Epidemiology and patterns of care for invasive breast carcinoma at a community hospital in Southern India

<p>Abstract</p> <p>Background</p> <p>Breast cancer incidence in India is on rise. We report epidemiological, clinical and survival patterns of breast cancer patients from community perspective.</p> <p>Methods</p> <p>All breast cancer patients treated at this hospital from July 2000 to July 2005 were included. All had cytological or histological confirmation of breast cancer. TNM guidelines for staging and Immunohistochemistry to assess the receptor status were used. Either lumpectomy with axillary lymph node dissection or Modified radical mastectomy (MRM) was done for operable breast cancer, followed by 6 cycles of adjuvant chemotherapy with FAC or CMF regimens to patients with pT >1 cm or lymph node positive or estrogen receptor negative and radiotherapy to patients after breast conservation surgery, pT size > 5 cm, 4 or more positive nodes and stage IIIB disease. Patients with positive Estrogen receptor or Progesterone receptor were advised Tamoxifene 20 mg per day for 3 years. Descriptive analysis was performed. Independent T test and Chi-square test were used. Overall survival time was computed by Kaplan – Meier method.</p> <p>Results</p> <p>Of 1488 cancer patients, 122 (8.2%) had breast cancer. Of 122 patients, 96.7% had invasive breast carcinoma and 3.3% had sarcoma. 94% came from the rural and semi urban areas. Premenopausal women were 27%. The median age was 50 years. Stage I-6.8%, II-45.8%, III-22%, IV-6.8%, Bilateral breast cancer – 2.5%. The mean pT size was 3.9 cm. ER and PR were positive in 31.6% and 28.1% respectively. MRM was done in 93.8%, while 6.3% patients underwent breast conservation surgery. The mean of the lymph nodes dissected were 3. CMF and FAC regimens were used in 48.8% and 51.2% of patients respectively. FAC group were younger than the CMF group (43.6 yr vs. 54 yrs, P = 0.000). Toxicities were more in FAC than CMF group, alopecia (100% vs. 26.2%), grade2 or more emesis (31.8% vs. 9.2%), grade2 or more fatigue (40.9% vs.19%), anemia (43.1% vs. 16.6%). Median Survival for the cohort was 50.8 months. ER positive patients had better median survival (P = 0.05).</p> <p>Conclusion</p> <p>MRM was the most frequent surgical option. CMF and FAC showed equivalent survival. FAC chemotherapy was more toxic than CMF. ER positive tumors have superior survival. Overall 3 year survival was 70 percent</p

Fetal transcerebellar diameter to abdominal circumference ratio (TCD/AC) and to femur length ratio (TCD/FL) in the assessment of normal fetal growth

Context: Intrauterine growth retardation (IUGR) is a major risk factor for perinatal mortality and morbidity, and its early detection is useful in deciding frequency of antenatal surveillance, optimal delivery timing, and early neonatal management to avoid perinatal mortality and morbidity. Most of the parameters for detection of IUGR are gestational age dependent. Transcerebellar diameter to abdominal circumference ratio (TCD/AC) is a gestational age independent parameter. IUGR due to uteroplacental insufficiency can present as isolated femur length reduction. So, transcerebellar diameter to femur length ratio (TCD/FL) can be useful in early detection of IUGR. Aims: To evaluate the accuracy of TCD/AC and utility of TCD/FL in normal pregnancy at varying periods of gestation and to derive a cut-off value for assessment of fetal growth. Materials and Methods: In this prospective study, 200 patients with cumulative ultrasound age (CUA) between 14-40 weeks. Routine ultrasound parameters and transcerebellar diameter were measured. TCD/AC and TCD/FL was calculated in all patients and for individual subgroups formed according to CUA. Statistical Analysis: Mean and standard deviation, 3rd, 50th and 97th percentile for TCD/AC and TCD/FL was determined for all patients to determine age specific cut off values. Relationship between continuous variables is studied using correlation and simple regression. Results: In our study, TCD with AC and FL show strong correlation throughout pregnancy. TCD/AC dispersed normally with mean value of 14.013 and SD of 0.738 and cut off value is 15.49. TCD/FL is dispersed normally throughout pregnancy with mean value 64.592 and SD of 3.998. TCD/AC, TCD/FL in subgroups also shows similar mean and SD as compared to entire study population. Conclusion: A cut off value of mean +/- SD (15.49), (72.588) for TCD/AC and TCD/FL could be used as a growth parameter for detection and determine the severity of IUGR

Multiple primary cancers: An enigma

Background: Incidence of multiple primary cancers though uncommon, is being frequently reported now-a-days owing to better diagnostic techniques, the prolonged life span and the increased incidence of long-term survival of cancer patients. Materials and Methods: This is a retrospective study. Cases of multiple malignancies diagnosed histopathologically were retrieved from the archives of department of surgical oncology. Clinical data were obtained from the medical records. They were categorized as synchronous malignancies if the interval between them was less or equal to 6 months and metachronous, if the interval was more than 6 months. Results: A total of 13 cases were encountered in the 5 year study period. Out of them two were in the metachronous category and the rest were synchronous as the 2nd malignancy was detected mostly during clinical evaluation of the patients for the primary malignancy. There was female predominance with age range being 43-68 years. Majority of the cases were in the 7th decade. The most common organ involved was breast, followed by cervix. Apart from bilateral breast malignancies, there were combinations like breast with uterine endometrial carcinoma, cervical carcinoma and even papillary thyroid carcinoma. Conclusion: Detection of multiple primary malignancies is becoming increasingly common in day-to-day practice. Greater awareness of this is required among both cancer patients and their treating clinicians