Costs and health effects of breast cancer interventions in epidemiologically different regions of Africa, North America, and Asia.

Contains fulltext : 51056.pdf (publisher's version ) (Closed access)We estimated the costs and health effects of treating stage I, II, III, and IV breast cancer individually, of treating all stages, and of introducing an extensive cancer control program (treating all stages plus early stage diagnosis) in three epidemiologically different world regions--Africa, North America, and Asia. We developed a mathematical simulation model of breast cancer using the stage distribution and case fatality rates in the presence and absence of treatment as predictors of survival. Outcome measures were life-years adjusted for disability (DALYs), costs (in 2000 U.S. dollars) of treatment and follow-up, and cost-effectiveness ratios (CERs; in dollars per DALY averted). Sensitivity analyses were performed to determine the robustness of the results. Treating patients with stage I breast cancer resulted in 23.41, 12.25, and 19.25 DALYs averted per patient in Africa, North America, and Asia, respectively. The corresponding average CERs compared with no intervention were 78 U.S. dollars , 1,960 U.S. dollars, and 62 U.S. dollars per DALY averted. The number of DALYs averted per patient decreased with stage; the value was lowest for stage IV treatment (0.18-0.19), with average CERs of 4,986 U.S. dollars in Africa, 70,380 U.S. dollars in North America, and 3,510 U.S. dollars per DALY averted in Asia. An extensive breast cancer program resulted in 16.14, 12.91, and 12.58 DALYs averted per patient and average CERs of 75 U.S. dollars, 915 U.S. dollars, and 75 U.S. dollars per DALY averted. Outcomes were most sensitive to case fatality rates for untreated patients, but varying model assumptions did not change the conclusions. These findings suggest that treating stage I disease and introducing an extensive breast cancer program are the most cost-effective breast cancer interventions

Is the sentinel lymph node pathology protocol in breast cancer patients associated with the risk of regional recurrence?

Contains fulltext : 118704.pdf (publisher's version ) (Open Access)BACKGROUND: Internationally, there is no consensus on the pathology protocol to be used to examine the sentinel lymph node (SN) in breast cancer patients. Previously, we reported that ultra-staging led to more axillary lymph node dissections (ALND). The question was, whether ultra-staging is effective in reducing the risk of regional relapse. METHODS: From January 2002 to July 2003, 541 patients from 4 hospitals were prospectively registered when they underwent a SN biopsy. In hospitals A, B, and C, 3 levels of the SN were examined pathologically, whereas in hospital D at least 7 additional levels were examined. Patients with a positive SN, including isolated tumor cells, underwent an ALND. This analysis focuses on the 341 patients with a negative SN. Primary endpoint was 5-year regional recurrence rate. RESULTS: In hospital D 34% of the patients had a negative SN as compared to 71% in hospitals A, B, and C combined (p < 0.001). At 5 years follow-up, 9 (2.6%) patients had developed a regional lymph node relapse. In hospital D none of the patients had a regional recurrence, as compared to 9 (2.9%) cases of recurrence in hospitals A, B, and C. CONCLUSION: The less intensified SN pathology protocol appeared to be associated with a slightly increased risk of regional recurrence. The absolute risk was still less than 3%, and does not seem to justify the intensified SN pathology protocol of hospital D

The effectiveness of MR imaging in the assessment of invasive lobular carcinoma of the breast.

Item does not contain fulltextInvasive lobular carcinoma (ILC) of the breast is, due to its diffuse infiltrative growth pattern, a diagnostic challenge. Even in retrospect, only up to 80% are visible at mammography. Moreover, both mammography and ultrasound tend to structurally underestimate the size of ILC. Breast magnetic resonance (MR) imaging is usually performed after initial cancer detection. In this setting, the sensitivity is approximately 96%. However, multiple cases have been reported in which ILC has been initially detected with MR imaging, thus implying a potential advantage of MR imaging over mammography in screening. The size of an ILC as reported on MR imaging correlates well with size at pathology (r = 0.89). Additional tumor foci are detected by MR imaging in approximately one-third of patients, and these foci are subsequently pathologically confirmed in 88%. Hence, preoperative MR imaging of ILC changes management in 28% of patients, often appropriately. Nevertheless, it is still essential to obtain histology prior to large changes in the therapeutic regime based on MR imaging findings, either by second-look ultrasound or by MR imaging-guided biopsy. Using this approach, it has been shown that preoperative MR imaging reduces the rate of reexcisions after breast-conserving surgery from 27% to 9%, without increasing the rate of mastectomies and without extending total therapy time. Finally, the early detection of contralateral carcinomas only visible at MR imaging in approximately 7% of patients with ILC implies that preoperative MR imaging in these patients improves survival, although the magnitude of this effect is unknown.1 mei 201