Promoters and barriers to mammography screening in multiethnic inner city patients.

INTRODUCTION: The goal of this study was to understand promoters and barriers to annual mammography screening among multiethnic inner city women aged 40 years and above. METHODS: Women at 4 community health centers were asked to fill out a self-administered survey and divided into 2 groups. Group A consisted of women who had a mammogram in the last 2 years and group B of women who had never had a mammogram or for whom it had been over 2 years since their last mammogram. RESULTS: One hundred forty-four of 172 (84%) women approached agreed to fill out the survey: 80% self-reported as group A and 20% as group B. Group A women were more likely to have someone recommend they get a mammogram, have a primary care provider (PCP), and have a female PCP. Group B women reported they were "too busy" and would prefer a walk-in mammogram clinic. CONCLUSIONS: Mammography screening remains a public health challenge.

Positive impact of a breast-health triaging system on breast-care access and physician satisfaction.

OBJECTIVE: Minority patients are at risk for delayed breast cancer treatment. Using nonsurgical breast specialists could improve access but requires appropriate referral to ensure prompt cancer care. Our objective was to evaluate a referral triage system in a combined medical/surgical breast health program (BHP). METHODS: A triage system based on imaging findings, examination, and patient age was instituted. An advanced practice nurse managed referrals and a prospective database. Referring providers were surveyed after 2 years. RESULTS: From 2003 to 2006, 4,840 referrals were made to surgeons (57%) and nonsurgeons (43%). Breast cancers were found in 8.5% of patients. Referral error occurred in 4 cancer patients (.1%). BHP-referred patients had significantly shorter times to surgical appointment (10 days) than non-BHP referrals (45 days). A referring provider survey indicated 96% satisfaction. CONCLUSIONS: A breast-care triage system expedited cancer care resulting in physician satisfaction and increased referrals.

Influence of breast cancer margin assessment method on the rates of positive margins and residual carcinoma.

BACKGROUND: We hypothesized that the method of breast cancer margin assessment may be associated with different rates of positive margins and residual carcinoma. METHODS: A total of 178 breast cancer specimens were divided into 2 groups (A and B) based on the margin assessment method used. Rates of positive margins, re-excision, and residual carcinoma at re-excision were compared and analyzed statistically. RESULTS: At least 1 margin was positive in 64.7% in group A and in 65.2% in group B. At directed re-excision 54% in group A and 51% in group B had residual carcinoma. The lateral margin was positive in 44% in group A compared with 26% in group B (P = .06). The posterior margin was positive in 19% in group A and in 51% in group B (P = .001). CONCLUSIONS: Two different breast cancer specimen margin assessment methods had comparable rates of positive margins and residual carcinoma at re-excision. Different patterns of specific margin positivity suggest that the method of margin assessment may alter results.

Tissue compression is not necessary for needle-localized lesion identification.

BACKGROUND: Tissue compression to enhance lesion visibility on radiography of needle-localized breast biopsy specimens is widely used. We hypothesized that compression is not necessary for detection of lesions on specimen radiography. METHODS: Forty-nine consecutive patients underwent needle-localization biopsies of 59 mammographic targets. All specimens were radiographed without and with compression. The films were later independently reviewed and compared with preoperative mammograms by 2 surgeons and a breast-imaging radiologist. The primary end point was identification of mammographic targets in noncompressed specimen radiographs. RESULTS: Twenty-nine targets were masses, 36 contained calcifications, and 14 contained previously placed clips. All mammographically localized lesions were identified on noncompressed views. Overall concordance for the 2 images was 100% for all 3 reviewers and 98% among reviewers. CONCLUSIONS: Tissue compression before specimen radiography is not routinely necessary for target lesion identification.

Can sentinel lymph node biopsy be omitted in patients with favorable breast cancer histology?

BACKGROUND: The widespread use of sentinel lymph node biopsy (SLNB) to replace axillary dissection has broadened the indications for axillary staging in breast cancer. Recent studies have demonstrated a finite risk of lymphedema and sensory morbidity associated with SLNB. We undertook this study to determine whether SLNB could be omitted in clinically node-negative patients with favorable-histology breast cancer. METHODS: We conducted a retrospective review of a prospective database of SLNBs performed at Memorial Sloan-Kettering Cancer Center from 1996 to 2003 to determine the incidence of lymph node metastases by histological subtype. For the favorable subtypes, the patient's age, tumor size, estrogen receptor status, lymphovascular invasion, nuclear grade, and histological grade were compared by nodal status to determine their predictive value. RESULTS: A total of 196 cases with favorable breast cancer subtypes were identified with a 4.1% (8 of 196) sentinel lymph node (SLN) positivity rate. Each of the histological subtypes included patients with positive SLNs, with the exception of adenoid cystic (n = 4) and secretory (n = 1) breast carcinoma, which were quite rare in our series. When compared by nodal status, the patient's age, tumor size, estrogen receptor status, lymphovascular invasion, nuclear grade, and histological grade failed to predict those with positive SLNs. CONCLUSIONS: Patients with favorable breast cancer histology have a small risk of axillary SLN metastases. The use of SLNB in these patients should be individualized, taking into consideration the small incidence of axillary metastases and the risks and benefits associated with the SLN procedure.

Primary lymphoma of the breast: a case of marginal zone B-cell lymphoma.

A case of primary marginal zone B-cell lymphoma in an elderly female patient is presented. Primary breast lymphomas are rare, comprising less than 1 per cent of all breast malignancies. These tumors have no clinical, pathologic, or radiologic pathognomonic features to distinguish them from breast adenocarcinoma. The diagnosis is usually made with an excisional biopsy, and more extensive surgery should be avoided. Delivery of radiation therapy and chemotherapy is tailored according to the histologic grade, stage of disease, and overall patient condition. This report summarizes the current knowledge reflected in the literature.