Breast embryology and the double-bubble deformity

Breast embryology and the double-bubble deformity. Plastic and Reconstructive Surgery, July 2014, Vol. 134(1), p.161e-162e.

Gigliofiorito, P., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/07000/Breast_Embryology_and_the_Double_Bubble_Deformity.42.aspx

Breast surgery remains one of the most popular branches of plastic surgery. More than 286,000 breast implants were placed in 2012 in the United States, and these numbers will probably increase in the next decade. The double-bubble deformity can be a disappointing complication during breast surgery, and patients often relate to it as a surgical mistake. However, as the author stated, it can also be a consequence of a patient’s own susceptibility.

NEJM Audio Summary: Breast cancer

NEJM Audio Summary: Breast cancer risk. Aug 2014 [podcast]

Breast-cancer risk and mutations in PALB2

http://podcast.nejm.org/summaries/nejm_2014.371.issue-6.summary.mp3

Postmastectomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction

Postmastectomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction: A University of British Columbia perspective. Plastic and Reconstructive Surgery, July 2014, Vol. 134(1), p.1e-10e.

Ho, A.L., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/07000/Postmastectomy_Radiation_Therapy_after_Immediate.2.aspx

 An increasing number of women who undergo immediate two-stage tissue expander/implant breast reconstruction will require postmastectomy radiation therapy. An important variable is the timing of radiotherapy relative to surgery. The authors report their experience treating a large consecutive series of patients who underwent postmastectomy radiation therapy to the tissue expander before exchange for a permanent implant.

Screening an asymptomatic person for genetic risk

Screening an asymptomatic person for genetic risk. NEJM, June 2014, 370: 2442-45 [Clinical Decisons]

Department of Bioethics and Humanities, University of Washington, Seattle

http://www.nejm.org/doi/pdf/10.1056/NEJMclde1311959

Case Study: Jim Mathis is a 45-year-old health-conscious man who has been a patient in an internal medicine–primary care practice for several years. At today’s visit, he talks about the family tree that he has sketched out and his discovery that three of his relatives had cancer — one had breast cancer, one ovarian cancer, and one prostate cancer.

Postmastectomy radiation in breast cancer with one to three involved lymph nodes

Postmastectomy radiation in breast cancer with one to three involved lymph nodes: ending the debate. The Lancet, June 2014, Vol. 383(9935), p.2104-06.

Poortmans, P.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60192-6/fulltext?rss=yes

Many trials in breast cancer have investigated various aspects of locoregional and systemic treatments. Combination of the results of these trials in a meticulous meta-analysis, as has been done several times by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG), fills the gaps in evidence and knowledge by conclusively showing significant trends and differences.

Adjuvant exemestane with ovarian suppression in premenopausal breast cancer

Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. NEJM, June 2014 [online]

Pagani, O., et al.

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1404037

The most effective adjuvant endocrine therapy for premenopausal women with hormone-receptor (estrogen, progesterone, or both)–positive breast cancer is uncertain. Tamoxifen for at least 5 years is a standard of care. Adjuvant suppression of ovarian function (hereafter, ovarian suppression) may be recommended in addition. For postmenopausal women, adjuvant therapy with an aromatase inhibitor, as compared with tamoxifen, improves outcomes.

Portrait, treatment choices and management of breast cancer in nonagenarians

Portrait, treatment choices and management of breast cancer in nonagenarians: An ongoing challenge. The Breast, June 2014, Vol. 23(3), p.221-5.

Merv, B., et al.

http://www.thebreastonline.com/article/S0960-9776(14)00050-2/abstract?rss=yes?rss=yes

There are only scarce data on the management of nonagenarians with breast cancer, and more particularly on the place of radiation therapy (RT). We report a retrospective study on patients aged 90 years old or older, with breast cancer, receiving RT. Records from RT departments from five institutions were reviewed to identify patients 90 years old of age and older undergoing RT over past decade for breast cancer. Tumors' characteristics were examined, as well treatment specificities and treatment intent. 

44 patients receiving RT courses were identified, mean age 92 years. Treatment was given with curative and palliative intent in 72.7% and 27.3% respectively. Factors associated with a curative treatment were performance status (PS), place of life, previous surgery, and tumor stage. Median total prescribed dose was 40 Gy (23–66). Hypo fractionation was used in 77%. Most toxicities were mild to moderate. RT could not be completed in 1 patient (2.3%). No long-term toxicity was reported. Among 31 patients analyzable for effectiveness, 24 patients (77.4%) had their diseased controlled until last follow-up, including 17 patients (54.8%) experiencing complete response. At last follow-up, 4 patients (12.9%) were deceased, cancer being cause of death for two of them.

The study shows that breast/chest RT is feasible in nonagenarians. Although the definitive benefit of RT could not be addressed here, hypofractionated therapy allowed a good local control with acceptable side effects.

Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality

Effect of radiotherapy after mastectomy and axillary survey on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. The Lancet, June 2014, Vol. 383(9935), p.2127-35.

Early Breast Cancer Trialists' Collaborative Group

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673614604888.pdf?id=baafQEJCKe7tA85F7c8Bu

Postmastectomy radiotherapy was shown in previous meta-analyses to reduce the risks of both recurrence and breast cancer mortality in all women with node-positive disease considered together. However, the benefit in women with only one to three positive lymph nodes is uncertain. We aimed to assess the effect of radiotherapy in these women after mastectomy and axillary dissection.

Breast cancer drug hope for leukaemia

Breast cancer drug hope for leukaemia. [online]. BBC News [Health]. June 2014

http://www.bbc.co.uk/news/health-28044146

Leukaemia research may lead to new drugs for difficult-to-treat breast cancers, say scientists.

These types of tumours cannot be treated with the targeted drugs which have hugely improved survival.

A team in Glasgow says a faulty piece of DNA which causes leukaemia also has a role in some tumours and could help in research for new drugs. 

Meanwhile, other researchers say they have taken tentative steps towards a blood test for breast cancer.

Three-dimensional nipple-areola tattooing

Three-dimensional nipple-areola tattooing: A new technique with superior results. Plastic and Reconstructive Surgery, May 2014, Vol. 133(5), p.1073-75.

Halvorson, E.G., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/05000/Three_Dimensional_Nipple_Areola_Tattooing___A_New.4.aspx

Traditional coloring techniques for nipple-areola tattooing ignore the artistic principles of light and shadow to create depth on a two-dimensional surface. The method presented in this article is essentially the inverse of traditional technique and results in a more realistic and three-dimensional reconstruction that can appear better than surgical methods. The application of three-dimensional techniques or “realism” in tattoo artistry has significant potential to improve the aesthetic outcomes of reconstructive surgery.

Quality-of-life outcomes between mastectomy alone and breast reconstruction

Quality-of-life outcomes between mastectomy alone and breast reconstruction: Comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plastic and Reconstructive Surgery, April 2014, Vol. 133(4), p.594(e)-595(e).

Cagli, B.M.D., et al.

file://mscl-users/Users/ecnt/L&D%20Services/CKeeling/Downloads/Quality_of_Life_Outcomes_between_Mastectomy_Alone.42%20(1).pdf

For women, breast cancer remains a common and dreaded experience; it is normal for a diagnosis of breast cancer to evoke grief, anger, and intense fear. The options of breast conservation and reconstruction give women a new sense of control over their treatment and are quite successful in helping women feel comfortable with their bodies again.

Understanding the effect of breast augmentation on quality of life

Understanding the effect of breast augmentation on quality of life: Prospective analysis using the BREAST-Q.
Plastic and Reconstructive Surgery, April 2014, Vol. 133(4), p.787-95.

Alderman, A.K., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/04000/Understanding_the_Effect_of_Breast_Augmentation_on.6.aspx

The aim of this study was to prospectively evaluate patient satisfaction and quality of life with elective breast augmentation. Patients with bilateral submuscular breast augmentations prospectively completed the BREAST-Q preoperatively and 6 weeks and 6 months postoperatively; t tests compared preoperative and postoperative scores at 6 weeks and 6 months, and standard indicators of effect sizes were calculated. Logistic regression was used to evaluate the association between patient and surgical factors on satisfaction outcomes.

Breast cancer screening pamphlets mislead women

Breast cancer screening pamphlets mislead women. BMJ 2014; 348

Gigerenzer, G.

http://www.bmj.com/content/348/bmj.g2636?rss=1

Why should I have mammography? That question is regularly asked in pamphlets for screening. The answer is also regularly misleading. Women are told what they should do, but without being given the facts necessary to make informed decisions. This form of paternalism has a long tradition. In a campaign poster in the 1980s, the American Cancer Society declared: “If you haven’t had a mammogram, you need more than your breasts examined.”

Management of women at high risk of breast cancer

Management of women at high risk of breast cancer. BMJ 2014, 348:g2756

Armstrong, A.C. and Evans, G.D.

http://www.bmj.com/highwire/filestream/696134/field_highwire_article_pdf/0/bmj.g2756

Breast cancer is the commonest malignancy diagnosed in women worldwide and accounts for over 30% of all cancers diagnosed in women in the United Kingdom.1 The average lifetime risk of developing breast cancer for women in the United Kingdom and United States is estimated to be 12%, although this may
be an overestimate, as it is not clear what age this assumes a woman lives to and whether full adjustment has been made for those who die young from other causes. It is also unclear whether multiple breast cancers in a single woman are counted as several women with breast cancer.

Anastrozole for prevention of breast cancer in high-risk postmenopausal women

Anastrozole for prevention of breast cancer in high-risk postmenopausal women: An international, double-blind, randomised placebo-controlled trial. The Lancet, March 2014, Vol. 383(9922), p.1041-48.

Cuzick, J., et al.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62292-8/abstract?rss=yes

Aromatase inhibitors effectively prevent breast cancer recurrence and development of new contralateral tumours in postmenopausal women. We assessed the efficacy and safety of the aromatase inhibitor anastrozole for prevention of breast cancer in postmenopausal women who are at high risk of the disease.

Breast cancer chemoprevention

Breast cancer chemoprevention: little progress in practice? The Lancet, March 2014 Vol. 383(9922), p.1018-20.

Cameron, D.A.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62555-6/fulltext?rss=yes

In The Lancet, Jack Cuzick and colleagues report the first results from IBIS-II (International Breast cancer Intervention Study II), in which 3864 postmenopausal women at high risk of breast cancer were randomly assigned to receive the potent, non-steroidal aromatase inhibitor anastrozole or placebo every day for 5 years. After a median follow-up of 5 years, 40 (2%) of 1920 women in the anastrozole group and 85 (4%) of 1944 in the placebo group had developed breast cancer (hazard ratio 0·47, 95% CI 0·32—0·68). This finding is in keeping with those of other similar studies.So far, unsurprisingly, the investigators have not recorded evidence for a difference in breast cancer or all-cause mortality: 18 deaths had been reported in the anastrozole group and 17 in the placebo group.

Venous thromboembolism risk in mastectomy and immediate breast reconstruction

Venous thromboembolism risk in mastectomy and immediate breast reconstruction: Analysis of the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program Data Sets. Plastic and Reconstructive Surgery, March 2014, Vol. 133(3), p.263e-273e.

Fischer, J.P., et al.

http://journals.lww.com/plasreconsurg/Abstract/2014/03000/Venous_Thromboembolism_Risk_in_Mastectomy_and.9.aspx

Venous thromboembolism, including deep venous thrombosis and pulmonary embolism, is a morbid and costly complication following surgical procedures. The authors aim to assess the added risk of venous thromboembolism in patients undergoing immediate breast reconstruction.

The effect of prior abdominal surgery on abdominally based free flaps in breast reconstruction

The effect of prior abdominal surgery on abdominally based free flaps in breast reconstruction. Plastic and reconstructive surgery, March 2014, Vol. 133(3), p.247e-255e.

Roostaeian, J., et al.

http://journals.lww.com/plasreconsurg/Abstract/2014/03000/The_Effect_of_Prior_Abdominal_Surgery_on.4.aspx

The abdomen has long remained the preferred donor site in breast reconstruction. Over time, the flap has evolved to limit morbidity with reduced muscular harvest. Previous abdominal operations, however, may limit the ability to perform a muscle- or fascia-sparing flap. The purpose of this study was to evaluate outcomes in women who had prior abdominal operations and underwent abdominally based autologous breast reconstruction.

Mastectomy rates for ductal carcinoma in situ vary widely in UK

Mastectomy rates for ductal carcinoma in situa vary widely in UK, audit shows [news item]. BMJ 2014; 348:g2332

Mayor, S.

http://www.bmj.com/content/348/bmj.g2332?rss=1&hwoasp=authn%3A1395931440%3A4044144%3A3266341127%3A0%3A0%3AKU2BGBsYX8ly%2BjhKOx1Tkg%3D%3D

Data from the UK NHS Breast Cancer Screening Programme show significant variation between hospitals in the number of women with ductal carcinoma in situ undergoing mastectomy when lumpectomy would normally be indicated, shows an audit reported last week at the European Breast Cancer Conference.

Breast cancer screening offers few benefits to women over 70

Breast cancer screening offers few benefits to women over 70, finds study [research news].  BMJ 2014; 348:g2333.

Wise, J.

http://www.bmj.com/highwire/filestream/691661/field_highwire_article_pdf/0/bmj.g2333

Extending the Netherlands’ breast cancer screening programme to include women over the age of 70 did not lead to a fall in the number of advanced stage breast cancers detected, even though the number of early stage tumours detected rose, an evaluation has found. The study’s leader, Gerrit-Jan Liefers, a surgical oncologist and head of the geriatric oncology research group at Leiden University Medical Centre, said that if the programme were effective he would expect the incidence of advanced stage cancer to decrease, because any cancer would have been detected at an earlier stage. The study’s finding “implies that the effect of
screening in elderly women is limited and leads to a large proportion of overdiagnosis,” he said.