Incorporating breast cancer screening program in the medical curriculum of Cebu Institute of Medicine

The objective of the study was to describe the incorporation of breast cancer screening program in the medical curriculum of a medical school and determine its feasibility in finding breast cancer.METHODS: From school year 2011 - 2012, a 3-hour module that assesses third year medical students' proficiency in clinical breast examination (CBE) was incorporated into the pre-clinical clerkship program at the Cebu Institute of Medicine. The students who have satisfactorily completed the module were invited to participate in the Breast Cancer Control Outreach Program (BCAcop). Pertinent data included: number of participating consultants and students,number of patients seen as well as their demographic and clinical profile, breast cancer cases found.RESULTS: Four BCAcop were conducted and 6 consultants supervised the medical students in the CBE modules and BCAcop. Seventy seven medical students passed the CBE module and participated in BCAcop. A total of 254 patients with age range of 8 to 80 (mean32 years) attended the lay forum while 246 patients (96.9%) consulted at the on-site breast clinic. Among those examined, 146 patients (59.3%) had essentially normal breasts. Fibrocystic change was the most frequent diagnosis with 49 patients (19.9%), followed by fibroadenoma with 34 patients (13.8%). Six patients (2.4%) were suspected to have breast cancer. Four patients (66.7%) proceeded to have a biopsy and were confirmed. Two patients availed of treatment.CONCLUSION: Incorporating breast cancer screening program in the medical school curriculum encourages medical students to participate in breast cancer control outreaches where their basic knowledge and skills on clinical breast exam are reinforced with actual patient contact. Furthermore, women with breast cancer are found and offered treatment through this program.

A prospective study on the quality of life after palliative surgery for patients with advanced breast or gastrointestinal malignancies

OBJECTIVE: To evaluate the quality of life (QoL) after palliative surgery of patients with advanced breast or gastrointestinal malignanciesMETHODS: Quality of Life (QoL) of 32 patients with advanced breast or gastrointestinal cancer (Stage IIIB up to Stage IV) was evaluated before surgery (baseline), then 7 and 30 days after surgery using the Medical Outcomes Study Short form (SF-36v2? Questionnaire).Statistical significance of the difference in outcomes was tested using the two-tailed T-test at 95% CI.RESULTS: Preoperatively, the patients scored poorly (scores below the average mean of 50) in all 8 subscales of the SF-36v2?. Seven days after a palliative surgery, patients showed significant improvement in all subscales except Vitality and Social Functioning.The patients experienced statistically significant changes in quality of life subscale scores on Physical Functioning, Role-Physical, Bodily Pain, General Health, Role Emotional, and Mental Health after surgery. A significant change in all subscales occurred 30 days after surgery compared to the baseline and 7 days post-op.CONCLUSIONS: While patients with advanced malignancy experienced problems with quality of life preoperatively, they improved postoperatively but not to the level of a normal person.

Sentinel lymph node biopsy using methylene blue dye - the Vicente Sotto Memorial Medical Center experience

Objectives: To determine the accuracy of SLNB using methylene blue dye. Methods: Breast cancer patients consulting at the VSMMC Breast Center with biopsy proven adenocarcinoma of the breast, a Tis, T1, T2 or T3 primary breast tumor and clinically negative ipsilateral axilla by palpation and ultrasound, were included in the study. The subjects underwent either modified radical mastectomy or breast conservation theraphy. Subareolar injection of 5 ml 1% methylene blue dye 5 minutes prior to sentinel lymph node biopsy. Three blue staining axillary lymph nodes were taken and sent to pathology for frozen section evaluation and after surgery, H & E staining. A completion axillary lymph node dissection was done in all patients. Accuracy of SLNB using methylene blue was calculated using final histopathology results as gold standard. Results: Twent patients were included in this study. SLNB in this group had an accuracy, sensitivity, specificity, PPV, and NPV of 95.0% 83.3%, 100%, 100%, and 93.3%, respectively. The false negative rate is 6.7%. On the average, the SLN's were identified in 14 minutes. Conclusion: Sentinel lymph node dissection with methylene blue has an accuracy of 95% in the VSMMC Breast Center. Key words: sentinel lymph node biopsy, methylene blue dye, breast cancer

The accuracy of combination ultrasound and fine needle aspiration biopsy in confirming malignancy in patients with clinically malignant breast masses seen at the breast center of Vicente Sotto Memorial Medical Center

Objectives: To determine if ultrasound can increase the accuracy of fine needle aspiration biopsy in confirming malignancy in clinically malignant breast masses. Methods: Clinically malignant breast masses underwent ultrasound, fine needle aspiration biopsy/cytology, and tissue biopsy. Accuracy of each test and in combination were calculated using histopathology as gold standard. Results: The accuracy of ultrasound alone was only 67.5% sensitivity of 90.0%, specificity of 33.3%, positive predictive value of 67.2% and negative predictive value of 68.8%, while FNAB alone has an accuracy of 89.2%, sensitivity of 90.0%, specificity of 87.9%, postive predictive value of 91.8%, and negative predictive value of 85.3%. With concordant findings in ultrasound and FNAB, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value are 94.3%, 97.6%, 81.8%, 95.3%, and 90%, respectively. Conclusion: With concordant findings in ultrasound and FNAB, accuracy in confirming malignancy is 94.3%. Key words: breast cancer, breast ultrasonography, fine needle aspiration biopsy/cytology

Correlation of tumor characteristics and adjuvant treatment in recurrent breast cancer at the Vicente Sotto Memorial Medical Center

Background: This study was conducted to determine the factors which may affect the incidence and recurrence of breast cancer in patients treated at the Vicente Sotto Memorial Medical Center (VSMMC). Methods: Utilizing hospital records, a case-control study was done on all breast cancer patients, treated at the VSMMC from January 200 to December 2007, comparing those who developed recurrence and those who did not. Results and Conclusions: Of the total of 404 patients treated at VSMMC during this period, only 370 patients (91.6%) with complete records were retrieved and included in the study. Overall recurrence rate was 17.8%. Age, parity, menopausal status nor family history of breast cancer, tumor characteristics, nor adjuvant therapy compliance, were the same for the two groups. More patients without recurrence underwent hormonal therapy (P=0.113). Those patients with recurrent breast cancer more often had positive lymph nodes (P=0.007). Key words: recurrent breast cancer

Early discharge after mastectomy: a safe alternative to the standard duration of postoperative hospital confinement

Objective: To determine if early discharge after mastectomy is a safe alternative to the standard duration of postoperative hospital confinement. Methods: This is a review of breast cancer patients who were discharged early after mastectomy consulting at the breast center at the Vicente Sotto Memorial Medical Center from May 2007-May 2010. The following variables were recorded: date of surgery, date of discharge, presence of surgical site morbidities such as infection, dehiscence, necrosis and significant pain, date of 1st drain removal, date of 2nd drain removal, presence of seroma, application of elastic bandage. Results: Of the 60 patients: 43 (71.7%) were from CVGH Breast Specialty Clinic and 17 (28.3%) from VSMMC Breast Clinic. There were 9 patients (15%) who developed surgical site morbidities, namely: infection -3 (5.0%), minimal partial wound dehiscence -4 (6.7%), superficial skin necrosis -2 (3.3%). No patient complained of significant pain on follow-up. The first drain was removed within a mean of 6 days. The second drain was removed a mean of 7 days. Fifteen patients (25%) developed seroma. There was no readmission due to morbidities. Conclusion: Early discharge after mastectomy is a safe alternative to the standard duration of postoperative hospital confinement. Key words: mastectomy, postoperative pain

An eight-year experience of implementing a pro-active approach to early detection of breast cancer in a community

OBJECTIVES: The objectives of this study were to determine the demographic as well as clinical profile of patients participating in the breast cancer community outreach program and determine if the Breast Cancer Community Outreach Program can successfully find breast cancer cases in the community.METHODS: In 2001, a breast cancer community outreach program was organized by the Vicente Sotto Memorial Center - Breast Center. The program components included breast cancer lay forum, breast self-examination (BSE) classes and breast clinic. Twenty seven breast cancer community outreach program were conducted in a span of 8 years.RESULTS: There were 1719 participants with a mean age of 32.5 years. The most common reason for consultation was breast check-up (79.6%), majority had normal breast examination findings (75.9%) and breast cancer was also identified in only 19 out of 1719 (1.1%). Most of these were early breast cancer.CONCLUSION: The Breast Cancer Community Outreach Program was not only vital in providing an-site breast cancer cases among women consulting at the community breast clinic.

A comparison of the demographic, clinical, knowledge, and cultural profiles of breast cancer patients with delayed consultation seen at Vicente Sotto Memorial Medical Center (VSMMC) Breast Center

OBJECTIVES: The study aimed to describe the demographic profile and determine the cause of delayed consultation among breast cancer patients seen at the Vicente Sotto Memorial Medical Center (VSMMC) Breast Center. The differences between these delayed consultations compared with those who consulted promptly, in terms of clinical, demographic, knowledge and cultural factors were determined.METHODS: A survey of all female patients with breast cancer seen at the Breast Center of the VSMMC from September 2007 to February 2008, analyzing demographic, clinical, knowledge and cultural factors was conducted. Statistical analysis was done using chi square to determine factors significantly associated with delayed consultation.RESULTS: Sixty-six (65.4%) out of 101 subjects had consulted late. Most of the delays were due to financial constraints. Delayed consultation was significantly associated with patient's low educational attainment up to elementary level only, and the patient's negative perceptions regarding the cause and possible cure of their cancer. During this time period, most breast cancer patients consulted late for their condition, primarily because of financial reasons.CONCLUSIONS: In summary, this study showed that financial factors, and inadequate education were major causes of delayed consultations. Inappropriate cultural beliefs may have also contributed to this delay. Modification of current advocacies in the community served by VSMMC is needed to address this problem. Financial support through the community, in whatever form, may be significant in decreasing the incidence of delayed consultation for breast cancer.

Treatment outcome of implementing "pain as the 5th vital sign" in the standard of care of pain management among patients admitted in the Department of General Surgery, Vicente Sotto Memorial Medical Center

OBJECTIVE: To determine the impact of monitoring pain as the 5th vital sign and the utilization of a protocolized analgesic regimen on pain treatment outcome among patients admitted in the Department of General Surgery. METHODS: Eight hundred fifty (850)admitted patients were included in the study. These were patients who underwent surgery (either trauma or non-trauma cases) and may or may not have had any complaint of pain magnitude. The Department's post operative analgesic regimen protocol (composed of tramadol and ketorolac combination)was followed. Pain scores were monitored every eight hours throughout the patient's hospitalization up to discharge and were documented on the new monitoring sheet of Vicente Sotto Memorial Medical Center. RESULTS: Of the 850 patients, 629 patients (74 percent) were non-trauma cases and 221 patients (26 percent) were trauma cases. On admission, 313 (51 percent) non-trauma patients and 171 (81 percent) trauma patients experienced severe pain. upon discharge, only 1 (0.6 percent) non-trauma patient continued to be suffering from severe pain and non from trauma cases. Five hundred five (80 percent) non-trauma patients and 140 (63 percent) trauma patients had mild pain, 114 (18 percent) non-trauma patients and 81 (37 percent) trauma patients were totally pain free. CONCLUSION: There was a significant reduction to pain from admission to discharge because patients were intervened appropriately of their respective symptoms by using proactive pain monitoring and providing analgesia using a protocolized analgesic regimen.

Clinical analysis of 1,393 females with mastalgia

To determine the clinical profile of benign and malignant mastalgia in terms of age distribution, geographic location, laterality, pain severity and pattern.METHOD: This is a 3-year (April 1,2001 until March 31, 2004) retrospective chart review of female patients presenting with mastalgia in a hospital-based government breast center at Vicente Sotto Memorial Medical Center, Cebu City. Malignant mastalgia was diagnosed based on histopathologic findings. Pain severity assessment was based on a numeric scale of 0 to 10. Exclusion criteria include patients without mastalgia as chief complaint, no histopathologic confirmation of malignancy and males. All statistical computations were done using Chi square test with a = 0.05.RESULTS: A total of 1237 patients (89 percent) had benign mastalgia with an average age of 29.72 +/- 10.96 years and 156 (11 percent) had malignant mastalgia with an average of 48.92 +/- 11.96 years. Patients less than 60 years of age had a statistically significant probability that their mastalgia is due to benign pathology (p CONCLUSION: Age above 60 years, right-sidedness and non-cyclical pain pattern are the only significant factors for differentiating whether the mastalgia is due to a benign or malignant etiology.

Clinical and demographic profile of male breast patients seen at Vicente Sotto Memorial Medical Center (VSMMC)

INTRODUCTION: Palpable breast tissue is so prevalent in studies of men and boys that some authors suggest differentiating it from clinically important gynecomastia. Understanding male breast problems present a great challenge to many physicians especially when there is no specific guidelines developed for men.OBJECTIVES: This study aims to determine the demographic and clinical profile of male patients with breast problems consulting at Vicente Sotto Memorial Medical Center.METHODOLOGY: This study is a review of 77 male patients seen at the breast center of Vicente Sotto Memorial Medical Center from April 1, 2001 to March 31, 2004. The clinical profile included the age, geographic origin, chief complaint, family history of breast cancer, clinical breast examination findings, attributes of the clinically palpable breast mass like number, size, consistency, laterality, location, associated breast pain and pain score, clinical diagnosis and final histopathologic report.RESULTS: Within this time period, there were 2,669 consultations seen at the breast clinic. A total of 77 male patients, comprising 2.9 percent were seen at the clinic. The mean age of occurrence was 36.2 years old. The frequency distribution of breast problem is highest between the ages of 20 to 29 years old at 40.3 percent. In all of the 69 patients (89.61 percent) with clinically palpable mass, 66 patients (95.65 percent) only had a solitary mass while 3 patients (4.35 percent) had two masses. Forty-three (59.7 percent) of the masses were less than 2 centimeters in diameter. Only 1 (1.4 percent) of the 72 masses was fixed to the chest wall which turned out to be a soft tissue sarcoma while the rest (98.6 percent) were freely movable. Based on the final histopathologic results, gynecomastia was the most common diagnosis among patients subjected to fine needle aspiration biopsy and excisional biopsy.CONCLUSION: Male breast problems are common in the third decade of life and among patients living the urban area like Metro Cebu. Male patients sought consultation due to problems of unilateral firm breast mass less than 2 centimeters in diameter located in the nipple-areola complex. The most common clinical diagnosis is that of gynecomastia which is supported by the final histopathologic result of the same condition.

Patterns of mammogram utilization and clinical profile of patients who underwent mammography at Cebu (Velez) General Hospital

BACKGROUND: Educating physicians on the proper utilization of mammography is vital to effective implementation of the breast cancer control program.OBJECTIVE: The general objective of this study was to determine the patterns of mammogram utilization and clinical profile of patients who underwent mammography at Cebu (Velez) General Hospital from January 1997 to February 2001.METHODS: Checklists embodying important breast health information, clinical data (age, sex, address, menstrual and obstetrical history, personal and family history of breast cancer, presenting breast signs and symptoms), referring physicians, and mammography reports over the last four years were reviewed.RESULTS: There were 468 mammograms done of which 279 (60 percent) were for diagnostics purposes and 189 (40 percent) for screening. The highest number of women who underwent screening mammography belonged to the 50-59 year age group. Gynecologists were the most frequent referring physicians for mammographic examination at 186 (40 percent) followed by 134 (29 percent) referrals from the general surgeons. There was an increasing trend of mammogram utilization noted over the past four years. Palpable mass in 172 (53 percent) patients was followed by mastodynia in 104 (33 percent) patients accounting for the most common indications for diagnostic mammography. Three hundred seventy-three (80 percent) mammogram results were negative and only 23 (5 percent) showed suspicious abnormalities warranting biopsy. Three hundred twenty-five (69.4 percent) of the mammograms showed extremely dense breasts which lowered sensitivity. There was a trend towards decreasing Grade IV radiographic density of the breast as the patients were older. Proper mammogram utilization at Cebu Velez General Hospital has increased over the last 4 years.

A survey on surgical site infection among cancer patients at Chong Hua Hospital

A retrospective descriptive study on the relative frequency of surgical site infection (SSI) among 235 operated cancer patients at Chong Hua Hospital was done covering the period from January 1991 up to May 1993. SSI occurred in 9.4 percent (22/235). There was a significant increase in SSI as the population became older (p=0.01). Dirty operations had a significantly higher infection rate of 50 percent (2/4) compared to 8.7 percent (20/211) for the rest (p=0.45). Clean operations had a significantly lower infection rate of 2.5 percent (3/121) compared to 16.7 percent (19/114) for the rest. There was no difference in SSI between early and late stage cancer cases. Operations in the alimentary tract had a significantly higher infection rate of 19.3 percent (11/57) compared to 6.4 percent (11/172) for operations on the other sites (p=0.004). Operations on solf tissues, breast and thyroid had a signifanctly lower rate of 4.6 percent (4/87) compared to 12.7 percent (18/142) for operations on other sites (p=0.045).(Author)

The role of bacterial contamination in the development of surgical site infection

The degree of bacterial contamination remains a major determinant in the development of surgical site infections (SSI), which continue to be a leading cause of morbidity among surgical patients. For this reason, we performed a prospective survey on the relative frequency of surgical site infections based on bacterial contamination categories. Of the 774 operations in our department over a six-month period from January 1 to July 31, 1989, the overall surgical site infection rate was 7.8% with specific surgical site infection rates of 2.5%, 5.8%, 14.7% and 16.9% on clean, clean-contaminated, contaminated and dirty operations respectively. A comparison with published acceptable surgical wound infection rates among the different bacterial contamination categories showed comparable results except for contaminated cases (p = 0.0376). Deep incisional SSI tended to be higher among dirty operations with a risk eight times higher compared with clean operations.The use of prophylactic antibiotics was also noted as they were practiced by the different surgeons, without specific guidelines as to their use. An in-depth study is needed to determine the effects of antibiotic prophylaxis on surgical site infection rate.