ABSTRACT
BACKGROUND: Breast cancer represents the leading form of invasive cancer among American women, killing nearly 50,000 annually. Several prognostic factors that are associated with survival include age, race, menopausal status, and the stage of disease at presentation. METHODS: Patient characteristics were collected based on a systematic chart audit of demographic features and medical, family, and social histories. We studied the survival of 220 patients with recurrent disease out of 1,429 consecutive patients with breast cancer seen over a 15-year period. RESULTS: Patients with a disease-free interval following diagnosis of less than 24 months were more frequently premenopausal and hormone receptor-negative than those with a disease-free interval of 24 months or greater. Patients with early recurrence had a shorter survival than patients with late recurrence. Menopausal status, nodal involvement, receptor status, and the site of recurrent disease were independent predictors of survival following recurrence. CONCLUSIONS: Premenopausal women with early recurrence of breast cancer experience a significantly shorter survival than those with late recurrence, even after adjustment for hormone receptor status and site of recurrence. This effect was not seen in postmenopausal women.
ABSTRACT
BACKGROUND: Axillary node dissection is considered a standard staging procedure in patients with breast cancer. The procedure is associated with significant morbidity and provides pathologists with many lymph nodes to evaluate. METHODS: A total of 174 women participated in a trial that included preoperative lymphoscintigraphy and intraoperative lymphatic mapping using a combination of a vital blue dye and radiocolloid mapping. RESULTS: The intraoperative lymphatic mapping correctly identified a sentinel lymph node (SLN) in 160 (92%) of 174 patients. One skip metastasis (0.7%) occurred in 136 women who had a subsequent complete node dissection. CONCLUSIONS: Lymphatic mapping and SLN biopsy using a combination of mapping techniques provide accurate nodal staging for women with breast cancer. With this technique, approximately 70% to 80% of women with no axillary metastases could be spared the morbidity of a complete node dissection.
ABSTRACT
BACKGROUND: Evidence-based medicine demands the use of information from clinical trials to direct medical care. Knowledge of the principles of trial design and conduct is important to assess the validity of results. METHODS: The authors review the key principles behind clinical study design and conduct, and they summarize important biases and confounding issues. RESULTS: Clear hypotheses, a well-described study population, precise measurements, freedom from bias, and consideration of any interactions are attributes of good clinical trials. CONCLUSIONS: The greatest level of evidence in support of a difference in outcome is associated with randomized, controlled clinical trials, particularly when combined with other randomized trials in a systematic fashion (meta-analysis).
ABSTRACT
BACKGROUND: Adjuvant chemotherapy for breast cancer is frequently accompanied by neutropenia requiring dose reduction or treatment delay that can potentially compromise therapeutic effectiveness. Recombinant granulocyte-colony stimulating factor (G-CSF) reduces the duration and severity of neutropenia. METHODS: Nineteen patients with newly diagnosed breast cancer receiving adjuvant systemic chemotherapy met criteria for dose reduction or treatment delay due to neutropenia. All were treated with G-CSF. The mean duration of G-CSF therapy was five days. RESULTS: An increase in mean absolute neutrophil count was seen in cycles with G-CSF. Chemotherapy treatment was delayed less often following the use of G-CSF. CONCLUSIONS: Breast cancer patients receiving adjuvant chemotherapy who face treatment delays or dose reductions can continue on full-dose intensity therapy using supportive G-CSF. Prospective trials are needed to accurately measure the impact of G-CSF on dose intensity and long-term disease control.
ABSTRACT
BACKGROUND: Various parameters assist in the definition of prognosis and in the choice of therapy for breast cancer. This study evaluates the effects of prognostic factors on disease outcome in elderly women. METHODS: A retrospective cohort analysis was performed on 1,267 consecutive patients with locoregional breast cancer, including 374 patients 65 years of age or older, who were referred to a university cancer center over an eight-year period. Information on prognostic factors, disease outcome, and survival was analyzed. RESULTS: Women 65 years of age or older were more likely to have early-stage cancers, lower histologic grade, higher hormone receptor levels, and lower S-phase fractions. They experienced a longer time to disease recurrence and overall longer survival than their younger counterparts. CONCLUSIONS: Advancing age should not be considered an unfavorable risk factor for breast cancer. Prognosis and treatment should be based on disease stage and histologic and biologic parameters rather than patient age.
ABSTRACT
Based on data from the Florida Cancer Data System for the periods from 1981 through 1984 and 1986 through 1989, the incidence of primary malignant brain tumors in those aged 65 years or older rose steadily. The incidence of primary brain tumors in elderly Floridians has escalated independent of increased case ascertainment associated with the introduction of computed tomography scanning or magnetic resonance imaging and is observed in anaplastic astrocytoma, glioblastoma, and lymphoma, but not in low-grade astrocytoma.
