Given breast cancer, does breast size matter? Data from a prospective breast cancer cohort.

PURPOSE: Body mass index (BMI), waist-to-hip ratio (WHR), and tumor characteristics affect disease-free survival. Larger breast size may increase breast cancer risk, but its influence on disease-free survival is unclear. The purpose of this study was to elucidate whether breast size independently influenced disease-free survival in breast cancer patients. METHODS: Body measurements were obtained preoperatively from 772 breast cancer patients in a population-based ongoing cohort from southern Sweden. The research nurse measured breast volumes with plastic cups used by plastic surgeons doing breast reductions. Clinical data were obtained from patient charts and pathology reports. RESULTS: Patients with a BMI ≥ 25 kg/m(2) had larger tumors (p 0.85 had larger tumors (p = 0.013), more advanced histological grade (p = 0.0016), and more axillary nodal involvement (p = 0.012). Patients with right + left breast volume ≥ 850 mL were more likely to have larger tumor sizes (p = 0.018), more advanced histological grade (p = 0.031), and more axillary nodal involvement (p = 0.025). There were 62 breast cancer events during the 7-year follow-up. Breast volume ≥ 850 mL was associated with shorter disease-free survival (p = 0.004) and distant metastasis-free survival (p = 0.001) in patients with estrogen receptor (ER)-positive tumors independent of other anthropometric measurements and age. In patients with ER-positive tumors, breast size was an independent predictor of shorter disease-free (HR 3.64; 95 % CI 1.42-9.35) and distant metastasis-free survival (HR 6.33; 95 %CI 1.36-29.43), adjusted for tumor characteristics, BMI, age, and treatment. CONCLUSION: A simple and cheap anthropometric measurement with standardized tools may help identify a subgroup of patients in need of tailored breast cancer therapy

A prospective study of psychiatric and psychosocial sequelae of bilateral subcutaneous mastectomy

Short- and long-term adaptation (two months and one year respectively) to bilateral subcutaneous mastectomy was studied in twenty-five consecutive patients operated upon at the Department of Plastic and Reconstructive Surgery, Malmo, Sweden. The results were related to preoperative personality and psychosocial profiles. Postoperative difficulties in accepting the surgical result, sexual dysfunctions and mental reactions with depression and anxiety were observed. Such reactions proved to be associated with specific personality characteristics

Accrual rate-limiting factors in a Swedish randomised ductal carcinoma in situ (DCIS) trial - a demographic study

In the last two decades the introduction of mammographic screening in the Western world has increased the number of diagnosed ductal carcinomas in situ (DCIS) considerably. In situ carcinoma of the breast is considered a heterogeneous disease, the natural history of which is not well known. Thus, appropriate treatment needs to be established. For this reason, a randomised trial studying the effect of breast conserving operation with or without postoperative radiotherapy was instituted in Southern Sweden in 1987. The aim of the present study was to assess patient accrual, identify limiting factors, and evaluate possible ways to influence these factors in order to increase patient accrual. Between 1987 and 1992, 331 patients had been registered with DCIS in the Regional Tumour Registry, 96 of which had been randomised. All 331 were subjected to chart review studying clinical data, mammography reports, cytology and pathology reports to identify inclusion and exclusion criteria according to the design of the trial. It was found that 5% (18/331) had an incorrect diagnosis of DCIS. According to the trial protocol 52% were not eligible (162/313). Fifty-eight per cent (n=88) of the 151 eligible patients had been correctly randomised. The most common reason for exclusion was lesion size. In 21% (66/313) the lesion was 'too large'. Several other limiting factors were identified such as in cytological and pathological definitions and reports, lack of information/awareness in certain physicians, patient reluctance to participate, which in turn may be influenced by the previous factor. With increased information to participating hospitals and considering the above given facts it should be possible to increase accrual from the 28% noted in the present consecutive demographic study to at least one-third of the diagnosed cases of DCIS

Breast reductions: what to do with all the tissue specimens?

In order to find some guidelines for adequate examination of the often very large amount of tissue removed at reduction mammoplasties, a thorough macro- and microscopic study of a total of 400 specimens from 200 consecutive cases of bilateral breast reductions was done. The majority of patients were younger than 30 years of age. In these cases no abnormalities were found and a thorough macroscopic examination performed by an experienced pathologist is believed to be sufficient in this age group. In older women we encountered diverse findings, the most noteworthy being lobular carcinoma in situ in 8% of patients in this series who were over 40 years of age. This indicates the need for generous histological sampling in this age group. The potential value of roentgenological examination is also discussed

Reliability of plastic cups to measure breast volume.

Abstract Breast volume measurement is valuable in clinical practice, and various methods have been used. Nonetheless, no commonly accepted standard technique exists for clinical everyday use and there is no optimal method that is quick, cheap, minimally invasive, and acceptable for the patient and for the surgeon. Previously, a study has shown that the volume measured with plastic cups differed little from that measured from mastectomy specimens. The aim of the present study was to test the reliability of breast volume measurements with plastic cups as a tool to measure breast volume in everyday clinical practice. The plastic cups were designed by the senior author (AR) and comprise 14 cups from 125 millilitres (ml) to 2000 ml. Six raters measured 12 breasts on the same day. The results show that there is a certain variation between different raters, and that a certain rater seems to consistently measure slightly lower or higher volumes than the other raters. The Intra Class Correlation (ICC) coefficient of average measures between raters is 0.89, that is, the agreement between different raters is high. According to the Bland-Altman plot, the overall assessment of the comparisons of measurements between the different raters shows that the direction of the mean differences is close to zero. The limits of agreements of the differences were within ±56 ml. The coefficient of variation (CV) between different raters was 14%. Breast volume measurement with plastic cups is an easily usable quick and cheap way to measure breast volume in everyday clinical practice. The measurements have an acceptable reliability

The contralateral breast at reconstructive surgery after breast cancer operation--a histopathological study

The present study concerns 73 patients with known unilateral breast carcinoma. Thirty of the patients had a primary invasive carcinoma removed and at a later operation contralateral subcutaneous mastectomy with implantation of a prosthesis. This was performed with or without ipsilateral breast reconstruction. Forty-three of the cases had an in situ carcinoma found by local excision, whereafter bilateral subcutaneous mastectomy was performed in 38 cases. Five cases had already had an ipsilateral mastectomy and contralateral subcutaneous mastectomy was performed. The histological examination of the subcutaneous mastectomy specimens was extensive with breasts cut into 3-5 mm slices, which were embedded and cut in large sections and cut in large sections allowing us to map all lesions. 42.5 per cent of the contralateral breasts contained invasive or in situ carcinoma. In about 70 per cent of the cases other histological lesions, considered more or less precancerous, were found in the contralateral breast. Our results speak in favor of an active approach to the contralateral breast at reconstruction, especially in cases with a long life expectancy after the first carcinoma. It is psychologically comforting to the patient to know that most of the breast gland, which could be the future origin of a new carcinoma, has been removed

Surgical strategy, methods of reconstruction, surgical margins and postoperative complications in oncoplastic breast surgery.

Oncoplastic breast surgery is an evolving discipline in the surgical treatment of breast cancer aimed to improve the outcome