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To give an overview of the trends and variation in breast-conserving surgery in patients with a breast tumouror = 2 cm (pT1) or2 andor = 5 cm (pT2), treated in general hospitals in the southeast and east of the Netherlands.Descriptive.Data from the regional cancer registries of the Comprehensive Cancer Centre South (CS) and the Comprehensive Cancer Centre Stedendriehoek Twente (CST) were used to study trends and variations in the use of breast-conserving surgery in 12,985 pT1 tumours and 8,893 pT2 tumours in the period 1990-2002.The mean percentage of patients that underwent breast-conserving surgery from 1990-2002 was 54 in the CS region and 43 in the CST region. In patients50 years old with a pT1 tumour a decrease in the percentage of breast-conserving surgery from 73 to 64 was seen in the CS region, and in the CST region this percentage decreased from 72 to 51. In pT2 tumours a decrease from 47 to 37 was seen in the CS region and from 34 to 31 in the CST region. In patients of 50 to 69 years of age with a pT1 tumour, the percentage of breast-conserving surgery increased in the CS region from 67 to 74 and in the CST region from 54 to 61. In pT2 tumours it increased from 40 to 44 and from 25 to 37. In patientsor = 70 years the percentage of breast-conserving surgery in pT1 tumours increased from 37 to 59 in the CS region and in the CST region from 42 to 50. In pT2 tumours it increased from 20 to 31 in the CS region whereas it remained 17 in the CST region. The variation in breast-conserving surgery between hospitals in the period 1999-2002 was large. The percentage of breast-conserving surgery in patients with pT1 tumours varied between 47 and 86 in the hospitals in the CS region and between 54 and 71 in the CST region. In patients with a pT2 tumour the percentages varied between 25 and 43 in the CST region and between 16 and 64 in the CS region.More than 20 years after the introduction of breast-conserving surgery a large regional variation still exists in the use of this treatment, in the CS region in particular. There is also wide inter-hospital variation.

To analyse the incidence and treatment of ductal carcinoma in situ (DCIS) of the breast in the population.Retrospective, descriptive.The incidence of DCIS in the period 1975-1997 in 8 hospitals in southeastern North Brabant and northern Limburg, the Netherlands, was analysed, using data from the Eindhoven Cancer Registry. Changes in the treatment of DCIS in the period 1984-1997 were studied, using information from the Breast Cancer Documentation Project.Between 1975 and 1997, 448 cases of DCIS were detected in 442 women. After adjustment for age according to the European Standard Population, the incidence rate of DCIS increased from 0.3 per 100,000 in 1975 to 13.4 in 1997. Of the 87 patients with DCIS between 50 and 69 years of age in 1996 and 1997, 68% was detected by the screening programme. The proportion of patients with DCIS undergoing ablation of the breast was 53% during the period 1984-1989, and varied around 45% thereafter. The other patients underwent local excision. The proportion of patients receiving radiotherapy after local excision decreased from 78% in the period 1984-1989 to 24% in the period 1994-1995 and rose to 41% during the last few years. Substantial differences in the treatment of DCIS were observed between the 8 hospitals.

A woman aged 38 displayed colicky pains and melaena two weeks after a laparoscopic cholecystectomy. The haemoglobin level was decreased, the serum hepatic enzyme levels were slightly increased. Diagnostic imaging examinations and finally, because of recurrent symptoms, an emergency laparotomy revealed a bleeding from a pseudoaneurysm of the proper hepatic artery next to the choledochus. The aneurysm was ligated. Seven months later the patient had no more symptoms. The possibility of haemobilia should be considered in every case of gastrointestinal bleeding after laparoscopic cholecystectomy.

To assess the effect of oestrogen (ER) and progesterone (PgR) receptors on the prognosis of patients with operable breast cancer and the decision to treat these patients with adjuvant tamoxifen.Retrospective.Eight community hospitals in the Southeast Netherlands.Using the registry of the Comprehensive Cancer Centre South, 2862 breast cancer patients were identified with stage I, II or IIIA tumours, treated during the period 1984-1992.ER and PgR status were known for 2393 (84%) and 1761 (62%) patients respectively. From 1991, over 80% of the postmenopausal, lymph node positive patients had received tamoxifen, irrespective of the steroid receptor status. Of all lymph node negative patients fewer than 3% received adjuvant systemic treatment. Among the lymph node negative patients the steroid receptor status was not a significant predictor of survival. Among the lymph node positive patients whose tumours were both ER-negative and PgR-negative, a 2.8-fold increased risk of death was found during the first four years after primary treatment. The risk of death was not increased if only the ER or only the PgR status was negative.This study shows that ER and PgR receptors are significant prognostic factors for survival in breast cancer patients with involved axillary lymph nodes. The prognostic effect appeared to be restricted to the first four years after primary treatment. Selection of patients for endocrine treatment should be based on the steroid receptor status, considering the importance of the steroid receptors for predicting the response to endocrine treatment.

To evaluate the treatment and prognosis of 82 patients with local relapse in the breast as the first event after breast-conserving therapy of operable breast cancer.Descriptive and retrospective.17 general hospitals in southeast North-Brabant and North-Limburg.Using the registries of the Comprehensive Cancer Centre South in Eindhoven (1981-1990) and the Bernard Verbeeten Institute in Tilburg (1981-1987), 82 patients were identified who had developed local recurrence after breast-conserving therapy.The mean age of the 82 patients at the time of detection of local recurrence was 51 years. 46 recurrences (56%) were localized at or near the site of the original tumour, 14 (17%) were detected elsewhere in the breast, 15 (18%) showed diffuse spread through the breast and seven (9%) were completely or partly localized in the skin. Nine recurrences (11%) were non-invasive. Of the 82 patients four received adjuvant systemic therapy only and no surgery. Of the 78 patients treated with surgery 72 underwent mastectomy, 6 local excision. After treatment, the actuarial five-year overall survival, distant recurrence-free survival and disease-free survival rates were 60%, 43% and 31% respectively. Local control, defined as survival without second local recurrence and without local progression of the disease, was 57% after five years.The five-year distant recurrence-free and disease-free survival rates for patients with local recurrence after breast conserving-therapy were low. The high proportion of second local recurrences and local progression of disease in this study underlines the difficulty of obtaining local control after treatment of local recurrence.