Men with breast cancer have better disease-specific survival than women.

Hypothesis: Male breast cancer patients have better disease-specific survival than carefully matched female breast cancer patients.

Design: Retrospective study.

Setting: University hospital.

Factors correlating with lymph node metastases in patients with T1 breast cancer.

Background: Identification of reliable predictors of axillary metastases (ALNM) may be useful in selecting appropriate management for patients with T1-size breast cancer. This study was undertaken to determine the degree of correlation between ALNM and several variables, including age, race, menopausal status, palpability, tumor size, positive margin on initial excision, histology, grade, lymphatic invasion (LI), estrogen receptor status (ER), progesterone receptor status, S-phase, and ploidy.

Methods: Data from 1416 patients with T1 breast cancers treated at Columbia-Presbyterian Medical Center between 1989 and 1998 was reviewed.

Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer.

Purpose: Most breast cancer survivors experience hot flashes; many use complementary or alternative remedies for these symptoms. We undertook a randomized clinical trial of black cohosh, a widely used herbal remedy for menopausal symptoms, among breast cancer patients.

Patients And Methods: Patients diagnosed with breast cancer who had completed their primary treatment were randomly assigned to black cohosh or placebo, stratified on tamoxifen use.

Axillary clearance in operable breast cancer: still a necessity?

Complete axillary dissection, as part of radical mastectomy, was the standard of care for the first three-quarters of this century. Long-term follow-up of these patients showed substantial cure rates for positive-node patients before systemic therapy was available, indicating a therapeutic value to nodal dissection. There was also good control of the axilla; axillary recurrence after removal of positive nodes was quite low.

Current treatment for lobular carcinoma in situ.

Background: We thought that observation for patients with lobular carcinoma in situ (LCIS) had been generally accepted by the mid-1980s. A questionnaire mailed to oncologic surgeons in 1988 revealed that 33% of the respondents still advised unilateral mastectomy, although a slim majority (54%) advised observation. New studies have been published in the intervening 8 years, and we decided it would be worth recirculating the 1988 questionnaire.

Axillary lymphadenectomy: a diagnostic and therapeutic procedure.

Axillary dissection for primary operable cancer follows the basic tenants of surgical oncology and achieves the stated goals. Local control is excellent with failure rates in the 0-2% range. Long-term and disease-free survival is improved with axillary dissection.

Systemic adjuvant therapy of breast cancer.

Systematic adjuvant therapy has improved the outcome for women with operable breast cancer. As a result, a substantial proportion of patients with this disease are candidates for adjuvant treatment. In providing a woman with recommendations for therapy, her risk of developing recurrent breast cancer needs to be assessed in relationship to the degree of benefit she will obtain from treatment.

Breast-conserving treatment: controversies and consensus.

Although breast-conserving therapy (BCT) is an accepted alternative for the treatment of breast cancer, numerous controversies surround the selection criteria and the treatment details. A review of the literature revealed that patient selection is of critical importance. However, there is disagreement over the relative importance of some of the criteria for patient selection.

Breast sarcoma.

Primary sarcoma of the breast is a rare problem and accounts for less than 5% of all soft-tissue sarcomas and less than 1% of all breast malignancies. As experience with breast sarcoma has increased, the perceived differences with other soft-tissue sarcomas has decreased. Outcome is predicated upon histologic type, degree of differentiation, and tumor size.

Is axillary lymph node dissection necessary in the routine management of breast cancer? Yes.

Axillary dissection for primary operable cancer follows the basic tenets of surgical oncology and achieves the stated goals. Local control is excellent, with failure rates of 0% to 2%. Long-term, disease-free survival is improved with axillary dissection.

The surgical management of primary invasive breast cancer.

The treatment of operable primary breast cancer has evolved dramatically in the past few decades. The standard operative procedure has changed from the radical mastectomy to the modified radical mastectomy, and the use of breast-conserving treatment is increasing. This article reviews trends in treatment of early-stage breast cancer, factors associated with increased risk for local recurrence after breast-conserving treatment, and the use of axillary lymph node dissection.

Breast reconstruction after mastectomy: who seeks it, who refuses?

Recent Food and Drug Administration hearings on silicone gel implants have drawn attention to the paucity of information about women who seek reconstruction after mastectomy compared with those who do not. New analyses of data gathered in the early 1980s address this issue. Three groups of mastectomy patients were compared: 117 women who sought and obtained delayed reconstruction, 26 who sought but decided against delayed reconstruction, and a comparison group of 53 who were not seeking reconstruction.

Controversies in the Surgical Management of Operable Breast Cancer.

The literature is reviewed regarding the surgical management of breast carcinoma, and controversies are discussed. Several unresolved issues remain in the surgical management of breast carcinoma. First, the optimal surgical treatment of patients who are at increased risk for having internal mammary lymph node metastases remains unknown.

Hypnotic efficacy and safety of triazolam administered during the postoperative period.

This study examined the hypnotic efficacy and safety of short-term use of triazolam following elective surgery. One hundred women (ages 26-69) who had received 0.125 mg of traizalam the evening before breast cancer surgery were enrolled in a randomized, double-blind study comparing triazolam to placebo.

Method of tumor detection influences disease-free survival of women with breast carcinoma.

Background: Screening mammography provides the primary means of reducing breast cancer mortality. Clinical breast examination (CBE) and breast self-examination (BSE) may be complementary screening modalities enabling palpation of interval cancers and detection of tumors not visualized by mammography; however, their combined contribution to improving prognosis has not been evaluated adequately.

Methods: Disease-free survival was assessed in relation to method of tumor detection among 729 consecutive patients treated by mastectomy and axillary dissection for primary breast carcinoma between 1976 and 1978.

Patient selection criteria for conservation surgery versus mastectomy: Memorial Hospital breast service experience.

Breast cancer remains the most common noncutaneous malignancy of women. Although the incidence of the disease continues to rise, most women now present with early (stage I or II) disease. Breast conservation has been demonstrated to be equal in efficacy to mastectomy in such patients in six modern-day randomized trials.

Menstrual timing of treatment for breast cancer.

Although the hormone dependency of breast cancer has been recognized for nearly a century, the influence on disease progression of cyclical hormonal levels among premenopausal women has not been extensively researched. The findings of recent studies, assessing the effect on prognosis of the hormonal milieu at the time of surgery, have been conflicting. However, several reports have noted improved survival among patients with positive, axillary lymph nodes surgically treated in the later phase of the menstrual cycle when progesterone levels are elevated.

Conservation surgery for breast cancer: selection criteria and technical considerations.

Patients with stage I or II breast cancer are candidates for either modified radical mastectomy or breast preservation therapy involving limited resection of the primary tumor, axillary dissection, and breast irradiation. The overall survival rates of both these approaches are comparable according to retrospective reviews and ongoing clinical trials, and long-term follow-up confirms the earlier findings. Thus, patients should be given the choice between these two options by surgeons, radiation therapists, and other physicians involved in their care.

Controversies in primary breast cancer management.

Adequate locoregional treatment of patients with primary operable breast cancer involves the control of multicentric disease in the breast and axillary dissection to stage the disease and control it in the axilla, when present. Two options, having equal survival rates in prospective, randomized studies, are breast preservation and mastectomy. In breast preservation, adequate tumor excision with clear histologic margins and axillary dissection is followed by breast irradiation.

Factors influencing prognosis in node-negative breast carcinoma: analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up.

Purpose: This study was undertaken to define prognostically favorable and unfavorable subgroups of node-negative breast carcinoma patients by employing conventional pathologic data.

Patients And Methods: Seven hundred sixty-seven women with T1N0M0/T2N0M0 breast carcinoma treated consecutively from 1964 through 1970 by modified or radical mastectomy without systemic adjuvant therapy were analyzed at a median follow-up duration of 18 years.

Results: Size and histologic type of the carcinoma were crucial discriminants of prognosis.

Role of contralateral breast biopsy in infiltrating lobular cancer.

Background: Although infiltrating lobular carcinoma (ILC) is known to be associated with higher rates of bilaterality, contralateral breast biopsies are not routinely performed in such patients.

Methods: The pathology reports of all patients with ILC admitted to Memorial Sloan-Kettering Cancer Center between 1970 and 1980 were retrospectively reviewed. The incidence of contralateral biopsies, random and directed, was determined.