Biomedical subjects

S Ciatto

Publications and source records attributed to S Ciatto.

At least 181 records · Page 10Linked to original sources

PubMed1986

New trends in the surgical treatment of primary breast cancer in the Florence District: 1979-1985.

The authors report on a consecutive series of 1979 TIS-T1A-T2A-T3A breast cancer cases surgically treated from 1979 to 1985. The study investigates the impact of recent reports on conservative surgery and of a national treatment protocol for breast cancer, encouraging the use of modified radical mastectomy (MRM) and quadrantectomy, axillary dissection and breast irradiation (QUART) as alternatives to Halsted's radical mastectomy (RM). RM frequency dropped from 52% to 8% in TIS-T1A and from 82% to 20% in T2A-T3A cases in the study period, in favor of MRM and of QUART, which increased from 10% to 54% in TIS-T1A cases. Although surgical choices differ widely according to individual surgeons, a definite trend towards more conservative surgery is evident, which demonstrates how the national treatment protocol has affected current surgical practice.

Breast↗

PubMed1986

A case-control study of the efficacy of a non-randomized breast cancer screening program in Florence (Italy).

In a rural area near Florence a population-based screening program for breast cancer was started in 1970, offering a mammography test every 2.5 years to all women between 40 and 70 years of age. In order to evaluate the efficacy of this program a case-control study has been carried out comparing the screening history of all women who died from breast cancer in this area in the years 1977-1984, and who had been diagnosed after the start of the program, with that of a matched group of living controls. The case-control study showed that the overall O.R. of dying from breast cancer in the study period for "screened" versus "never-screened" women was 0.53 (95% C.I. = 0.29-0.95). After evaluation of other variables as potential confounders the adjusted O.R. estimates were respectively 0.57 (95% C.I. = 0.35-0.92) and 0.32 (95% C.I. = 0.20-0.52) for women screened only once or at least twice. No significant protective effect was shown for women below the age of 50 years.

Adult↗

PubMed1986

Cost-effectiveness of chest X-ray follow-up of patients treated for seminoma of the testis.

The authors report on a consecutive series of 253 cases of seminoma of the testis followed with periodic chest X-ray examinations from a minimum of three to a maximum of 27 years. The detection rate of asymptomatic intrathoracic metastases (ITM) was considered together with the costs of the follow-up procedure. Chest X-ray follow-up is not advisable beyond one year from primary treatment, since most (14 of 18) ITM occur in the first year, the detection rate of ITM beyond this date is too low (0.11% patients/year), and the related costs are too high (over $130,000 per ITM detected). Chest X-ray follow-up is questionable even in the first year after primary treatment for Stage I cases because of the low detection rate (1.38% patients/year) and the high costs (over $14,000 per ITM detected), whereas it appears to be opportune in Stages IIA and IIB.

Cost-Benefit Analysis↗

PubMed1986

Breast cancer risk factors in Italian women: a multicentric case-control study.

To evaluate the importance of several risk factors for breast cancer in the Italian female population, a large multicentric case-control study was conducted in 10 breast clinics in Italy. The study included 1,556 women affected by breast cancer, histologically and/or cytologically confirmed. Controls were 1,505 women admitted to a hospital in the same town, matched with cases for residence and with the same age distribution of the Italian female population. The risk factors considered in this study were family history of breast cancer, reproductive history, height and weight, use of oral contraceptives, other hormonal therapies and smoking history. The results of this study confirm the significant role of a positive family history of breast cancer (RR = 2.37); the relative risk was even higher when a first-degree relative was affected or the breast cancer was bilateral. The analysis of the reproductive history showed a significant trend of increasing risk with increasing age at first birth and, although less evident, with increasing number of children. Quetelet's index (kg/m-2) was positively correlated with breast cancer risk, mostly in postmenopausal women. Among other studied factors, only late age at menopause confirmed an increased risk for breast cancer, whereas age at menarche, use of oral contraceptives and smoking histories did not show any significant correlation with breast cancer risk. These results are in substantial agreement with other international studies, but represent an interesting contribution to studies about the Italian female population.

Abortion, Spontaneous↗

PubMed1986

Symptomatic recurrences of carcinoma of the rectum and sigmoid. The influence of radiotherapy on the quality of life.

One hundred forty-three patients irradiated for locoregional recurrences after curative surgery for cancer of the rectum and sigmoid were studied retrospectively. An analysis was made of the symptomatic response and survival in the total series and in three subgroups treated with different dose levels (40 Gy or lower, between 40 and 50 Gy, 50 Gy or higher). The symptom-free period was calculated as percent of the overall survival. Symptomatic control was obtained in 80.4 percent of the cases, and the crude patient survival rate was 17.5 percent at two years. No significant difference was found in the three subgroups treated with different dose levels. The cumulative time/patient asymptomatic periods in the total series and in the three subgroups were 31.5, 30.2, 31.8, and 31.9 percent respectively, of the survival period.

Adult↗

PubMed1986

Patterns of axillary metastases in breast cancer.

Thirty-seven (4.1%) cases of nodal metastases skipping the first level are reported in a consecutive series of 912 breast cancer axillary dissections including 392 N+ cases. First level nodes examination is sufficiently accurate in assessing the quality of nodal status (negative or positive) but not the extent of nodal involvement (number of involved nodes).

Axilla↗

PubMed1985

Early detection of breast cancer recurrences through periodic follow-up--is it useless?

The authors report on a multicentric consecutive series of 1120 breast cancer first recurrences. Cases detected as subjectively asymptomatic thanks to periodic follow-up examinations are compared to cases detected as symptomatic. The relapse-free interval from primary treatment was shorter for asymptomatic recurrences, confirming that an earlier diagnosis was achieved in these cases. In spite of this diagnostic anticipation, median and actuarial survival from primary treatment did not differ when asymptomatic recurrences were compared to symptomatic recurrences. The study results did not show any prognostic impact of periodic follow-up in breast cancer and urge for prospective controlled studies on this diffuse and expensive practice.

Breast Neoplasms↗

PubMed1985

Staging breast cancer--screening for occult metastases.

The authors report on 1,017 consecutive breast cancer cases without symptomatic metastases staged by means of chest X-ray (CXR), skeletal survey (BXR) and bone scintigraphy (BS). Occult metastases (DM) detection rate was 0.88%: 0.29% for lung and 0.59% for bone DM. The detection rate was correlated with clinical stage: 0.36% for stage I, 0.20% for stage II, 0.26% for stages I and II, and 2.77% for stage III cases. The sensitivity based on DM cases prevalent or surfacing within 6 months of follow-up was 0.30 for CXR, 0.22 for BXR and 0.55 for BS; specificity was 0.99, 0.98 and 0.90, respectively. The study confirms the possibility of early detection of DM with preoperative staging, but the extremely low detection rates in stage I and II cancers do not advise such a routine procedure. The higher detection rate of DM may suggest adoption of the routine staging procedure in stage III cancers. In these cases, although no evidence is available of a favorable prognostic impact of early detection and treatment of DM, an unnecessary mastectomy could be avoided in about 3% of cases in the presence of DM detected by the staging procedure.

Age Factors↗

PubMed1985

Circulating immune complexes (CIC) as tumor marker in the follow-up of breast cancer.

We report on the possible diagnostic and prognostic role of circulating immune complexes (CIC) determination in breast cancer. A sensitivity of 87% and a specificity of 90% were observed in a case-control study of 15 cancers and 25 noncancer healthy controls. A direct correlation of CIC level to the presence and probably to the entity of the tumor mass was assessed by comparing preoperative to postoperative CIC determinations in cancer cases: CIC levels were significantly lower after tumor removal. These preliminary results suggest further studies on the use of CIC determination in the follow-up of breast cancer for the early diagnosis of recurrent disease.

Adult↗

PubMed1984

Early detection of local recurrences in the follow-up of primary breast cancer.

The results of physical examination (PE) in the detection of local recurrences (LR) from breast cancer are reviewed in the follow-up experience of 1139 breast cancer patients. A minimum follow-up time of 5 years was considered. LR accounted for 40% of total first relapses and isolated (without distant metastases) LR represented about 1/3 of total relapses. The chest wall was the most frequent site of LR. The extent of LR was correlated with the probability of associated distant metastases detectable at the time of LR diagnosis, whereas no correlations were found with the presence or absence of subjective symptoms at diagnosis. The mean free interval from primary surgery was 3 months shorter for LR detected in asymptomatic phase than in the symptomatic phase. This difference increased to 5 months for recurrences detected in the first 2 years, when PE controls were repeated every 6 months whereas a smaller difference of 2 months was observed over 2 years with yearly controls. The mean and 5-year actuarial survival was better (75.5 vs. 64.9 months and 54% vs. 40%) for cases detected in the asymptomatic phase than in the symptomatic phase; however, the difference was not statistically significant for the small sample considered and could be even partially due to length biased sampling. On the basis of the reported results, PE should still be recommended as a follow-up test, although further studies are needed to assess its real impact on prognosis.

Breast Neoplasms↗

PubMed1983

Prognostic role of estrogen receptor determination in breast cancer.

The authors report on 283 primary, non-metastatic, breast cancer cases consecutively referred after surgery and followed-up from a minimum of 10 months to a maximum of 3.5 years. All cases were studied according to the presence of estrogen receptors (ER). ER presence was correlated with age and menstrual status, with ER+ cases more frequent in older patients. No correlation was found between ER and nodal status. Prognosis was evaluated in terms of disease-free survival at 2 years (actuarial method). No correlation between ER and survival was evident for N- cases, whereas a better prognosis was recorded for ER+N+ patients compared to ER-N+, although the difference was not statistically significant. The observed results are compared with recent literature data and agree with other recent reports, which did not confirm the previously undiscussed statement regarding the prognostic role of ER determination. According to these studies and to the present study, the prognostic role of ER determination seems at least questionable and particularly the postoperative adjuvant treatment of ER-N- cases should be reconsidered.

Adult↗

PubMed1983

Reasons for failure of physical examination in breast cancer detection (analysis of 232 false-negative cases).

The diagnostic role of physical examination (PE) is evaluated in 1450 cases of breast cancer detected in 34,677 women controlled at the Centro per lo Studio e la Prevenzione Oncologica in the period 1974-1981. In 47 cancer cases, PE findings were normal since the neoplasm was not clinically palpable because of its size and site, and in another 185 cases the clinical diagnosis was benignancy without evidence of suspect signs. Therefore, the overall sensitivity of PE was 84%. PE errors did not involve a therapeutic delay for the patient in 75% of cases in which a biopsy was recommended for clinical benignancy or for suspicion on the basis of other diagnostic methods. The present study confirms that PE has a good diagnostic sensitivity when the examined population is represented by self-referred women, who for the most part are symptomatic, whereas it cannot be considered as the only diagnostic test for early diagnosis in mass screening, since in asymptomatic women a large number of cancers are not clinically palpable. Moreover, PE shows lower sensitivity for small lesions and in younger women. Extensive use of fine needle aspiration cytology and other diagnostic methods in association with PE is therefore recommended to reduce the possibility of errors.

Adult↗

PubMed1983

The role of chest X-ray in the follow-up of primary breast cancer.

The results of chest X-ray (CXR) survey in the follow-up of 1697 breast cancer patients are reviewed. Intrathoracic metastases (ITM) accounted for 26% of total first recurrences, but the rate dropped to 13% if isolated ITM and to 7% if asymptomatic isolated ITM were considered. Thus the role of CXR survey was limited to the detection of 39 cases of isolated ITM in the asympatomatic phase out of 7100 patients-year for a total number of 11,543 CXR examinations. Moreover, no difference in mean survival was observed if symptomatic and asymptomatic ITM were considered and survival was calculated from the time of first treatment. A small gain of 3 months, not statistically significant, of mean life from metastases diagnosis was recorded for asymptomatic cases, which is probably entirely due to the lead time effect of anticipated diagnosis. CXR survey in breast cancer follow-up may add to the knowledge of the natural history of the disease, but it appears worthless for other purposes. Thus the high costs related to CXR survey may be unacceptable, and a randomized study on the role of CXR is suggested and justified.

Breast Neoplasms↗

PubMed1983

Glucose-6-phosphate dehydrogenase activity and estrogen receptors in human breast cancer.

Both estradiol receptors and glucose-6-phosphate dehydrogenase activity (G6PDH) were measured on the same tissue sample from 143 patients who had undergone mastectomy for primary breast cancer. G6PDH activity in the estrogen receptor positive group (ER+) was higher than in the negative one (ER-). Moreover, the distribution of the enzymatic values in the ER+ group appeared to derive from two partially overlapped distributions. The authors suggest that only those ER+ tumors which show elevated G6PDH activity contain functional receptors. The determination of G6PDH activity at the time of mastectomy is proposed as an additional test in selecting those patients who would be likely to benefit from endocrine therapy.

Breast Neoplasms↗

PubMed1982

Bilateral cancer of the breast.

The authors reviewed a series of 2311 primary breast cancers followed-up from 1 to 11 years after radical mastectomy. Twenty-eight simultaneous and 40 metachronous controlateral breast cancers were observed in the study period with an average annual incidence rate of 4.5%. Younger age and histologic evidence of lobular carcinoma at first cancer diagnosis was significantly associated with contralateral cancer, whereas first cancer stage did not seem to be a risk factor. Contralateral metachronous cancer significantly worsened the expected prognosis, which was not true for simultaneous bilateral cancers. The possible reasons for this negative prognostic influence of a second breast cancer and the role of preventive measures such as contralateral mastectomy are discussed. At the present time, an accurate annual clinico-mammographic follow-up seems to be a most advisable course of action.

Breast Neoplasms↗

PubMed1982

Radiation therapy of recurrences of carcinoma of the rectum and sigmoid after surgery.

Loco-regional recurrences are the most common type of postsurgical relapse of rectal and sigmoid carcinoma. The authors report on 108 consecutively treated patients: site, clinical features and symptoms of the recurrences are considered together with treatment results. A symptomatic effect was generally achieved with 35 to 45 Gy, while higher doses did not improve the response. Due to the high frequency of simultaneous involvement of perineum and true pelvis the authors recommend irradiation of both regions. Palliation is the sole aim in most cases. However, curative treatment can be attempted in single perineal recurrences.

Adult↗

PubMed1982

Postoperative radiation therapy after vaginal surgery for endometrial cancer.

From 1958 to 1978, 88 consecutive patients affected by endometrial cancer were referred to the Radiology Institute of the University of Florence, for radiation therapy after vaginal hysterectomy and bilateral salpingo-oophorectomy. Five and ten-year actuarial survival rates are 71% and 62%. In the evaluable patients, results are analysed according to: extension of the tumor, as assessed by pathological evaluation (60 pats.), histologic grade of differentiation (44 pats.), and neoplastic infiltration of myometrium (32 pats.). When the tumor is limited to the uterine body, a 5-year actuarial survival is achieved in 89% of the cases; when the cervix or the adnexa and other pelvic structures are involved, this percentage decreases to 62.5% and 37.5%. The prognosis is also affected by the histological grade of differentiation and the depth of myometrial infiltration.

Actuarial Analysis↗

PubMed1982

Postoperative radiation therapy after vaginal surgery for endometrial cancer.

Adult↗