Breast Neoplasms

Albert US, Altland H, Duda V, Engel J, Geraedts M, Heywang-Köbrunner S, Hölzel D, Kalbheim E, Koller M, König K, Kreienberg R, Kühn T, Lebeau A, Nass-Griegoleit I, Schlake W, Schmutzler R, Schreer I, Schulte H, Schulz-Wendtland R, Wagner U, Kopp I. · Planungskommission und Arbeitsgruppenleiter der Konzertierten Aktion Brustkrebs-Früherkennung in Deutschland, Deutschland. · Chirurg. · Pubmed #18463837 No free full text.

Abstract: The updated 2008 German Guideline for Early Detection of Breast Cancer provides evidence-based and consensus-based recommendations of the knowledge gained by the German Society for Surgery and the German Society of Plastic, Aesthetic, and Reconstructive Surgeons together with 29 professional societies, associations, and nonmedical organizations. The guideline is meant to assist physicians, healthy women, and patients in medical decisions with recommendations regarding the diagnostic chain in early detection of breast cancer. In addition to these recommendations, the guideline also includes descriptions of quality assurance for resources, procedures, outcomes, and evaluation using a set of quality indicators. It updates the previous version from 2003. The guideline's recommendations are presented. They are described in detail in the full publication (in German) Geburtsh Frauenh 2008; 68:251-261. The long version of the Guideline, methods report, and evidence report are available on the internet at www.awmf-leitlinien.de (reg. no. 077/001) with free access.

Pestalozzi B, Castiglione M, Anonymous00140. · Klinik und Poliklinik für Onkologie, Universitätsspital Zürich, Zürich, Switzerland. · Ann Oncol. · Pubmed #18456775 links to  free full text

This publication has no abstract.

Aebi S, Castiglione M, Anonymous00116. · Breast/Gynecologic Cancer Center and Department of Medical Oncology, Inselspital, Bern, Switzerland. · Ann Oncol. · Pubmed #18456751 links to  free full text

This publication has no abstract.

Kataja V, Castiglione M, Anonymous00109. · Department of Oncology, Kuopio University Hospital, Kuopio, Finland. · Ann Oncol. · Pubmed #18456744 links to  free full text

This publication has no abstract.

Albert US, Altland H, Duda V, Engel J, Geraedts M, Heywang-Köbrunner S, Hölzel D, Kalbheim E, Koller M, König K, Kreienberg R, Kühn T, Lebeau A, Nass-Griegoleit I, Schlake W, Schmutzler R, Schreer I, Schulte H, Schulz-Wendtland R, Wagner U, Kopp I. · Planungskommission und Arbeitsgruppenleiter der Konzertierten Aktion Brustkrebs-Früherkennung in Deutschland. · Rofo. · Pubmed #18438746 No free full text.

This publication has no abstract.

Mann RM, Kuhl CK, Kinkel K, Boetes C. · No affiliation provided · Eur Radiol. · Pubmed #18389253 links to  free full text

This publication has no abstract.

De Palma R, Liberati A, Ciccone G, Bandieri E, Belfiglio M, Ceccarelli M, Leoni M, Longo G, Magrini N, Marangolo M, Roila F, Anonymous00180. · PRI-ER Oncology Research Group, Agenzia Sanitaria Regionale, Viale Aldo Moro 21, Bologna, Italy. · J Clin Oncol. · Pubmed #18309939 No free full text.

Abstract: PURPOSE: In the area of anticancer drugs, the legitimate search for effective interventions can be jeopardized by the strong pressure for accelerated approval, which may hinder the full assessment of their benefit-risk profile. We aimed to produce drug-specific recommendations using an explicit approach that separates the judgments on quality of evidence from the judgment about strength of recommendations. MATERIALS AND METHODS: We used the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system to develop recommendations for the use of specific anticancer drugs/regimens; 12 clinical questions relevant to adjuvant treatment of breast (three), colorectal (four) and lung (five) cancer have been assessed by multidisciplinary panels supported by a group of methodologists. RESULTS: For nine of 12 questions, recommendations were produced (one strong and six weak in favor and one weak and one strong against the index treatment); for the remaining three questions no specific course of action could be recommended. The perceived benefits to risk balance of the treatment was the most important and statistically significant (P < .01) predictor of panels' recommendations and of their strength, whereas panelists' personal (age, sex) and professional (specialty) characteristics were not statistically associated. CONCLUSION: Because the GRADE system sets out an explicit process going from evaluation of the quality of evidence and benefit-risk profile to the judgment of the strength of recommendations, in this experience, it proved very useful to combine methodologic rigor with the interdisciplinary participation that is important in the definition of evidence based clinical policies.

Seifart U, Albert US, Heim ME, Hübner J, Jungkunz W, Prokein R, Rick O, Hoffmann M, Engenhart-Cabillic R, Kopp I, Wagner U, Kalder M. · Hamm-Kliniken, Bad Soden-Salmünster. · Rehabilitation (Stuttg). · Pubmed #18188805 No free full text.

Abstract: Secondary lymphedema is one of the most frequent long-term side effects affecting up to 30% of all breast cancer patients after local surgical and radiation treatment. Destruction of the lymphatic system causes a progressive and chronic condition with functional impairments and disabilities limiting patients in their daily activities and involving nearly all aspects of their quality of life. Also, problems in the occupational area may be caused by lymphedema. The need for improving oncological management for early diagnosis and referral for effective treatment of lymphedema is a major goal of breast cancer heath care while survival improves. METHOD: A systematic consensus process was performed involving all relevant partners and providers of lymphedema health care to develop a practical documentation concept and make recommendations according to the evidence of clinical studies and currently available guidelines. RESULTS: A practical concept of documentation with defined assessment points was developed for evaluation and monitoring of lymphedema, which included the assessment of quality of life parameters with recognised instruments by the patient themselves. Consensus recommendations for the postoperative management, prevention, treatment and follow-up of breast cancer patients along a clinical algorithm for in- and outpatient care were finalized. CONCLUSION: With improved survival, long-term side effects with major impact on quality of life become a most important end point criteria of oncological treatment. The clearly defined documentation concept and the comprehensive recommendations for lymphedema management may assist clinicians and patients to make timely decisions about in- and outpatient health care practice to optimize the interface between acute medicine and rehabilitation. Patients' compliance with treatment and prevention routines will be as important as ensuring the continuity of care. A longitudinal prospective study evaluating the effectiveness and efficacy of the consensus recommendation is currently being implemented.

Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, Hurria A, Extermann M, Girre V, Brain E, Audisio RA, Bartelink H, Barton M, Giordano SH, Muss H, Aapro M, Anonymous00355. · Department of General Medical Oncology, University Hospital Gasthuisberg, Leuven, Belgium. · Lancet Oncol. · Pubmed #18054880 No free full text.

Abstract: Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality in women worldwide. Elderly individuals make up a large part of the breast cancer population, and there are important specific considerations for this population. The International Society of Geriatric Oncology created a task force to assess the available evidence on breast cancer in elderly individuals, and to provide evidence-based recommendations for the diagnosis and treatment of breast cancer in such individuals. A review of the published work was done with the results of a search on Medline for English-language articles published between 1990 and 2007 and of abstracts from key international conferences. Recommendations are given on the topics of screening, surgery, radiotherapy, (neo)adjuvant hormone treatment and chemotherapy, and metastatic disease. Since large randomised trials in elderly patients with breast cancer are scarce, there is little level I evidence for the treatment of such patients. The available evidence was reviewed and synthesised to provide consensus recommendations regarding the care of breast cancer in older adults.

Borneman T, Piper BF, Sun VC, Koczywas M, Uman G, Ferrell B. · Department of Nursing Research & Education, Division of Population Sciences, Beckman Research Institute, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA. · J Natl Compr Canc Netw. · Pubmed #18053431 links to  free full text

Abstract: Fatigue, despite being the most common and distressing symptom in cancer, is often unrelieved because of numerous patient, provider, and system barriers. The overall purpose of this 5-year prospective clinical trial is to translate the NCCN Cancer-Related Fatigue Clinical Practice Guidelines in Oncology and NCCN Adult Cancer Pain Clinical Practice Guidelines in Oncology into practice and develop a translational interventional model that can be replicated across settings. This article focuses on one NCCN member institution's experience related to the first phase of the NCCN Cancer-Related Fatigue Guidelines implementation, describing usual care compared with evidence-based guidelines. Phase 1 of this 3-phased clinical trial compared the usual care of fatigue with that administered according to the NCCN guidelines. Eligibility criteria included age 18 years or older; English-speaking; diagnosed with breast, lung, colon, or prostate cancer; and fatigue and/or pain ratings of 4 or more on a 0 to 10 screening scale. Research nurses screened all available subjects in a cancer center medical oncology clinic to identify those meeting these criteria. Instruments included the Piper Fatigue Scale, a Fatigue Barriers Scale, a Fatigue Knowledge Scale, and a Fatigue Chart Audit Tool. Descriptive and inferential statistics were used in data analysis. At baseline, 45 patients had fatigue only (> or = 4) and 24 had both fatigue and pain (> or = 4). This combined sample (N = 69) was predominantly Caucasian (65%), female (63%), an average of 60 years old, diagnosed with stage 3 or 4 breast cancer, and undergoing treatment (82%). The most common barriers noted were patients' belief that physicians would introduce the subject of fatigue if it was important (patient barrier); lack of fatigue documentation (professional barrier); and lack of supportive care referrals (system barrier). Findings showed several patient, professional, and system barriers that distinguish usual care from that recommended by the NCCN Cancer-Related Fatigue Guidelines. Phase 2, the intervention model, is designed to decrease these barriers and improve patient outcomes over time, and is in progress.

Sautter-Bihl ML, Budach W, Dunst J, Feyer P, Haase W, Harms W, Sedlmayer F, Souchon R, Wenz F, Sauer R, Anonymous00109, Anonymous00110. · Municipal Hospital Karlsruhe, Germany. · Strahlenther Onkol. · Pubmed #18040609 No free full text.

Abstract: BACKGROUND: The present paper is an update of the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO) [34]. These recommendations have been elaborated on the basis of the S3 guidelines of the German Cancer Society that were revised in March 2007 by an interdisciplinary panel [18]. METHODS: The DEGRO expert panel performed a comprehensive survey of the literature, comprising lately published meta-analyses, data from recent randomized trials and guidelines of international breast cancer societies, referring to the criteria of evidence- based medicine [25]. In addition to the more general statements of the German Cancer Society, this paper emphasizes specific radiotherapeutic aspects. It is focused on radiotherapy after breast-conserving surgery. Technique, targeting, and dose are described in detail. RESULTS: Postoperative radiotherapy significantly reduces rates of local recurrence. The more pronounced the achieved reduction is, the more substantially it translates into improved survival. Four prevented local recurrences result in one avoided breast cancer death. This effect is independent of age. An additional boost provides a further absolute risk reduction for local recurrence irrespective of age. Women > 50 years have a hazard ratio of 0.59 in favor of the boost. For DCIS, local recurrence was 2.4% per patient year even in a subgroup with favorable prognostic factors leading to premature closure of the respective study due to ethical reasons. For partial-breast irradiation as a sole method of radiotherapy, results are not yet mature enough to allow definite conclusions. CONCLUSION: After breast-conserving surgery, whole-breast irradiation remains the gold standard of treatment. The indication for boost irradiation should no longer be restricted to women <or= 50 years. Partial-breast irradiation is still an experimental treatment and therefore discouraged outside controlled clinical trials. Omission of radiotherapy after breast-conserving surgery of DCIS should be restricted to individual exceptions.

Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L. · London Region Breast Screening Programme, Quality Assurance Reference Centre, St Bartholomew's Hospital, London, UK. · Ann Oncol. · Pubmed #18024988 links to  free full text

Abstract: Breast cancer is a major cause of suffering and death and is of significant concern to many women. Early detection of breast cancer by systematic mammography screening can find lesions for which treatment is more effective and generally more favourable for quality of life. The potential harm caused by mammography includes the creation of unnecessary anxiety and morbidity, inappropriate economic cost and the use of ionising radiation. It is for this reason that the strongest possible emphasis on quality control and quality assurance is required. Development of the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis has been an initiative within the Europe Against Cancer Programme. The fourth edition of the multidisciplinary guidelines was published in 2006 and comprises approximately 400 pages divided into 12 chapters prepared by >200 authors and contributors. The multidisciplinary editorial board has prepared a summary document to provide an overview of the fundamental points and principles that should support any quality screening or diagnostic service. This document includes a summary table of key performance indicators and is presented here in order to make these principles and standards known to a wider scientific community.

Marzo Castillejo M, Bellas Beceiro B, Nuin Villanueva M, Peguera Cierco P, Moreno Baquerano M, Anonymous00075. · Grupo de Prevención del Cáncer del PAPPS. · Aten Primaria. · Pubmed #19288696 links to  free full text

This publication has no abstract.

Lancaster JM, Powell CB, Kauff ND, Cass I, Chen LM, Lu KH, Mutch DG, Berchuck A, Karlan BY, Herzog TJ, Anonymous00375. · H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. · Gynecol Oncol. · Pubmed #17950381 No free full text.

Abstract: Women with germline mutations in the cancer susceptibility genes, BRCA1 or BRCA2, associated with Hereditary Breast/Ovarian Cancer syndrome, have up to an 85% lifetime risk of breast cancer and up to a 46% lifetime risk ovarian cancer. Similarly, women with mutations in the DNA mismatch repair genes, MLH1, MSH2 or MSH6, associated with the Lynch/Hereditary Non-Polyposis Colorectal Cancer (HNPCC) syndrome, have up to a 40-60% lifetime risk of both endometrial and colorectal cancer as well as a 9-12% lifetime risk of ovarian cancer. Genetic risk assessment enables physicians to provide individualized evaluation of the likelihood of having one of these gynecologic cancer predisposition syndromes, as well the opportunity to provide tailored screening and prevention strategies such as surveillance, chemoprevention, and prophylactic surgery that may reduce the morbidity and mortality associated with these syndromes. Hereditary cancer risk assessment is a process that includes assessment of risk, education and counseling conducted by a provider with expertise in cancer genetics, and may include genetic testing after appropriate consent is obtained. This commentary provides guidance on identification of patients who may benefit from hereditary cancer risk assessment for Hereditary Breast/Ovarian Cancer and the Lynch/Hereditary Non-Polyposis Colorectal Cancer syndrome.

Buscombe J, Paganelli G, Burak ZE, Waddington W, Maublant J, Prats E, Palmedo H, Schillaci O, Maffioli L, Lassmann M, Chiesa C, Bombardieri E, Chiti A, Anonymous00305. · Royal Free Hospital, London, UK. · Eur J Nucl Med Mol Imaging. · Pubmed #17943283 No free full text.

Abstract: Procedure guidelines for scintigraphic detection of sentinel node in breast cancer are presented.

Bevers TB, Armstrong DK, Arun B, Carlson RW, Cowan KH, Daly MB, Fleming I, Garber JE, Gemignani M, Gradishar WJ, Krontiras H, Kulkarni S, Laronga C, Lawton T, Loftus L, Macdonald DJ, Mahoney MC, Merajver SD, Seewaldt V, Sellin RV, Shapiro CL, Singletary E, Ward JH, Anonymous00155. · National Comprehensive Cancer Network · J Natl Compr Canc Netw. · Pubmed #17927926 No free full text.

This publication has no abstract.

Jalali R, Singh S, Budrukkar A. · Tata Memorial Hospital, Mumbai, India. · Acta Oncol. · Pubmed #17851869 No free full text.

Abstract: Breast conservation surgery followed by external beam radiotherapy to breast has become the standard of care in management of early carcinoma breast. A boost to the tumour bed after whole breast radiotherapy is employed in view of the pattern of tumour bed recurrences in the index quadrant and was particularly considered in patients with some adverse histopathological characteristics such as positive margins, extensive intraductal carcinoma (EIC), lymphovascular invasion dose in patients even without such factors and for all age groups. The maximum absolute reduction of local recurrences by the addition of boost is especially seen in young premenopausal patients. At the same time, the addition of boost is associated with increased risk of worsening of cosmesis and no clear cut survival advantage. Radiological modalities such as fluoroscopy, ultrasound and CT scan have aided in accurate delineation of tumour bed with increasing efficacy. A widespread application of these techniques might ultimately translate into improved local control with minimal cosmetic deficit. The present article discusses the role of radiotherapy boost and the means to delineate and deliver the same, identify the high risk group, optimal technique and the doses and fractionations to be used. It also discusses the extent of adverse cosmetic outcome after boost delivery, means to minimise it and relevance of tumour bed in present day scenario of advanced radiotherapy delivery techniques like Intensity modulated radiation therapy (IMRT).

Manning K, Tepfer B, Goldklang G, Loyd R, Garimella P, Halkar R. · Trident Molecular Imaging, 545 Old Norcross Road, Lawrenceville, GA 30045, USA. · Mol Imaging Biol. · Pubmed #17701257 No free full text.

Abstract: PURPOSE: Positron emission tomography, combined with computed tomography (PET/CT) has provided clinicians with useful information regarding the diagnosis, initial staging, restaging, and therapy monitoring of malignancies since the beginning of the current century. Our intent here is to identify the critical steps in clinical workups and follow-up, in the true outpatient clinical setting of a freestanding imaging center, for utilization of PET/CT in four different cancer types. METHODS: The four most common reasons for referrals to our facility were identified by reviewing two years of referral data. They were lung cancer (including solitary pulmonary nodule), lymphomas, breast cancer, and colorectal cancer. A review of published literature from 1996 and later was accepted as evidence of appropriateness for utilizing PET/CT in various clinical scenarios. In addition, a medical advisory board consisting of 15 referring physicians representing various specialties was established to provide practical advice regarding the appropriate use of PET/CT in clinical situations. National Comprehensive Cancer Network (NCCN) guidelines were also referenced to establish a baseline for clinical workups at various stages of disease. RESULTS: Several inconsistencies were identified among the three primary sources of information leading to the establishment of a standardized algorithm for each cancer type. NCCN data did not always agree with published literature, which was also often different from actual clinical practices of referring physicians. The most common inconsistencies included differing opinions from the referrers vs what was published in the NCCN guidelines, especially with regard to the utilization of PET/CT for applications not yet covered by insurance companies. After a reconciliation of the medical advisory board's clinical practices and several published articles, a consensus was established by the medical advisory board for the use of PET/CT imaging for the four cancer types, enabling us to identify the appropriate timing of PET/CT utilization in patient work-ups. CONCLUSIONS: A PET/CT-centric clinical practice decision tree algorithm can be established by assessing a variety of sources of information. Although published literature and NCCN guidelines offer validated guidance to appropriateness, and third party insurance payors have established their own appropriateness standards, our experience showed that inclusion of practical experience from referring physicians who frequently utilize PET/CT imaging provided additional, useful input.

Anonymous00322. · No affiliation provided · J Am Coll Surg. · Pubmed #17660085 No free full text.

Abstract: This is the second of two articles reprinted with permission from: Practice guideline for breast conservation therapy in the management of invasive breast carcinoma. In: Practice Guidelines and Technical Standards. Reston, VA: American College of Radiology;2006:443-468. In this reprinting "G" in Section IV is available in the Online version only. For Section VI please refer to the first publication of ductal carcinoma in-situ (J Am Coll Surg 2007:205:145-161). Parts of this article have been shortened for brevity. The full article is available through the American College of Radiology. The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice guidelines and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice guidelines and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review, requiring the approval of the Commission on Quality and Safety as well as the ACR Board of Chancellors, the ACR Council Steering Committee, and the ACR Council. The practice guidelines and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline and technical standard by those entities not providing these services is not authorized.

Anonymous00331. · Dana Farber/Brigham and Women's Hospital, Boston, MA, USA. · J Am Coll Surg. · Pubmed #17617343 No free full text.

This publication has no abstract.

Anonymous00123, Anonymous00124, Anonymous00125, Baildam A, Bishop H, Boland G, Dalglish M, Davies L, Fatah F, Gooch H, Harcourt D, Martin L, Rainsbury D, Rayter Z, Sheppard C, Smith J, Weiler-Mithoff E, Winstanley J, Church J. · Royal College of Surgeons, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK. · Eur J Surg Oncol. · Pubmed #17604938 No free full text.

This publication has no abstract.

Anonymous00109, Kalaja VV. · No affiliation provided · Ann Oncol. · Pubmed #17491064 links to  free full text

This publication has no abstract.

Anonymous00090, Pestalozzi B. · No affiliation provided · Ann Oncol. · Pubmed #17491045 links to  free full text

This publication has no abstract.

Siegel E, Krupinski E, Samei E, Flynn M, Andriole K, Erickson B, Thomas J, Badano A, Seibert JA, Pisano ED. · University of Maryland, Department of Radiology, Baltimore, MD, USA. · J Am Coll Radiol. · Pubmed #17412136 No free full text.

Abstract: This paper on digital mammography image display is 1 of 3 papers written as part of an intersociety effort to establish image quality standards for digital mammography. The information included in this paper is intended to support the development of an American College of Radiology (ACR) guideline on image quality for digital mammography. The topics of the other 2 papers are digital mammography image acquisition and digital mammography image storage, transmission, and retrieval. The societies represented in compiling this document were the Radiological Society of North America, the ACR, the American Association of Physicists in Medicine, and the Society for Computer Applications in Radiology. These papers describe in detail what is known to improve image quality for digital mammography and make recommendations about how digital mammography should be performed to optimize the visualization of breast cancers using this imaging tool. Through the publication of these papers, the ACR is seeking input from industry, radiologists, and other interested parties on their contents so that the final ACR guideline for digital mammography will represent the consensus of the broader community interested in these topics.

Avrin D, Morin R, Piraino D, Rowberg A, Detorie N, Zuley M, Seibert JA, Pisano ED. · University of Utah, Department of Radiology, Salt Lake City, Utah, USA. · J Am Coll Radiol. · Pubmed #17412135 No free full text.

Abstract: This paper on digital mammography image storage, retrieval, and transmission is 1 of 3 papers written as part of an intersociety effort to establish image quality standards for digital mammography. The information included in this paper is intended to support the development of an American College of Radiology (ACR) guideline on image quality for digital mammography. The topics of the other 2 papers are digital mammography image acquisition and digital mammography image display. The societies that were represented in compiling this document were the Radiological Society of North America, the ACR, the American Association of Physicists in Medicine, and the Society for Computer Applications in Radiology. These papers describe in detail what is known to improve image quality for digital mammography and make recommendations about how digital mammography should be performed to optimize the visualization of breast cancers using this imaging tool. Through the publication of these papers, the ACR is seeking input from industry, radiologists, and other interested parties on their contents so that the final ACR guideline for digital mammography will represent the consensus of the broader community interested in these topics.