2 years versus 1 year of adjuvant trastuzumab for HER2-positive breast cancer

2 years versus 1 year of adjuvant trastuzumab for HER2-positive breast cancer: An open-label, randomised controlled trial. The lancet, Sept 2013, Vol. 382(9897), p.1021-28.

Goldhirsch, A., et al.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61094-6/abstract?rss=yes

Trastuzumab has established efficacy against breast cancer with overexpression or amplification of the HER2 oncogene. The standard of care is 1 year of adjuvant trastuzumab, but the optimum duration of treatment is unknown. We compared 2 years of treatment with trastuzumab with 1 year of treatment, and updated the comparison of 1 year of trastuzumab versus observation at a median follow-up of 8 years, for patients enrolled in the HERceptin Adjuvant (HERA) trial.

Adjuvant docetaxel and cyclophosphamide plus trastuzumab in patients with HER2-amplified early stage breast cancer

Adjuvant docetaxel and cyclophosphamide plus trastuzumab in patients with HER2-amplified early stage breast cancer: A single-group, open-label, phase 2 study. The lancet oncology, Oct 2013, Vol. 14(11), p.1121-28.

Jones, F.E., et al.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(13)70384-X/abstract?rss=yes

Previous results suggest that docetaxel plus cyclophosphamide improves disease-free survival (DFS) and overall survival compared with doxorubicin plus cyclophosphamide in early stage breast cancer. We assessed the addition of 1 year of trastuzumab to a non-anthracycline regimen, docetaxel plus cyclophosphamide, in patients with HER2-amplified early stage breast cancer and examined whether this regimen was equally effective in patients with TOP2A-amplified and TOP2A-non-amplified disease.

Breast cancer in women at high risk

Breast cancer in women at high risk: The role of rapid genetic testing for BRCA1 and -2 mutations and the consequences for treatment strategies. The breast, Oct 2013, Vol. 22(5), p.561-68

Francken, A.B., et al.

http://www.thebreastonline.com/article/S0960-9776(13)00210-5/abstract?rss=yes

Specific clinical questions rise when patients, who are diagnosed with breast cancer, are at risk of carrying a mutation in BRCA1 and -2 gene due to a strong family history or young age at diagnosis. These questions concern topics such as 1. Timing of genetic counseling and testing, 2. Choices to be made for BRCA1 or -2 mutation carriers in local treatment, contralateral treatment, (neo)adjuvant systemic therapy, and 3. The psychological effects of rapid testing. The knowledge of the genetic status might have several advantages for the patient in treatment planning, such as the choice whether or not to undergo mastectomy and/or prophylactic contralateral mastectomy.

The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction

The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: A systematic review. Plastic and reconstructive surgery, Sept 2013, Vol. 132(3), p.511-18.

Lam, T.C., et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/09000/The_Effects_of_Postmastectomy_Adjuvant.1.aspx

The authors performed a systematic review of the literature on the outcome of therapy for patients with breast cancer who underwent adjuvant radiotherapy after an immediate two-stage prosthetic breast reconstruction, either following tissue expansion (stage 1) or after removal of the tissue expander and insertion of a final breast implant (stage 2). Their outcomes were compared to those of patients who had reconstruction without postmastectomy irradiation.

Impact of surgical techniques, biomaterials and patient variables on rate of nipple necrosis after nipple-sparing mastectomy

Impact of surgical techniques, biomaterials and patient variables on rate of nipple necrosis after nipple-sparing mastectomy. Plastic and reconstructive surgery, Sept 2013, Vol. 132(3), p.330e-338e.

Gould, D.J., et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/09000/Impact_of_Surgical_Techniques,_Biomaterials,_and.4.aspx

Nipple-sparing mastectomy is appropriate for selected patients with early-stage breast cancer or high breast cancer risk. However, the postoperative rate of nipple necrosis is relatively high (10 to 30 percent). This study analyzed the impact of clinicopathologic and surgical variables on partial and total nipple necrosis rates after nipple-sparing mastectomy and compared overall complication rates between nipple-sparing and skin-sparing mastectomy.

NICE approves new test for spread of breast cancer

NICE approves new test for spread of breast cancer.

NHS Choices, Aug 2013

http://www.nhs.uk/news/2013/08August/Pages/NICE-approves-new-test-for-spread-of-breast-cancer.aspx

Duration of trastuzumab for HER2-positive breast cancer

Duration of trastuzumab for HER2-positive breast cancer. The lancet oncology, July 2013, Vol.14(8), p.678-79.

Montemurro, F. and Aglietta, M.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(13)70273-0/fulltext?rss=yes

Several large randomised trials completed in the mid-2000s produced overwhelming evidence that the anti-HER2 monoclonal antibody trastuzumab, administered either concomitantly or sequentially with adjuvant chemotherapy for 12 months, increases the cure rate for women with HER2-positive operable breast cancer. One surprising aspect of this success story is that the choice of 12-month treatment duration was mostly as a result of a best guess, rather than on the basis of pre-existing evidence. 

Predictors of recurrence for ductal carcinoma in situ after breast-conserving surgery

Predictors of recurrence for ductal carinoma in situ after breast-conserving surgery. The lancet oncology, Aug 2013, Vol.14(9), p. e348-e357.

Benson, J.R. and Wishart, G.C.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(13)70135-9/abstract?rss=yes

Ductal carcinoma in situ (DCIS) constitutes a major public health problem, with up to half of screen-detected cancers representing pure forms of DCIS without evidence of invasion. A proportion of cases detected with routine screening would not have progressed to a life-threatening form of breast cancer during the patient's lifetime, and overdiagnosis of breast cancer is a cause for concern.

Combination endocrine treatments unproven in breast cancer

Combination endocrine treatments unproven in breast cancer. The lancet oncology, Sept 2013, Vol. 14(10), p.917-18.

Buzdar, A.U.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(13)70364-4/fulltext?_eventId=login&rss=yes

Ovarian ablation, which was introduced more than 100 years ago, was the first endocrine treatment for advanced breast cancer, followed by adrenalectomy and hypophysectomy. These ablative therapies have since been replaced by antioestrogen treatments, luteinising-hormone-releasing hormone agonists, and aromatase inhibitors.Other endocrine treatments with different mechanisms of action have also become available for breast cancer: oestrogens, progestins, androgens, antiandrogens, and selective oestrogen-receptor downregulators.

Subglandular breast augmentation with textured, anatomic, cohesive silicone implants

Subglandular breast augmentation with textured, anatomic, cohesive silicone implants: A review of 440 consecutive patients. Plastic and reconstructive surgery, Aug 2013, Vol. 132(2), p.295-303.

Lista, F., et al.

http://journals.lww.com/plasreconsurg/Fulltext/2013/08000/Subglandular_Breast_Augmentation_with_Textured,.11.aspx

The Allergan Style 410 implant is a textured, anatomic, highly cohesive silicone gel–filled breast implant. Despite its widespread use in both Europe and Canada, limited data exist regarding long-term outcomes. The purpose of this study was to investigate outcomes using the Style 410 implant for primary subglandular breast augmentation.

Breast reconstruction with the Bostwick Autoderm technique

Breast reconstruction with the Bostwick Autoderm technique. Plastic and reconstructive surgery, Aug 2013, Vol. 132(2), p.261-70.

Ladizinsky, D.A., et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/08000/Breast_Reconstruction_with_the_Bostwick_Autoderm.6.aspx

In 1990, Bostwick presented a technique wherein excess skin in the ptotic breast provides a deepithelialized inferiorly based dermal flap at the time of mastectomy. This adjoins the inferior border of the pectoralis major muscle, creating a complete autologous vascularized pocket, which is then covered by Wise pattern skin flaps.

Microvascular autologous breast reconstruction in the context of radiation therapy

Microvascular autologous breast reconstruction in the context of radiation therapy: Comparing two reconstructive algorithms. Plastic and reconstructive surgery, Aug 2013, Vol. 132(2), 251-57.

Patel, K., et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/08000/Microvascular_Autologous_Breast_Reconstruction_in.1.aspx

When postmastectomy radiation therapy is anticipated, delaying autologous reconstruction prevents radiation delivery issues and radiation-induced contour irregularities. Delayed-immediate autologous breast reconstruction may allow for maintenance of the breast skin envelope as compared with delayed reconstruction with the temporary insertion of a tissue expander. The authors compared perioperative complications and revision surgery rates of comparative cohorts to determine which method is preferable.

The timing of preoperative prophylactic low-molecular-weight heparin administration in breast reconstruction

The timing of preoperative prophylactic low-molecular-weight heparin administration in breast reconstruction. Plastic and reconstructive surgery, Aug 2013, Vol. 132(2), p.279-84.

Keith, J.N., et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/08000/The_Timing_of_Preoperative_Prophylactic.8.aspx

Venous thromboembolism continues to be problematic despite increased recognition and advancements in venous thromboembolism prophylaxis. Although migration toward preoperative chemoprophylaxis increases, plastic surgeons seem reticent to adopt this practice. This study evaluates preoperative enoxaparin administration in breast reconstruction patients.

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, Aug 2013, Vol. 132(2), p.201e-209e.

Eltahir, Y., et al.

http://journals.lww.com/plasreconsurg/Abstract/2013/08000/Quality_of_Life_Outcomes_between_Mastectomy_Alone.3.aspx

Published data on quality of life in women after breast reconstruction are inconsistent. This cross-sectional study evaluated the quality of life of women after successful breast reconstruction in comparison with those who underwent mastectomy alone.

Patterns of metastatic spread in early breast cancer

Patterns of metastatic spread in early breast cancer. The breast, August 2013, Vol. 22(4), p.449-54.

Klevesath, M.B., et al.

http://www.sciencedirect.com/science/article/pii/S0960977613000982

The aim of this study was to prospectively investigate metastatic pathways of spread to lymph node versus bone marrow and identify biological characteristics that determine these patterns in early invasive breast cancer.

A prognostic tool to predict fatigue in women with early-stage breast cancer undergoing radiotherapy

A prognostic tool to predict fatigue in women with early-stage breast cancer undergoing radiotherapy. The breast, August 2013, Vol. 22(4), p.504-09.

Courtier, N., et al.

http://www.sciencedirect.com/science/article/pii/S0960977612002032

Fatigue during and after radiotherapy impacts negatively on normal functioning and quality of life. A pre-treatment estimate of the risk of fatigue would facilitate the targeting of timely interventions to limit consequential behavioural symptoms arising. We have developed a prognostic tool to predict the risk of fatigue in women with early-stage breast cancer undergoing radiotherapy.

Should all postmenopausal patients with hormone receptor-positive breast cancer receive initial therapy with aromatase inhibitors?

Should all postmenopausal patients with hormone receptor-positive breast cancer receive initial therapy with aromatase inhibitors?  The breast, August 2013, Vol. 22(4), p.488-94.

Aapro, M., et al.

http://www.sciencedirect.com/science/article/pii/S096097761300009X

In the past few years aromatase inhibitors (AIs) have shown superior efficacy to the previous standard adjuvant endocrine therapy, tamoxifen, and are now recommended as part of current adjuvant endocrine therapy. A range of treatment strategies have been explored.

Perceived risk and adherence to breast cancer screening guidelines among women with a familial history of breast cancer

Perceived risk and adherence to breast cancer screening guidelines among women with a familial history of breast cancer: A review of the literature. The breast, August 2013, Vol. 22(4), p.395-404.

Walker, M.J., et al.

http://www.sciencedirect.com/science/article/pii/S0960977612002494

A small positive association has been consistently demonstrated between perceived breast cancer risk and mammography use. Evidence specific to women with familial breast cancer risk has not been previously reviewed.

The effect of mammography pain on repeat participation in breast cancer screening

The effect of mammography pain on repeat participation in breast cancer screening: A systematic review. The breast, August 2013, Vol. 22(4), p.389-94.

Whelehan, P., et al.

http://www.sciencedirect.com/science/article/pii/S096097761300057X

Uptake is crucial to reducing breast cancer mortality through screening. This review synthesised all available evidence on mammography pain as a deterrent to subsequent breast screening. Ten databases were searched. Studies containing empirical data relating mammography pain to breast screening re-attendance were included (n = 20). In the most robust studies asking women why they had not re-attended, 25%–46% cited pain, equivalent to approximately 47,000–87,000 women per year in England. The most robust evidence for an association between pain experienced at a previous mammogram and subsequent rates of re-attendance suggests that women who previously experienced pain are more likely than those who did not to fail to re-attend: RR 1.34 (95% CI: 0.94–1.91). The complexity of the pain phenomenon and of screening behaviours must be recognised. However, there is sufficient evidence to conclude that painful mammography contributes to non-re-attendance. Given the importance of cumulative participation, effective pain-reducing interventions in mammography are needed.

Sorting through the arguments on breast screening

Sorting through the arguments on breast screening.  JAMA, 2013, 309(24), p.2553-4.

Marmot, M.G.

http://jama.jamanetwork.com/article.aspx?articleid=1691913

Views on the benefits and harms of breast cancer screening are sharply polarized and increasingly vocal. Allegations of harming women are flung in both directions. The antiscreeners claim that benefit is minimal and overdiagnosis is so frequent that women are being subject to unnecessary interventions and treatment. The proscreeners claim that if the critics win the day, women will be deprived of the benefits that screening brings of early diagnosis and reductions in mortality from breast cancer.