Psychosocial factors affecting the therapeutic decision-making and postoperative mood states in Japanese breast cancer patients who underwent various types of surgery: body image and sexuality.
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OBJECTIVE: We conducted an empirical study to clarify how psychosocial factors (e.g. body image and sexuality) influence therapeutic decision-making and to identify the factors that affect post-operative mood states in Japanese women who underwent various types of surgery. METHODS: One hundred and two patients who had undergone surgical treatment for breast cancer participated in this study. Twenty-five patients had undergone mastectomy, 67 breast conserving treatment and 11 skin-sparing mastectomy and immediate breast reconstruction. The participants were evaluated based on a battery of questionnaires including value estimates of decision-making factors, a shortened version of the Profile of Mood States and self-efficacy. RESULTS: The patients regarded the possibility of cure and recurrence of cancer as well as the physician's support as important, regardless of the treatments they had chosen. The patients that had immediate breast reconstruction placed significantly more importance on their body image and sexuality (i.e. physical appearance, attractiveness to partner and self-evaluation of femininity and sexuality) than the mastectomy patients. After surgery, the former group tended to have a more negative mood on the shortened version of the Profile of Mood States than the latter group. Degree of self-efficacy had a marked influence on the patients' mood after surgery. CONCLUSIONS: This study suggests the importance of discussing body image and sexuality that has tended to be disregarded in therapeutic decision-making situations in breast cancer patients in Japan. Self-efficacy is a crucial variable for improving mood after treatment. (+info)
Complex engagement of DNA damage response pathways in human cancer and in lung tumor progression.
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Tumor initiation and progression provide a multitude of occasions for the generation of DNA damage and the consequent activation of the DNA damage response (DDR) pathway. DDR signaling involves the engagement of key factors such as ATM, CHK2, 53BP1 and the phosphorylation of histone H2AX (gamma-H2AX). The systematic study of DDR in human tumors and normal tissues by high-throughput tissue microarrays revealed that ATM and gamma-H2AX were engaged in cancer but the extent of their activation was strongly affected by the organ and cell type involved, whereas 53BP1 loss was the most consistent feature among the tumor studied. Unexpectedly, we also observed activated DDR markers in morphologically normal tissues, also in association with inflammation. Analysis of the dynamic engagement of DDR along the different stages of lung tumorigenesis showed that 53BP1 loss occurs early at the transition from normal to dysplastic change whereas the activated forms of ATM and CHK2, but not gamma-H2AX, initially accumulate in pre-invasive lesions and are then lost during tumor progression. In individual lung tumors, the activation of ATM, CHK2 and the presence of 53BP1 were consistently correlated, whereas gamma-H2AX did not correlate with activated ATM. Finally, the study of associations between critical clinicopathological parameters and activated DDR factors highlighted a statistically meaningful correlation between reduced local tumor extension and the phosphorylation of ATM, CHK2 and the presence of 53BP1, whereas no significant correlations with parameters such as survival or relapse of early-stage lung carcinomas were found. (+info)
Prophylactic mastectomy in BRCA1/2 mutation carriers and women at risk of hereditary breast cancer: long-term experiences at the Rotterdam Family Cancer Clinic.
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BACKGROUND: BRCA1/2 mutation carriers and women from a hereditary breast(/ovarian) cancer family have a highly increased risk of developing breast cancer (BC). Prophylactic mastectomy (PM) results in the greatest BC risk reduction. Long-term data on the efficacy and sequels of PM are scarce. METHODS: From 358 high-risk women (including 236 BRCA1/2 carriers) undergoing PM between 1994 and 2004, relevant data on the occurrence of BC in relation to PM, complications in relation to breast reconstruction (BR), mutation status, age at PM and preoperative imaging examination results were extracted from the medical records, and analyzed separately for women without (unaffected, n = 177) and with a BC history (affected, n = 181). RESULTS: No primary BCs occurred after PM (median follow-up 4.5 years). In one previously unaffected woman, metastatic BC was detected almost 4 years after PM (primary BC not found). Median age at PM was younger in unaffected women (P < .001), affected women more frequently were 50% risk carriers (P < .001). Unexpected (pre)malignant changes at PM were found in 3% of the patients (in 5 affected, and 5 unaffected women, respectively). In 49.6% of the women opting for BR one or more complications were registered, totaling 215 complications, leading to 153 surgical interventions (71%). Complications were mainly related to cosmetic outcome (36%) and capsular formation (24%). CONCLUSIONS: The risk of developing a primary BC after PM remains low after longer follow-up. Preoperative imaging and careful histological examination is warranted because of potential unexpected (pre)malignant findings. The high complication rate after breast reconstruction mainly concerns cosmetic issues. (+info)
Circular local skin flap. A new approach to areola reconstruction.
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PURPOSE: Despite the numerous surgical options available today for nipple-areola reconstruction, the results are often unsatisfactory. The present study proposes a simple and efficient method for areola reconstruction that uses a circular local skin flap. METHODS: We prospectively followed five patients that underwent areola reconstruction using a circular local skin flap. A circle, approximately 5 cm in diameter, was marked on the desired area for the new areola. A thin centripetal undermining of 1.5-2 cm was performed, which created a flap with a central pedicle of approximately 1-2 cm. After hemostasis, the thin flap was fixed in its former position with continuous sutures. RESULTS: The mean procedure time was 20 minutes (+/-9). The postoperative results were classified as satisfactory by four of the five patients at six months postoperative. Due to superficial undermining, the resulting scar resembled the appearance of the transition from the mammary skin to the areola. Dermopigmentation was only required in one areola. No complications such as dehiscence, necrosis, hematoma, or infection occurred. CONCLUSION: This technique achieved satisfactory results with low morbidity and few complications, and is thus a potentially promising resource for areola reconstruction. (+info)
Expanding the role of breast conservation surgery by immediate volume replacement with the latissimus dorsi flap.
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INTRODUCTION: Many women with early breast cancer are treated with Mastectomy, instead of Breast Conservation Surgery (BCS), for fear of suboptimal tumor removal or cosmetic failure due to volume and shape loss. These women can be satisfactorily treated by BCS and immediate volume replacement. Synchronous breast augmentation by the autologous Latissimus Dorsi (LD) Muscle or Myocutaneous Flaps in the treatment of relatively large and/or retroareolar breast tumors was investigated in this study held at the National Cancer Institute of Cairo University and at the Aswan Cancer Center. PATIENTS AND METHODS: Between October 2000 and March 2003, 29 patients with histologically proven breast cancer were treated by BCS and immediate volume replacement with LD muscle or myocutaneous flaps. Patients' age ranged from 32 to 57 years. Tumors' size ranged from 28 to 69mm. Axillary dissections revealed positive lymph glands in 58.6% of cases. Tumor location was in the central quadrant in 45%, in the upper quadrants in 41% and in the lower quadrants in 14% of cases. The LD myocutaneous flap was used in 21 cases while, in the remaining 8 cases, only the LD muscle was needed. RESULTS: The median size of the lumpectomy specimen was 219cm3. The safety margins obtained ranged between 9 and 28mm. The mean combined operating time was 238 minutes. The mean blood loss was 320ml and no patient required blood transfusion. The median hospital stay was 5 days. Persistent seroma in the back occurred in 52% of patients, requiring a median of 5 weekly aspirations. No sepsis or flap viability problems were encountered. Cosmetic results were satisfactory in 69% of patients. Only 17% showed some asymmetry in size, 7% some discrepancy in skin color and 7% a mild difference in Nipple Areola Complex (NAC) level. CONCLUSION: Mastectomy can be avoided in a large number of women with small breast/tumor ratio or retroareolar tumors. Immediate volume replacement with LD flap can extend the role of BCS to these patients. This can be achieved without compromising the adequacy of resection, with minimal morbidity, very satisfactory cosmetic results, no need for prosthesis or contra lateral mammaplasty and no effect on postoperative clinical or radiological follow-up. (+info)
Diffusion of good practices of care and decline of the association with case volume: the example of breast conserving surgery.
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BACKGROUND: Several previous studies conducted on cancer registry data and hospital discharge records (HDR) have found an association between hospital volume and the recourse to breast conserving surgery (BCS) for breast cancer. The aim of the current study is to depict concurrent time trends in the recourse to BCS and its association with hospital volume. METHODS: Admissions of breast cancer patients for BCS or mastectomy in the period 2000-2004 were identified from the discharge database of the Veneto Region (Italy). The role of procedural volume (low < 50, medium 50-100, high > 100 breast cancer surgeries/year), and of individual risk factors obtainable from HDR was assessed through a hierarchical log-binomial regression. RESULTS: Overall, the recourse to BCS was higher in medium (risk ratio = 1.12, 95% confidence interval 1.07-1.18) and high-volume (1.09, 1.03-1.14) compared to low-volume hospitals. The proportion of patients treated in low-volume hospitals dropped from 22% to 12%, with a concurrent increase in the activity of medium-volume providers. The increase over time in breast conservation (globally from 56% to 67%) was steeper in the categories of low- and medium-volume hospitals with respect to high caseload. CONCLUSION: The growth in the recourse to BCS was accompanied by a decline of the association with hospital volume; larger centers probably acted as early adopters of breast conservation strategies that subsequently spread to smaller providers. (+info)
Options for immediate breast reconstruction following skin-sparing mastectomy.
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BACKGROUND: Skin-sparing mastectomy (SSM) is a type of breast cancer surgery presupposed as breast reconstruction surgery. Cosmetically, it is an extremely effective breast cancer operation because the greater part of the breast's native skin and infra-mammary fold are conserved. All cases of SSM and immediate breast reconstruction performed by the senior author during the last five years were reviewed. METHODS: There are three implant options for breast reconstruction, namely, deep inferior epigastric perforator (DIEP) flap, latissimus dorsi myocutaneous (LDM) flap, and breast implant, and one of these was used for reconstruction after comprehensive evaluation. RESULTS: From 2001 to 2005, immediate reconstructions following SSM were performed on 124 cases (128 breasts) by the same surgeon. Partial necrosis of the breast skin occurred in 4 cases of SSM. The mean follow-up was 33.6 months. During the follow-up, there was local recurrence following surgery in 3 cases. The overall aesthetic results of immediate breast reconstruction after SSM are better than those after non-SSM. CONCLUSION: SSM preserves the native breast skin and infra-mammary fold, and is an extremely useful breast cancer surgery for breast reconstruction. SSM is an excellent breast cancer surgical technique. We think this procedure should be considered in more facilities conducting breast reconstruction in Japan. (+info)
Custom-made nipple prosthesis: a long-term satisfaction survey.
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BACKGROUND: Nipple-areola reconstruction or prosthesis completes the process of breast reconstruction. Although custom made nipple prosthesis (CNP) have been used for almost 10 years, little follow-up data on patient satisfaction is available. We assessed long-term patient satisfaction with CNP. MATERIALS AND METHODS: All patients undergoing CNP from 2000 to 2001 were sent anonymous postal questionnaires. Perceived benefit and satisfaction with size, colour, and projection, were assessed using a modified Likart scale (1 not satisfied, 5 very satisfied). Results are expressed as median and interquartile range (IQR). RESULTS: Of 52 patients who had CNP, 29 responded to the questionnaire (56% response rate), median age (IQR) 56.1 years (52-61). The median time since CNP was 2 years (0.6-3), 67% felt they had benefited from the prosthesis and 39% wore their CNP regularly. Most patients were highly satisfied with CNP size, colour and projection, median score 5 (4-5) for each variable. Patients with CNP Patients with CNP < 3 years were more likely to be satisfied with CNP than those with CNP for = 3 years, 60% vs 18%, p = 0.04. Patients who were satisfied with their CNP (median age 52.9 years, IQR 45.3-59.2 years), were younger than patients not satisfied with their CNP (median age 59 years, IQR 54.7-62 years), p = 0.031, Z = -2.16. Three patients had subsequent nipple reconstruction, a further 7 (24%) wanted nipple reconstruction. All respondents thought CNP should be offered at the time of initial surgery. CONCLUSIONS: Most patients are highly satisfied with CNP, with highest satisfaction in the first 3 years after CNP. CNP should be offered at the time of initial surgery. (+info)