ABSTRACT
PURPOSE: The oncological safety of nipple-sparing mastectomy in the context of immediate breast reconstruction is debatable. Previous studies report wide variations in local recurrence rates and randomised or matched cohort study designs are lacking. The aim of this study is to compare the local recurrence rate after nipple-sparing mastectomy to that after conventional mastectomy. Further, to compare the disease-free, overall and breast cancer-specific survival rates. METHODS: A retrospective review of all patients undergoing nipple-sparing mastectomy with immediate implant-based breast reconstruction at Karolinska University Hospital, Sweden, in the years 2000-2012 was conducted. These were matched 1:3 to patients operated by conventional mastectomy. Matching variables were age, tumour stage and year of surgery. RESULTS: Sixty-nine nipple-sparing mastectomies in 67 patients (study group) and 206 conventional mastectomies in 203 patients (control group) were included in the study. Median follow-up was 36 and 35 months for the study and control group, respectively. No local recurrence occurred in the study group, while seven local recurrences were observed in the control group (p = 0.197). The estimated 5-year figures were 100% and 95.8% (local recurrence-free survival), 94.1% and 82.5% (disease-free survival), 96.2% and 91.3% (overall survival) and 98.0% versus 94.8% (breast cancer-specific survival). Survival rates did not differ significantly between groups. CONCLUSIONS: Nipple-sparing mastectomy may be offered to selected breast cancer patients without any negative impact on oncological safety.
Subject(s)
Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Carcinoma, Lobular/surgery , Mastectomy/methods , Neoplasm Recurrence, Local , Nipples , Organ Sparing Treatments/methods , Adult , Aged , Aged, 80 and over , Cohort Studies , Disease-Free Survival , Female , Humans , Mammaplasty/methods , Middle Aged , Retrospective Studies , Sweden , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: To compare the effects of two different ultra-low doses of continuous combined hormone therapy and placebo on mammographic breast density in postmenopausal women. METHODS: A subpopulation of 255 postmenopausal women from the CHOICE trial were randomly assigned to 0.5 mg 17beta-estradiol (E2) + 0.25 mg norethisterone acetate (NETA), 0.5 mg E2 + 0.1 mg NETA, or placebo. Women using hormone replacement therapy (HRT) up to 2 months prior to the study were excluded; 154 women fulfilled the inclusion criteria. Mammograms were performed at baseline and after 6 months. Breast density was evaluated by visual classification scales and a computer-assisted digitized technique. RESULTS: No significant differences were detected between the active treatment groups and the placebo group in the digitized quantification. The mean baseline values for density around 20% were unchanged after 6 months. Also, visual classifications showed no increase in breast density in any study group. CONCLUSION: In contrast to currently available bleed-free regimens, the new ultra-low-dose combination of 0.5 mg E2 and 0.1 mg NETA seems to have very little or even a neutral effect on the breast. Both digitized quantification and visual assessment of breast density were unchanged after 6 months. Larger prospective studies should be performed to confirm this new finding.
