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Background The use of clinical features to allocate adjuvant therapy in the treatment of ductal carcinoma in situ with breast-conserving therapy remains controversial. Methods A review of patients with ductal carcinoma in situ treated with breast-conserving therapy was performed. The recurrence rate was examined in relation to patient age, tumor characteristics, Van Nuys Prognostic Index, and the receipt of prescribed adjuvant therapies. Results Six percent of patients (17 of 294) had developed local recurrences after a median follow-up period of 63 months. Fifty-nine percent of patients (91 of 154) with estrogen receptor–positive tumors did not receive prescribed tamoxifen. Thirty-one percent of patients (45 of 147) with Van Nuys Prognostic Index scores ≥7 did not receive recommended radiation therapy. Receipt of prescribed adjuvant therapy did not result in a decrease in the rate of local recurrence. Patient age was the only factor associated with local recurrence on univariate but not on multivariate analysis ( P = .374). Conclusions A low rate of local recurrence was achieved despite a large number of patients' not receiving prescribed adjuvant therapies.

The present study investigated relations between reported childhood abuse and recent traumatic stress symptoms in women newly diagnosed with breast cancer (n=330).As part of a larger ongoing study, patients from eight public and private hospitals were referred by their physicians and completed the Childhood Trauma Questionnaire (CTQ), and the Impact of Events Scale-breast cancer (IES), which measured breast cancer-related intrusive and avoidant symptoms.Emotional abuse, physical abuse, and sexual abuse were correlated with intrusive symptoms. Cancer-related avoidant symptoms approached significance in their relation to emotional and sexual abuse. Multivariate analysis, controlling for age and time since diagnosis, revealed that childhood emotional abuse was an independent predictor of breast cancer-related intrusive symptoms, but that childhood physical abuse and sexual abuse were not significant predictors.Childhood emotional, physical, and sexual abuse were associated with breast cancer-related intrusive symptoms. Emotional abuse uniquely predicted intrusive symptoms after controlling for other predictors. Results suggest that a cancer diagnosis may trigger cognitive and emotional responses that relate to patients' prior trauma experiences.Physicians and psychologists treating women with breast cancer should be aware that a history of childhood abuse may exacerbate patients' cancer-related intrusive symptoms. Interventions for women affected by both childhood abuse and breast cancer may be most effective when they address both stressors and associated emotional responses. Findings highlight the importance of additional research to explore links between prior trauma and distress following a cancer diagnosis stress.

Background: Incidental breast cancer is occasionally found in spot localization biopsy specimens adjacent to mirocalcifications in benign breast disease. Because this phenomenon could prove problematic for percutaneous sampling of microcalcifications without excisional biopsy, we studied surgical specimens from patients with cancers incidental to microcalcifications and compared them with specimens with microcalcifications within the malignancy. Methods: The pathology database at the Mount Sinai Medical Center from January 1993 to July 1998 was reviewed to identify breast cancer patients who underwent spot localization biopsy for microcalcifications. Patients presenting with microcalcifications within malignancy (determinate) were compared with patients with mirocalcifications in benign breast tissue adjacent to malignancy (incidental). Results: Thirty-two (13%) of the 241 specimens had microcalcifications in benign tissue adjacent to malignancy and 209 (87%) had microcalcifications within the malignancy. Fifty-six percent of the incidental cases and 65% of the controls had ductal carcinoma in situ. Infiltrating lobular carcinoma accounted for 25% of the incidental cancers and 2% of the determinate cancers (P

Background Onco type DX is a 21-gene assay that calculates a risk of distant recurrence in women with estrogen-receptor–positive, lymph node–negative breast cancer. The purpose of this study was to determine whether the results of Onco type DX influence the decision to administer chemotherapy. Methods A retrospective study was performed on 85 consecutive patients with estrogen-receptor–positive, lymph node–negative breast cancer who had an Onco type DX recurrence score (RS) obtained. Tumor size, tumor grade, and treatment were then compared within each risk category. Statistical analysis was performed using STATA software. Results Tumors that were high grade and Her-2/neu positive more frequently had a high RS. Treatment was changed as a result of Onco type DX in 44% of patients. Conclusions Onco type DX RS is significantly related to tumor grade and Her2/neu status. In this study, the treatment of 44% of patients was altered as a consequence of Onco type DX RS.

SummaryBased on breast cancer families with multiple and/or early-onset cases, estimates of the lifetime risk of breast cancer in carriers of BRCA1 or BRCA2 mutations may be as high as 85%. The risk for individuals not selected for family history or other risk factors is uncertain. We determined the frequency of the common BRCA1 (185delAG and 5382insC) and BRCA2 (6174delT) mutations in a series of 268 anonymous Ashkenazi Jewish women with breast cancer, regardless of family history or age at onset. DNA was analyzed for the three mutations by allele-specific oligonucleotide hybridization. Eight patients (3.0%, 95% confidence interval [CI] 1.5%–5.8%) were heterozygous for the 185delAG mutation, two (0.75%, 95% CI 0.20–2.7) for the 5382insC mutation, and eight (3.0%, 95% CI 1.5–5.8) for the 6174delT mutation. The lifetime risk for breast cancer in Ashkenazi Jewish carriers of the BRCA1 185delAG or BRCA2 6174delT mutations was calculated to be 36%, approximately three times the overall risk for the general population (relative risk 2.9, 95% CI 1.5–5.8). For the 5382insC mutation, because of the low number of carriers found, further studies are necessary. The results differ markedly from previous estimates based on high-risk breast cancer families and are consistent with lower estimates derived from a recent population-based study in the Baltimore area. Thus, presymptomatic screening and counseling for these common mutations in Ashkenazi Jewish women not selected for family history of breast cancer should be reconsidered until the risk associated with these mutations is firmly established, especially since early diagnostic and preventive-treatment modalities are limited.

The most expeditious way of reducing surgical costs is through reducing hospital stay. Multivariate analysis was used to identify potentially alterable factors affecting postoperative hospital stay for 73 consecutive patients undergoing modified radical mastectomy by 6 surgeons during a 12-month period. Stepwise logistic regression was used to identify independently significant preoperative variables associated with hospital stays equal to or greater than the median of 5 days. Intraoperative techniques and postoperative management were then evaluated using Cox proportional hazards model, with length of stay as the dependent variable after consideration for the significant independent preoperative factors. Age, history of heart disease, hypertension, diabetes, obesity, and American Society of Anesthesiologists (ASA) risk were significantly associated with prolonged stay (more than 4 days) in univariate analysis. Only age (P0.001) and cardiac history (P = 0.013) were significant independent predictors of hospital stay in multivariate analysis. After consideration for age and cardiac history, the only significant intraoperative or postoperative factor associated with hospital stay was the use of dressings incorporating Steri-Strips. This study suggests that the attribution of the reduction in hospital stay to discharge with drains in place is due to numerous factors, only one of which is the willingness to send patients home with the drains.

We prospectively studied 168 consecutive patients with colorectal cancer to identify perioperative determinants of infectious complications. All patients received preoperative bowel preparation with laxatives, enemas, oral neomycin and erythromycin base, and intravenous cefazolin. Age, sex, admission hematocrit value, operative procedure, specimen length, duration of operation, blood loss, transfusions, tumor size, tumor differentiation, nodal status, and Dukes' stage were evaluated in relation to infectious complications using multivariate analysis. Infectious complications developed in 24 of the 168 patients in the study (14 percent) and these accounted for the four deaths. Blood transfusion (p = 0.0100) and admission hematocrit value (p = 0.0191) were significantly related to postoperative infectious complications. Low admission hematocrit values appeared to protect patients from infectious complications. Patients who had postoperative infectious complications received 2.14 +/- 2.75 units of blood compared with 0.82 +/- 1.37 units in patients without infectious complications (p = 0.0005). Although blood transfusion was associated with high operative blood loss, prolonged procedures, and large specimens (p less than 0.005), none of these factors was significantly associated with infectious complications (p greater than 0.10). Blood transfusion is immunosuppressive in other clinical situations and may be a more significant factor affecting postoperative immune function and susceptibility to infectious complications than previously recognized.

The effect of thymectomy on prognosis following mammary tumor excision was evaluated in female C3H MTV + mice, 5 to 6 months old, with spontaneous tumors 0.5 to 1 cm in diameter after random allocation to thymectomy or sham operation. Significant differences between these two groups were noted in absolute survival, disease-free survival, interval to tumor reappearance, and survival following tumor reappearance. Thymectomy prolonged survival both in tumor-free and tumor-bearing mice and delayed the reappearance of the tumors. The results indicate that thymectomy, when used as an adjuvant to surgical ablation of mammary tumors, has a therapeutic role. Both the previously reported protective effect of thymectomy against the risk of mammary neoplasia and the observed protective role following tumor occurrence could be attributed to its metabolic and immunoregulatory effects.

Summary We prospectively studied 169 patients with Crohn's disease to determine if postoperative infectious complications could be related to perioperative blood transfusions. Postoperative septic complications developed in 18 of the 69 patients who received more than 1 unit of blood (26 percent) compared with 8 of the 100 patients (8 percent) who received 1 unit of blood or no blood (p=0.0014). Previous operation, low body weight, and having an ostomy were also related to septic complications. Patients receiving more than 1 unit of blood were significantly more likely to have low preoperative serum albumin levels, to have undergone abdominoperineal or small bowel resection, and to have an astomy. Postoperative septic complications were significantly related to perioperative blood transfusions after controlling for these potential confounding factors independently by subgrouping and simultaneously by using multiple logistic regression. Blood transfusion may be a more significant factor in postoperative immune suppression and susceptibility to infection than previously recognized.