Speciality
Spotlight

 




 


Obstetric & Gynaecology


 

 




Breast
Disease

   

  • Efficacy of Bilateral Prophylactic Mastectomy in Women with a Family History of Breast Cancer.

    LC Hartmann, DJ Schaid, et al (Mayo Clinic and Mayo Found, Rochester, Minn; St Vincent’s Hosp, Dublin)


    N Engl J Med 340:77-84, 1999.


       


    Methods – Retrospective chart review between 1960 and 1993 identified 639 women with a family history of breast who underwent a bilateral prophylactic mastectomy (median age at mastectomy, 42 years). Most of the patients (66%) were at moderate risk of breast cancer, but one third were at high risk. Breast cancer incidence and deaths were compared between the high-risk patients and a group of 403 of their sisters who had not undergone prophylactic mastectomy. Patients were followed up for a median of 14 years.

       


    Findings :The Gail model estimated that 37.4 breast cancers would be expected to have occurred in moderate-risk group. Prophylactic mastectomy significantly reduced the risk of breast cancer by 90% to 94% in the patients at high risk and it also reduced the risk of death from breast cancer by 81% to 94% in the patients at high risk. At the last visit, ovarian cancer had developed in 2 patients in the high-risk group.

       


    Conclusions drawn from the study: Prophylactic mastectomy is superior to surveillance for women with a moderate to high risk of breast cancer, significantly reducing not only the occurrence of this disease but also deaths caused by breast cancer. The development of ovarian cancer in 2 patients underscores the need to follow up these patients to identify subsequent ovarian and other cancers.

       

  • Putting the Risk of Breast Cancer in Perspective.

    K-A Pillips, et al (Princess Margaret Hosp, Toronto; Ontario Cancer Genetics Networks, Canada; Cancer Care Ontario, Toronto)

    N Engl J Med 340: 141-144, 1999.

      


    Background – Women tend to overestimate their risk of breast cancer. This occurs in part because the “1 in 9” statistic often

    quoted in the media is based on the cumulative lifetime risk for a women aged 85 years or older, yet breast cancer is uncommon

    at younger ages.

      

    Method :The 1995 Ontario Cancer Registry was examined to determine, based on a cohort of 1000 women, the number who

    died of breast cancer, lung cancer, or cardiovascular causes (including cerebrovascular events).

      

    Findings: The greatest proportion of deaths caused by breast cancer occurs in middle-aged women, in whom 20% of all deaths

    are caused by breast cancer. However, at other ages, the proportion of deaths resulting from cardiovascular disease is greater

    than that caused by breast cancer, particularly for women aged 60 years or older. The proportion of deaths resulting from lung

    cancer is similar to that caused by breast cancer, with breast cancer deaths peaking in middle age and lung cancer deaths

    peaking between 50 and 69 years of age.

        

    Conclusion drawn from this study as well as other studies have shown that more women primarily fear cancer (61%) rather than

    cardiovascular disease (9%), when actually cardiovascular disease is the greatest killer. Better education about the risk of breast

    cancer is needed, so that patients will not forego important therapies (such as estrogen replacement therapy) for the fear of

    developing breast cancer.

          

  • William H Hindle, Raquel D Arias, et al (Univ of Southern California School of Medicine, Los Angeles)

    Lack of utility in clinical practice of cytologic examination of nonbloody cyst fluid from palpable breast cysts.


    Am J Obstet Gynecol, 182(6),pg.1300 -5


     


    Objective : This study was undertaken to answer the following question: Does cytologic evaluation of nonbloody fluid aspirated from breast cysts contribute to appropriate clinical management?

     


    Study Design: A retrospective review of palpable breast cyst fluid cytologic reports and associated medical records was undertaken to determine whether the cytologic findings affected patient management. Breast cyst size, fluid volume, fluid color, and patient age were abstracted from 689 medical records (1988-1999) of women whose palpable cysts had been aspirated at the Breast Diagnostic Center, Women’s and Children’s Hospital, Los Angeles. These observations were correlated with the fluid cytologic reports.

     


    Results : Except for frankly bloody fluid, all breast fluid cytologic reports listed the results as a cellular, inadequate for cytologic diagnosis, or no malignant cells identified.

     


    Conclusion: In clinical practice only frankly bloody fluid should be submitted for cytologic analysis. All other cyst fluid should be discarded.

        

      



 

 

Speciality Spotlight

 

 

Breast Disease
   

  • Efficacy of Bilateral Prophylactic Mastectomy in Women with a Family History of Breast Cancer.
    LC Hartmann, DJ Schaid, et al (Mayo Clinic and Mayo Found, Rochester, Minn; St Vincent’s Hosp, Dublin)
    N Engl J Med 340:77-84, 1999.
       
    Methods – Retrospective chart review between 1960 and 1993 identified 639 women with a family history of breast who underwent a bilateral prophylactic mastectomy (median age at mastectomy, 42 years). Most of the patients (66%) were at moderate risk of breast cancer, but one third were at high risk. Breast cancer incidence and deaths were compared between the high-risk patients and a group of 403 of their sisters who had not undergone prophylactic mastectomy. Patients were followed up for a median of 14 years.
       
    Findings :The Gail model estimated that 37.4 breast cancers would be expected to have occurred in moderate-risk group. Prophylactic mastectomy significantly reduced the risk of breast cancer by 90% to 94% in the patients at high risk and it also reduced the risk of death from breast cancer by 81% to 94% in the patients at high risk. At the last visit, ovarian cancer had developed in 2 patients in the high-risk group.
       
    Conclusions drawn from the study: Prophylactic mastectomy is superior to surveillance for women with a moderate to high risk of breast cancer, significantly reducing not only the occurrence of this disease but also deaths caused by breast cancer. The development of ovarian cancer in 2 patients underscores the need to follow up these patients to identify subsequent ovarian and other cancers.
       

  • Putting the Risk of Breast Cancer in Perspective.
    K-A Pillips, et al (Princess Margaret Hosp, Toronto; Ontario Cancer Genetics Networks, Canada; Cancer Care Ontario, Toronto)
    N Engl J Med 340: 141-144, 1999.
      
    Background – Women tend to overestimate their risk of breast cancer. This occurs in part because the “1 in 9” statistic often
    quoted in the media is based on the cumulative lifetime risk for a women aged 85 years or older, yet breast cancer is uncommon
    at younger ages.
      
    Method :The 1995 Ontario Cancer Registry was examined to determine, based on a cohort of 1000 women, the number who
    died of breast cancer, lung cancer, or cardiovascular causes (including cerebrovascular events).
      
    Findings: The greatest proportion of deaths caused by breast cancer occurs in middle-aged women, in whom 20% of all deaths
    are caused by breast cancer. However, at other ages, the proportion of deaths resulting from cardiovascular disease is greater
    than that caused by breast cancer, particularly for women aged 60 years or older. The proportion of deaths resulting from lung
    cancer is similar to that caused by breast cancer, with breast cancer deaths peaking in middle age and lung cancer deaths
    peaking between 50 and 69 years of age.
        
    Conclusion drawn from this study as well as other studies have shown that more women primarily fear cancer (61%) rather than
    cardiovascular disease (9%), when actually cardiovascular disease is the greatest killer. Better education about the risk of breast
    cancer is needed, so that patients will not forego important therapies (such as estrogen replacement therapy) for the fear of
    developing breast cancer.
          

  • William H Hindle, Raquel D Arias, et al (Univ of Southern California School of Medicine, Los Angeles)
    Lack of utility in clinical practice of cytologic examination of nonbloody cyst fluid from palpable breast cysts.
    Am J Obstet Gynecol, 182(6),pg.1300 -5
     
    Objective : This study was undertaken to answer the following question: Does cytologic evaluation of nonbloody fluid aspirated from breast cysts contribute to appropriate clinical management?
     
    Study Design: A retrospective review of palpable breast cyst fluid cytologic reports and associated medical records was undertaken to determine whether the cytologic findings affected patient management. Breast cyst size, fluid volume, fluid color, and patient age were abstracted from 689 medical records (1988-1999) of women whose palpable cysts had been aspirated at the Breast Diagnostic Center, Women’s and Children’s Hospital, Los Angeles. These observations were correlated with the fluid cytologic reports.
     
    Results : Except for frankly bloody fluid, all breast fluid cytologic reports listed the results as a cellular, inadequate for cytologic diagnosis, or no malignant cells identified.
     
    Conclusion: In clinical practice only frankly bloody fluid should be submitted for cytologic analysis. All other cyst fluid should be discarded.
        

      

 

By |2022-07-20T16:41:29+00:00July 20, 2022|Uncategorized|Comments Off on Breast Disease

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