Effect of Margin Status on Local Recurrence After Breast Conservation and Radiation Therapy for Ductal Carcinoma In Situ

Effect of Margin Status on Local Recurrence After Breast Conservation and Radiation Therapy for Ductal Carcinoma In Situ
Clive Dunne, John P. Burke, Monica Morrow, and Malcolm R. Kell
J Clin Oncol 27:1615-1620, 2009

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Surgical margins negative for DCIS should be obtained after BCS for DCIS. A margin threshold of 2 mm seems to be as good as a larger margin when BCS for DCIS is combined with RT

There is a difference between Europe and North America regards the amount of normal tissue that should be removed for clear margins in DCIS. In Europe, 10mm is the favoured margin, whereas 1mm may be regarded as clear in North America.

This study shows that a smaller margin combined with radiation therapy is as effective as taking a larger margin

Breast Cancer in the Elderly

Led by Professor Bob Leonard from the Royal Marsden Hospital, a number of excellent articles on breast oncology issues in the elderly

How Age affects the biology of breast cancer
Breast Cancer in Older Women: Trials and Tribulations
The Role of Surgery in the Treatment of Older Women with Breast Cancer
Breast Radiotherapy: Considerations in Older Patients
Quality of Life and Patient-reported Outcomes in the Older Breast Cancer Patient

Assessment of the Accuracy of the Gail Model in Women With Atypical Hyperplasia

Assessment of the Accuracy of the Gail Model in Women With Atypical Hyperplasia
V. Shane Pankratz, Lynn C. Hartmann, Amy C. Degnim, Robert A. Vierkant, Karthik Ghosh, Celine M. Vachon, Marlene H. Frost, Shaun D. Maloney, Carol Reynolds, and Judy C. Boughey
J Clin Oncol 26:5374-5379, 2008

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The Gail model significantly underestimates the risk of breast cancer in women with atypia. Its ability to discriminate women with atypia into those who did and did not develop breast cancer is limited. Health care professionals should be cautious when using the Gail model to counsel individual patients with atypia

The feasibility of sentinel node biopsy in the previously treated breast

The feasibility of sentinel node biopsy in the previously treated breast
M. Koizumi, M. Koyama, K. Tada, S. Nishimura, Y. Miyagi, M. Makita, M. Yoshimoto, T. Iwase, R. Horii, F. Akiyama and T. Saga
European Journal of Surgical Oncology (EJSO) Volume 34, Issue 4, April 2008, Pages 365-368

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Previous axillary dissection or irradiation to the breast greatly influences lymphatic flow. Irradiation to the breast may be a strong factor for the visualization of contralateral axillary nodes. Despite the frequent alteration of lymphatic flow, SNB seems to be feasible in secondary or recurrent breast cancer patients.

High Risk Screening - adding US to Mammography - ACRIN Results

Combined Screening With Ultrasound and Mammography vs Mammography Alone in Women at Elevated Risk of Breast Cancer
Wendie A. Berg; Jeffrey D. Blume; Jean B. Cormack; Ellen B. Mendelson; Daniel Lehrer; Marcela Bohm-Velez; Etta D. Pisano; Roberta A. Jong; W. Phil Evans; Marilyn J. Morton; Mary C. Mahoney; Linda Hovanessian Larsen; Richard G. Barr; Dione M. Farria; Helga S. Marques; Karan Boparai; for the ACRIN 6666 Investigators
JAMA 2008;299 2151-2163

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Adding a single screening ultrasound to mammography will yield an additional 1.1 to 7.2 cancers per 1000 high-risk women, but it will also substantially increase the number of false positives.

Results of the ACRIN 6666 trial, whose results were presented at RSNA 2007. As expected ultrasound is good at picking up additional cancers, not visualized on mammography, BUT at a significant cost of false positivies and unnecessary biopsies.

Screen-detected vs symptomatic breast cancer: is improved survival due to stage migration alone?

Screen-detected vs symptomatic breast cancer: is improved survival due to stage migration alone?
G C Wishart, D C Greenberg, P D Britton, P Chou, C H Brown, A D Purushotham & S W Duffy
British Journal of Cancer (2008) 98, 1741-1744

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An interesting paper from Cambridge. The authors suggest that tumours picked up at screening are biologically different enough that current methods for estimating prognosis and therefore treatment, overestimate the benefit of systemic treatments in screen-detected cancers and lead to overtreatment of these patients.

Prevention of futile sentinel node procedures in breast cancer: Ultrasonography of the axilla and fine-needle aspiration cytology are obligatory

Prevention of futile sentinel node procedures in breast cancer: Ultrasonography of the axilla and fine-needle aspiration cytology are obligatory
F. Gilissen, R. Oostenbroek, R. Storm, P. Westenend and P. Plaisier
European Journal of Surgical Oncology (EJSO 34, Issue 5, May 2008, Pages 497-500

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By preoperative US and FNA of the axilla in patients with breast cancer, half of the axillary metastases can be detected prior to surgery. In more than a quarter of breast cancer patients, a futile SNP can be prevented.

Therefore, preoperative US of the axilla plus FNA are obligatory in patients with breast carcinoma.