Atypical Ductal Hyperplasia at the Margin of Lumpectomy Performed for Early Stage Breast Cancer: Is there Enough Evidence to Formulate Guidelines?

Background. Negative margins are associated with a reduced risk of ipsilateral breast tumor recurrence (IBTR) in women with early stage breast cancer treated with breast conserving surgery (BCS). Not infrequently, atypical ductal hyperplasia (ADH) is reported as involving the margin of a BCS specimen, and there is no consensus among surgeons or pathologists on how to approach this diagnosis resulting in varied reexcision practices among breast surgeons. The purpose of this paper is to establish a reasonable approach to guide the treatment of ADH involving the margin after BCS for early stage breast cancer. Methods. the published literature was reviewed using the PubMed site from the US National Library of Medicine. Conclusions. ADH at the margin of a BCS specimen performed for early stage breast cancer is a controversial pathological diagnosis subject to large interobserver variability. There is not enough data evaluating this diagnosis to change current practice patterns; however, it is reasonable to consider reexcision for ADH involving a surgical margin, especially if it coexists with low grade DCIS. Further studies with longer followup and closer attention to ADH at the margin are needed to formulate treatment guidelines

Persistence with Mammography Screening and Stage at Breast Cancer Diagnosis among Elderly Appalachia-West Virginia Women

The objective of this study is to evaluate the association between persistence with mammography screening and stage at breast cancer diagnosis in elderly Appalachia-West Virginia women diagnosed with first incident breast cancer. The study utilized West Virginia Cancer Registry-Medicare linked database to identify women age 70 and above diagnosed with first incident breast cancer in 2007. Persistence to mammography screening was defined as having had at least three mammography screenings before breast cancer diagnosis. A multiple logistic regression was conducted to assess the association between persistence with mammography screening and stage at breast cancer diagnosis in these women. Of the 221 elderly Appalachia-West Virginia women included in the analysis, 113 women (51.1%) were persistent to mammography screening before their diagnosis with breast cancer. In a multiple logistic regression after adjusting for all the variables, as compared to elderly women who were not persistent with mammography screening, women who were persistent with mammography screening were significantly more likely to be diagnosed with early stage breast cancer (adjusted odds ratio=4.25, 95% confidence interval=1.96-9.19). Persistence with mammography screening is significantly associated with earlier stages of breast cancer in the rural and underserved Appalachia-West Virginia women. The study findings suggest targeting interventions to encourage regular mammography in these women for whom there are no clear guidelines

Tumor markers in breast cancer - European Group on Tumor Markers recommendations

Recommendations are presented for the routine clinical use of serum and tissue-based markers in the diagnosis and management of patients with breast cancer. Their low sensitivity and specificity preclude the use of serum markers such as the MUC-1 mucin glycoproteins ( CA 15.3, BR 27.29) and carcinoembryonic antigen in the diagnosis of early breast cancer. However, serial measurement of these markers can result in the early detection of recurrent disease as well as indicate the efficacy of therapy. Of the tissue-based markers, measurement of estrogen and progesterone receptors is mandatory in the selection of patients for treatment with hormone therapy, while HER-2 is essential in selecting patients with advanced breast cancer for treatment with Herceptin ( trastuzumab). Urokinase plasminogen activator and plasminogen activator inhibitor 1 are recently validated prognostic markers for lymph node-negative breast cancer patients and thus may be of value in selecting node-negative patients that do not require adjuvant chemotherapy. Copyright (C) 2005 S. Karger AG, Basel

A family history of breast cancer will not predict female early onset breast cancer in a population-based setting

ABSTRACT: BACKGROUND: An increased risk of breast cancer for relatives of breast cancer patients has been demonstrated in many studies, and having a relative diagnosed with breast cancer at an early age is an indication for breast cancer screening. This indication has been derived from estimates based on data from cancer-prone families or from BRCA1/2 mutation families, and might be biased because BRCA1/2 mutations explain only a small proportion of the familial clustering of breast cancer. The aim of the current study was to determine the predictive value of a family history of cancer with regard to early onset of female breast cancer in a population based setting. METHODS: An unselected sample of 1,987 women with and without breast cancer was studied with regard to the age of diagnosis of breast cancer. RESULTS: The risk of early-onset breast cancer was increased when there were: (1) at least 2 cases of female breast cancer in first-degree relatives (yes/no; HR at age 30: 3.09; 95% CI: 128-7.44), (2) at least 2 cases of female breast cancer in first or second-degree relatives under the age of 50 (yes/no; HR at age 30: 3.36; 95% CI: 1.12-10.08), (3) at least 1 case of female breast cancer under the age of 40 in a first- or second-degree relative (yes/no; HR at age 30: 2.06; 95% CI: 0.83-5.12) and (4) any case of bilateral breast cancer (yes/no; HR at age 30: 3.47; 95%: 1.33-9.05). The positive predictive value of having 2 or more of these characteristics was 13% for breast cancer before the age of 70, 11% for breast cancer before the age of 50, and 1% for breast cancer before the age of 30. CONCLUSION: Applying family history related criteria in an unselected population could result in the screening of many women who will not develop breast cancer at an early age

Node-positive breast cancer: Which are the best chemotherapy regimens?

Breast cancer-associated mortality has been significantly reduced since the 1990s, mainly because of early diagnosis and systemic therapeutic interventions. All three therapy components-cytostatic therapy, endocrine therapy and targeted antibody therapy-are at present necessary tools for the curative treatment of primary breast cancer. This article reviews the evidence base for the use of various chemotherapy schedules in patients with primary, node-positive breast cancer, including schedules in combination with targeted HER2/neu therapy

Are there socioeconomic gradients in stage and grade of breast cancer at diagnosis? Cross sectional analysis of UK cancer registry data

Socioeconomic gradients in uptake of breast cancer screening in the United Kingdom should, intuitively, lead to socioeconomic gradients in disease progression at diagnosis. However, studies have found little evidence of such an effect. Although this could be interpreted as evidence that socioeconomic gradients in uptake of screening do not have clinically important consequences, all of the published studies have used data from before (pre-1988) or during the early stages (1988-95) of implementation of the national breast cancer screening programme. We investigated the relation between socioeconomic position and progression of breast cancer at diagnosis by using recent data from the Northern and Yorkshire Cancer Registry and Information Service (NYCRIS), which is estimated to achieve around 93% ascertainment

Breast tumor diagnosis in digital mammograms

Breast cancer has been classified as the most common cancer in most part of the world [1]. Breast cancer is caused by the growth of the abnormal cells in the breast. Breast cancer not only develops in women but also on men. However, the incidents of breast cancer in women are more common than men. Breast cancer is dangerous and may take away one’s life if there is no early detection and treatment are not done to remove the cancer cell present in the breast. Although the prevention methods for breast cancer may be unclear, it is found out that the earlier the detection and treatment conducted to the patients, the higher the survivability of the patients. Digital mammography is a specific type of breast imaging that uses low-dose x-rays to detect cancer early especially before women experience any symptoms [2]. The early signs of breast cancer can be detected in mammograms. Hence, digital mammograms have been classified as one of the best methods to detect breast cancer. In the studies [2] has shown that digital mammograms produce a better result than film mammograms in a group of young women, premenopausal and perimenopausal women, and women with dense breasts. 335 women were found to be infected with breast cancer in the test. However, there is also a limitation present in digital mammograms. High breast density can affect the performance of diagnosis in digital mammography as it increases the difficulty in finding abnormalities in a mammogram. Digital mammograms are only able to yield the best accuracy in the result for the women who are under the age of 50 and absent from menopause or undergoes menopause in a period of less than one year

Improved Classification of Breast Cancer Data using Hybrid Techniques

Breast cancer is the second leading cancer for women in developed countries including India. Many new cancer detection and treatment approaches were developed. The most effective way to reduce breast cancer deaths is detect it earlier. The frequent occurrence of breast cancer and its serious consequences have attracted worldwide attention in recent years. Problems such as low rate of accuracy and poor self-adaptability still exist in traditional diagnosis. In order to solve these problems, an Ada Boost-SVM classification algorithm, Combined with k-means is proposed in this research for the early diagnosis of breast cancer. The effectiveness of the proposed methods are examined by calculating its accuracy, confusion matrix which give important clues to the physicians for early diagnosis of breast cancer

Cowden syndrome - Diagnostic skin signs

Cowden syndrome is a rare autosomal dominant familial cancer syndrome with a high risk of breast cancer. The most important clinical features include carcinomas of the breast and thyroid, and hamartomatous polyps of the gastrointestinal tract. There are characteristic mucocutaneous features which allow early recognition of the disease and are generally present before internal malignancies develop. We report on a woman in whom the diagnosis of Cowden syndrome was first made after she had been treated for both breast cancer and melanoma. Copyright (C) 2001 S. KargerAG, Basel