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BMJ Case Reports May 2021Malignant lesions of the vermiform appendix make up a rare subset of colorectal cancer. While colorectal cancer frequently metastasises to the liver, lung, regional...
Malignant lesions of the vermiform appendix make up a rare subset of colorectal cancer. While colorectal cancer frequently metastasises to the liver, lung, regional lymph nodes and peritoneum, metastasis to the breast is extremely rare. Here, we describe the case of an 84-year-old woman who had the incidental finding of appendiceal adenocarcinoma following emergency laparoscopic appendectomy. She declined further operative or adjuvant treatment for her disease. She represented 1 year later with metastatic appendiceal adenocarcinoma disease to her left breast. A simple mastectomy for symptomatic treatment was performed. In this report, we describe the first case of appendiceal adenocarcinoma metastases to the breast. Due to its rarity, there is a paucity of evidence related to the management of this condition. The limited evidence is reviewed and discussed.
Topics: Adenocarcinoma; Aged, 80 and over; Appendectomy; Appendiceal Neoplasms; Breast Neoplasms; Female; Humans; Mastectomy
PubMed: 33990297
DOI: 10.1136/bcr-2020-240808 -
Breast Cancer Research and Treatment Sep 2020With an increasing emphasis on patient-centered care, clinicians in subspecialties such as breast surgery and radiation oncology that offer multiple therapeutic options... (Review)
Review
PURPOSE
With an increasing emphasis on patient-centered care, clinicians in subspecialties such as breast surgery and radiation oncology that offer multiple therapeutic options with equivalent outcomes are under increasing pressure to aid patients with the decision-making process. The aim of this review is to summarize existing studies that either evaluated factors in patient's decision-making regarding locoregional therapy in early-stage breast cancer or evaluated benefit thresholds required to change therapy decisions.
METHODS
A PubMed search to identify prospective or retrospective studies written in English reporting factors in patient decision-making regarding locoregional therapy in early-stage breast cancer was conducted. No restriction was placed on publication date. Studies that focused on breast reconstruction decisions or on patient preferences for decision-making involvement were excluded.
RESULTS
A total of 39 studies were identified; 19 examining patient preferences for breast-conserving surgery versus mastectomy, 7 on preferences for contralateral prophylactic mastectomy, 2 on non-surgical options, 2 on the extent of axillary surgery, and 9 on radiation therapy decisions. Themes such as fear of recurrence, desire to avoid additional invasive therapy, and the importance of physician preference were common, but many studies also highlighted factors important to specific subpopulations of women.
CONCLUSIONS
Patient preference is difficult to define and measure, and heterogeneity across studies renders direct comparison difficult. Future work is needed to define women's risk-thresholds for certain treatments, delve into the psychological factors that direct their decisions, and understand how patients' valuations of risk interact with society's.
Topics: Breast Neoplasms; Female; Humans; Mastectomy; Mastectomy, Segmental; Neoplasm Recurrence, Local; Neoplasm Staging; Patient Preference; Patient-Centered Care; Radiotherapy
PubMed: 32691377
DOI: 10.1007/s10549-020-05737-9 -
Journal of Plastic, Reconstructive &... Oct 2016Women not undergoing breast reconstruction after mastectomy tend to be older. This review aims to aid in effective, evidence-based choices regarding breast... (Review)
Review
AIM
Women not undergoing breast reconstruction after mastectomy tend to be older. This review aims to aid in effective, evidence-based choices regarding breast reconstruction in an older population, appraising the influencing patient factors described in the literature and those directing the reconstructive surgeon. This may refute current misconceptions and ensure surgical decisions are made based on evidence without ageist assumptions. The review forms the basis of an evidence-based algorithm addressing each step of the decision-making process.
METHOD
A literature search was conducted using PubMed, Medline, Evidence.nhs.uk and the Cochrane database. Search terms initially were breast reconstruction, mastectomy, elderly, older, decision, reasons and rationale. A separate literature search was performed for each of the individual 'steps' in the decision-making process.
RESULTS
Overall, 44 papers were obtained. For each section of the decision-making process, titles and abstracts were screened for relevance. Only English language papers were included.
CONCLUSION
If reconstruction is oncologically plausible and co-morbidities and frailty formally assessed, older women should be actively informed about breast reconstruction, receive support and engage in 'shared decision-making'. The older patient is less likely to do research independently. Amongst other factors, body image, cancer fears, employment and carer responsibilities play a part in the decision. With adequate preoperative and frailty assessment and early involvement of the geriatrician and anaesthetist, microsurgical reconstruction is safe. Autologous reconstruction has better long-term outcomes than implant-based reconstructions in this age group, correlating with improved survival and longevity of reconstruction. Age alone should not be considered a contraindication to breast reconstruction.
Topics: Age Factors; Aged; Breast Neoplasms; Decision Making; Emotional Adjustment; Female; Humans; Mammaplasty; Mastectomy
PubMed: 27498596
DOI: 10.1016/j.bjps.2016.06.003 -
Clinics in Plastic Surgery Jan 2018The armamentarium of the modern breast surgeon includes the time-tested procedures of modified radical mastectomy and lumpectomy with sentinel lymph node biopsy with... (Review)
Review
The armamentarium of the modern breast surgeon includes the time-tested procedures of modified radical mastectomy and lumpectomy with sentinel lymph node biopsy with postoperative radiation, but has evolved to include several options that produce excellent oncologic endpoints and improved cosmesis. These options include skin- and nipple-sparing mastectomies with immediate reconstruction as well as oncoplastic procedures that allow larger excisions and better postoperative breast shape. This article provides an overview of these modern surgical approaches for breast cancer treatment.
Topics: Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Combined Modality Therapy; Female; Humans; Mastectomy
PubMed: 29080650
DOI: 10.1016/j.cps.2017.07.002 -
Annals of Plastic Surgery Jun 2021Mastectomies are an integral part of breast cancer treatment for many patients.1 Of those patients, a significant number have previously undergone breast augmentation...
BACKGROUND
Mastectomies are an integral part of breast cancer treatment for many patients.1 Of those patients, a significant number have previously undergone breast augmentation before being diagnosed with breast cancer. Therefore, we developed the novel technique of performing nipple- and implant-sparing mastectomies (NISMs) for women with prior breast augmentations. This study will assess the plausibility of using NISMs versus nipple-sparing mastectomies (NSMs) in this subgroup of patients by comparing the complication rates.
METHODS
Data were collected on age, tumor size, tumor grade, receptors, and the interval between mastectomy and implant exchange for both groups. Descriptive statistics were used to summarize patient characteristics. Independent samples t tests, χ2 tests, and Fisher exact tests were used to compare the NISM and NSM cohorts. Logistic regression was used to assess the association between complications and mastectomy type and was summarized as an odds ratio with a 95% confidence interval.
RESULTS
Fifteen patients underwent an NISM and 35 patients underwent an NSM. The overall rate of complications was less in NISM cases than in NSM cases (20% vs 27%). However, this difference was not statistically significant (odds ratio, 0.54; 95% confidence interval, 0.18-1.64; P = 0.278).
CONCLUSIONS
The overall complication rate was lower with NISMs compared with NSMs. Nipple- and implant-sparing mastectomy is a novel, viable, and safe option for patients with breast cancer and a history of submuscular breast augmentation.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Mastectomy, Subcutaneous; Nipples; Organ Sparing Treatments; Retrospective Studies
PubMed: 33538504
DOI: 10.1097/SAP.0000000000002696 -
Menopause (New York, N.Y.) Nov 2019Ductal carcinoma in situ (DCIS) has the potential to progress to invasive carcinoma. The optimal management of DCIS and methods for individualizing treatment of DCIS are...
OBJECTIVE
Ductal carcinoma in situ (DCIS) has the potential to progress to invasive carcinoma. The optimal management of DCIS and methods for individualizing treatment of DCIS are still being determined. This evidence map depicts the robustness and topical span of research on DCIS management choice on patient-centered and clinical outcomes.
METHODS
We searched PubMed, EMBASE, PsycINFO, PubMed Health, PROSPERO, and clinical practice guideline sites to identify systematic reviews of DCIS management options and consulted with topic experts. A bubble plot visualizes the literature volume and research content for patient-centered outcomes. An online decision tree facilitates discussions with patients and guides through the available evidence.
RESULTS
In total, 40 systematic reviews met inclusion criteria. The research syntheses addressed DCIS management options, including the role of magnetic resonance imaging, axillary surgery/sentinel lymph node biopsy, and excisional biopsy. The map shows existing evidence for mutually exclusive treatment options including active surveillance, breast-conserving surgery, nipple sparing mastectomy, and simple mastectomy. Research findings for intraoperative radiation, adjuvant radiation therapy, adjuvant hormone therapy, hypofractionation radiotherapy, accelerated partial breast irradiation, radiation therapy plus boost, and combined radiation and hormone therapy, as well as for breast reconstruction after mastectomy and surveillance mammography postsurgery are also displayed. The evidence map highlights a scarcity of robust evidence on patient-centered outcomes.
CONCLUSIONS
The evidence map provides an overview of DCIS research showing the range of management options and remaining decisional dilemmas that follow a diagnosis of DCIS. It maps the evidence in accessible tools to guide practice and future research. : Video Summary:http://links.lww.com/MENO/A448.
Topics: Adult; Antineoplastic Protocols; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Combined Modality Therapy; Disease Management; Evidence-Based Medicine; Female; Humans; Mammography; Mastectomy; Mastectomy, Segmental; Middle Aged; Systematic Reviews as Topic; Treatment Outcome
PubMed: 31567868
DOI: 10.1097/GME.0000000000001397 -
International Journal of Surgical... 2020. Surgery has been known as the procedure of choice for breast cancer management since 1700 years before Christ. Nowadays, breast-conserving surgery and mastectomy are... (Comparative Study)
Comparative Study
UNLABELLED
. Surgery has been known as the procedure of choice for breast cancer management since 1700 years before Christ. Nowadays, breast-conserving surgery and mastectomy are performed in selected cases with specific clinical criteria. Here, we compare these two procedures for breast cancer patients with variable features in Cancer Research Center, Tehran, as a single institution experience.
METHODS
In this 25-year follow-up retrospective cohort study, we identified breast cancer patients who had undergone breast-conserving therapy or mastectomy. Disease-free survival and overall survival were evaluated using Kaplan-Meier survival analysis and the log-rank test between the two groups. A value less than 0.05 was considered statistically significant.
RESULTS
A total of 3358 breast cancer patients, including 61% breast-conserving therapy and 39% mastectomy cases were identified, with a mean follow-up time of 94 months. The overall survival and disease-free survival of all cases were significantly better in breast-conserved patients, particularly in early-stage breast cancer with favorable clinical, pathological, and biological features. Ten-year disease-free survival and overall survival in breast-conserving therapy and mastectomy cases were 74%, 88% and 58%, 80%, respectively.
CONCLUSION
Breast-conserving surgery and radiation therapy prove to be an appropriate treatment option for breast cancer patients in terms of overall survival and disease-free survival when indicated.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Intraductal, Noninfiltrating; Female; Follow-Up Studies; Humans; Iran; Mastectomy, Segmental; Mastectomy, Simple; Middle Aged; Retrospective Studies; Survival Analysis
PubMed: 32181017
DOI: 10.1155/2020/8709231 -
Plastic and Reconstructive Surgery Oct 2022Despite the increased use of nipple-sparing mastectomies, there are limited data examining long-term cancer recurrence rates in these patients. The objective of this...
BACKGROUND
Despite the increased use of nipple-sparing mastectomies, there are limited data examining long-term cancer recurrence rates in these patients. The objective of this study was to analyze breast cancer recurrence in patients who underwent therapeutic nipple-sparing mastectomy with a median of 10 years of follow-up.
METHODS
All patients undergoing nipple-sparing mastectomy at a single institution were retrospectively reviewed temporally to obtain a median of 10 years of follow-up. Patient demographic factors, mastectomy specimen pathologic findings, and oncologic outcomes were analyzed. Univariate analysis was performed to identify independent risk factors for locoregional recurrence.
RESULTS
One hundred twenty-six therapeutic nipple-sparing mastectomies were performed on 120 patients. The most frequently observed tumor histology included invasive ductal carcinoma (48.4 percent) and ductal carcinoma in situ (38.1 percent). Mean tumor size was 1.62 cm. Multifocal or multicentric disease and lymphovascular invasion were present in 31.0 percent and 10.3 percent of nipple-sparing mastectomy specimens, respectively. Sentinel lymph node biopsy was performed in 84.9 percent of nipple-sparing mastectomies, and 17.8 percent were positive. The rate of positive frozen subareolar biopsy was 7.3 percent ( n = 82) and that of permanent subareolar pathology was 9.5 percent ( n = 126). The most frequently observed pathologic tumor stages were stage I (44.6 percent) and stage 0 (33.9 percent). The incidence of recurrent disease was 3.17 percent per mastectomy and 3.33 percent per patient. On univariate analysis, no demographic, operative, or tumor-specific variables were independent risk factors for locoregional recurrence.
CONCLUSIONS
Overall recurrence rates are low in patients undergoing nipple-sparing mastectomy at a median follow-up of 10-years. Close surveillance should remain a goal for patients and their providers to promptly identify potential recurrence.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Risk, III.
Topics: Breast Neoplasms; Female; Follow-Up Studies; Humans; Mammaplasty; Mastectomy; Mastectomy, Subcutaneous; Neoplasm Recurrence, Local; Nipples; Retrospective Studies
PubMed: 35943969
DOI: 10.1097/PRS.0000000000009495 -
Lymphatic Research and Biology Apr 2022Sexual functions in women with lymphedema secondary to breast cancer surgery have not been investigated sufficiently. This study aimed to compare patients with and...
Sexual functions in women with lymphedema secondary to breast cancer surgery have not been investigated sufficiently. This study aimed to compare patients with and without lymphedema after total mastectomy in terms of emotional state, sexual functions, and quality of life. We also investigated the factors affecting sexual functions in these patients. Married women 20-55 years of age, who presented to lymphedema polyclinic of Health Sciences University Ankara Training and Research Hospital after having undergone total mastectomy at least 1 year earlier owing to breast cancer were included. Twenty-five patients with lymphedema were assigned to the lymphedema group, and 20 without lymphedema to the control group. Hospital Anxiety and Depression Scale (HADS) was used to assess emotional state. We evaluated sexual functions of the participants by Female Sexual Function Index (FSFI) and quality of life with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QOL-C30). There was no statistically significant difference in age and body mass index between the groups ( > 0.05). The mean HADS score was 13.4 ± 6.5 in lymphedema group and 13.4 ± 6.0 in control group. The groups were also similar in aspect of the HADS score ( > 0.05). FSFI and global health and physical function scores of EORTC QOL-C30 were statistically significantly lower in the lymphedema group ( < 0.05). A statistically significant correlation was found between FSFI and age and time elapsed postmenopause ( < 0.05, for both). We evaluated sexual functions of the patients who underwent mastectomy in this study. Although the HADS score is similar in patients with and without lymphedema, both sexual functions and quality of life are adversely affected in patients who undergo mastectomy and develop lymphedema. This study is important for investigating whether lymphedema developing after total mastectomy affects sexual functions of the patients.
Topics: Breast Neoplasms; Female; Humans; Lymphedema; Mastectomy; Mastectomy, Simple; Pilot Projects; Quality of Life; Surveys and Questionnaires
PubMed: 33646047
DOI: 10.1089/lrb.2020.0053 -
Asian Pacific Journal of Cancer... May 2021There are limited data concerning the use of mastectomy and associated factors in China in recent years. This study aimed to investigate the uptake of mastectomy and... (Observational Study)
Observational Study
OBJECTIVE
There are limited data concerning the use of mastectomy and associated factors in China in recent years. This study aimed to investigate the uptake of mastectomy and determine the associations between patients' characteristics and mastectomy among Chinese women with breast cancer.
METHODS
A retrospective analysis of female breast cancer cases from 1st January 2015 to 31st December 2019 from a tertiary hospital was conducted. Socio-demographic data, clinical data, and surgery types were collected by reviewing the medical record system. Chi-squared test, Fisher's exact test and multivariate logistic regression analysis were used to determine any correlations of patients' characteristics with mastectomy.
RESULTS
A total of 1,171 women with breast cancer were identified, and 76.60% of them underwent a mastectomy. The mastectomy rates showed an increase from 70.62% in 2015 to 86.87% in 2017 and then dropped to 71.91% in 2019. Women undergoing mastectomy were older and were more likely to be married and have at least one child. They had an advanced cancer stage, larger tumour size, and more lymph node invasion and were positive for HER-2 overexpression. Older age, larger tumour size (2-5 cm), higher cancer stages (stage 2- stage 3) and being positive for HER-2 were the four independent variables that significantly predicted the uptake of mastectomy.
CONCLUSIONS
Our results showed a wide application of mastectomy in China and uncovered the factors associated with mastectomy uptake from a single-centre experience. Findings suggested the potential overuse of mastectomy among women with early-stage breast cancer, and highlighted the significance of promoting cancer screening in China. Findings could be also used to develop relevant provisions and interventions to facilitate breast cancer treatment decision-making and screening planning.
.Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Mastectomy; Middle Aged; Prognosis; Retrospective Studies; Young Adult
PubMed: 34048191
DOI: 10.31557/APJCP.2021.22.5.1599