Breast Disease

There are concerns that physiologic changes of the peripartum breast may result in complications in breast conservation therapy. We present the complications of breast conservation surgeries and mastectomies performed for pregnancy-associated breast cancer (PABC).

From April 1989 through April 2008, sixty-seven breast cancer patients underwent surgical management for PABC, defined as surgery during pregnancy or within one year postpartum. Records of women who had surgery were examined for post-operative wound complications of milk fistula, cellulitis, abscess, or hematoma.

Forty-seven patients underwent mastectomy. Twenty were treated with conservative breast surgery. There were six complications, all treated in the outpatient setting. There were no documented milk fistulae.

In our series, we had few postoperative complications and no milk fistulae for those patients undergoing surgery for PABC. When compared to those who had mastectomy for PABC, women who underwent breast conserving therapy did not appear to have increased frequency of surgical complications.

To hasten and improve anticancer drug development, we created a novel approach to generating and analyzing preclinical dose-scheduling data so as to optimize benefit-to-toxicity ratios.

We applied mathematical methods based upon Norton-Simon growth kinetic modeling to tumor-volume data from breast cancer xenografts treated with capecitabine (Xeloda®, Roche) at the conventional schedule of 14 days of treatment followed by a 7-day rest (14-7).

The model predicted that 7 days of treatment followed by a 7-day rest (7-7) would be superior. Subsequent preclinical studies demonstrated that this biweekly capecitabine schedule allowed for safe delivery of higher daily doses, improved tumor response, and prolonged animal survival.

We demonstrated that the application of Norton-Simon modeling to the design and analysis of preclinical data predicts an improved capecitabine dosing schedule in xenograft models. This method warrants further investigation and application in clinical drug development.

Recently, the number of prophylactic mastectomies (PM) in the United States has increased due to a better understanding of the genetic and biological behavior of breast cancer. Consensus guidelines regarding indications for PM are published; however, studies evaluating adherence to published guidelines are lacking. The present study analyzed the indications and possible decision-making process leading to PM among 579 patients who underwent mastectomy.

Data from 579 female patients who underwent mastectomies between 01/2005 and 12/2007 were retrospectively collected and analyzed.

PM was performed in 128 patients. Contralateral prophylactic mastectomy was performed in 103 patients (80.5%), and 21 (16.4%) underwent bilateral prophylactic mastectomy (four patients (3.12%) with bilateral pathology were excluded). with a mean age of 49 ± 9 years. The indications for PM, either alone or in combination, included strong family history, prior history of breast cancer, histological risk factors and a BRCA mutation.

Strong family history was the most common indication for PM and adherence to published consensus guidelines regarding the indications for PM was 97.6%. Depression, anxiety and hypothyroidism were the most common co-morbidities observed and the effect these conditions may have on the decision-making process for PM requires further evaluation.

Male Breast Cancer (MBC) is very rare and accounts for less than one percent of all cancers in men. Because of the low incidence of MBC it has not attracted extensive studies. The current study is the first cohort of men with breast carcinoma reported in our country to date.

We retrospectively reviewed the medical records of 58 MBC patients who had been treated at Shahid Faghihi Hospital in Shiraz, Iran, between 1990 and 2007. Data regarding general characteristics of patients including: age at time of diagnosis, family history of breast cancer, site, stage, size and location of tumor, histopathology of primary tumor, and treatment modalities (surgery, chemotherapy, radiation and hormone therapy) were obtained by reviewing medical records.

Among 58 MBC patients included in current study, 98.3% of patients were presented with a palpable mass, while 22.4% had breast skin deformity, and 12.1% patients had breast discharge. The median age at time of diagnosis was 60 years (range, 34–84 years). Infiltrative ductal carcinoma was found in 96.2% of patients, insitu ductal carcinoma in 3.8% of patients. The histopathological diagnosis of 5 breast tumors was missed. 4.3% of tumors were diagnosed in stage 0, 10.6% in stage one, 74.5% in stage two, and 10.6% in stage three. Regional lymph node involvement were diagnosed in 20.7% of patients, and 15.5% patients had distant metastasis at the time of diagnosis.

This study, in spite of limitations, suggests that the incidence of MBC is increasing, and men are diagnosed with later-stage disease than women. Therefore, MBC screening should become a part of female breast cancer registry system.

Breast cancer is a highly heterogeneous disease globally. Public health prevention measures require an understanding of the burden of breast cancer and its risk factors. The purpose of this study was to describe the clinical, pathologic, and epidemiologic characteristics of breast cancer patients in Tanzania.

Data was abstracted from the medical records of all breast cancer patients attending Ocean Road Cancer Institute (ORCI) over a 2-year period from July 2007 to June 2009. Tumor tissue paraffin blocks were collected for all patients with available tissues for the determination of estrogen receptor (ER) and progesterone receptor (PR). Data for all patients was analyzed descriptively and by using unconditional logistic regression, by comparing early stage (ES), defined as stages I and II and late stage (LS), defined as stages III and IV patients to obtain odds ratios (ORs), 95% confidence intervals (CIs), and P-values.

Among the 488 patients, stage was determined for 356~patients, 90.7% of whom presented in LS. Of the 57 tumor tissues, 49.1% were ER-/PR-. Patients with ulceration (OR = 4.97; 95% CI = 1.07, 23.04; p = 0.04) and peau d'orange (OR = 6.78; 95% CI = 1.48, 31.17; p = 0.01) were more likely to present in LS rather than ES. Male breast cancer accounted for 2.9% of all breast cancers and inflammatory breast cancer (IBC) comprised 4.3–5.5% of cases based on registered t4d diagnosis or the criteria of IBC signs, if t4d was not reported in the medical records.

Most breast cancer patients in Tanzania are diagnosed at advanced disease stages with about half of the tumors being ER-/PR-. These data strongly support that reducing barriers to care, down-staging of disease at diagnosis, implementation of clinical guidelines for management of advanced cases, and palliative care are the four most essential factors that need to be addressed to reduce morbidity and mortality from breast cancer in Tanzania. Further research is needed to quantify the magnitude and molecular features of two relatively rare forms of breast cancer that may account for a greater proportion of the burden of breast cancer in Tanzania compared to the USA and Western Europe: male breast cancer and IBC.