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At least 1,153 records · Page 64Linked to original sources
PubMed1984

Serum and tissue proteinase-like peptidase activities in women undergoing total mastectomy for breast cancer.

Serum proteinase-like peptidases and proteinase inhibitor activities have been determined in 40 women with breast cancer at presentation and following total mastectomy. Activities of these enzymes have also been determined in homogenates of malignant (n = 13) and non-malignant (n = 11) breast tissue and benign breast lesions (n = 10). Following surgical treatment, the serum collagenase-like, cathepsin B-like and cathepsin H-like peptidase activities were significantly reduced. In addition, the activities of collagenase-like, cathepsin B-like and elastase-like peptidases were significantly higher in malignant breast tissue than in either non-malignant tissue from the same breast, or benign breast lesions. These findings are consistent with the suggestion that proteinases may have a role in tumour invasion.

Adult↗
PubMed1986

Comparison of Halsted mastectomy with quadrantectomy, axillary dissection, and radiotherapy in early breast cancer: long-term results.

From 1973 to 1980 we randomly assigned 701 patients with breast cancer measuring less than 2 cm in diameter and with no palpable axillary lymph nodes to Halsted radical mastectomy (n 349) or to 'quadrantectomy' with axillary dissection and radiotherapy to the ipsilateral breast tissue (n 352). The two groups were comparable in age distribution, size and site of primary tumor, menopausal status, and frequency of axillary metastases. The average follow-up time was 103 months. Actuarial curves show no difference between the two groups in the disease-free interval after surgery or in the overall survival rate. At 8 yr the disease-free survival was 77% for the patients in the Halsted group and 80% for those in the 'quadrantectomy' group, and the overall survival was 83 and 85% respectively. We conclude that small breast cancers may be safely treated with the conservative treatment described. In our opinion total ablative operations are not justified.

Axilla↗
PubMed1989

Relation between estrogen receptor concentration and clinical and histological factors: their relative prognostic importance after radical mastectomy for primary breast cancer.

After modified radical mastectomy, 490 primary breast cancer patients were followed for a median of 75 months. Bloom grade was measured in 340 patients and ER status in 341. Follow-up of these patients has yielded the following results: (a) The value of traditional indices has been reaffirmed. (Cox's multivariate analysis identified, in order of decreasing importance, the number of invaded lymph nodes, the initial tumor size and the histological grade. Other variables were found to be of lesser importance and were correlated with the three main indices.) (b) The value of ER status disappeared after more than 3 years of follow-up. (c) ER positive patients fared better after recurrence. This was interpreted as being a consequence of their responsiveness to hormonal treatment.

Adult↗
PubMed1993

Treatment of the post-mastectomy pain syndrome with topical capsaicin.

Twenty-one patients with post-mastectomy pain syndrome (PMPS) were entered in an open-label trial of topical 0.025% capsaicin treatment (3 daily applications for 2 months). Out of 19 evaluable patients, 2 (10.5%) reported complete disappearance of all symptoms, and 11 (57.9%) had a reduction of pain which was never worse than mild at the end of treatment. Three months after cessation of treatment, 11 of 13 of the responding patients continued to have good pain relief, with only 1 continuing to use capsaicin. Treatment was well tolerated with no drop-out due to side effects. This is the first independent confirmation of the usefulness of capsaicin in the PMPS, following the recent publication of a randomized, placebo-controlled clinical study showing significant pain relief with 0.075% capsaicin but not with vehicle cream. Further experimental and clinical research on the properties of capsaicin in other painful peripheral neuropathies is desirable.

Administration, Topical↗
PubMed1985

Psychological effects of breast conserving therapy in comparison with radical mastectomy.

Psychosocial sequelae of breast conserving therapy (BCT) and radical mastectomy (RM) have been compared. Also, in the BCT group, the cosmetic results were judged by the patients themselves and two plastic surgeons. Body image in the BCT group (n = 114) was significantly more positive than in the RM group (n = 58). Patients treated with BCT had even less fear of recurrence of the cancer and would, if necessary, choose the same treatment again. Cosmetic results were good to excellent in 75% of the cases as judged by the two plastic surgeons. Most of the patients with a bad grading by the surgeons were happy with the results.

Adult↗
PubMed1985

Reduced thoracic vertebrae metastases following post mastectomy parasternal irradiation.

A retrospective study of 118 women with breast cancer metastatic to bone is presented. All had originally received post mastectomy adjuvant radiation therapy for Stage II (T2 N0, T2 N1, T1 N1) infiltrating duct carcinoma of breast. Sixty-two women (group A) received a parasternal portal and 56 women (group B) did not. There was significantly less metastatic involvement of the mid-dorsal vertebrae D5-6-7-8, 13% in group A compared to 60% in group B. The mean time to diagnosis of metastatic disease was 33 months (group A) and 36 months (group B). The dose of radiation to the vertebrae through which the parasternal beam exited was estimated at between 1000-1600 rad over three to four weeks. This observation may have significant implications for the management of high risk operable breast cancer.

Bone Neoplasms↗
PubMed1988

Radiotherapy for the prevention of local-regional recurrence in high risk patients post mastectomy receiving adjuvant chemotherapy.

From 1977 to 1986, 63 patients at high risk for isolated local-regional recurrence following mastectomy and adjuvant chemotherapy received post-operative radiotherapy. All patients had operable primary tumors (T1-3a). For entire group the mean and median number of positive nodes were 10 and 8, respectively. Radiotherapy consisted of 4500 to 5000 rad to the chest wall and regional nodes. Chemotherapy consisted of CMF +/- prednisone (45 patients), CAF (16 patients), and other variable regimens (2 patients). Relapse occurred in 23 patients with only two patients experiencing an isolated local-regional recurrence. In 3 patients local-regional recurrence appeared simultaneously with or following distant metastases and in 18 patients the pattern of failure was distant metastases alone. With a median follow-up of 28 months (range 9-87 mo.), 40 patients are alive without disease, 9 are alive with disease, and 14 have died with disease. The 4-year actuarial overall survival is 67% and the 4-year actuarial disease-free survival is 47%. The 4-year actuarial probability of an isolated local-regional recurrence is 5%. Complications related to the radiation included a 9% incidence of moderate to severe arm edema. This study demonstrates the ability of radiation to reduce the incidence of local-regional recurrence in a previously identified high risk group of patients and has produced encouraging survival results with minimal morbidity.

Actuarial Analysis↗
PubMed1992

Determinants of the psycho-social outcome after operation for breast cancer. Results of a prospective comparative interview study following mastectomy and breast conservation.

In a prospective interview study, designed to compare the psycho-social outcome after a breast-conserving vs. a mastectomy operation, we analysed possible predictors of the psycho-social adjustment. 99 women with breast cancer histopathological TNM stages I and II were consecutively admitted to the study. Half-structured interviews, based on the Social Adjustment Scale and a scale by P. Maguire, were performed 4 and 13 months after the operation. Living together with the spouse seems to protect women from developing psycho-social problems postoperatively. Women who were gainfully employed or who were given radiotherapy had a higher risk of poor adjustment after 4 months. At 13 months, the scorings indicate that radiotherapy has a reassuring effect. Type of surgery was controlled for in the analysis and showed that, of the risk factors studied, the most consistent trend for an overall better outcome was in the breast-conserved group except for sexual disturbances.

Adult↗
PubMed1993

Vascular density and the response of breast carcinomas to mastectomy and adjuvant chemotherapy.

Using morphometric analysis of histological preparations, in a retrospective study vascular indices, expressing the extent of vascularisation, were determined for a number of mammary carcinomas. The indices were found to be related to the survival of the patients treated with modified radical mastectomy in combination with pre- and postoperative chemotherapy, the cases with low indices having the shorter survival. The impaired access of the cytotoxic agents to cells in the deficiently vascularised tumours was considered as an explanation. It was concluded that determination of vascular density in tumours may have a prognostic value in regard to the treatment response, and may be helpful in choosing the appropriate treatment.

Adult↗
PubMed1993

Psychosocial adjustment among husbands of women treated for breast cancer; mastectomy vs. breast-conserving surgery.

Psychosocial adjustment was measured among 56 spouses of women operated for breast cancer. Of 69 eligible husbands, 56 participated. Twenty women underwent breast-conserving surgery (BCT) and 36 had a mastectomy (MT). An interview was conducted with each woman and her husband separately, 4 and 13 months after surgery. Two instruments were used; SBAS (Social Behaviour Assessment Schedule) and a scale (TB) constructed specifically for the study. The husbands of the women in the MT group were significantly more depressed after 4 months and reported complaints related to their wive's disease more often than did those in the BCT group. After 4 months, the marital relation was assessed as more positive in the MT group. A total of 48% of the husbands in the sample expressed some emotional distress during the investigation period, which is similar to levels seen among breast cancer-operated women themselves. Overall, only marginally better scores were seen for husbands married to women who had undergone breast-conserving surgery. Few researchers have studied psychosocial reactions in the breast cancer patient's family. Since patterns of social support empirically influence the rehabilitation of the cancer patient, this field of investigation is important.

Adaptation, Psychological↗
PubMed2004

Surgical risk reduction: prophylactic salpingo-oophorectomy and prophylactic mastectomy.

Investigators have used retrospective and prospective study designs to provide much needed data on the extent of risk reduction after prophylactic oophorectomy and mastectomy in women at increased risk for breast and ovarian cancer. In this publication we identify those women who may wish to consider prophylactic surgery, review data demonstrating the efficacy of prophylactic surgery, and discuss potential surgical complications. We also present data about the frequency of use and psychosocial impact of prophylactic surgery in this typically young group of women. Finally, we provide general treatment guidelines for the practicing clinician.

Breast Neoplasms↗
PubMed2005

Total skin-sparing mastectomy without preservation of the nipple-areola complex.

BACKGROUND: We hypothesized that total skin-sparing mastectomy (TSM) including where the skin overlying the nipple and areola is preserved would be oncologically safe and facilitate improved cosmetic reconstruction. METHODS: A review (May 2003 through January 2005) was completed on all procedures that were performed through an inframammary incision or a previous scar with reconstruction using Botox, AlloDerm, and a subpectoral tissue implant. RESULTS: Thirty-one patients had 50 TSMs. Twelve percent (6/50) of TSMs had the skin of the nipple and areola resected: 4 (14% of tumors) because of tumor involvement and 2 (4%) because of skin necrosis. Fourteen percent of patients had other complications: 4% (2/50) had infection and/or flap necrosis and 10% (5/50) had superficial epidermolysis requiring no intervention, for a total complication rate of 18%. Average cosmetic score was 8.5 (range 4 to 10). No recurrences are evident after mean follow-up of 7.9 +/- 5.4 months. CONCLUSION: Our short-term experience suggests that TSM has an acceptable complication rate, is theoretically oncologically safe, and facilitates an improved cosmetic result.

Adult↗
PubMed2006

Closure of partial mastectomy.

A longstanding controversy surrounds whether to close breast parenchyma at the completion of a partial mastectomy for breast cancer. Modification of a technique described 80 years ago finds the middle ground between various opinions and simultaneously addresses 2 issues: (1) approximation of the deep and superficial surfaces of the parenchyma, without sutures within the parenchyma, minimizes "dents;" and (2) a radial suture line preserves the distance from the nipple to the periphery of the breast which minimizes traction on the nipple.

Breast Neoplasms↗
PubMed2004

[Breast reconstruction after mastectomy for breast cancer: which reconstructive surgical procedure should be retained?].

Post-mastectomy breast reconstruction represents a surgical option that may improve psychosocial outcome without modifying patients' survival. Psychosocial impact of used surgical technique and moment of realization of breast reconstruction remains unclear. However, complications are negatively related to patients' satisfaction. There is no guideline for BR indications. Therefore, a review of clinical and cosmetic outcomes of different breast reconstruction modalities was necessary. It permitted to propose a shared decision-making algorithm for the choice of moment and technique of BR according to the presence of radiotherapy that appears to be the main risk factor of clinical outcome of breast reconstruction. It also disclosed some limits in information reliability about clinical outcome of particular associations of breast reconstruction and radiotherapy. Proportion of women pursuing breast reconstruction, and particularly immediate breast reconstruction, is rising. Clinical surveys assessing relation between radiotherapy and clinical and psychosocial outcome of breast reconstruction are urgently expected.

Breast Neoplasms↗
PubMed2005

Impact of IRB requirements on a multicenter survey of prophylactic mastectomy outcomes.

OBJECTIVE: This study assesses the variability in requirements among six institutional review boards (IRBs) and the resulting protocol variations for a multicenter mailed survey. STUDY DESIGN AND SETTING: We utilized a cross-sectional mailed survey to gather information on long-term psychosocial outcomes of prophylactic mastectomy among women at six health maintenance organizations, all of which are part of the Cancer Research Network. In the context of this collaborative study, we characterized the impact of the different sites' IRB review processes on the study protocol and participation. RESULTS: IRB review resulted in site differences in physician consent prior to participant contact, invitation letter content and signatories, and incentive type. The review process required two to eight modifications beyond the initial application and resulted in unanticipated delays and costs. CONCLUSION: Site-to-site variability in IRB requirements may adversely impact scientific rigor and delay implementation of collaborative studies, especially when not considered in project planning. IRB review is an essential aspect of research but one that can present substantial challenges for multicenter studies.

Breast Neoplasms↗
PubMed2006

Envelope mastectomy and immediate reconstruction (EMIR), improving outcome without oncological compromise.

AIM: To determine the long term oncological safety and aesthetic acceptability of envelope mastectomy and immediate reconstruction (EMIR). PATIENTS AND METHODS: A retrospective review of 71 cases was carried out. Oncological assessment was by clinical examination, mammography, ultrasound, and, where indicated, MRI scan. Aesthetic assessment was based on detailed clinical examination as well as subjective self-assessment of the outcome. RESULTS: During follow-up (mean 48 months), there were three local recurrences, only one involving the nipple-areolar complex. The mean aesthetic score was 0.75 (out of 1), representing a good aesthetic outcome and patient satisfaction. CONCLUSION: Nipple-areolar complex preservation is a safe option and EMIR produced a good aesthetic outcome, which is oncologically safe. Furthermore, it does not preclude post-operative radiotherapy.

Adult↗
PubMed2004

Preoperative psychological reactions and quality of life among women with an increased risk of breast cancer who are considering a prophylactic mastectomy.

A consecutive sample of 56 women with a familial risk for breast cancer who were considering a prophylactic mastectomy (PM) completed questionnaires preoperatively concerning risk perception, expectations with regard to surgery, anxiety and depressive symptoms (the Hospital Anxiety and Depression Scale (HAD) scale) and quality of life (The Swedish SF-36 Health Survey). 16 had had a previous breast cancer (Group BC) and 40 had not (Group R). They were compared with normative data from an age-matched random sample of the Swedish population and with a reference sample of women with breast cancer. Most women estimated their breast cancer risk accurately. No statistically significant differences were found between Group BC and the normative sample on the HAD scale and SF-36, but Group R reported better physical functioning, emotional role functioning and mental health than the reference sample with breast cancer. Group BC scored closer to them than to the normative sample. Levels of emotional problems and quality of life were comparable to normative values among women considering PM. All women in the present study had previous genetic counselling and our results suggest that their interest in PM was not due to an overestimation of their personal risk.

Adult↗