ABSTRACT
OBJECTIVE: Examining the distribution of breast cancer (BC) stage and molecular subtype among women aged below (< 45 years), within (45-65 years), and above (> 65 years) the recommended screening age range helps to understand the screening program's characteristics and contributes to enhancing the effectiveness of BC screening programs. METHODS: In this retrospective study, female patients with newly diagnosed BC from 2010 to 2020 were identified. The distribution of cases in terms of TNM stages, severity classes, and subtypes was analysed according to age groups. RESULTS: A total of 3282 women diagnosed with BC were included in the analysis. Among these cases 51.4% were detected outside the screening age group, and these were characterized by a higher TNM stage compared to those diagnosed within the screening age band. We observed significantly higher relative frequency of advanced BC in the older age group compared to both the screening age population and women younger than 45 years (14.9% vs. 8.7% and 7.7%, P < 0.001). HR-/HER2- and HER+ tumours were relatively more frequent among women under age 45 years (HR-/HER2-: 23.6%, HER2+: 20.5%) compared to those within the screening age range (HR-/HER2-: 13.4%, HER2+: 13.9%) and the older age group (HR-/HER2-: 10.4%, HER2+: 11.5%). CONCLUSIONS: The findings of our study shed light on potential areas for the improvement of BC screening programs (e.g., extending screening age group, adjusting screening frequency based on molecular subtype risk status) in Hungary and internationally, as well.
ABSTRACT
[This corrects the article DOI: 10.3389/pore.2022.1610383.].
ABSTRACT
This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified based on the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The professional guideline primarily reflects the resolutions and recommendations of the current ESMO, NCCN and ABC5, as well as that of the St. Gallen Consensus Conference statements. The recommendations cover classical prognostic factors and certain multigene tests, which play an important role in therapeutic decision-making. From a didactic point of view, the text first addresses early and then locally advanced breast cancer, followed by locoregionally recurrent and metastatic breast cancer. Within these, we discuss each group according to the available therapeutic options. At the end of the recommendations, we summarize the criteria for treatment in certain rare clinical situations.
Subject(s)
Breast Neoplasms , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Female , Humans , Medical OncologyABSTRACT
Összefoglaló. Bevezetés és célkituzések: Az együttmuködés, a csoportmunka életünk szinte minden területén képes növelni a hatékonyságot. A rákgyógyításban már évtizedek óta alkalmazott onkoteamek muködését vizsgálva, annak egyértelmu célja az orvosi hatékonyság, az egymástól tanulás és a jogi védelem biztosítása. Jelenleg egy másik aspektust hangsúlyozva próbáljuk bemutatni a kooperatív munka muködését, megvilágítva a kommunikációban részt vevok lehetoségeit és dilemmáit, illetve legfoképpen a pszichés támogató hatást. Módszer és eredmények: A Pécsi Tudományegyetem Klinikai Központjának Onkoterápiás Intézetében 12 éve muködik a kétlépcsos onkoteamrendszer. Az onkoterápiás megbeszéléseken egyéves idoszak alatt 21 orvos, több adminisztrátor, klinikai kutatási munkatárs, szakdolgozó, gyógyszerész és pszichológus vett részt, a résztvevok szakmai tapasztalata igen széles spektrumot fedett le. A megbeszélések során az egyes betegek onkológiai életútja került részletes diszkusszióra interaktív formában, végül a döntési részletek rögzítésre kerültek a központi informatikai rendszerben. Megfigyeléseink rávilágítottak a csapatmunka elonyeire, illetve a csoport által ellátott feladatok megosztó, kiegyensúlyozó, oktatást segíto hatásaira. Az orvosok által kitöltött kérdoívek pedig bizonyították, hogy a közvetlen munkatársak közötti szakmai megbeszélés, egyféle "Bálint-csoport" muködésként a pszichés terhek megosztásában is szerepet játszhat. Következtetés: A rákgyógyítás területén az elmúlt évek során bekövetkezett gyors fejlodés, a fokozott elvárások, illetve az ezen a területen végzett, sokszor igen összetett és lelkileg is megterhelo szakmai munka kiemelten fontossá teszi a hatékony minoségbiztosítási módszerek és együttmuködési formák alkalmazását, melyek segítségével lehetoség nyílik a szakmai eszmecseréken át a többirányú tudástranszferre és a kiégést megelozo csoportventilációra. Orv Hetil. 2021; 162(9): 344-351. INTRODUCTION: The teamwork, the cooperation is always able to elevate effectiveness in every field of life. The tumor board meetings which are widely used in cancer treatment process in the last decades were originally established to warrant the medical, educational and legal quality assurance. Over these aspects, here we present the possibilities and dilemmas of the team work in the communication practices and most of all the psychological support of the participants. METHOD AND RESULTS: The two-level oncotherapy tumor board system was introduced 12 years ago at the Institute of Oncotherapy, Clinical Center, University of Pécs. During a one-year long observation period, 21 physicians and several administrators, study coordinators, pharmacists, nurses and psychologists with different experiences participated in the oncotherapy tumor board discussions. In the meetings, the specific cancer histories of the patients were analyzed in an interactive form, and finally the detailed decisions were stored in the medical database system. Our observations proved the advantages, moreover, the task sharing, balancing and educational effects of the teamwork. The results obtained from the questionnaires filled out by the physicians proved that the direct conversation between department colleagues works like a case-discussing "Bálint-group" in taking the role of distributing of the psychological burden of the physicians. CONCLUSION: The immense advancements in cancer treatment during the last years, moreover, the increased expectations and the complex and mentally charging professional tasks all demand the establishment of more effective quality control and cooperation methods. Introducing these new methods, it would lead to more efficient professional discussions, knowledge transfer and burnout preventive group-related psychological ventilation. Orv Hetil. 2021; 162(9): 344-351.
Subject(s)
Burnout, Professional , Medical Oncology , Neoplasms , Quality of Health Care , Burnout, Professional/prevention & control , Emotional Intelligence , Governing Board , Humans , Medical Oncology/organization & administration , Neoplasms/therapyABSTRACT
Since the III. Breast Cancer Consensus Conference, a number of new evidence based on clinical trial results have been published which justified updating the 2016 recommendation. In addition to classical prognostic factors, some multigenic tests, which we have incorporated into the recommendation, will play an important role in therapeutic decision-making. The professional guide primarily reflects the resolutions and recommendations of the current ESMO, NCCN, ABC4, as well as the St. Gallen Consensus Conference. From a didactic point of view, the text follows first the line of early and then locally advanced breast cancer, locoregionally recurrent and metastatic breast cancer. Within these, we discuss each group according to therapeutic options.
Subject(s)
Breast Neoplasms , Breast Neoplasms/drug therapy , Humans , Practice Guidelines as TopicABSTRACT
The article presents the practice guideline of systemic treatment of breast cancer and recommendations of the 3rd Hungarian Breast Cancer Consensus Conference. It reflects the recent international guidelines (ESMO, NCCN, ABC2, St Gallen's) irrespectively of the current financial opportunities. Here we follow the early - locally advanced - locally relapsed - metastatic breast cancer line for didactic considerations and we discuss the different subgroups of breast cancer based on hormone receptor and HER2 receptor status. Diagnosis and treatment options of rare clinical entities are summarised at the end of the paper.
Subject(s)
Breast Neoplasms/therapy , Practice Guidelines as Topic , Antineoplastic Agents/therapeutic use , Chemotherapy, Adjuvant , Consensus , Female , HumansABSTRACT
By now therapy decision taken by a multi-disciplinary oncology team in cancer care has become a routine method in worldwide. However, multi-disciplinary oncology team has to face more and more difficulties in keeping abreast with the fast development in oncology science, increasing expectations, and financial considerations. Naturally the not properly controlled decision mechanisms, the permanent lack of time and shortage of professionals are also hindering factors. Perhaps it would be a way out if the staff meetings and discussions of physicians in the oncology departments were transformed and provided with administrative, legal and decision credentials corresponding to those of multi-disciplinary oncology team. The new form of the oncotherapy oncoteam might be able to decide the optimal and particular treatment after previous consultation with the patient. The oncotherapy oncoteam is also suitable to carry out training and tasks of a cancer centre and by diminishing the psychological burden of the doctors it contributes to an improved patient care. This study presents the two-level multi-disciplinary and oncotherapy oncology team system at the University of Pécs including the detailed analysis of the considerations above.
Subject(s)
Decision Making , Interdisciplinary Communication , Medical Oncology/standards , Neoplasms/therapy , Patient Care Team , Patient Participation , Quality Assurance, Health Care , Clinical Trials as Topic/methods , Clinical Trials as Topic/standards , Clinical Trials as Topic/trends , Humans , Medical Oncology/trends , Neoplasms/drug therapy , Neoplasms/radiotherapy , Neoplasms/surgery , Patient Care Team/organization & administration , Patient Care Team/standards , Patient Care Team/trendsABSTRACT
INTRODUCTION/AIM: The importance of preoperative neoadjuvant (NA) systemic treatment in operable breast cancer has significantly increased in the last few years. The aim of our retrospective study was to determine the effect of NA therapy in breast cancer patients treated in our unit and analyze radiological and pathological response rates in the context of surgical treatment. MATERIALS AND METHODS: One hundred and fourteen cases of breast cancer with NA therapy were analyzed and clinical data were collected from March 2007 to December 2010. Twenty-two patients received NA treatment for inoperable tumours. As far as operable cancers (92 patients), the indications for NA treatment were high tumour grade, presence of axillary metastasis and relatively young age. 5-Fluorouracil-Epirubicin-Cyclophosphamid or Taxotere-Epirubicin regimens were administered in 6 cycles followed by radiological evaluation and surgery. Herein, we compared the preoperative staging with the pathological results after surgery. RESULTS: NA therapy resulted in complete regression in 17% of patients, significant regression in 21%, while moderate regression was achieved in 43% of patients. No regression was detected in 19%. The decrease in T stage was not followed by decrease in N stage in significant number of cases. Moreover, in some cases NA therapy caused complete radiological regression, while histologically it still remained positive. In certain cases, breast conserving surgery was feasible due to down-staging caused by NA therapy. CONCLUSION: NA therapy was effective primarily in decreasing tumour size; however, it was less effective on axillary lymph node metastases. Due to the presence of the residual DCIS component, the volume of resection could not be decreased as much as down-staging of the invasive cancer would have permitted.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Carcinoma/drug therapy , Carcinoma/pathology , Mastectomy/methods , Neoadjuvant Therapy/methods , Adult , Age Factors , Aged , Axilla , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/surgery , Carcinoma/diagnostic imaging , Carcinoma/surgery , Carcinoma, Ductal, Breast/drug therapy , Carcinoma, Ductal, Breast/pathology , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Lobular/drug therapy , Carcinoma, Lobular/pathology , Carcinoma, Medullary/drug therapy , Carcinoma, Medullary/pathology , Carcinoma, Papillary/drug therapy , Carcinoma, Papillary/pathology , Chemotherapy, Adjuvant , Cyclophosphamide/administration & dosage , Docetaxel , Drug Administration Schedule , Epirubicin/administration & dosage , Female , Fluorouracil/administration & dosage , Humans , Lymphatic Metastasis , Mastectomy/statistics & numerical data , Mastectomy, Segmental , Middle Aged , Neoplasm Grading , Neoplasm Staging , Neoplasm, Residual/pathology , Radiography , Retrospective Studies , Taxoids/administration & dosage , Treatment OutcomeABSTRACT
Gastrointestinal stromal tumours (GIST) constitute the most frequent group of mesenchymal tumours in the gastrointestinal tract (GI). During the last several decades major advances have been taken in the diagnostics, treatment, and understanding of its pathogenesis. However, much less is known about the either metachronous or synchronous concurrence of GIST and other tumours of different histogenesis. In the present study clinicopathological data of 43 patients with histologically proved gastrointestinal stromal tumour were studied mainly in regard of the occurrence of a secondary neoplasm. Among the 43, 7 cases were found with secondary tumour mainly of epithelial origin. In three cases (cases 3, 5, and 7) GIST concurred with colorectal adenocarcinoma, in one case (case 1) GIST occurred in a patient with a 3-years-history of chronic lymphocytic leukaemia (CLL), in other two (cases 2 and 4) the stromal tumour was combined with in situ adenocarcinoma of the stomach and carcinoid of the pancreas, respectively. In case 6, GIST concurred with a duodenal Brunner gland adenoma. In five cases the stromal tumour and the other neoplasm occurred synchronously, and in four of them, being the stromal tumour clinically silent, GISTs were intraoperative findings. This confirms the importance of surgical intraabdominal control before closure. In one hand the repeated concurrence of GIST and colorectal adenocarcinoma in our series, and on the other hand, that of GIST and adenocarcinoma of the stomach in the literature, may indicate an at least partly common factor, which may be involved in the pathogenesis of these neoplasms.
