Tuesday, 28 April 2015

Breast density legislation

Breast density legislation - practical considerations. NEJM 2015, 372: 593-5


Slanetz, P.J., et al.


http://www.nejm.org/doi/full/10.1056/NEJMp1413728?af=R&rss=currentIssue


Ever since Nancy Cappello, a Connecticut woman who hadn't been told that her mammograms showed dense breast tissue, was diagnosed with stage 3 breast cancer in 2004 and advocated for a new state law, there's been a growing movement to educate women about breast density and the potential role of supplemental screening in early cancer detection. Cappello's state was the first to pass a law requiring physicians to offer supplemental whole-breast ultrasonography to women with dense breasts — defined as containing more than 50% fibroglandular tissue — and mandating that insurers cover the additional screening.
Since then, the number of breast-density laws in the United States has grown rapidly: as of January 2015, a total of 21 states had adopted such legislation. Laws vary considerably among states, with some requiring only that physicians notify women with dense breasts of their status and others stipulating that supplemental screening be offered to such women. Most state laws, however, do not mandate insurance coverage of additional screening, though the lack of such coverage could increase income-based health disparities.

Pertuzumab, Trastuzumab, and Docetaxel in HER2-Positive metastatic breast cancer

Pertuzumab, Trastuzumab and Docetaxel in HER2-Positive metastatic breast cancer. NEJM 2015, 372: 724-34


Swain, S.M., et al.


http://www.nejm.org/doi/full/10.1056/NEJMoa1413513?af=R&rss=currentIssue


In patients with metastatic breast cancer that is positive for human epidermal growth factor receptor 2 (HER2), progression-free survival was significantly improved after first-line therapy with pertuzumab, trastuzumab, and docetaxel, as compared with placebo, trastuzumab, and docetaxel. Overall survival was significantly improved with pertuzumab in an interim analysis without the median being reached. We report final prespecified overall survival results with a median follow-up of 50 months.

Thursday, 26 March 2015

Over-diagnosis in breast cancer

Over-diagnosis in breast cancer - 45 years to become a mainstream idea. BMJ [podcast]

https://soundcloud.com/bmjpodcasts/overdiagnosis-in-breast-cancer-45-years-to-become-a-mainstream-idea

Does breast reconstruction after mastectomy for breast cancer affect overall survival?

Does breast reconstruction after mastectomy for breast cancer affect overall survival? Long-term follow-up of a retrospective population-based cohort. Plastic and Reconstructive Surgery, March 2015, Vol. 135(3), p.468e-476e.

Platt, J., et al.

http://journals.lww.com/plasreconsurg/Abstract/2015/03000/Does_Breast_Reconstruction_after_Mastectomy_for.4.aspx

Background: This study compared overall and breast cancer–specific survival using long-term follow-up data among women diagnosed with invasive breast cancer undergoing mastectomy or breast reconstruction.

Friday, 27 February 2015

Comparison of postoperative pain control in autologous abdominal free flap versus inplant-based breast reconstructions

Comparison of postoperative pain control in autologous abdominal free flap versus inplant-based breast reconstructions. Plastic and Reconstructive Surgery, Feb 2015, Vol. 135(2), p.356-67.

Gassman, A.A., et al.

http://journals.lww.com/plasreconsurg/Abstract/2015/02000/Comparison_of_Postoperative_Pain_Control_in.9.aspx

Women who undergo mastectomy and breast reconstruction are shown to express more pain than those who undergo mastectomy alone. The authors evaluated postoperative pain outcomes following breast reconstruction.

Advanced age is a predictor of 30-day complications after autologous but not implant-based post-mastectomy breast reconstruction

Advanced age is a predictor of 30-day complications after autologous but not  implant-based post-mastectomy breast reconstruction. Plastic and Reconstructive Surgery, Feb. 2015, Vol. 135(2), p.253e-261e

Butz, D.R., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2015/02000/Advanced_Age_Is_a_Predictor_of_30_Day.6.aspx

Older breast cancer patients undergo postmastectomy breast reconstruction infrequently, in part because of a perception of increased surgical risk. This study sought to investigate the effects of age on perioperative complications after postmastectomy breast reconstruction.

Ovarian suppression in premenopausal breast cancer

Ovarian suppression in premenopausal breast cancer [audio]. NEJM, Jan 2015

Francis, P.A., et al.

https://feedly.com/i/subscription/feed/http://podcast.nejm.org/nejm_audio_summaries.xml




Pertuzumab, Trastuzumab and Docetaxel in HER-2 positive metastatic breast cancer

Pertuzumab, Trastuzumab and Docetaxel in HER-2 positive metastatic breast cancer. NEJM, Feb 2015, 372: 724-34

Swain, S.M., et al.

http://www.nejm.org/doi/full/10.1056/NEJMoa1413513?af=R&rss=currentIssue

In patients with metastatic breast cancer that is positive for human epidermal growth factor receptor 2 (HER2), progression-free survival was significantly improved after first-line therapy with pertuzumab, trastuzumab, and docetaxel, as compared with placebo, trastuzumab, and docetaxel. Overall survival was significantly improved with pertuzumab in an interim analysis without the median being reached. We report final prespecified overall survival results with a median follow-up of 50 months.

Breast density legislation - Practical considerations

Breast density legislation - Practical considerations. NEJM, 2015, 372: 593-595.

Slanetz, P.J.

http://www.nejm.org/doi/full/10.1056/NEJMp1413728?af=R&rss=currentIssue&

Ever since Nancy Cappello, a Connecticut woman who hadn't been told that her mammograms showed dense breast tissue, was diagnosed with stage 3 breast cancer in 2004 and advocated for a new state law, there's been a growing movement to educate women about breast density and the potential role of supplemental screening in early cancer detection. Cappello's state was the first to pass a law requiring physicians to offer supplemental whole-breast ultrasonography to women with dense breasts — defined as containing more than 50% fibroglandular tissue — and mandating that insurers cover the additional screening. Since then, the number of breast-density laws in the United States has grown rapidly: as of January 2015, a total of 21 states had adopted such legislation. Laws vary considerably among states, with some requiring only that physicians notify women with dense breasts of their status and others stipulating that supplemental screening be offered to such women. Most state laws, however, do not mandate insurance coverage of additional screening, though the lack of such coverage could increase income-based health disparities.

Thursday, 22 January 2015

Atypical hyperplasia of the breast

Atypical hyperplasia of the breast - risk assessment and management options. NEJM 2015, 372: 78-89.
[preview]

Hartmann, L.C., et al.

http://www.nejm.org/doi/full/10.1056/NEJMsr1407164?af=R&rss=currentIssue

Some benign breast lesions have a greatly increased risk of becoming invasive cancers. Atypical hyperplasia is a common high-risk benign lesion, and measures to prevent its progression to cancer are available but underutilized.

Understanding the factors that influence breast reconstruction decision making in Australian women

Understanding the factors that influence breast reconstruction decision making in Australian women. The Breast, Jan. 2015 [in press]

Somogyi, R.B., et al.

http://www.thebreastonline.com/article/S0960-9776(14)00218-5/abstract?rss=yes


Breast reconstruction is safe and improves quality of life. Despite this, many women do not undergo breast reconstruction and the reasons for this are poorly understood. This study aims to identify the factors that influence a woman's decision whether or not to have breast reconstruction and to better understand their attitudes toward reconstruction.

The breast reconstruction evaluation of acellular dermal matrix as a Sling Trial

The breast reconstruction evaluation of acellular dermal matrix as a Sling Trial: Design and methods of a prospective randomized trial. Plastic and Reconstructive Surgery, Jan 2015, Vol. 135(1), p.20e-28e.

Agarwal, J.P., et al.

http://journals.lww.com/plasreconsurg/Abstract/2015/01000/The_Breast_Reconstruction_Evaluation_of_Acellular.8.aspx

Recent literature has focused on the advantages and disadvantages of using acellular dermal matrix in breast reconstruction. Many of the reported data are from low level-of-evidence studies, leaving many questions incompletely answered. The present randomized trial provides high-level data on the incidence and severity of complications in acellular dermal matrix breast reconstruction between two commonly used types of acellular dermal matrix.

Tamoxifen for prevention of breast cancer

Tamoxifen for prevention of breast cancer: Extended long-term follow-up of the IBIS-I breast cancer prevention trial. The Lancet Oncology, Jan. 2015, Vol. 16(1), p.67-75.

Cuzick, J., et al.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)71171-4/fulltext?rss=yes

Four previously published randomised clinical trials have shown that tamoxifen can reduce the risk of breast cancer in healthy women at increased risk of breast cancer in the first 10 years of follow-up. We report the long-term follow-up of the IBIS-I trial, in which the participants and investigators remain largely masked to treatment allocation.

Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer

Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. The Lancet Oncology, Jan 2015, Vol. 16(1), p.47-56.

Bartelink, H., et al.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)71156-8/fulltext?rss=yes

Since the introduction of breast-conserving treatment, various radiation doses after lumpectomy have been used. In a phase 3 randomised controlled trial, we investigated the effect of a radiation boost of 16 Gy on overall survival, local control, and fibrosis for patients with stage I and II breast cancer who underwent breast-conserving treatment compared with patients who received no boost. Here, we present the 20-year follow-up results.

Adjuvant Paclitaxel and Trastuzumab for node-negative, HER-2 positive breast cancer

Adjuvant Paclitaxel and Trustuzumab for node-negative, HER-2 positive breast cancer. NEJM, 2015; 372: 134-141.

Tolaney, S.M., et al.

http://www.nejm.org/doi/full/10.1056/NEJMoa1406281?af=R&rss=currentIssue

No single standard treatment exists for patients with small, node-negative, human epidermal growth factor receptor type 2 (HER2)–positive breast cancers, because most of these patients have been ineligible for the pivotal trials of adjuvant trastuzumab.

Monday, 24 November 2014

Analysis of risk factors for complications in expander/implant breast reconstruction by stage of reconstruction

Analysis of risk factors for complications in expander/implant breast reconstruction by stage of reconstruction. Plastic and Reconstructive Surgery, Nov 2014, Vol. 134(5), p.692e-699e

Hirsch, E.M., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2014/11000/Analysis_of_Risk_Factors_for_Complications_in.7.aspx

Expander/implant breast reconstruction is a common approach to breast reconstruction. Although several studies evaluate risk factors for complications during the overall reconstructive process, no studies currently evaluate risk factors by stage of reconstruction. This information is important, as it can help guide physician and patient decision making.

Postmastectomy radiotherapy in patients with breast cancer

Postmastectomy radiotherapy in patients with breast cancer - author's reply. The Lancet, Nov 2014, Vol. 384(9957), p.1846-47

Early Breast Cancer Trialists' Collaborative Group 

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62240-6/fulltext?rss=yes#bib1

Our meta-analysis of individual patient data from trials in women given mastectomy and axillary clearance to at least level ll showed that radiotherapy reduced mortality from breast cancer by 20% in women with one to three positive lymph nodes (rate ratio [RR], irradiated vs not, 0·80, 95% CI 0·67—0·95; 2p=0·01) and by 13% in women with at least four positive lymph nodes (RR 0·87, 95% CI 0·77—0·99; 2p=0·04). Little reason of how radiotherapy works exists to think that this treatment for breast cancer has any appreciable abscopal effect and so, as Ismail Jatoi suggests, these results showed that a proportion of the deaths avoided by radiotherapy would have arisen from cells localised within the areas targeted by radiotherapy (ie, the chest wall and, for most trials, the regional lymph nodes).

Fertility advice

Breast cancer women 'not offered fertility advice'.  BBC News, Nov 2014

http://www.bbc.co.uk/news/health-30129324


Most young women diagnosed with breast cancer do not receive fertility advice, despite the fact their treatment could leave them unable to have children.
Chemotherapy can stop the ovaries working for a while or may bring on an early menopause.
Charity Breast Cancer Care, which surveyed 170 women under 45, wants all younger women to be referred to a fertility expert at diagnosis.

Treatment patterns and duration in post-menopausal women with HR+/HER2

Treatment patterns and duration in post-menopausal women with HR+/HER2 - metastatic breast cancer in the US: a retrospective chart review in community oncology practices.Current Medical Research and Opinion, Nov. 2014.

Macalalad, A.R., et al.

http://informahealthcare.com/doi/abs/10.1185/03007995.2014.980885

Clinical guidelines prefer endocrine therapy (ET) as initial treatment for post-menopausal women with hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2−) metastatic breast cancer (mBC). Chemotherapy (CT) should be reserved for patients who develop symptomatic visceral disease or have no clinical benefit after three sequential ET regimens. It is unclear if real-world clinical practice reflects these guidelines.

Breast reconstruction using free posterior medial thigh perforator flaps

Breast reconstruction using free posterior medial thigh perforator flaps: Intraoperative anatomical study and clinical results. Plastic and Reconstructive Surgery, Nov 2014, Vol. 134(5), p.880-91.

Satake, T., et al.

http://journals.lww.com/plasreconsurg/Abstract/2014/11000/Breast_Reconstruction_Using_Free_Posterior_Medial.5.aspx

The free posterior medial thigh perforator flap is a fasciocutaneous flap on the posterior and medial thigh, based on perforators from the deep femoral vessels. In this study, the authors evaluated the anatomical basis of posterior and medial thigh perforators from the deep femoral vessels.