imaging modalities, such as breast magnetic resonance imaging, to attempt to find the primary index lesion. If the primary cancer remains occult and the molecular markers are consistent with a breast origin, then the recommended treatment includes multimodality therapy including surgery, chemotherapy/endocrine treatment, and radiation. Historically, the modified radical mastectomy was the standard of practice. Recently, in the era of improved adjuvant therapies, breast-conserving surgery with irradiation is also being considered. Multiple retrospective reviews have shown no difference in survival or recurrence with these two surgical pathways. However, due to the rare nature of this clinical presentation, no multiinstitutional or prospective clinical trial data are available.  Key words: axillary lymph node dissection, axillary metastasis, breast cancer, breast conservation, local recurrence, occult primary tumor, radiotherapy 

scholarly journals Multifocal and multicentric breast cancer, is it time to think again?

2020 ◽  
Vol 102 (1) ◽  
pp. 62-66 ◽  
Author(s):  
YA Masannat ◽  
A Agrawal ◽  
L Maraqa ◽  
M Fuller ◽  
SK Down ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
Disease Recurrence ◽  
Locoregional Control ◽  
Current Evidence ◽  
Multicentric Breast Cancer ◽  
Risk Of Disease ◽  
Short Narrative

Multifocal multicentric breast cancer has traditionally been considered a contraindication to breast conserving surgery because of concerns regarding locoregional control and risk of disease recurrence. However, the evidence supporting this practice is limited. Increasingly, many breast surgeons are advocating breast conservation in selected cases. This short narrative review summarises current evidence on the role of surgery in multifocal multicentric breast cancer and shows that when technically feasible the option of breast conservation is oncologically safe.

Ten-Year Multi-Institutional Results of Breast-Conserving Surgery and Radiotherapy in BRCA1/2-Associated Stage I/II Breast Cancer

2006 ◽  
Vol 24 (16) ◽  
pp. 2437-2443 ◽  
Author(s):  
Lori J. Pierce ◽  
Albert M. Levin ◽  
Timothy R. Rebbeck ◽  
Merav A. Ben-David ◽  
Eitan Friedman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
Breast Conservation Surgery ◽  
Breast Cancers ◽  
Mutation Status ◽  
High Risk Women ◽  
Mutation Carriers ◽  
Significant Difference

Purpose We compared the outcome of breast-conserving surgery and radiotherapy in BRCA1/2 mutation carriers with breast cancer versus that of matched sporadic controls. Methods A total of 160 BRCA1/2 mutation carriers with breast cancer were matched with 445 controls with sporadic breast cancer. Primary end points were rates of in-breast tumor recurrence (IBTR) and contralateral breast cancers (CBCs). Median follow-up was 7.9 years for mutation carriers and 6.7 years for controls. Results There was no significant difference in IBTR overall between carriers and controls; 10- and 15-year estimates were 12% and 24% for carriers and 9% and 17% for controls, respectively (hazard ratio [HR], 1.37; P = .19). Multivariate analyses for IBTR found BRCA1/2 mutation status to be an independent predictor of IBTR when carriers who had undergone oophorectomy were removed from analysis (HR, 1.99; P = .04); the incidence of IBTR in carriers who had undergone oophorectomy was not significantly different from that in sporadic controls (P = .37). CBCs were significantly greater in carriers versus controls, with 10- and 15-year estimates of 26% and 39% for carriers and 3% and 7% for controls, respectively (HR, 10.43; P < .0001). Tamoxifen use significantly reduced risk of CBCs in mutation carriers (HR, 0.31; P = .05). Conclusion IBTR risk at 10 years is similar in BRCA1/2 carriers treated with breast conservation surgery who undergo oophorectomy versus sporadic controls. As expected, CBCs are significantly increased in carriers. Although the incidence of CBCs was significantly reduced in mutation carriers who received tamoxifen, this rate remained significantly greater than in controls. Additional strategies are needed to reduce contralateral cancers in these high-risk women.

Letrozole Is More Effective Neoadjuvant Endocrine Therapy Than Tamoxifen for ErbB-1– and/or ErbB-2–Positive, Estrogen Receptor–Positive Primary Breast Cancer: Evidence From a Phase III Randomized Trial

2001 ◽  
Vol 19 (18) ◽  
pp. 3808-3816 ◽  
Author(s):  
Matthew J. Ellis ◽  
Andrew Coop ◽  
Baljit Singh ◽  
Louis Mauriac ◽  
Antonio Llombert-Cussac ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tyrosine Kinases ◽  
Primary Breast Cancer ◽  
Breast Conservation ◽  
Growth Factor Receptor ◽  
Tamoxifen Resistance ◽  
Breast Conserving Surgery ◽  
Phase Iii ◽  
Neoadjuvant Endocrine Therapy ◽  
Double Blinded

PURPOSE: Expression of ErbB-1 and ErbB-2 (epidermal growth factor receptor and HER2/neu) in breast cancer may cause tamoxifen resistance, but not all studies concur. Additionally, the relationship between ErbB-1 and ErbB-2 expression and response to selective aromatase inhibitors is unknown. A neoadjuvant study for primary breast cancer that randomized treatment between letrozole and tamoxifen provided a context within which these issues could be addressed prospectively. PATIENTS AND METHODS: Postmenopausal patients with estrogen– and/or progesterone receptor–positive (ER+ and/or PgR+) primary breast cancer ineligible for breast-conserving surgery were randomly assigned to 4 months of neoadjuvant letrozole 2.5 mg daily or tamoxifen 20 mg daily in a double-blinded study. Immunohistochemistry (IHC) for ER and PgR was conducted on pretreatment biopsies and assessed by the Allred score. ErbB-1 and ErbB-2 IHC were assessed by intensity and completeness of membranous staining according to published criteria. RESULTS: For study biopsy-confirmed ER+ and/or PgR+ cases that received letrozole, 60% responded and 48% underwent successful breast-conserving surgery. The response to tamoxifen was inferior (41%, P = .004), and fewer patients underwent breast conservation (36%, P = .036). Differences in response rates between letrozole and tamoxifen were most marked for tumors that were positive for ErbB-1 and/or ErbB-2 and ER (88% v 21%, P = .0004). CONCLUSION: ER+, ErbB-1+, and/or ErbB-2+ primary breast cancer responded well to letrozole, but responses to tamoxifen were infrequent. This suggests that ErbB-1 and ErbB-2 signaling through ER is ligand-dependent and that the growth-promoting effects of these receptor tyrosine kinases on ER+ breast cancer can be inhibited by potent estrogen deprivation therapy.

scholarly journals Review of Breast Conservation Therapy: Then and Now

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-13 ◽  
Author(s):  
Susan Hoover ◽  
Elizabeth Bloom ◽  
Sunil Patel
Keyword(s):  
Breast Cancer ◽  
State Of The Art ◽  
Breast Conservation ◽  
Breast Conservation Therapy ◽  
Breast Conserving Surgery ◽  
Breast Irradiation ◽  
Improved Outcomes ◽  
Breast Preservation ◽  
Hormonal Therapies ◽  
Local Regional Recurrence

Breast conservation therapy (BCT), which is the marriage of breast conserving surgery and radiation therapy to the breast, has revolutionized the treatment of breast cancer over the last few decades. Surgical direction had seen a heightened interest in the performance of cosmetically superior partial and segmental resections in breast conservation as well as increased demand by patients for breast preservation. The broadening of approaches to delivery of breast irradiation from whole breast to accelerated partial breast has allowed more patients to opt for breast conservation and allowed for what appears to be comparable measurable outcomes in emerging data. As well, the addition of state-of-the-art chemotherapeutic and hormonal therapies has allowed improved outcomes of patients from both local regional recurrence and overall survival standpoints. This paper will provide an overview of BCT and review some of the newest developments in optimizing this therapy for patients with breast cancer from a surgical-, medical-, and radiation-oncology standpoint.

scholarly journals Inequalities in breast-conserving surgery for female breast cancer in Świętokrzyskie Province, Poland

2021 ◽  
Author(s):  
Agnieszka Paszko ◽  
Dominik Maślach ◽  
Małgorzata Żendzian-Piotrowska ◽  
Michalina Krzyżak
Keyword(s):  
Breast Cancer ◽  
Rural Women ◽  
Rural Areas ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
Female Breast Cancer ◽  
Breast Conservation Surgery ◽  
Disease Stage ◽  
Age Group ◽  
Breast Radiotherapy

Introduction: Breast cancer is the most common cancer among women in the world. Differences in the treatment of breast cancer may be observed by age, disease stage, place of residence and comorbid conditions. Aim: The aim of the study was to analyse the differences in the use of breast-conserving surgery among women in the Świętokrzyskie Province. Material and methods: The study included 483 female residents of Świętokrzyskie Province who were diagnosed with invasive breast cancer in 2013. Following indicators, recommended to evaluate the compliance with the best oncology practice, were calculated: a proportion of patients receiving post-operative breast radiotherapy after the breast-conserving surgery and a proportion of the breast-conservation surgery in pT1 cases. Results and discussion: The difference in the distribution of surgical procedures by age group (breast-conserving surgery vs. mastectomy) in pT1 cases was statistically significant (P = 0.006). The highest values of both indicators were observed in the age group recommended for breast cancer screening in Poland, while the lowest in women 70 years of age and older. Our study revealed a non-significantly higher proportion of patients receiving post-operative breast radiotherapy after breast conserving-surgery in urban than in rural women, amounting to 36.5% and 29.4%, respectively. Conclusions: Existing inequalities in the use of breast-conserving surgery indicate the need to consider the recommended breast cancer treatment to the highest possible proportion of patients residing in rural areas.

Preoperative dose-dense sequential chemotherapy of epirubicin/cyclophosphamide followed by docetaxel/capecitabine in patients with early breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10598-10598
Author(s):  
S. Iacobelli ◽  
E. Cianchetti ◽  
C. Ficorella ◽  
D. Angelucci ◽  
S. Grossi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Preoperative Chemotherapy ◽  
Pathologic Complete Response ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
High Rate ◽  
Response To Treatment ◽  
Sequential Chemotherapy ◽  
Dose Dense

10598 Background: The use of preoperative chemotherapy for breast cancer has been shown to result in similar disease-free and overall survival as postoperative adjuvant chemotherapy. Additionally, the rate of pathologic complete response (pCR) in the breast after preoperative chemotherapy has been shown to correlate with survival. The objective of this study was to evaluate the activity and safety of a dose-dense and sequential chemotherapy of epirubicin/cyclophosphamide (EC) followed by docetaxel/capecitabine (DXe) given preoperatively in patients with early breast cancer not candidate to breast-conserving surgery. Methods: Forty-one women with histologically/cytologically confirmed primary breast cancer (T2–3, N0–2, M0) received 4 cycles of EC (cyclophosphamide, 600 mg/m2 and epirubicin, 90 mg/m2) q2 weeks followed by two cycles of DXe (docetaxel, 36 mg/m2 days 1, 8, and 15 and capecitabine, 1250 mg/m2 days 5–18) q 28 days, with pegfilgrastim support. The study was designed as a Simon’s two-step phase II study. The primary end point of the study was the incidence of pCR defined as the absence of invasive cancer in the breast at definitive surgery. Results: Thirty-nine out of 41 enrolled patients were evaluable for response to treatment (one patient withdrew from the study for G4 neutropenia after the first EC cycle, and the other for therapy refusal after the 4 EC cycles). A pCR was observed in 10 patients for a total pCR rate of 25.6%. Interestingly, all but one of the 10 pCR cases showed ER/PR-negative/Her2-positive tumors. A clinical response (CR or PR) detected by palpation and by imaging was observed in 37 patients, for an overall response rate of 95%. Twenty-nine patients (75%) underwent breast-conserving surgery. The treatment was well tolerated: one patient experienced G3 mucositis and another patient required a 25% dose reduction of capecitabine because of hand-foot syndrome. There was no case of cardiac toxicity, thrombocytopenia or any other serious adverse event. Conclusions: The dose-dense sequential combination EC/DXe is endowed with good antitumor activity and limited toxicity, allowing a high rate of pCR and breast conservation. Thus, this regimen can be considered for further clinical trial. No significant financial relationships to disclose.

Predictors of adjuvant radiation therapy in the treatment of male breast cancer and its impact on outcomes: A propensity matched analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12516-e12516
Author(s):  
Veli Bakalov ◽  
Thejus Thayyil Jayakrishnan ◽  
Stephen Abel ◽  
Christie Hilton ◽  
Bindu Rusia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Male Breast Cancer ◽  
Cox Regression ◽  
Breast Conservation ◽  
Male Breast ◽  
Breast Conservation Surgery ◽  
P Value ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy

e12516 Background: Male breast cancer (MBC) accounts for 1% of all breast cancers and there is a paucity of data on factors impacting the treatment strategies and outcomes. We hypothesized that adjuvant radiation therapy (Adj-RT) may improve survival outcomes and sought to examine predictive factors for Adj-RT receipt. Methods: We queried the National Cancer Database (NCDB) for patients with stages I-III MBC treated with surgery (breast conservation surgery- BCS or mastectomy-MS) within 180 days of diagnosis (years 2004-2015). Multivariable logistic regression identified predictors of adjuvant radiation therapy receipt. Multivariable Cox regression evaluated predictors of survival. Propensity matching for adj-RT accounted for indication biases. Results: We identified 6,217 patients meeting the eligibility criteria (1457 BCS vs. 4760 MS). The majority of patients were white (85%) and within the age range of 50-80 years (74%). Although Adj-RT was omitted for 30% of BCS patients, the utilization was higher compared to MS (OR=26, p-value=0.001). The predictors of Adj-RT use were – African American race, higher stage, higher grade, presence of lymphovascular invasion and ER/Her-2 positivity for the entire cohort and higher age, urban location and higher income for BCS. Adj-RT was associated with lower mortality in the propensity matched model (overall HR for BCS=0.28, p-value<0.001; overall HR for MS=0.62,p-value=0.001) and is shown in the table. Conclusions: This study demonstrates there may be an association between decreased mortality and Adj-RT in MBC undergoing BCS. Although this implies that Adj-RT should be routinely delivered, it appears to be omitted frequently and its use requires further investigation. The study also suggests a benefit to Adj-Rt after MS for stage-III MBC. [Table: see text]

A COMPARATIVE STUDY OF COMPLICATIONS OF MRM (MODIFIED RADICAL MASTECTOMY) VERSUS BCS (BREAST CONSERVATION THERAPY) IN EARLY INVASIVE BREAST CANCER. A RESULT FROM SAVERA CANCER AND MULTISPECIALITY HOSPITAL PATNA, BIHAR.

2021 ◽  
pp. 66-67
Author(s):  
Vijay Pratap Singh ◽  
Akash Singh ◽  
Pranab Kumar Verma ◽  
Vishal Mohan Singh ◽  
Arun Kumar Jha
Keyword(s):  
Breast Cancer ◽  
Statistical Analysis ◽  
Breast Tissue ◽  
Breast Conservation ◽  
Surgical Margin ◽  
Radical Mastectomy ◽  
P Value ◽  
Shoulder Dysfunction ◽  
The Difference

Background: Early breast cancer patients admitted in the surgical oncology department of Savera Cancer and Multispeciality Hospital. Patients were divided in two treatment arms; Arm A and Arm B. Arm A patient went through MRM and Arm B patients went through BCS. This study included prospective cases of 1 year from June 2019 to June 2020. Method: In all MRM group patients all breast tissue, skin, nipple areola complex and level 1, 2, 3 lymph nodes removed. In all BCS group patients lump was removed with an envelope of normal appearing breast tissue. In all resected specimens free surgical margin was ensured via histopathology reports (HPR). Patients were reviewed in early post operative period for complications and follow up done at the end of 1st, 3rd, 6th and 12th month for recurrence. In treatment Arm A (MRM) 08 patients developed arm ede Result: ma; 05 patients developed shoulder dysfunction; 07 patients developed ap necrosis; 07 patients developed arm dysesthesia. Whether in treatment ARM B (BCT) 04 patient had Seroma formation; 13 patients developed wound infection & wound contracture. Complications were reported in 35% of MRM group (35 out of 100 cases), while they were absent in 65% (65 out of 100). However, in the BCS group, complications were reported in 6.66% cases only (15 out of 100 cases), while were absent in 93.33% (75 out of 100). P value by statistical analysis being 0.283, the difference being statistically insignicant. Recurrence were present in 6.66% of MRM group (8/100) while they were absent in 92.34 % (92/100). However in BCS group recurrences were present in 3.33 % (3/100) and were absent in 97.67% (97/100). P value by statistical analysis being 1, the difference being statistically insignicant. Grading of complications has been captured from CTCAE Version 5.0 (Common Terminology Criteria for Adverse Events). Conclusion: There is slight signicant difference in the recurrence rate, whether the patient had undergone BCS or MRM based on our short term follow-up. However a long term follow-up is required.

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