Which Patients Need an Axillary Clearance after Sentinel Node Biopsy?

Sentinel lymph node biopsy (SLNB) is a safe and accurate minimally invasive method for detecting axillary lymph node (ALN) involvement in the clinically negative axilla thereby reducing morbidity in patients who avoid unnecessary axillary lymph node dissection (ALND). Although current guidelines recommend completion ALND when macro- and micrometastatic diseases are identified by SLNB, the benefit of this surgical intervention is under debate. Additionally, the management of the axilla in the presence of isolated tumour cells (ITCs) in SLNB is questioned. Particularly controversial is the prognostic significance of minimal SLNB metastasis in relation to local recurrence and overall survival. Preliminary results of the recently published Z0011 trial suggest similar outcomes after SNB or ALND when the SN is positive, but this finding has to be interpreted with caution

Getting the right balance in treatment of ductal carcinoma in situ (DCIS)

As a result of mammographic detection, ductal carcinoma in situ (DCIS) is an increasing problem in breast clinics. Both histopathology and molecular profiling can identify subtypes likely to progress to invasive disease, but there is no subgroup with a zero likelihood of subsequent invasion. In patients with low/intermediate grade DCIS, if breast irradiation is not being carried out after free margins have been achieved the patient should be aware of the risks of withholding and the benefits and morbidity of adjuvant radiotherapy. Either tamoxifen or an aromatase inhibitor may be of value in those with low/intermediate ER+ve disease if radiotherapy is being withheld. For those patients with extensive or multicentric DCIS, mastectomy is the appropriate treatment. This is best combined with sentinel node biopsy and all such cases should be offered immediate reconstruction.----------------------------Cite this article as:Fentiman IS. Getting the right balance in treatment of ductal carcinoma in situ (DCIS). Int J Cancer Ther Oncol 2013; 1(2):01029.DOI: http://dx.doi.org/10.14319/ijcto.0102.9

Getting the right balance in treatment of ductal carcinoma in situ (DCIS)

As a result of mammographic detection, ductal carcinoma in situ (DCIS) is an increasing problem in breast clinics. Both histopathology and molecular profiling can identify subtypes likely to progress to invasive disease, but there is no subgroup with a zero likelihood of subsequent invasion. In patients with low/intermediate grade DCIS, if breast irradiation is not being carried out after free margins have been achieved the patient should be aware of the risks of withholding and the benefits and morbidity of adjuvant radiotherapy. Either tamoxifen or an aromatase inhibitor may be of value in those with low/intermediate ER+ve disease if radiotherapy is being withheld. For those patients with extensive or multicentric DCIS, mastectomy is the appropriate treatment. This is best combined with sentinel node biopsy and all such cases should be offered immediate reconstruction.----------------------------Cite this article as:Fentiman IS. Getting the right balance in treatment of ductal carcinoma in situ (DCIS). Int J Cancer Ther Oncol 2013; 1(2):01029.DOI: http://dx.doi.org/10.14319/ijcto.0102.9 </p

Management of operable breast cancer in older women

Older women are not being given the opportunity to benefit from the improvements in both local and systemic treatment for breast cancer. Mammographic screening call/recall system ceases at age 72, making access more difficult. Knowledge about breast cancer in those aged >75 is significantly reduced in terms of understanding symptoms and personal risk but studies have shown that intervention can improve this, at least in the short term. Although older women are more likely to have estrogen receptor positive tumours, nevertheless, more than one-third of women aged over 70 have grade III, aggressive breast cancers. Whenever possible, older women should be offered breast conserving therapy rather than mastectomy since this not only improves their quality of life but also reduces risk of subsequent mental health problems. Endocrine treatment alone should not be used other than in patients with severe co-morbidity and a life-expectancy of less than a year. As adjuvant treatment in those with estrogen receptor positive cancers, the choice between tamoxifen and an aromatase inhibitor will depend upon co-morbidity, side-effects and patient choice