ABSTRACT
BACKGROUND: Radiation associated angiosarcoma (RAAS) of the breast is a rare, but lethal complication of breast conserving surgery (BCS). Early recognition and knowledge of treatment modalities is imperative for successful treatment. We present the experience of a large community cancer center, with review of the literature. METHODS: The Christiana Care Department of Pathology and the Helen F. Graham Cancer Center and Research Institute databases were queried from 2001-2011 and 2011-2015 respectively for soft tissue neoplasms of the breast. A total of 2,153 patients with diagnosis of malignant neoplasm of the breast not otherwise specified (NOS) were identified. There were seven cases of RAAS identified. RESULTS: Seven patients with RAAS were identified. Average age at presentation was 70 years with a range of 58-87. Time from radiation therapy to diagnosis was 8.5 years with a range of 4.0 years to 14.9 years. Five of seven patients presented with skin lesions, all with varying clinical signs. Clinical lymphedema was not identified in any of these patients. CONCLUSION: Radiation associated angiosarcoma of the breast is an aggressive tumor with poor prognosis. Larger studies are needed to evaluate adjuvant treatments; however the small number of cases makes this prohibitive. Genetic testing and potentially targeted therapies are emerging as options for treatment and prevention of this complicated disease process.
Subject(s)
Breast Neoplasms/diagnosis , Hemangiosarcoma/diagnosis , Neoplasms, Radiation-Induced/diagnosis , Aged , Aged, 80 and over , Breast Neoplasms/therapy , Female , Gene Amplification , Hemangiosarcoma/therapy , Humans , Middle Aged , Neoplasms, Radiation-Induced/therapy , Proto-Oncogene Proteins c-myc/genetics , Rare Diseases , Retrospective StudiesABSTRACT
In the USA, 80% of patients with breast cancer are treated by community breast surgeons. NCDB data indicate that there are only small differences in outcomes between lower volume cancer programs and higher volume programs. There is some evidence that breast cancer patients of high-volume breast focused surgeons may have improved outcomes. This article discusses the challenges community breast surgeons face and some ways that the quality of care could be monitored and improved. Quality reporting programs of the Commission on Cancer and Mastery of Breast Surgery Program of the American Society of Breast Surgeons are recommended as tools to track and improve outcomes in breast cancer care.
