Breast Neoplasms: Azavedo E

Harford J, Azavedo E, Fischietto M, Anonymous00020. · Office of International Affairs, National Cancer Institute, Bethesda, Maryland 20892, USA. · Cancer. · Pubmed #18837020 No free full text.

Abstract: Breast cancer is serious public health problem in countries of all resource levels. Although major advances in the detection and treatment of the disease have occurred in higher income settings, similar progress has been slow or scarce in most low- and middle-income countries (LMCs). The poorer outcomes in LMCs may relate to the limited capability of their healthcare systems (HCS) to provide successful early detection, diagnosis, and treatment of breast cancer. Impediments to better outcomes include insufficient numbers of appropriately trained healthcare workers, limited access to screening/treatment facilities, inadequate supplies of necessary drugs, and timeliness of treatment after diagnosis. Clearly, these HCS deficiencies are broader than the scope of the Breast Health Global Initiative (BHGI) and are not unique to the issue of breast cancer. To address issues in HCS that hinder the delivery of breast health services, the BHGI Healthcare Systems and Public Policy Panel explored the HCS structures and function needed to operate a breast care program (BCP). Like with all BHGI guidelines, those proposed by this panel were expressed in terms of 4 strata of resource levels: basic, limited, enhanced, and maximal. The current report describes the issues and questions related to HCS that are important to consider when designing, implementing, and measuring the performance of a BCP. Health ministers, other policymakers, healthcare personnel, administrators, and anyone else involved in developing a BCP can use and adapt this framework to improve outcomes and ensure the more effective use of resources.

Azavedo E, Boné B. · Department of Diagnostic Radiology, Karolinska Hospital, Stockholm, Sweden. · Eur Radiol. · Pubmed #10101662 No free full text.

Abstract: Over the last two decades, the use of breast implants both for breast augmentation and for breast reconstruction following mastectomy has increased substantially. It is estimated that around two million women have undergone breast augmentation, while hundreds of thousands have had breast reconstruction surgery. Different types of material have been used for breast implants, but silicone gel implants have been the dominating implant type. Many implants can lead to complications, such as hardening and rupture, and may therefore need in vivo evaluation by imaging, particularly if they lead to clinical symptoms. They can also pose problems in the assessment of surrounding breast tissue by conventional mammography. In this respect, imaging modalities such as ultrasound, computed tomography and magnetic resonance imaging offer greater possibilities to assess a failing implant, as well as surrounding breast tissue. Several factors, mainly of a psychological nature, lead to requests for breast implants. In this review article, only the imaging aspects of breasts with silicone gel implants will be dealt with. Each modality is concisely presented with its possibilities and limitations.

Lundström E, Sahlin L, Skoog L, Hägerström T, Svane G, Azavedo E, Sandelin K, von Schoultz B. · Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden. · Climacteric. · Pubmed #16857657 No free full text.

Abstract: OBJECTIVE: To analyze the expression of Syndecan-1 in dense and non-dense human breast tissue. METHODS: Specimens of histologically normal tissue were obtained from postmenopausal women undergoing surgery for breast cancer. Each tissue block was subject to radiological examination and pair-wise samples of dense and non-dense tissue were collected. Semi-quantitative assessment of immunohistochemical staining intensity for Syndecan-1 and estrogen receptor subtypes was performed. RESULTS: The expression of Syndecan-1 in all tissue compartments was significantly higher in dense than in non-dense specimens. The strongest staining was recorded in stromal tissue. There was a strong correlation between epithelial estrogen receptor alpha and stromal cell Syndecan-1 expression in dense tissue (rs = 0.7; p = 0.02). This association was absent in non-dense tissue. CONCLUSION: An increase of Syndecan-1 in all tissue compartments and a redistribution from epithelium to stroma may be a characteristic feature for dense breast tissue.

Thurfjell MG, Vitak B, Azavedo E, Svane G, Thurfjell E. · Department of Oncology, Radiology and Clinical Immunology, Uppsala University Hospital, Sweden. · Acta Radiol. · Pubmed #10665871 No free full text.

Abstract: PURPOSE: To evaluate the effect of old mammograms on the specificity and sensitivity of radiologists in mammography screening. MATERIAL AND METHODS: One hundred and fifty sets of screening mammograms were examined by 3 experienced screeners twice: once without and once in comparison with older mammograms. The films came from a population-based screening done during the first half of 1994 and comprised all 35 cancers detected during screening in 1994, 12/24 interval cancers, 14/34 cancers detected in the following screening and 89 normal mammograms. RESULTS: Without old mammograms, the screeners detected an average of 40.3 cancers (range 37-42), with a specificity of 87% (85-88%). With old mammograms, the screeners detected 37.7 cancers (range 34-42) with a specificity of 96% (94-99%). The change in detection rate was not significant. However, the increase in specificity was significant for each screener (p = 0.0002-0.03). CONCLUSION: Mammography screening with old mammograms available for comparison decreased the false-positive recall rate. The effect on sensitivity, however, was unclear.

Anderson BO, Yip CH, Smith RA, Shyyan R, Sener SF, Eniu A, Carlson RW, Azavedo E, Harford J. · Department of Surgery, University of Washington, Seattle, Washington 98195, USA. · Cancer. · Pubmed #18816619 No free full text.

Abstract: Breast cancer outcomes in low- and middle-income countries (LMCs) correlate with the degree to which 1) cancers are detected at early stages, 2) newly detected cancers can be diagnosed correctly, and 3) appropriately selected multimodality treatment can be provided properly in a timely fashion. The Breast Health Global Initiative (BHGI) invited international experts to review and revise previously developed BHGI resource-stratified guideline tables for early detection, diagnosis, treatment, and healthcare systems. Focus groups addressed specific issues in breast pathology, radiation therapy, and management of locally advanced disease. Process metrics were developed based on the priorities established in the guideline stratification. The groups indicated that cancer prevention through health behavior modification could influence breast cancer incidence in LMCs. Diagnosing breast cancer at earlier stages will reduce breast cancer mortality. Programs to promote breast self-awareness and clinical breast examination and resource-adapted mammographic screening are important early detection steps. Breast imaging, initially with ultrasound and, at higher resource levels with diagnostic mammography, improves preoperative diagnostic assessment and permits image-guided needle sampling. Multimodality therapy includes surgery, radiation, and systemic therapies. Government intervention is needed to address drug-delivery problems relating to high cost and poor access. Guideline dissemination and implementation research plays a crucial role in improving care. Adaptation of technology is needed in LMCs, especially for breast imaging, pathology, radiation therapy, and systemic treatment. Curricula for education and training in LMCs should be developed, applied, and studied in LMC-based learning laboratories to aid information transfer of evidence-based BHGI guidelines.

Abdsaleh S, Wärnberg F, Azavedo E, Lindgren PG, Amini RM. · No affiliation provided · Histopathology. · Pubmed #18393972 No free full text.

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