Locoregionally recurrent breast cancer: incidence, risk factors and survival

Locoregional recurrence (LRR) after therapy for early breast cancer is common. Patients with LRR can suffer both local consequences and symptoms of metastatic disease, as LRR is an independent predictor of subsequent distant metastases. Much of the available data on LRR is derived from small, single institution, retrospective studies, so marked differences in the incidence rates for LRR, it's risk factors and subsequent systemic recurrence are reported. The purpose of this review was to try and collate this data in a format that would be useful for both clinicians and their patients.     

男性乳腺癌的临床病理特征及生存分析

目的 探讨男性乳腺癌患者的临床病理特征及影响预后的因素。方法 回顾性分析1999年1月至2010年5月经病理证实的55例接受手术治疗的男性乳腺癌患者。采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行生存比较,多因素分析用Cox风险比例回归模型。结果 55例患者的5年生存率为61.8％。肿瘤TNM分期Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的5年生存率分别为75.0％、69.6％、45.4％和20.0％,差异有统计学意义（P＜0.05）。组织学分级Ⅰ、Ⅱ和Ⅲ级患者的5年生存率分别为83.3％、67.5％和333％,差异有统计学意义（P＜0.05）。单因素分析显示,不同组织学分级、T分期、TNM分期、淋巴结有无转移及是否放疗均与男性乳腺癌患者的5年生存率有关（P＜0.05）。Cox回归模型分析显示,组织学分级（HR=3.690,95％CI：1.476～9.225,P＜0.05）和TNM分期（HR=3.437,95％CI：1.447～8.163,P＜0.05）是影响男性乳腺癌预后的独立因素。结论 组织学分级和TNM分期是影响男性乳腺癌预后的独立因素。男性乳腺癌的诊治有待进一步研究。     

Clinical characteristics and survival outcome of breast cancer in southwest Nigerian women

Background

Breast cancer is the commonest cause of cancer-related deaths in the world. There is paucity of data on breast cancer incidence, epidemiological features, treatment and survival in our environment and, thus, the aim of this study is to document our findings on the clinical characteristics and survival outcome of patients seen in one of the teaching hospitals in Nigeria.

Materials and methods

This is a prospective non-selective cohort study of 139 consecutive cases of breast cancer seen in Olabisi Onabanjo University Teaching Hospital in Sagamu, Ogun State, Nigeria, from 1^st January 2004 to 31^st December 2008. Appropriate treatment was given after histological confirmation. Follow up was for a minimum of 36 months. Patients were classified into various groups based on age, menstrual status, parity, body mass index (BMI), histological stage and lump size. Results were analyzed using SPSS, and were expressed in percentages and frequency tables. Kaplan-Meier survival curves were constructed for each group and test of equality of survival for each group, Mantel-Cox, was done. A p value of <0.05 was considered to be significant.

Results

All 139 patients were female. The mean age was 48.1, and commonest symptom was lumps in 100 (72%) cases and mean duration of symptoms was 10.1 months. The mean lump size was 8.2 cm. Five patients had Manchester stage 1 while 39 patients (28%) had stage 4. The mean duration of survival was 29.8 months. Sixty-three (45.2%) patients survived for 36 months and more. There was no significant difference in survival in patients who were below 40 years and those above 40 years. Survival was better in patients with lumps less than 5 cm than those with lumps bigger than 5 cm (p < 0.001), at premenopausal than postmenopausal (p = 0.015) stage and at stages 1 and 2 than stages 3 and 4 (p < 0.001).

Conclusion

Breast cancer presentation and survival in our study is characterized by late presentation, affecting predominantly premenopausal women and with poor overall survival. There is a need to increase awareness and set up screening programmes to promote early detection and treatment.     

ABO blood group and breast cancer incidence and survival

ABO blood type has been associated with risk and survival for several malignancies; however, data for an association with breast cancer are inconsistent. Our study population consisted of Nurses' Health Study participants with self-reported serologic blood type and/or ABO genotype. Using Cox proportional hazards regression, we examined the association between serologic blood type and incident breast cancer among 67,697 women, including 3,107 cases. In addition, we examined the association with ABO genotype in a nested case-control study of 1,138 invasive breast cancer cases and 1,090 matched controls. Finally, we evaluated the association between serologic blood type and survival among 2,036 participants with breast cancer. No clear association was seen between serologic blood type or ABO genotype and risk of total breast cancer, invasive breast cancer or breast cancer subtypes. Compared to women with blood type O, the age-adjusted incidence rate ratios for serologic blood type and total breast cancer were 1.06 (95% CI, 0.98-1.15) for type A, 1.06 (95% CI, 0.93-1.22) for AB and 1.08 (95% CI, 0.96-1.20) for B. In genetic analyses, odds ratios for invasive breast cancer were 1.05 (95% CI, 0.87-1.27) for A/O, 1.21 (95% CI, 0.86-1.69) for A/A, 0.84 (95% CI, 0.56-1.26) for A/B, 0.84 (95% CI, 0.63-1.13) for B/O and 1.17 (95% CI, 0.35-3.86) for B/B, compared to O/O. No significant association was noted between blood type and overall or breast cancer-specific mortality. Our results suggest no association between ABO blood group and breast cancer risk or survival.     

Bilateral breast cancer: one disease or two?

Our purpose was to determine whether bilateral breast cancer depends upon genetic predisposition to multiple tumors or, alternatively, represents two independent sporadic events. Biological concordance of hormone receptors and histopathology in bilateral tumors, family history of breast cancer, age at diagnosis, and survival were evaluated in 88 patients. The immunoreactivity of paired tumors from 51 patients to six different immunocytochemical markers was compared.Neither histologic patterns nor immunocytochemical reactions showed concordance between bilateral tumors. Absence of concordance (other than for estrogen receptors) and lack of associations with positive family history and early age of onset support an interpretation of independent tumor origins and does not suggest a major role for genetic determinants in the majority of cases of bilateral breast cancer.     

Lung cancer in a health area of Spain: incidence,characteristics and survival

GARCÍA PRIM J.M., GONZÁLEZ BARCALA F.J., PAZ ESQUEJE J., POSE REINO A., FONDEVILA LÓPEZ A. & VALDÉS CUADRADO L. (2010) European Journal of Cancer Care 19 , 227–233
Lung cancer in a health area of Spain: incidence, characteristics and survival To examine the incidence, characteristics, therapeutic approach and survival of diagnosed lung cancer (LC) in the Santiago de Compostela Health Area. A retrospective study was carried out on LC for a period of 3 years. Of the 481 cases collected, 92.7% were male. The median age was 66.93 years. The crude incidence for men and women was 80.71 and 5.84 per 100 000 inhabitants respectively. Among the non‐small cell lung cancers (NSCLC), 68.1% were diagnosed in stage IIIB or IV. The cancer had already spread in 62.2% of the small cell lung cancer (SCLC). Chemotherapy was used in 51.6% of patients. The survival probability from the first to the fifth year was 47.7%, 24.3%, 12.9%, 10% and 8.9% respectively. The median survival at 5 years was 12.12 months for NSCLC, rising to 29.8 months in stage I, and 8.85 months in SCLC. In our Health Area LC occurs more often in men, in whom the prevalence of smoking is very high. The most common histology type was squamous cell carcinoma. In the majority of cases, the diagnosis is made in the advanced stages, which accounts for the low percentage of surgical treatments and the short survival.     

Bilateral breast cancer after cured Hodgkin's disease

Three patients developed bilateral breast cancer at 10 to 24 years after mantle irradiation for locally or systemically advanced Hodgkin's disease (HD). Four of the six cancers in the three patients were detected only by mammography. Pathologically, five of the cancers were intraductal carcinomas (four with an invasive component) with one being a lobular carcinoma. Five of the six lesions were Stage I pathologically without evidence of axillary nodal involvement. It is recommended that female patients with Hodgkin's disease who have received mantle irradiation as part of the therapy for their Hodgkin's disease and who are observed for 10 or more years after completion of mantle irradiation be considered at risk for the development of breast cancer. Such patients should be monitored appropriately by routine bilateral mammograms to increase the early detection of early stage lesions.     

81例男性乳腺癌临床特征及生存分析

目的探讨男性乳腺癌的临床特点、治疗和预后。方法回顾性分析81例男性乳腺癌患者的临床及病理特征、复发转移及生存情况。结果本组5年无病生存率和5年总生存率分别为63.6%和77.7%。单因素分析结果显示,影响患者无病生存时间的因素有肿物大小（P=0.002）、淋巴结状况（P=0.041）、临床分期（P=0.000）和辅助化疗（P=0.033）。影响本组患者总生存时间的因素有肿瘤大小（P=0.002）、淋巴结状况（P=0.012）、临床分期（P=0.000）和辅助化疗（P=0.040）。COX多因素分析示临床分期（P=0.000）和辅助化疗（P=0.018）为影响患者无病生存时间的独立因素;同时,临床分期（P=0.000）和辅助化疗（P=0.012）也是影响患者总生存时间的独立因素。结论男性乳腺癌发病率低,预后较差,病理类型以浸润性导管癌为主。以手术为主的综合治疗为其公认的治疗模式,其预后与临床分期和辅助化疗有关。应注意早期诊断和治疗,并重视术后辅助化疗等综合治疗。     

The incidence, indications and outcome for the non-operative management of breast cancer

BACKGROUND AND OBJECTIVES: This study aimed to identify the proportion of patients with breast cancer who do not undergo primary operative treatment, to identify the reasons surgery is not performed, and to determine the outcome for this group of patients. METHODS: Data was obtained from the Bedford Breast Cancer Registry for all non-metastatic patients presenting between January 1990 and December 2004 who were initially treated non-operatively. Robust diagnostic, therapeutic, and follow-up data on all patients was collected prospectively during this period. RESULTS: One hundred and eighty-five out of 2110 episodes of breast cancer were treated non-operatively during this period. Sixty-eight percent of patients were unfit for surgery, 15% had inoperable tumours, and 17% refused surgical intervention. Median survival and 5-year survival rate for all non-operative patients were 3.7 years and 41.2%. Median survival for inoperable patients was 3.7 years, compared with 3.5 years for those unfit for surgery and 4.2 years for those who refused surgery. The 5-year survival rate for patients refusing surgery was 43%, compared with 61% for a matched group of patients undergoing standard surgical therapy. CONCLUSIONS: This study provides useful data on the reasons for, and outcome of, the non-operative management of breast cancer.     

Local recurrence of breast cancer following surgery and radiotherapy: incidence and outcome

Local recurrence of cancer in the treated breast following breast-conserving surgery and radiotherapy occurs in a minority of patients, but can represent a significant clinical problem. The impact of local relapse on the subsequent course of the disease is disputed. The aim of this retrospective review was to identify the rate and prognostic factors for breast recurrence and to determine the subsequent outcome. The case notes of 2159 patients treated between 1989 and 1992 were reviewed. Actuarial local relapse rate was 6.3% at 5 years. Factors predictive for recurrence on multivariate analysis were age (P<0.001), status of excision margins (P=0.019), and pathological UICC stage (P=0.01). One hundred and sixty-one patients developed local recurrence in the treated breast of whom 101 were treated with further surgery. The 5-year cancer-specific survival of this group was comparable with that of the patients who remained free of breast relapse (82 vs. 88%) but subsequently fell to 61 vs. 80% at 8 years (P<0.001). Sixty patients were unable to have salvage surgery; their cancer-specific survival was much worse than that of patients with operable recurrences at 33% at 5 years and 13% at 8 years. Eighty-three patients (4% of the original 2159 patients) had uncontrolled local disease at time of death or last follow-up. The prognosis of patients who developed recurrence within 2 years of their initial treatment was inferior to those who developed recurrences after 4 years (cancer-specific survival 5 years post-recurrence 23 vs. 57% P=0.008). Systemic therapy should be considered for patients with early breast recurrence in view of their inferior survival.     

Clinicopathologic characteristics and survival of male breast cancer

Backgrounds

Male breast cancer (MBC) is a rare disease and accounts for <1 % of all breast cancers.

Methods

We retrospectively analyzed clinicopathologic characteristics and prognosis of MBC patients who were diagnosed in our hospital between March 2002 and March 2012.

Results

The median age of diagnosis of MBC was 62 years, which was 9 years older than female breast cancer (FBC) patients. The highest proportion of MBC patients was in the 50–59-year age group. The percentage of invasive ductal carcinoma in MBC was much higher than in FBC (P = 0.000). The positive rate of estrogen receptors in MBC patients (87.9 %) was significantly higher than in FBC patients (P = 0.048), whereas HER-2 was positive in 17.2 % of MBC patients, which was significantly lower than in FBC patients (P = 0.001). There was a consistent significant difference in luminal subtypes of FBC and MBC patients (P = 0.000). The overall survival rates of MBC were significantly higher than FBC (P = 0.004). HER-2-positive patients had a statistically worse prognosis than HER-2-negative patients (P = 0.040). Lymph node metastasis and larger tumor size were also associated with poorer prognosis (P = 0.056 and P = 0.088). The level of hormones was examined in 7 patients, and abnormal hormone levels were detected in 4.

Conclusion

The FBC patients were significantly different from the MBC in clinicopathologic and prognostic characteristics. HER-2 positivity was an important factor for prognosis.     

Bilateral breast cancer

Between the years 1972 and 1982, 1,880 women were treated for breast cancer at the Tel-Aviv Medical Center. One thousand two hundred fifteen detailed charts are included in our study. Sixty-six patients (5.4%) were diagnosed as having bilateral breast cancer. The mean age at first tumor diagnosis was 55.1 years. Bilateral breast cancer appears to be more common in nulligravidas and women who have delivered up to two children. In patients where the first tumor was greater than 4 cm in diameter, there was a higher incidence of a second tumor. A total of 65.2% of all patients who developed a second breast tumor had no axillary lymph node metastasis at the time the first breast tumor was diagnosed. There was no correlation between the histological types of the first and second tumors. The longer the woman survived after the first cancer diagnosis, the greater the likelihood of her developing a second tumor; the longer the interval between the diagnosis of the two cancers, the better the survival rate.     

Estrogen receptor-positive breast cancer in Japanese women: trends in incidence,characteristics, and prognosis

BackgroundThe incidence of breast cancer in Japanese women has doubled in all age groups over the past two decades.Patients and methodsWe examined the characteristics of the tumors treated in three time periods between 1982 and 2010. Estrogen receptor (ER), progesterone receptor (PgR) and HER2 status were assessed by immunohistochemistry. Correlation of hormone receptor levels with clinicopathological factors and prognosis was analyzed in ER-positive, HER2-negative breast cancer in two age groups (≤50 years versus >50 years).ResultsThe frequency of ER-positive breast cancer in women aged 50 years or younger increased greatly over the interval studied (1982–1991: 52.5%, 1992–2001: 72.6%, 2002–2010: 87.1%, P < 0.0001). The frequency of ER-positive tumors also significantly increased in women over 50 years of age (1982–1991: 69.4%, 1992–2001: 73.3%, 2002–2010: 78.6%, P = 0.029). In ER-positive, HER2-negative breast cancer, tumor grade was negatively correlated with expression levels of ER and PgR. Prognosis for patients with ER-positive, HER2-negative disease significantly improved over time, due to advances in adjuvant therapies.ConclusionIt is necessary to establish risk factors, both genetic and environmental, capable of predicting the risk of ER-positive breast cancer and thus enable the efficient selection of candidates for hormone receptor-targeted chemoprevention.     

Menstrual cycle characteristics and incidence of premenopausal breast cancer.

BACKGROUND: Epidemiologic studies have indicated that menstrual cycle characteristics such as age at menarche and age at menopause are associated with breast cancer risk. Anovulation, which is more common with long or irregular cycles, has been hypothesized to reduce the incidence of breast cancer. METHODS: We analyzed data from the Nurses' Health Study II, a cohort of 116,671 female registered nurses ages 25 to 42 years at baseline. Information on menstrual cycle characteristics was assessed in 1989 and 1993, and incident cases of premenopausal breast cancer were ascertained through 2001. RESULTS: During 1,135,496 person-years of follow-up (1989-2001), 1,163 incident cases of invasive premenopausal breast cancer were diagnosed. Overall, women with long menstrual cycles at ages 18 to 22 years (>32 days or too irregular to estimate) did not experience a significantly lower breast cancer risk compared with women with normal cycle lengths (26-31 days) at that age [covariate-adjusted hazard ratio (HR), 0.92; 95% confidence interval (95% CI), 0.79-1.06]. Among women ages <40 years, those with menstrual cycles lasting >32 days or too irregular to estimate at ages 18 to 22 years had a decreased incidence of breast cancer (covariate-adjusted HR, 0.71; 95% CI, 0.53-0.97). Current menstrual cycle characteristics were not associated with breast cancer incidence. CONCLUSION: Overall, longer or irregular cycles at ages 18 to 22 years or in early adulthood were not associated with reduced premenopausal breast cancer risk. However, longer menstrual cycles at ages 18 to 22 years were associated with a lower incidence of premenopausal breast cancer before age 40.