Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “MASTECTOMY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources
PubMed1989

Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer.

In 1985 we presented results of a randomized trial involving 1843 women followed for five years that indicated that segmental breast resection (lumpectomy) followed by breast irradiation is appropriate therapy for patients with Stage I or II breast cancer (tumor size, less than or equal to 4 cm), provided that the margins of the resected specimens are free of tumor. Women with positive axillary nodes received adjuvant chemotherapy. Lumpectomy followed by irradiation resulted in a five-year survival rate of 85 percent, as compared with 76 percent for total mastectomy, a rate of survival free of distant disease of 76 percent, as compared with 72 percent, and a disease-free survival rate of 72 percent, as compared with 66 percent. In the current study, we have extended our observations through eight years of follow-up. Ninety percent of the women treated with breast irradiation after lumpectomy remained free of ipsilateral breast tumor, as compared with 61 percent of those not treated with irradiation after lumpectomy (P less than 0.001). Among patients with positive axillary nodes, only 6 percent of those treated with radiation and adjuvant chemotherapy had a recurrence of tumor in the ipsilateral breast. Lumpectomy with or without irradiation of the breast resulted in rates of disease-free survival (58 +/- 2.6 percent), distant-disease-free survival (65 +/- 2.6 percent), and overall survival (71 +/- 2.6 percent) that were not significantly different from those observed after total mastectomy (54 +/- 2.4 percent, 62 +/- 2.3 percent, and 71 +/- 2.4 percent, respectively). There was no significant difference in the rates of distant-disease-free survival (P = 0.2) or survival (P = 0.3) among the women who underwent lumpectomy (with or without irradiation), despite the greater incidence of recurrence of tumor in the ipsilateral breast in those who received no radiation. We conclude that our observations through eight years are consistent with the findings at five years and that these new findings continue to support the use of lumpectomy in patients with Stage I or II breast cancer. We also conclude that irradiation reduces the probability of local recurrence of tumor in patients treated with lumpectomy.

Breast Neoplasms↗
PubMed1995

Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer.

BACKGROUND: Previous findings from a clinical trial (Protocol B-06) conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP) indicated the worth of lumpectomy and breast irradiation for treating breast cancer. After the discovery by NSABP staff members of falsified information on patients enrolled in the study by St. Luc Hospital in Montreal, separate audits were conducted at St. Luc Hospital and other participating institutions. We report the results of both audits and update the study findings through an average of 12 years of follow-up. METHODS: Patients with either negative or positive axillary nodes and tumors 4 cm or less in diameter were randomly assigned to one of three treatments: total mastectomy, lumpectomy followed by breast irradiation, or lumpectomy without irradiation. Three cohorts of patients were analyzed. The first cohort included all 2105 randomized patients, who were analyzed according to the intention-to-treat principle. The second cohort consisted of 1851 eligible patients in the first cohort with known nodal status who agreed to be followed and who accepted their assigned therapy (among those excluded were 6 patients from St. Luc Hospital who were declared ineligible because of falsified biopsy dates). The third cohort consisted of the patients in the second cohort minus the 322 eligible patients from St. Luc Hospital (total, 1529 patients). RESULTS: Regardless of the cohort, no significant differences were found in overall survival, disease-free survival, or survival free of disease at distant sites between the patients who underwent total mastectomy and those treated by lumpectomy alone or by lumpectomy plus breast irradiation. After 12 years of follow-up, the cumulative incidence of a recurrence of tumor in the ipsilateral breast was 35 percent in the group treated with lumpectomy alone and 10 percent in the group treated with lumpectomy and breast irradiation (P < 0.001). CONCLUSIONS: Our findings continue to indicate that lumpectomy followed by breast irradiation is appropriate therapy for women with either negative or positive axillary nodes and breast tumors 4 cm or less in diameter.

Breast Neoplasms↗
PubMed1986

Classification of mastectomy deformity.

This article proposes a classification system for mastectomy reconstruction based on skin and muscle deficiency. This system is helpful in planning surgery and in presenting lecture material. It could also be helpful in organizing material in future publications on mastectomy deformity by providing guidelines regarding the choice of procedure as it corresponds to the degree of deformity. Finally, it may enhance our ability to develop statistical measures for comparing different reconstructive techniques.

Adult↗
PubMed2005

Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results.

We have undertaken a pooled analysis of the 6 major randomized trials comparing mastectomy (MT) and breast-conserving therapy (BCT) in the treatment of primary breast cancer. Specifically, these trials compared the 2 most widely used options in local treatment: mastectomy and axillary dissection (MT) versus breast-conserving surgery, axillary dissection, and breast radiotherapy (BCT). The early results of these 6 trials formed the basis for a 1990 National Institutes of Health Consensus statement. However, most of these trials have recently published long-term follow-up results, and this pooled analysis incorporates the updated results of these 6 trials. For each of these trials, the observed number of treatment events was compared with that expected under the null hypothesis, given the number of patients per arm and the total number of events. Approximate odds ratios were computed using the observed and expected number of events, and the variance of the observed number of events. These were then pooled across trials to give overall odds ratios for the risk of locoregional recurrence, total recurrence, and death. Four of the 6 trials show that MT significantly reduces the risk of locoregional recurrence when compared with BCT, and the pooled odds ratio also shows a significant benefit for MT (odds ratio [OR], 1.561; 95% confidence interval [CI], 1.289-1.890; P < 0.001). However, only 1 trial shows a statistically significant benefit for MT in reducing mortality, and the pooled odds ratio shows no significant difference between MT and BCT (OR, 1.070; 95% CI, 0.935-1.224; P = 0.33). This pooled analysis confirms that MT and BCT have comparable effects on mortality, even after long-term follow up. However, BCT is associated with a significantly greater risk of locoregional recurrence.

Adult↗
PubMed1989

Depression after surgery for breast cancer. Comparison of mastectomy and lumpectomy.

The impact of the loss of the breast in women undergoing surgical treatment for breast cancer is subordinated to the confrontation with the diagnosis of a malignancy in causing depression. The equal distribution of depression in mastectomy and in lumpectomy patients supports the hypothesis that it is the confrontation with the potentially lethal outcome of the diagnosis which is decisive in causing depression. The grief reaction following mastectomy has two components: a depressive reaction to the loss of the breast and an anticipatory grief for anticipation of the potentially lethal outcome. Psychosocial therapeutic support in breast malignancy must give priority to coping with the diagnosis of cancer over the loss of the breast.

Adaptation, Psychological↗
PubMed2005

Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran.

BACKGROUND: There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran. METHODS: A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences. RESULTS: In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%). CONCLUSION: The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance).

Adult↗
PubMed1996

Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group.

PURPOSES: A randomized trial was conducted to compare tumorectomy and breast irradiation with modified radical mastectomy. We have analyzed the patterns of failure in each arm of the trial and the prognostic factors that have an independent effect on treatment failures and overall survival. PATIENTS AND METHODS: The trial included 179 patients with breast cancer of up to 20 mm in diameter at macroscopic examination. Eighty-eight patients had conservative management and 91 a mastectomy. All patients had axillary dissection with frozen-section examination. For patients with positive axillary nodes (N+), a second randomization was performed: lymph node irradiation versus no further regional treatment. Patterns of failure were determined by a competing-risk approach and multivariate analysis. A prognostic-score was determined by multivariate analysis. RESULTS: Overall survival, distant metastasis, contralateral breast cancer, new primary malignancy, and locoregional recurrence rates were not significantly different between the two surgical groups, or between lymph node irradiation groups. Most recurrences appeared during the first 10 years. Three distinct prognostic groups were determined taking into account age, tumor size, histologic grading, and number of positive axillary nodes. CONCLUSION: Long-term results support conservative treatment with limited surgery and systematic breast irradiation as a safe procedure for the management of small breast cancers. Four easily obtainable clinical and histologic factors may be combined in a prognostic score that is highly predictive of overall and event-free survival.

Adult↗
PubMed2000

[Breast cancer: value of postoperative locoregional irradiation following mastectomy].

A CRUCIAL STEP: Locoregional control is a crucial step in the achievement of cancer cure. After mastectomy, locoregional irradiation (RT) clearly reduces the incidence of chest wall and nodal relapse, especially with initial lesions measuring more than 5 cm or with nodal involvement and/or large lymphatic or vascular emboli. CLINICAL PROOF: Two recent randomized trials have confirmed the benefit of well-adapted locoregional irradiation. In the Danish trial, including premenopausal "high-risk" women treated by mastectomy and chemotherapy (CMF protocol), RT reduced locoregional relapses from 32% to 9% (p < 0.01) and increased the 10-year survival rate from 45% to 54% (p < 0.01). These results are now confirmed in postmenopausal women with an increase in the 10-year survival rate from 36% to 45% (p < 0.001). In the Canadian trial, locoregional relapses decreased from 25% to 13% and the 10-year survival rate increased from 56% to 65%. The meta-analysis published in 1995 by the EBCTCG showed only a modest benefit due to locoregional irradiation in breast cancer. However, when small trials and old trials started before 1970 were excluded because of imperfect methodologies and inadequate irradiation techniques, the benefit of "modern" radiotherapy appeared as significant in 7,840 patients selected in this way. IN CLINICAL PRACTICE: Thus, since locoregional irradiation can avoid some metastatic evolution developed only after "local" or "nodal" relapse, it must be integrated into a multidisciplinary strategy. Nevertheless, this treatment must be safe. This can be achieved with new irradiation techniques including the definition of anatomical volumes and previsional dosimetry. The most important point concerns the treatment of internal mammary nodes, especially when previous chemotherapy including anthracyclines has been performed. The use of a direct field, with at least 40% of the dose delivered by electrons in an alternating scheme is recommended to ensure very good protection of the heart and lungs.

Adult↗
PubMed2001

[Conservative therapy of I and II stage breast cancer--successful alternative to modified radical mastectomy].

A clinical trial was conducted at the Center's Clinic to compare breast conserving treatment (quandrantectomy + radiation) (BCT) with modified radical mastectomy (M). It included 190 patients with stage I-II carcinoma up to 30 mm (BCT with "negative margin"--122; M--68). All the patients had undergone full axillary dissection. Mean total dose of 48.8 Gy was delivered to the whole breast by means of an external beam. No boost to tumor bed was given. Forty-one percent of tumors in the mastectomy group were of medial or central localization. The locoregional recurrence rates were significantly different (BCT--4.09 vs. M--20.5%; p < 0.001). However, the differences between distant metastasis occurrence and 5-year survival were not (BCT--4.91 and 95.6%; M--11.76 and 91.8%; p > 0.5, respectively). Nor were they significant for the localization/5-year survival relationship: lateral breast tumor--92%, medial--100% and central--89% (p > 0.6).

Adult↗
PubMed2001

[Interactive cd-rom on the choice between breast-sparing treatment and mastectomy: positive responses from patients and surgeons].

OBJECTIVE: To assess how breast cancer patients and surgeons rate an interactive decision aid, using CD-ROM technology, developed to support a choice between breast-conserving therapy and mastectomy. DESIGN: Questionnaire investigation. METHOD: Written questionnaires were presented to patients as soon as they had finished using the CD-ROM. They responded on a 5-point scale. Surgeons (n = 14) were sent a written questionnaire to investigate their experiences of using the CD-ROM program. RESULTS: The interactive CD-ROM was offered to 92 consecutive breast cancer patients. Responses were obtained from 86 (93%) of the patients. The remainder were inadvertently not given the questionnaire. All of the patients evaluated the program as positive. Most of the patients found the program to be 'interesting', 'clear', 'useful', 'encouraging', and 'reassuring'. A majority (n = 76) expressed the view that the amount of information received was 'just right'. The interactive, computer-based method was evaluated as 'agreeable' by 74 patients. Almost all of the patients (n = 82) recommended that the program be shown to other patients. All of the surgeons (n = 14) stated that their patients' evaluations of the program were positive. Moreover, most of the surgeons (n = 10) were of the opinion that the program 'considerably contributed' to the provision of information. With the exception of one surgeon (n = 13), they all held the view that the program can be offered to breast cancer patients facing a choice between breast-conservation or mastectomy on a standard basis. CONCLUSION: Interactive decision-making support by means of a CD-ROM for patients with breast cancer, received positive evaluations from both the patients and surgeons.

Adult↗
PubMed1992

Comparison of partial and modified radical mastectomy in the community setting--"10 years later".

Conservative surgery followed by postoperative radiation is considered equivalent to a modified radical mastectomy (MRM) for the treatment of early breast cancer. It cannot be assumed that results from selected academic centres are equivalent to those obtained in the general community setting, because there may be differences in patient selection or surgical or radiotherapy techniques that may adversely affect outcome. A quality-control study of women who were seen at the British Columbia Cancer Agency and were treated by partial mastectomy (PM) was begun in 1983. Eighty-four women who underwent conservative surgery between January 1979 and November 1982 and were referred to the British Columbia Cancer Agency were matched with 84 women who underwent MRM. The mean follow-up was 10.5 years. At 10 years disease-free survival in both groups was 63%. Survival overall for the PM group was 72.6% and for the MRM group was 69%. The survival rate decreased with increasing size of the tumour and increasing number of nodes. In women with lymph-node involvement there was a survival advantage for those treated by PM and radiation compared with those treated by MRM. The woman's age at diagnosis did not affect these findings. Recurrence and complication rates were similar in both groups, and treatment was considered equivalent.

Adult↗
PubMed1992

Total mastectomy is not always mandatory for the treatment of recurrent breast cancer after lumpectomy alone.

To determine the treatment that offered the best local control for isolated local recurrences of breast cancer after lumpectomy without radiotherapy, the authors reviewed 355 patients initially treated by lumpectomy (with or without axillary dissection) without radiotherapy. Local breast cancer recurred in 79 patients. They underwent either repeat partial mastectomy (PM) or completion total mastectomy (TM). Twenty-four patients (5 TM, 19 PM) received radiotherapy. Local control was defined as the absence of further recurrence of breast or chest-wall cancer. The 19 patients treated with repeat PM and radiotherapy had an actuarial local control rate of 82% at 5 years. Those treated with TM (28 patients) [corrected] or TM plus radiation (5 patients) had rates of local control of 60% and 52% respectively. Although there were no significant differences between the TM and PM plus radiotherapy groups, the 27 patients who had a repeat PM without radiotherapy had a significantly lower rate of local control (32%, p < 0.005). Treatment of recurrent breast cancer with PM and radiotherapy is a viable alternative to TM for enhancing local control. Repeat PM alone gave much poorer results. The authors conclude that local cancer recurrences after lumpectomy alone do not necessarily require TM and can often be treated with repeat excision and radiotherapy.

Adult↗
PubMed2004

[Comparative clinical evaluation of the effectiveness of modified radical mastectomy and organ-preserving therapy in localized breast cancer (pT1-2N0M0)].

The outcome of 320 patients with breast tumors was followed. Modified total mastectomy with subsequent irradiation, chemo- and/or hormone therapy was given to 164 patients. Limb-saving surgery was performed in 156. Incidence of locally advanced recurrences did not differ significantly in the two groups--3.7 and 5.5%, respectively. Nor did 5-year overall (90 +/- 1.4% and 88.4% +/- 1.6%, respectively) and relapse-free survival (88.4 +/- 1.2% and 83.5 +/- 1.4%, respectively) (p < 0.05). Hence, mastectomy is not worth more than sparing treatment.

Breast Neoplasms↗
PubMed1992

[Development of thoracic wall recurrence after mastectomy. Surgical consequences].

It has been demonstrated, that in a regular mastectomy a certain amount of glandular tissue is left back in the overlying skin flaps. If direct skin closure is achieved postoperatively, the glandular tissue remnants are laid with the skin flaps on top of the denuded pectoral muscle. Since these glandular tissue remnants may contain or develop breast cancer, a latter recurrence on the thoracic wall may take place. In order to avoid these iatrogenic thoracic wall recurrences an interpositioning of vital tissues between the thoracic wall and the skin is recommended. This is achieved by reconstructing the breast immediately after mastectomy.

Breast↗
PubMed2004

Pattern of local-regional recurrence in patient with early breast cancer after mastectomy: an analysis of 357 cases at King Chulalongkorn Memorial Hospital.

A retrospective review was performed on 357 patients with early stage I-IIIA operable breast cancer who were treated with mastectomy and referred to the clinic at the Division of Radiation Therapy, Department of Radiology, King Chulalongkorn Memorial Hospital between Jan 1991 and Dec 2001. Patients characteristics, treatment modalities and pattern of local and regional failure were evaluated. The median and mean age in the present study were 49 and 50.2 years, respectively. Stage I, II and IIIA were 10.9%, 79.6% and 9.5%, respectively. One hundred and ninety-seven patients (55.2%) received postoperative radiation therapy (RT). Adjuvant chemotherapy was given in 247 patients (69.2%) while 122 patients (34.2%) received adjuvant hormonal therapy. Sixty one patients (17.1%) received both adjuvant chemotherapy and hormonal therapy. However, 12.6% (45/357) did not receive any adjuvant treatment. Median follow up time was 42.6 months (range 6-136 months). Ipsilateral supraclavicular node and chest wall were the most common sites of local-regional recurrence. The chest wall recurrence rate was 10.4% (37/357), which was 16.9% (27/160) in the non postoperative radiation (No RT) group and 5.1% (10/197) in the postoperative radiation (RT) group. For ispilateral supraclavicular node, the recurrence rate was 10.6% (38/357), which was 15.6% (25/160) and 6.6% (13/197) for non RT and RT groups, respectively. The incidence of ipsilateral axilla, ipsilateral internal mammary node and ipsilateral infraclavicular node recurrence rate were 4.2%, 3.6% and 0.8%, respectively. Overall, chest wall and ipsilateral supraclavicular node were the most common sites of local-regional recurrence in early stage operable breast cancer who underwent mastectomy Postoperative adjuvant radiation therapy decreased the risk of local-regional recurrence.

Adult↗
PubMed1992

Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group.

The Danish Breast Cancer Cooperative Group (DBCG) conducted a randomized trial comparing breast conservation with mastectomy in patients with invasive mammary carcinoma. From January 1983 to March 1989, the trial accrued a total of 1153 women. Of this number, 905 patients (79%) were randomly assigned to one of the two treatment options, whereas 248 patients (21%) did not accept randomization. Of the randomly assigned patients, 90% received the surgical option to which they had been originally assigned. In the breast conservation arm the tumor was excised with the intention of obtaining free margins determined at gross examination, and radiotherapy was subsequently administered to residual breast tissue. The axilla was dissected in all instances. Patient and tumor characteristics were similar in the two randomization arms. The median follow-up time was 40 months. At 6 years of life-table analysis the probability of recurrence-free survival was 70% in the breast conservation arm against 66% in the mastectomy arm. Survival figures were 79% against 82%, respectively.

Breast Neoplasms↗
PubMed1990

[Modified radical mastectomy in the treatment of stage III breast carcinoma].

From 1972 to 1982, 237 patients with stage III breast carcinoma were admitted into our institute. One hundred and eleven cases underwent Auchincloss and Madden modified radical mastectomy (MRM), and the remaining 126 cases received Halsted radical mastectomy (RM). The 5 and 10 years survival rates were 59.17% (61/111), and 36.92% (24/65) in MRM group. The 5 and 10 years survival rates were 53.17% (67/126) and 29.31% (17/58) in RM group. There were no statistically significant differences in the long-term survival rates between the two groups (P greater than 0.05). The authors believe that MRM causing less trauma should be considered in the treatment of stage III breast carcinoma unless in cases with major pectorial muscle involvement or large metastatic axillary nodes.

Adult↗
PubMedDate not supplied

A comparison of the effects of lumpectomy versus mastectomy on sexual behaviors.

The purpose of this study was to investigate the effects of lumpectomy and mastectomy on female sexual behaviors. It is assumed frequently that lumpectomy causes fewer sexual sequelae for the patient. Although review of the literature indicated consensus regarding the advantage of lumpectomy in preserving body image, no such consensus exists regarding preservation of female sexuality. The literature also was unclear regarding treatment and demographic factors that may be useful in identifying patients at risk for sexual difficulties. A convenience sample of 165 women participated in the study. Data were collected using the Sexual Behaviors Questionnaire and the Watts' Sexual Functioning Questionnaire. Findings indicate that no significant difference existed in sexuality between women treated by lumpectomy and those treated by mastectomy. Other factors with a significant positive effect on sexuality included a history of minimal alcohol use, absence of chemotherapy treatment, and tamoxifen use. Counseling women and their partners about the sexual side effects of cancer treatments is an important part of the health professional's role.

Adult↗