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Query: UMLS:C0006142 (breast cancer)
 160,383 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sera and effusion fluids of patients with breast cancer (BC) contain immune complexes (IC). Antigens present in these complexes were isolated as follows: a pool of effusions from patients with BC was fractionated with ammonium sulfate. The proteins precipitating at 40% saturation were further fractionated by filtration through a Sephadex G-200 column. The material recovered in the first peak (molecules larger than monomeric IgG) was brought to pH 3.0 to dissociate the IC, and the mixture was filtered through a column of Sephacryl S-300 at pH 3.0. Proteins smaller than monomeric IgG were collected, radioiodinated, and used as antigens (125Ag) to search for corresponding antibodies in sera of patients with BC (BCS) and of healthy individuals (NHS). 125Ag was reacted with the sera and the immune complexes obtained were precipitated with an antiserum to human Ig and analyzed by SDS-polyacrylamide gel electrophoresis followed by autoradiography. Both NHS and BCS contained antibodies against two antigens; one of these appeared as a strong band of 17KD, the other as a doublet of approximately 25KD. It is concluded that some of the proteins in the IC from patients with BC are auto-antigens. No BC-specific antigens were identified.
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PMID:Antigens in immune complexes from patients with breast cancer. Identification of autoantigens in immune complexes isolated from breast cancer effusions. 692 80

A retrospective review was conducted of all early-stage breast cancer patients treated with breast-conservation surgery plus radiation therapy (BCS/RT) to determine mortality and recurrence rates and to evaluate prognostic factors for these outcomes. Between 1982 and 1988, 121 patients with stages I and II breast cancer were treated with BCS/RT at our institution. Most of the patients (83%) had re-excision of the initial biopsy site and at final surgical evaluation, only 4 patients had positive margins (3.2%). Median follow-up was 89.7 months. Cox proportional hazards regression models were used to select prognostic factors significant for breast cancer-specific mortality, overall disease recurrence, and local recurrence. Breast cancer survival rates were 92% at 5 years and 83% at 10 years. Prognostic factors predicting breast cancer mortality included positive lymph nodes (relative risk=.9; 95% confidence interval, 1.2,12.2) and a higher grade (relative risk=1.9; 95% confidence interval, 1.1,3.3). For disease recurrence, prognostic factors included positive nodes (relative risk=2.6; 95% confidence interval, 1.2, 5.5), and a negative progesterone-receptor status (relative risk=0.3; 95% confidence interval, 0.2, 0.8). Local recurrence rates were 2.5% at 5 years and 14% at 10 years. No prognostic factors were significant for local recurrence; however, most patients had negative margins after surgery.
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PMID:Prognostic factors after conservative surgery and radiation therapy for early stage breast cancer. 953 92

One of the etiologic factors involved in local recurrence after breast-conserving surgery may be malignant seeding of the wound during the lumpectomy procedure. A total of 340 patients with stage I and II breast cancer were entered into the study. Of these, 270 patients received breast-conserving surgery (BCS group), and the other 70 patients underwent mastectomy (control group). After resection, lavage cytology was performed at the surgical wound. There were 55 patients (20.4%) who showed positive lavage cytology in the BCS group. In the control group, there were only 3 patients (4.3%) with positive cytology. Positivity was significantly higher in the former group (p = 0.00064). Patients with evidence of cutting across cancer lesions showed significantly higher positive rates in lavage cytology (p < 0.00001). Positivity in lavage cytology was significantly higher in patients with positive surgical margins evaluated by frozen sections (p = 0.0017), touch cytology (p < 0.0001) and formalin-fixed, paraffin-embedded sections (lateral or medial margin; p = 0.0036, anterior and posterior margin: p = 0.0210). The positivity was also significantly higher in patients with an extensive intraductal component (p < 0.0001), and less than or equal to 50 (p = 0.0061) years of age. Multivariate analysis revealed that the highest relative risk factor for positive cytology was evidence of cutting across cancer lesions (relative risk = 8. 166; p < 0.00001).
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PMID:Malignant seeding of the lumpectomy cavity upon breast-conserving surgery. 1046 Oct 58

The 1992 NIH Consensus Development Conference reported that "breast conservation treatment is an appropriate method of primary therapy for the majority of women with stage I and II breast cancer and is preferable because it provides survival equivalent to total mastectomy and axillary dissection while preserving the breast." This conclusion has been solidly confirmed by recent updates of all of the prospective clinical trials performed. The uneven utilization of this BCS indicates the personal discomfort of some surgeons in recommending it or in communicating their recommendations to patients. The appropriate candidate for mastectomy is the patient in whom it is evident that BCS will not control the tumor. This conclusion may be drawn after one or even two attempts at revision have shown more extensive microscopic disease. The experience with preoperative chemotherapy programs such as NSABP Protocol B-18 shows that even for larger tumors primary excision or excision after preoperative chemotherapy provides reasonable rates of local control with no evidence of diminished distant control or survival. Very large tumors, often accompanied by other grave signs, are best treated by primary chemotherapy, because they are essentially not stage I or stage II disease. Although recognizing that better long-term cure rates are a function of the treatment of micrometastases with adjuvant chemotherapy, surgeons should remember the need to balance cosmetic factors with techniques required for good local control. Cosmetic factors are always important, but the primary concern is adequate removal of the primary tumor with pathologically negative margins. The best way to prevent the need for a salvage mastectomy following local recurrence is to obtain adequate control at the initial procedure, but this does not mean that aggressive local surgery is needed, and it certainly does not mean that a primary mastectomy is needed except in unusual cases.
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PMID:Surgical considerations for invasive breast cancer. 1057 49

Radiotherapy following breast-conserving surgery for the treatment of first primary breast cancer is the standard of care and is widely used despite its small survival benefit. The effects of radiotherapy in metachronous contralateral breast cancer are unknown. We examined the use of radiotherapy and its effect on cause-specific and all-cause mortality among women with metachronous contralateral breast cancer treated with breast-conserving surgery in community settings. Using data from the 1985-2000 Surveillance, Epidemiology, and End Results program, we identified women with stage 0-III metachronous contralateral breast cancer that occurred at least six months after stage 0-III first primary breast cancer. Cause-specific and all-cause mortality of women age 40-69 who did and who did not receive radiotherapy following breast-conserving surgery for metachronous contralateral breast cancer were compared in proportional hazard models using propensity scores to balance covariates by radiotherapy use. We adjusted for misclassification of radiotherapy use. Based on misclassification-corrected analyses, 43.2 percent of 1,083 women with metachronous contralateral breast cancer did not receive radiotherapy after BCS. After adjustment for propensity scores and radiotherapy misclassification, women who did not receive radiotherapy had 2.2 times greater risk of cause-specific and 1.7 times greater risk of all-cause mortality. In community settings, a high percentage of women with stage 0-III metachronous contralateral breast cancer did not receive radiotherapy following breast-conserving surgery. Unlike the small survival benefit of radiotherapy after first primary breast cancer, omission of radiotherapy after metachronous contralateral breast cancer significantly increased the risk of cause-specific and all-cause mortality.
Breast Cancer Res Treat 2007 May
PMID:The effects of radiotherapy for the treatment of contralateral breast cancer. 1703 21

We evaluated the contribution of an epirubicin-based adjuvant chemotherapy on disease-free survival (DFS) in poor prognosis, node-negative breast cancer (BC) patients. Poor prognostic factors were defined as: pathologic tumor size >or= 4 cm, estrogen-receptor negative, and progesterone-receptor negative. Scarff-Bloom Richardson grade 2 tumors must have two of these factors, and only one in case of grade 3. Between 1988 and 1994, 328 patients were randomized to receive either no systemic treatment (control, n = 161), or fluorouracil 500 mg/m(2), epirubicin 50 mg/m(2), cyclophosphamide 500 mg/m(2), 6 cycles every 21 days (FEC50, n = 167), without any hormonal treatment. The median follow up was 114 months. The 10-year DFS rates were 64 and 71%, respectively (p = 0.23). In the Cox regression model, independent prognostic factors of relapse were the number of nodes examined < 10 (p = 0.002), BCS (p = 0.01), and premenopausal status (p = 0.04). In this model, the relative risk of relapse was 1.46 (CI95 %: 1.05-1.87) in favor of FEC50. In patients who underwent BCS, 21 % developed a local relapse (24 versus 18 %, respectively). The 10-year local DFS was 70.5 and 79.3 %, respectively (p = 0.27). The 10-year overall survival was not different (74.1 versus 70.7 %, p = 0.82). After 10 years of follow-up, the FEC50 regimen reduced the risk of relapse in poor-prognosis node-negative BC patients. The incidence of local relapse was high, and probably related to inclusion criteria. Epirubicin was probably underdosed in such patients, and ongoing studies using 100 mg/m(2) of epirubicin will give us the answer in a near future.
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PMID:Epirubicin-based chemotherapy as adjuvant treatment for poor prognosis, node-negative breast cancer: 10-year follow-up results of the French Adjuvant Study Group 03 trial. 1707 56

The invasive disease free survival, the overall survival, and the relative risk of death compared to the Danish population as well as the risk of recurrence and new malignancies is reported for low-risk breast cancer patients of the DBCG 89-A programme. The study includes a comparison between those patients who, according to the present criteria, would be defined low-risk and those who would be defined high-risk (the retrospective lowhigh-risk group) and a comparison of treatment by mastectomy and BCS combined with radiation therapy. The DBCG 89-A programme scheduled 10 years of follow-up. Data was supplemented by record linkage to the Hospital Discharge Registry (date of event) and the Central Population Registry (date of death). The study population consisted of 8 850 patients. With 12 years of follow-up 3 811 events (43%) were recorded: loco-regional recurrence 8%, distant recurrence 11%, contralateral cancer 6%, secondary cancer 8%, and deaths 11%. The DBCG registry had an incomplete reporting of events in these low-risk patients, due to premature discontinuation of control. The incidence of recurrences was higher for the retrospective low --> high-risk group than for the low-risk group. The 10-year overall survival was 76%; lower in the retrospective low --> high-risk group (71%) than in the low-risk group (83%). The 5-year survival following local recurrence was 68% after mastectomy and 81% after BCS. The risk of mortality was higher than in the general population for all subgroups of patients. The relative risk of mortality expressed in terms of the standardized mortality ratio was 10.4 for young patients (26-39 years) and 1.2 for old patients aged 70-74 years and 1.3 for patients in the retrospective low-risk group and 1.9 for patients in the low --> high-risk group. The loco-regional treatment given did not cure all patients, in particular young patients and those of the retrospective low --> high-risk group.
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PMID:Recurrence pattern and prognosis in low-risk breast cancer patients--data from the DBCG 89-A programme. 1846 37

Administrative data may provide valuable information for monitoring the quality of care at population level and offer an efficient way of gathering data on individual patterns of care, and also to shed light on inequalities in access to appropriate medical care. The aim of the study was to investigate the role of patient and hospital characteristics in the initial treatment of early breast cancer using administrative data. Incident breast cancer patients were identified from hospital discharge records and linked to the radiotherapy outpatient database during 2000-2004 in the Piedmont region of Northwestern Italy. Women treated with breast-conserving surgery followed by radiotherapy (BCS + RT) were compared to those treated with BCS without radiotherapy (BCS w/o RT) or mastectomy using multinomial logistic regression models. Out of 16,022 incident cases, 46.2% received BCS + RT, 20.3% received BCS w/o RT, and 33.5% received a mastectomy. Compared to BCS + RT, the factors associated with BCS w/o RT were: increased age (OR = 1.54; 95% CI = 1.29-1.85, for ages 70-79 vs. <50), being unmarried (1.24; 1.13-1.36), presence of co-morbidities (1.32; 1.10-1.58), being treated at hospitals with low surgical volume (1.31; 1.07-1.60 for hospitals with less than 50 vs. > or =150 interventions/year), and living far from radiotherapy facilities (1.75; 1.39-2.20 for those at a distance of >45 min). These same factors were also associated with mastectomy. During the 5-year period observed, there was a trend of reduced probability of receiving a mastectomy (0.70; 0.56-0.88 for 2004 vs. 2000). The presence or absence of nodal involvement was positively associated with mastectomy (2.28; 1.83-2.85) and negatively associated with BCS w/o RT (0.65; 0.56-0.76). After adjustment for potential confounders, education level did not show any association with the type of treatment. Social and geographical factors, in addition to hospital specialization, should be considered to reduce inappropriateness of care for breast cancer.
Breast Cancer Res Treat 2009 Sep
PMID:Appropriateness of early breast cancer management in relation to patient and hospital characteristics: a population based study in Northern Italy. 1905 Oct 8

The analysis of point-level (geostatistical) data has historically been plagued by computational difficulties, owing to the high dimension of the nondiagonal spatial covariance matrices that need to be inverted. This problem is greatly compounded in hierarchical Bayesian settings, since these inversions need to take place at every iteration of the associated Markov chain Monte Carlo (MCMC) algorithm. This paper offers an approach for modeling the spatial correlation at two separate scales. This reduces the computational problem to a collection of lower-dimensional inversions that remain feasible within the MCMC framework. The approach yields full posterior inference for the model parameters of interest, as well as the fitted spatial response surface itself. We illustrate the importance and applicability of our methods using a collection of dense point-referenced breast cancer data collected over the mostly rural northern part of the state of Minnesota. Substantively, we wish to discover whether women who live more than a 60-mile drive from the nearest radiation treatment facility tend to opt for mastectomy over breast conserving surgery (BCS, or "lumpectomy"), which is less disfiguring but requires 6 weeks of follow-up radiation therapy. Our hierarchical multiresolution approach resolves this question while still properly accounting for all sources of spatial association in the data.
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PMID:Hierarchical Multiresolution Approaches for Dense Point-Level Breast Cancer Treatment Data. 1915 42

PURPOSE Few data are available on breast cancer characteristics, treatment, and survival for women age 80 years or older. PATIENTS AND METHODS We used the linked Surveillance, Epidemiology and End Results-Medicare data set from 1992 to 2003 to examine tumor characteristics, treatments (mastectomy, breast-conserving surgery [BCS] with radiation therapy or alone, or no surgery), and outcomes of women age 80 years or older (80 to 84, 85 to 89, > or = 90 years) with stage I/II breast cancer compared with younger women (age 67 to 79 years). We used Cox proportional hazard models to examine the impact of age on breast cancer-related and other causes of death. Analyses were performed within stage, adjusted for tumor and sociodemographic characteristics, treatments received, and comorbidities. Results In total, 49,616 women age 67 years or older with stage I/II disease were included. Tumor characteristics (grade, hormone receptivity) were similar across age groups. Treatment with BCS alone increased with age, especially after age 80. The risk of dying from breast cancer increased with age, significantly after age 80. For stage I disease, the adjusted hazard ratio of dying from breast cancer for women age > or = 90 years compared with women age 67 to 69 years was 2.6 (range, 2.0 to 3.4). Types of treatments received were significantly associated with age and comorbidity, with age as the stronger predictor (26% of women age > or = 80 years without comorbidity received BCS alone or no surgery compared with 6% of women age 67 to 79 years). CONCLUSION Women age > or = 80 years have breast cancer characteristics similar to those of younger women yet receive less aggressive treatment and experience higher mortality from early-stage breast cancer. Future studies should focus on identifying tumor and patient characteristics to help target treatments to the oldest women most likely to benefit.
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PMID:Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. 2030 51


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