Axillary disease recurrence after sentinel lymph node dissection for breast carcinoma.

BACKGROUND: Surgical recommendation for early-stage breast carcinoma includes removal of the primary breast tumor and evaluation of the axillary lymph nodes on the ipsilateral side. Sentinel lymph node dissection (SLND) is increasingly being used to evaluate axillary lymph nodes in clinically lymph node negative patients as an alternative to axillary lymph node dissection (ALND). Results from SLND are highly predictive of metastatic involvement in the axilla, and are associated with fewer side effects. However, the greatest concern with SLND alone is the potential for a higher rate of axillary lymph node recurrence. The purpose of the current study was to review data collected on 700 consecutive patients with early-stage breast carcinoma who underwent SLND without concomitant ALND. METHODS: A retrospective study was conducted using the oncology registry at Park Nicollet Health Services (Minneapolis, MN). Consecutive breast carcinoma cases with SLND only for axillary surgery, from January 28, 1999 to December 31, 2003, were included in the study. During this period, 700 patients with breast carcinoma were identified who had SLND alone. Fifty-two patients were excluded from the analysis because they had ductal carcinoma in situ. RESULTS: With a median follow-up of 33 months (range, 2-73 mos), axillary lymph node recurrence occurred in 4 of 647 (0.62%) patients overall. In these 4 patients, the axillary lymph node recurrences were isolated to the axillary lymph nodes and amenable to surgery. CONCLUSIONS: Data from the current study showed that axillary lymph node recurrence after SLND occurred very infrequently in early-stage breast carcinoma, and these results were comparable to other studies.

Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer.

BACKGROUND: Axillary lymph node dissection (ALND) is often associated with permanent arm side effects. Side effects after sentinel lymph node dissection (SLND) should be less common, because the surgery is less extensive. METHODS: The study compared side effects and interference with daily life between 169 women who underwent an SLND and 78 who underwent an ALND for breast cancer. Patients rated symptom severity and interference with daily life caused by pain, numbness, limitation of arm range of motion (ROM), and arm swelling at 1, 6, and 12 months after surgery by using the Measure of Arm Symptom Survey. Repeated-measures and regression analyses for each time period were used to determine associations between symptoms and dissection type. RESULTS: At 1 month, SLND patients reported less pain, numbness, limitation in ROM, and seromas than ALND patients. At 6 months, SLND patients had less pain, numbness, and arm swelling, and at 12 months, SLND patients had less numbness, arm swelling, and limitation in ROM than ALND patients. At 1 month, pain, numbness, and limitation in ROM interfered significantly more with daily life for ALND patients. At 6 and 12 months, only numbness interfered more with daily life for ALND patients. CONCLUSIONS: SLND was associated with fewer side effects than ALND at all time points.

Evaluating a risk-based model for mammographic screening of women in their forties.

BACKGROUND: A risk-based model was developed for recommendations for mammography screening of women in their 40s. We determined retrospectively the proportion of women already diagnosed in their 40s with breast cancer (BC) who would have been recommended for mammography screening by this model. METHODS: Information was obtained from 404 women who were diagnosed with BC in their 40s from 1990 to 1998 at a large midwestern hospital. Data on BC detection method, mammography history, and BC risk factors existing before diagnosis were obtained from 353 of these women by mailed questionnaires. Data for an additional 51 women who had died were obtained by chart review. Two algorithms, the Exact Age Procedure (EAP) and the Grouped Age Procedure (GAP), were used to calculate the proportion of women who would have been recommended for mammography screening based on age, race, and BC risk factors. RESULTS: Of women diagnosed with BC in their 40s, 74.5% would have been recommended for screening by the EAP and 70.5% by the GAP. The model would have recommended screening for approximately one half of the women who had no conventional risk factors (54% by EAP, 48% by GAP). CONCLUSION: Although use of the risk-based model could result in more recommendations for screening than individual recommendations based on patient-physician discussions about the woman's risk factors, one in four women diagnosed with breast cancer in their 40s would not have been recommended for mammography screening.

Quality of life after postmastectomy breast reconstruction.

PURPOSE/OBJECTIVES: To explore women's expectations about postmastectomy reconstruction and factors affecting their quality of life after reconstruction. DESIGN: Qualitative focus group study. SETTING: Integrated healthcare system in a midwestern suburban community. SAMPLE: 17 women who had undergone mastectomies with immediate reconstruction between 1.4 and 5 years previously and had participated in a study of women newly diagnosed with breast cancer. METHODS: An experienced focus group moderator conducted two focus group sessions. Comments from the sessions were audiotaped and transcribed verbatim. The sessions involved semistructured, open-ended questions about perceptions of preparation, experience, and satisfaction regarding postmastectomy reconstruction. Thematic content analysis began with open coding at the level of individual comments and proceeded through two levels of higher-order categorization. FINDINGS: Although women felt well informed about breast surgery, they wished they had been more informed about some issues. Ratings of satisfaction generally were high despite some concerns about cosmetic outcome and persistent anxiety about recurrence. CONCLUSIONS: Reconstruction allows women to feel comfortable in clothing, but recovery can be difficult, and reconstruction does not neutralize the biggest emotional challenge of breast cancer: fear of recurrence. IMPLICATIONS FOR PRACTICE: Women appreciate thorough information to prepare them for reconstruction and recovery. For aspects of recovery in which substantial variation exists, the range of experiences should be provided.