Tuesday 2 April 2019

[Comment] Assessment of breast cancer risk: which tools to use?



by Montserrat Garcia-Closas, Nilanjan Chatterjee  

The Lancet Oncology: Comment, Volume 20 issue 4, p.463-464, April 01 2019

Risk-assessment tools are used in routine clinical practice to identify women at increased risk of breast cancer and to inform counselling about lifestyle changes, genetic testing, screening timing or modality, and eligibility for risk-reducing drugs or surgery. In The Lancet Oncology, Mary Beth Terry and colleagues1 report a comparative validation of four models—the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm model (BOADICEA), BRCAPRO, the Breast Cancer Risk Assessment Tool (BCRAT), and the International Breast Cancer Intervention Study model (IBIS)—used in clinical practice to provide absolute risk estimates for breast cancer on the basis of different sets of factors.

Theories of Etiopathogenesis of Breast Implant–Associated Anaplastic Large Cell Lymphoma




by Rastogi, Pratik; Riordan, Edward; Moon, David; Deva, Anand K.  

Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3S - p 23S–29S

Summary: Breast implant–associated anaplastic large cell lymphoma is a malignancy of T lymphocytes that is associated with the use of textured breast implants in both esthetic and reconstructive surgeries. Patients typically present with a delayed seroma 8–10 years following implantation or—less commonly—with a capsular mass or systemic disease. Current theories on disease pathogenesis focus on the interplay among textured implants, Gram-negative bacteria, host genetics, and time. The possible roles of silicone leachables and particles have been less well substantiated. This review aims to synthesize the existing scientific evidence regarding breast implant–associated anaplastic large cell lymphoma etiopathogenesis.

Utility of Two Surgical Techniques Using a Lateral Intercostal Artery Perforator Flap after Breast-Conserving Surgery: A Single-Center Retrospective Study



Kim, Jae Bong; Eom, Jeung Ryeol; Lee, Jeong Woo; Lee, Jeeyeon; Park, Ho Yong; Yang, Jung Dug  

Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3 - p 477e–487e

Background: Immediate partial breast reconstruction after breast-conserving surgery has become a new paradigm in treating breast cancer. Among the volume replacement techniques used for small to moderate-sized breasts, the perforator flap method has many advantages. The authors present anatomical studies and two surgical techniques using lateral intercostal artery perforator flaps. Methods: Data from 40 patients who underwent breast reconstruction using the lateral intercostal artery perforator flap between January of 2011 and June of 2016 were included. The authors conducted comparative analyses of the propeller flap and the turnover flap. They used three-dimensional computed tomography in lateral intercostal artery perforator flap anatomical studies, analyzing the distribution probability of the dominant perforator, the vertical distance from the axillary fold, and the horizontal distance from the anterior border of the latissimus dorsi.
Results: The most dominant perforator used for lateral intercostal artery perforator flaps was the sixth lateral intercostal artery perforator (43.6 percent of cases), followed by the seventh lateral intercostal artery perforator (39.1 percent of cases); their mean distances from the latissimus dorsi and the axillary folds were determined and reported. Complications included three cases requiring additional treatment for fat necrosis (propeller method, two cases; turnover method, one case) and venous congestion in only two cases that used the propeller method. Cosmetic satisfaction was 90 percent or greater for both techniques, indicating that results were rated as either excellent or good. Conclusion: The authors believe that their study results can broaden the application of partial breast reconstruction by using the lateral intercostal artery perforator flap after breast-conserving surgery, with three-dimensional computed tomography for anatomical studies, and using one of the authors’ two described surgical techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

The changes of quality of life and their correlations with psychosocial factors following surgery among women with breast cancer from the post-surgery to post-treatment survivorship



by Fei-Hsiu Hsiao, Wen-Hung Kuo, Guey-Mei Jow, Ming-Yang Wang, King-Jen Chang, Yu-Ming Lai, Yu-Ting Chen, Chiun-Sheng Huang

The Breast: April 2019, Volume 44, pages 59-65

This 14-month study aimed to examine the changes of quality of life following breast cancer surgery and associations of such changes with depression and anxiety levels, and protective factors (attachment styles in close relationship, and meaning in life) based on positive psychology theory.

Tackling the diversity of breast cancer related lymphedema: Perspectives on diagnosis, risk assessment, and clinical management



by Anna Michelotti, Marco Invernizzi, Gianluca Lopez, Daniele Lorenzini, Francesco Nesa, Alessandro De Sire, Nicola Fusco  

The Breast: April 2019, Volume 44, Pages 15-23

Breast cancer related lymphedema (BCRL) develops as a consequence of surgical treatment and/or radiation therapy in a significant number of breast cancer patients. The etiology of this condition is multifactorial and has not yet been completely elucidated. Risk factors include high body mass index, radical surgical procedures (i.e. mastectomy and axillary lymph node dissection), number of lymph nodes removed and number of metastatic lymph nodes, as well as nodal radiation, and chemotherapy. However, these predisposing factors explain only partially the BCRL occurrence, suggesting the possible involvement of individual determinants.

Risk factors for metachronous contralateral breast cancer: A systematic review and meta-analysis



by Delal Akdeniz, Marjanka K. Schmidt, Caroline M. Seynaeve, Danielle McCool, Daniele Giardiello, Alexandra J. van den Broek, Michael Hauptmann, Ewout W. Steyerberg, Maartje J. Hooning  

The Breast: April 2019, Volume 44, pages 1-14

The risk of developing metachronous contralateral breast cancer (CBC) is a recurrent topic at the outpatient clinic. We aimed to provide CBC risk estimates of published patient, pathological, and primary breast cancer (PBC) treatment-related factors.

Current Risk Estimate of Breast Implant–Associated Anaplastic Large Cell Lymphoma in Textured Breast Implants



 by Collett, David J.; Rakhorst, Hinne; Lennox, Peter; Magnusson, Mark; Cooter, Rodney; Deva, Anand K.  

Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3S - p 30S–40S

Background: With breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) now accepted as a unique (iatrogenic) subtype of ALCL directly associated with textured breast implants, we are now at a point where a sound epidemiologic profile and risk estimate are required. The aim of this article is to provide a comprehensive and up-to-date global review of the available epidemiologic data and literature relating to the incidence, risk, and prevalence of BIA-ALCL. Methods: All current literature relating to the epidemiology of BIA-ALCL was reviewed. Barriers relating to sound epidemiologic study were identified, and trends relating to geographical distribution, prevalence of breast implants, and implant characteristics were analyzed. Results: Significant barriers exist to the accurate estimate of both the number of women with implants (denominator) and the number of cases of BIA-ALCL (numerator), including poor registries, underreporting, lack of awareness, cosmetic tourism, and fear of litigation. The incidence and risk of BIA-ALCL have increased dramatically from initial reports of 1 per million to current estimates of 1/2,832, and is largely dependant on the “population” (implant type and characteristics) examined and increased awareness of the disease.
Conclusions: Although many barriers stand in the way of calculating accurate estimates of the incidence and risk of developing BIA-ALCL, steady progress, international registries, and collegiality between research teams are for the first time allowing early estimates. Most striking is the exponential rise in incidence over the last decade, which can largely be explained by the increasingly specific implant subtypes examined—driven by our understanding of the pathologic mechanism of the disease. High-textured high-surface area implants (grade 4 surface) carry the highest risk of BIA-ALCL (1/2,832).

Breast Implant Illness: A Way Forward



by Magnusson, Mark R.; Cooter, Rod D.; Rakhorst, Hinne; McGuire, Patricia A.; Adams, William P. Jr; Deva, Anand K.

Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3S - p 74S–81S

Summary: The link between breast implants and systemic disease has been reported since the 1960s. Although many studies have looked at either supporting or refuting its existence, the issue still persists and has now been labeled “breast implant illness.” The rise of patient advocacy and communication through social media has led to an increasing number of presentations to plastic surgeons. This article summarizes the history of breast implants and systemic disease, critically analyzes the literature (and any associated deficiencies), and suggests a way forward through systematic scientific study.