Explanatory factors for variation in the use of breast conserving surgery and radiotherapy in the Netherlands, 1990-2001.

The use of Breast Conserving Surgery (BCS) followed by radiotherapy (BSC-RT) in pT1 (2cm) and pT2-tumours (2-5cm) was investigated in the Netherlands from 1990 to 2001. From the Netherlands Cancer Registry, patients were selected with invasive tumours <5.0cm.

The safety of breast-conserving therapy in patients with breast cancer aged < or = 40 years.

Background: The objectives of this study were to study the probability of local control after breast-conserving therapy (BCT) in a large population of patients with early-stage breast cancer aged < or = 40 years and to determine which factors had prognostic value.

Methods: All patients (n = 758) aged < or = 40 years with clinical stage I or II breast cancer who underwent BCT in general hospitals in the southern part of the Netherlands between 1988 and 2002 were selected for the current analysis. BCT included local excision of the tumor followed by irradiation of the breast.

Trends in the prognosis of patients with primary metastatic breast cancer diagnosed between 1975 and 2002.

We performed a population-based study, including 1089 patients with primary metastatic breast cancer, diagnosed in South-East Netherlands between 1975 and 2002, and tried to give an answer to the question if prognosis of this patient group has improved or not. Follow-up was completed until 1 January 2005. The median survival times for patients with primary metastatic disease were 18, 17 and 20.

Follow-up after curative treatment for breast cancer: why do we still adhere to frequent outpatient clinic visits?

Follow-up after curative treatment for breast cancer consists of frequent outpatient clinic visits, scheduled at regular intervals. Its aim is primarily to detect local disease recurrence, or a second primary breast cancer, but also to provide information and psychosocial support. The cost-effectiveness of these frequent visits is being questioned however, leading to a search for less intensive follow-up strategies, such as follow-up by the general practitioner, patient-initiated or nurse-led follow-up or contact by telephone.

Improving the quality and efficiency of follow-up after curative treatment for breast cancer--rationale and study design of the MaCare trial.

Background: After curative treatment for breast cancer women frequently attend scheduled follow-up examinations. Usually the follow-up is most frequent in the first 2-3 years (2-4 times a year); thereafter the frequency is reduced to once a year in most countries. Its main aim is to detect local disease recurrence, or a second primary breast cancer, but also to provide information and psychosocial support.

Survival after negative sentinel lymph node biopsy in breast cancer at least equivalent to after negative extensive axillary dissection.

Aim: Sentinel lymph node biopsy (SLNB) without completion axillary lymph node dissection (ALND) is replacing ALND as the axillary staging procedure of choice in breast cancer patients with a clinically negative axilla even though it is unclear whether this influences patient survival. Our aim was to compare the survival of breast cancer patients with a negative SLNB without completion ALND to that of extensive ALND-negative patients.

Methods: Eindhoven Cancer Registry data on breast cancer patients diagnosed between 1989 and 2002 with follow-up to 1 January 2005 was used.

A comparison of quality of life, disease impact and risk perception in women with invasive breast cancer and ductal carcinoma in situ.

We compared the health-related quality of life, impact of the disease, risk perception of recurrence and dying of breast cancer, and understanding of diagnosis of patients with ductal carcinoma in situ (DCIS) and invasive breast cancer 2-3 years after treatment. We included all women (N=211) diagnosed with DCIS or invasive breast cancer TNM stage I (T1, N0, and M0) in three community hospitals in the southern part of The Netherlands in the period 2002-2003. After verifying the medical files, 180 disease free patients proved eligible for study entry, 47 of whom had DCIS and 133 stage I invasive breast cancer.

Margin status and the risk of local recurrence after breast-conserving treatment of lobular breast cancer.

Background: Invasive lobular breast carcinoma is known for its multicentricity and is associated with a higher incidence of incomplete excision after breast-conserving therapy. The aim of the study was to examine the influence of positive surgical margins on the local recurrence rate in patients diagnosed with invasive lobular cancer and treated with breast-conserving therapy.

Methods: All 416 women diagnosed with invasive lobular breast cancer and undergoing breast-conserving treatment between 1995 and 2002 were selected from the population-based Eindhoven Cancer Registry.

Clinical management of women with metastatic breast cancer: a descriptive study according to age group.

Background: The primary aim of treatment of a patient who has developed metastatic disease is palliation. The objectives of the current study are to describe and quantify the clinical management of women with metastatic breast cancer from the diagnosis of metastatic disease until death and to analyze differences between age groups.

Methods: Data were collected from the medical files of all patients (n = 116) who had died after December 31, 1999, after a diagnosis of metastatic breast cancer in two teaching hospitals in the south of the Netherlands.

Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer prognosis than younger patients: a population-based study.

It is likely that the shift from post- to pre-operative radiotherapy and the introduction of total mesorectal excision (TME) surgery have contributed to the observed improved survival of rectal cancer in the south of the Netherlands. However, no improvement was seen for patients aged 70 or older. To investigate possible causes of this lack of improvement, we examined the risk of treatment-related complications and overall survival.

[The long-term prognosis of locally recurrent breast cancer after breast conserving treatment].

Objective: To study the long-term prognosis of patients with locally recurrent breast cancer following breast-conserving treatment.

Design: Descriptive.

Method: Data were collected on 266 patients in 11 Dutch centres; in these patients, an isolated local recurrence of an infiltrating mammary carcinoma for which they had received breast-conserving treatment was diagnosed before January 1st, 1994.

The significance of one positive axillary node.

Aims: The aim of this study was to identify a subgroup of patients with breast cancer that can safely avoid axillary dissection.

Methods: Using data collected by the Eindhoven Cancer Registry, we compared the clinico-pathological features of 489 patients with only one positive lymph node to those of 817 patients with more than one positive lymph node in the axilla. All patients underwent complete axillary dissection, not preceded by a sentinel node biopsy.

Increased health care utilisation among 10-year breast cancer survivors.

Objective: We investigated self-reported health care utilisation of women who survived breast cancer for 10 years and identified predictors of health care utilisation.

Methods: The population-based Eindhoven Cancer Registry was used to select all women who were diagnosed with breast cancer in 1993, in six hospitals in the Netherlands, and were disease-free at the time of data collection. Health status, psychological well-being, satisfaction with life and health care use were compared with same age controls.

The prognosis of patients with local recurrence more than five years after breast conservation therapy for invasive breast carcinoma.

Aims: The increasing use of breast-conserving therapy (BCT) and the rising incidence and improved prognosis of early breast are causing a substantial increase in the absolute number of patients with a late local recurrence following BCT. This study examined the characteristics and the prognosis of patients with a local recurrence occurring more than 5 years after BCT.

Methods: In the period 1982-1997, 3280 patients with invasive breast cancer underwent breast-conserving therapy in one of the eight community hospitals in the South-eastern part of The Netherlands.

[Trends and variation in breast conserving surgery in the southeast and east of the Netherlands over the period 1990-2002].

Objective: To give an overview of the trends and variation in breast-conserving surgery in patients with a breast tumour < or = 2 cm (pT1) or > 2 and < or = 5 cm (pT2), treated in general hospitals in the southeast and east of the Netherlands.

Design: Descriptive.

Method: Data from the regional cancer registries of the Comprehensive Cancer Centre South (CS) and the Comprehensive Cancer Centre Stedendriehoek Twente (CST) were used to study trends and variations in the use of breast-conserving surgery in 12,985 pT1 tumours and 8,893 pT2 tumours in the period 1990-2002.

Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer.

We have studied the long-term prognosis of 266 patients considered to have isolated local recurrence in the breast following conservative surgery and radiotherapy for early breast cancer. The median follow-up of the patients still alive after diagnosis of local relapse was 11.2 years.

Fibrin gel-immobilized primary osteoblasts in calcium phosphate bone cement: in vivo evaluation with regard to application as injectable biological bone substitute.

Osteogenic injectable bone substitutes may be useful for many applications. We developed a novel injectable bone substitute based on osteoblast-fibrin glue suspension and calcium phosphate bone cement (BC). Human osteoblasts were isolated from trabecular bone samples and cultured under standard conditions.

The prognostic significance of axillary lymph-node micrometastases in breast cancer patients.

Aims: We analysed the results of regional community practice to determine the prognosis of axillary lymph-node micrometastases in women with breast cancer.

Methods: Patient data were retrieved from the population-based Eindhoven Cancer Registry in The Netherlands. Between 1975 and 1997, 10,111 patients were diagnosed as having invasive breast cancer.

Long-term prognosis of patients with axillary recurrence after axillary dissection for invasive breast cancer.

Aim: To investigate the long-term prognosis of patients with axillary recurrence after axillary dissection for invasive breast cancer and describe the long-term survivors.

Methods: Between 1984 and 1994, 4669 patients with invasive breast cancer underwent axillary dissection in eight community hospitals in the south-eastern part of The Netherlands. Using follow-up data of the population-based Eindhoven Cancer Registry, 59 patients with axillary recurrence were identified.

Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study.

The prevalence of coexistent diseases in addition to breast cancer becomes increasingly important in an ageing population. However, the clinical implications are unclear. The age-specific prevalence of serious comorbidity among all new breast cancer patients diagnosed from 1995 to 2001 (n=8966) in the South of the Netherlands was analysed in relation to age, stage and treatment.

Diagnosis, treatment and prognosis of internal mammary lymph node recurrence in breast cancer patients.

Recurrences in the internal mammary lymph nodes (IMLN) are very rare, despite the fact that these nodes remain untreated in most patients. The aim of this study was to assess the chance for IMLN recurrence in a large patient series and to get insight into diagnostics, treatment and prognosis of this type of recurrence. Follow-up of nearly 6000 breast cancer patients resulted in the tracing of only six patients with IMLN recurrence.

Staging in patients with locoregionally recurrent breast cancer: current practice and prospects for positron emission tomography.

The aim of this study was to describe the extent and yield of daily clinical practice when staging patients with a locoregional recurrence (LRR) of breast carcinoma and to explore the prospects for positron emission tomography (PET). The population-based Eindhoven Cancer Registry was used to select all breast cancer patients in the southeast of the Netherlands with a first episode of LRR between January 1, 1994 and June 30, 2000 (n = 175). Additional data concerning staging procedures and follow-up were collected from the medical records.