Management of mammographically detected breast cancer:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
1997
|
| Series: | Surgical oncology clinics of North America
6,2 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XVII S., S. 195 - 413 Ill., graph. Darst. |
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| adam_text | MANAGEMENT OF MAMMOGRAPHICALLY
i DETECTED BREAST CANCER
CONTENTS
Preface xv
Blake Cady
New Era in Breast Cancer: Impact of Screening
on Disease Presentation 195
Blake Cady
Mammographic screening produces markedly smaller breast can¬
cers with fewer axillary lymph nodes and more ductal carcinoma
in situ. Over the past 25 years at the New England Deaconess Hos¬
pital, the mean maximum diameter of breast cancers has decreased
by 10% every 5 years and is now only 2.1 cm. The median maxi¬
mum diameter in the years from 1989 to 1993 is only 1.5 cm. Ax¬
illary lymph node metastases also are declining progressively. This
continuing decline in mean and median maximum diameters and
incidence of axillary lymph node metastases shows no signs of
abating at the present time. Universal mammographic screening of
appropriately aged women should be a public health goal to fur¬
ther this trend towards markedly earlier breast cancer detection
with much higher survival and new opportunities for modified
therapy.
Current Use and How to Increase Mammography
Screening in Women 203
Barbara K. Rimer
Mammography reduces mortality from breast cancer, but it still is
underused. This article provides an overview of barriers and facil¬
itators to mammography. Additionally, clinical strategies for in¬
creasing mammography use are presented.
SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA
VOLUME 6 • NUMBER 2 • APRIL 1997 vii
Determinants of Quality in Mammography 213
Lawrence W. Bassett
This article is written for physicians and other health care provid¬
ers who refer women for mammography. Mammography is per¬
formed frequently on healthy women who are seeking to stay
healthy (screening mammography) or on patients with a breast prob¬
lem, such as a palpable lump (diagnostic mammography). Poor qual¬
ity mammography can result in adverse consequences for the ex¬
aminee. It is the premise of this article that the determinants of the
quality of mammography begin when a woman is scheduled for
her examination and do not end until tracking, monitoring, and
follow up protocols are completed. Quality assurance is defined as
all of the activities performed to ensure a quality mammography;
quality control is defined more narrowly and focuses on the tech¬
nical components of the examination. The American College of Ra¬
diology s Breast Imaging Reporting and Data System (BI RADS)
has vastly improved film interpretation, description of findings,
reporting of results, management recommendations, patient track¬
ing and monitoring, and the statistical analysis of the effectiveness
of mammography.
Updated Results of the Trials of Screening Mammography 233
Daniel B. Kopans
Most analysts agree that screening women for breast cancer can
reduce the death rate by at least 25% to 30%. In 1993 the National
Cancer Institute created a great deal of confusion among women
and their physicians by withdrawing support for screening women
aged 40 to 49 years. The controversy arose as a result of the inap¬
propriate and scientifically insupportable analysis of data from the
early results from the randomized controlled trials of screening.
Despite that the trials were not designed to evaluate women aged
40 to 49 years as a separate subgroup and that they lacked the
statistical power to permit legitimate analysis of this subgroup,
women aged 40 to 49 years were analyzed separately, and erro¬
neous conclusions were drawn. In an effort to justify these conclu¬
sions, other data have been analyzed improperly to try to suggest
that significant screening parameters change at menopause or at
the age of 50, whereas the facts do not support any abrupt change.
There are no parameters such as breast density, cancer detection
rate, or positive predictive value that change abruptly at age 50 or
any other age. With longer follow up of the screening trial data
and the commensurately greater statistical power, the most recent
meta analyses provide statistically significant proof that screening
can reduce the death rate from breast cancer for women aged 40
to 49 years by at least 24%.
Viii CONTENTS
Ultrasonographic Guidance for Needle Biopsy
of Breast Lesions 265
Norman L. Sadowsky, A. Alan Semine, Elsie Levin,
and Elizabeth Kelly
The use of imaging guided needle biopsies of the breast to establish
the histology of lesions has become an important tool in the clinical
management of breast pathology. Avoiding excision of benign le¬
sions and allowing definitive surgery of malignant lesions to be
planned from the outset are to the benefit of the patient and also
decrease the cost of breast health care. The use of ultrasonographic
guidance for such procedures provides a safe and effective real
time technique to sample tissue while the patient lies in a com¬
fortable supine position. The operator who has a good understand¬
ing of the procedure will be able to obtain reliable specimens effi¬
ciently and consistently.
The Role of Stereotactic Biopsy in Abnormal Mammograms 285
Laurie L. Fajardo and Gia A. DeAngelis
For many nonpalpable breast abnormalities detected by mammog
raphy, a percutaneous stereotactic breast needle biopsy can be used
to provide a diagnosis less invasive and less costly than traditional
surgical excisional biopsy. Radiologists performing stereotactic
core biopsy should ensure that a lesion has been sampled suffi¬
ciently, particularly in the case of microcalcifications. Five or more
core biopsy samples are obtained when sampling solid masses, and
10 or more core biopsies may be necessary for lesions depicted as
microcalcifications. Following an imaging guided core breast bi¬
opsy, it is critically important to correlate the pathologic findings
with the initial mammographic diagnosis. Complications following
core biopsy, regardless of the number of samples obtained, are un¬
common. In the current environment of health care cost contain¬
ment, increased use of stereotactic core breast biopsy is expected
as a substitute for surgical excisional biopsy.
Results from a Multidisciplinary Breast Center:
Analysis of Disease Discovered 301
Melvin J. Silverstein, Parvis Gamagami, Riccardo Masetti,
Michael D. Legmann, Pamela H. Craig, and Eugene D. Gierson
This article reviews nonrandomized data on mammographically
detected breast cancer collected over a 13 year period from The
Breast Center in Van Nuys, California. Among 2320 biopsies, 560
nonpalpable cancers (24%) were detected. When compared with
1640 patients who presented with palpable breast cancer detected
during the same period, patients with nonpalpable mammograph¬
ically detected breast cancer had a lower probability of recurrence
CONTENTS ix
and a higher probability of survival after 10 years. These data are
also analyzed by age, comparing patients 49 years old and younger
with those 50 years old and older.
How to Perform Adequate Local Excision
of Mammographically Detected Lesions 315
Blake Cady
With an increasing proportion of nonpalpable breast cancers being
discovered by mammography, the opportunities for breast conser¬
vation are increasing commensurately. It is important to have a
practical surgical approach for local excision to preserve cosmetic
appearance and simplify management. Skin incisions should be
circular and central for the bulk of local excisions and lumpecto
mies of both invasive and noninvasive breast cancers to allow both
the greatest flexibility for later mastectomy if it is required and the
best cosmetic appearance. Suggestions are based on two decades
of clinical practice and careful evaluation of consultant patients
encountered and patients operated upon and managed. Adherence
to Langer s lines of skin orientation and meticulous attention to
surgical detail; with better cosmetic appearance, will pay large div¬
idends in patient satisfaction. Guidelines for use of local anesthesia,
handling of the residual cavity after local excision, management of
the surgical specimen, and wound closures are elaborated.
Pathology of Mammographically Discovered Breast Cancer:
Clinical Implications of Size and Histologic Differentiation 335
David L. Page and George F. Gray, Jr
The special considerations of prognostic and therapeutic strategies
for invasive breast cancers 1 cm or smaller are presented, empha¬
sizing the problems of case definition and the importance of his¬
tologic type, grade, and nodal status. Particularly, the associations
of small invasive cancers that allow certainty of benign clinical evo¬
lution after local therapy are contrasted with those elements that
indicate possibility of distant metastases.
Role of Axillary Dissection in Mammographically
Detected Breast Cancer 343
Faek R. Jamali, Scott H. Kurtzman, and Peter J. Deckers
The traditional rationale for axillary lymphadenectomy in patients
with breast cancer was that the procedure was therapeutic, diag¬
nostic, and needed to determine adjuvant therapy. Recent data
have shown that there is little, if any, therapeutic value to this
procedure and that the decision to use adjuvant chemotherapy or
hormonal therapy may no longer be absolutely contingent on ax¬
illary node status. Increasingly, primary tumor factors are being
used to establish the aggressiveness of cancers. Therefore, the
X CONTENTS
widespread use of axillary lymphadenectomy especially in small,
mammographically detected breast cancers is questioned.
The Role of Radiation Therapy After Local Excision
of Invasive and Noninvasive Breast Cancer 359
Lawrence B. Marks and Leonard R. Prosnitz
Data from randomized and nonrandomized studies demonstrate
that the addition of breast irradiation after local excision of invasive
and noninvasive breast cancers markedly reduces the breast failure
rate. Local excision with breast irradiation remains the standard
approach for breast conserving therapy for both invasive and non¬
invasive cancers. Some data suggest that there might be patient
subgroups that could be treated with local excision without radio¬
therapy, but additional studies are necessary to better define these
groups.
Systemic Adjuvant Therapy in Mammographically
Discovered Invasive Cancer 381
William C. Wood
Most mammographically discovered invasive breast cancers are 1
cm or smaller in diameter. These cancers have such a favorable
prognosis that systemic therapy may be inappropriate. Special his¬
tologies, micrometastatic deposits in axillary lymph nodes, and le¬
sions of borderline size all pose special problems of interpretation
relative to the role of systemic therapy.
Ductal Carcinoma in Situ: The Success of Breast Conservation
Therapy: A Shared Experience of Two Single Institutional
Nonrandomized Prospective Studies 385
Michael D. Lagios and Melvin J. Silverstein
In separate studies at The Breast Center in Van Nuys and the Chil¬
dren s Hospital in San Francisco, California, 342 patients with duc¬
tal carcinoma in situ (DCIS) were treated by either lumpectomy
alone or lumpectomy and radiation therapy. These cases were an¬
alyzed in a consistent manner and classified to subtype (grade),
size, and margin width. The outcome results were virtually iden¬
tical, and a common database was established. The results of these
studies indicate that an adequate surgical margin is the most im¬
portant consideration in achieving local control. Radiation therapy
was shown to provide an absolute reduction of 8% for the high
grade DCIS with adequate margins and 11% for those with inter¬
mediate margins, but for lower grade subtypes and for DCIS with
smaller margins, radiation therapy provides no significant benefit
for local control. Size and subtype should not be contraindications
for breast conservation as long as adequate margins can be estab¬
lished.
CONTENTS Xi
Twenty Year Follow up of Minimal Breast Cancer from
the Breast Cancer Detection Demonstration Project 393
Marvin J. Lopez and Charles R. Smart
Since the 1960s, the potential benefits of early detection of breast
cancer through screening with physical examination and mam
mography have been studied. In a mass screening study begun in
1973 by the Breast Cancer Detection Demonstration Project
(BCDDP), mammography detected 90% of the cancers that were
diagnosed. Of the women aged 35 to 74 years from the BCDDP
study who were diagnosed with minimal breast cancer, the 20 year
cumulative breast cancer survival rates were 95.8% for 469 women
with in situ breast cancer and 82.8% for 769 women with invasive
breast cancers 1 cm or smaller in size.
Technologic Advances in Breast Imaging: Current and
Future Strategies, Controversies, and Opportunities 403
Ferris M. Hall
This article summarizes current strategies for breast imaging in the
diagnosis of breast cancer. It describes how technologic advances,
particularly image guided percutaneous core biopsies, are rapidly
changing these strategies. Sonography now plays a major role in
the diagnosis of breast cancer. The future roles for MR imaging
and scintimammography are also discussed.
Index 411
Subscription Information Inside back cover
*ii CONTENTS
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| spelling | Management of mammographically detected breast cancer Blake Cady, guest ed. Philadelphia [u.a.] Saunders 1997 XVII S., S. 195 - 413 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Surgical oncology clinics of North America 6,2 Mammographie Tumeurs du sein Breast Neoplasms Mammography Brustkrebs (DE-588)4008528-4 gnd rswk-swf Frühcarcinom (DE-588)4280820-0 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Brustkrebs (DE-588)4008528-4 s Frühcarcinom (DE-588)4280820-0 s DE-604 Cady, Blake Sonstige oth Surgical oncology clinics of North America 6,2 (DE-604)BV007071205 6,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007636585&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Management of mammographically detected breast cancer Surgical oncology clinics of North America Mammographie Tumeurs du sein Breast Neoplasms Mammography Brustkrebs (DE-588)4008528-4 gnd Frühcarcinom (DE-588)4280820-0 gnd |
| subject_GND | (DE-588)4008528-4 (DE-588)4280820-0 (DE-588)4143413-4 |
| title | Management of mammographically detected breast cancer |
| title_auth | Management of mammographically detected breast cancer |
| title_exact_search | Management of mammographically detected breast cancer |
| title_full | Management of mammographically detected breast cancer Blake Cady, guest ed. |
| title_fullStr | Management of mammographically detected breast cancer Blake Cady, guest ed. |
| title_full_unstemmed | Management of mammographically detected breast cancer Blake Cady, guest ed. |
| title_short | Management of mammographically detected breast cancer |
| title_sort | management of mammographically detected breast cancer |
| topic | Mammographie Tumeurs du sein Breast Neoplasms Mammography Brustkrebs (DE-588)4008528-4 gnd Frühcarcinom (DE-588)4280820-0 gnd |
| topic_facet | Mammographie Tumeurs du sein Breast Neoplasms Mammography Brustkrebs Frühcarcinom Aufsatzsammlung |
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