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Purpose: This study aimed to estimate the 5- and 10-year survival rates of breast cancer in Iran. Methods: This retrospective cohort study was performed in 2019 on breast cancer patients registered in the national cancer registry system of Iran during 2007–2014. The patients were contacted to collect their information and status (alive or dead). Age and pathological type of tumor were categorized into five groups, and the place of residence was divided into 13 regions. The Kaplan-Meier method and the Cox proportional hazards model were used for data analysis. Results: A total of 87,902 patients were diagnosed with breast cancer during the study, 22,307 of whom were followed-up. The 5- and 10-year survival rates of the patients were 80% and 69%, respectively. The mean age of the patients was 50.68 ± 12.76 years (median age, 49 years). About 2.3% of the patients were male. The 5- and 10-year survival rates were 69% and 50% in men, respectively. The highest survival rate was reported in the age group of 40–49 years, and the lowest rate was found in the age group of ≥70 years. Of all pathological types, 88% were found in the invasive ductal carcinoma group; the highest survival rate was reported in the noninvasive carcinoma group. The highest survival rate was reported in the Tehran region and the lowest in the Hamedan region. Based on the results, the Cox proportional hazards model, sex, age group, and pathological type were statistically significant differences. Conclusion: This nationwide study performed on breast cancer patients indicated an improvement in the overall survival rate of these patients over the past years (the 5-year survival rate increased from 71% in 2011 to 80% in the present study), which might be attributed to advances in cancer management.

Background: Ovarian cancer (OC) is the 7th most common cancer, with 239,000 new cases per year. In Iran, it is the 8th most common cancer, with an ASIR of 3.9/100,000 women. The 5-year overall survival in Iran based on previous studies is about 61% which in comparison with eastern countries has better survival. Methods: The study included patients from the Iran National Cancer Registry from 2009-2014. Several steps were taken to control data quality. This study used a Kaplan-Meier survival curve to compare OC survival rates across geographical, pathological, and other variables. All analyses were done in R (4.02) and SPSS (26), with a 0.05 P-value considered statistically significant. Results: The study enrolled 7977 cases of OC. OC's ASIR was 4.10/100,000. In epithelial and non-specific OC, ASIR was >0.5. Five-year survival was 55% and 10-year survival was 45%. Conclusion: OC is the 8th most common cancer in Iran, with lower age-specific incidence and better overall survival than East Asia and North America. In Iran, as in Eastern Europe, OC incidence correlated with reduced total fertility rate and population aging. Five and 10-year overall survival rates were 55% and 44%, respectively, higher than the West. This may be because late stage OC patients are excluded from pathology and classified as “undiagnosed” in death certificates or hospitalization files.

Breast cancer is one of the most common challenges for women's health. Until now, neoadjuvant chemotherapy is a standard approach in locally advanced breast cancer (LABC), as it increases the probability of breast-conserving surgery (BCS). This study aimed to compare the survival rate in neoadjuvant and adjuvant groups to suggest a better treatment strategy for locally advanced breast cancer.The study was conducted between 2009 and 2019 on 845 LABC patients at the Cancer Research Center of Shahid Beheshti University of Medical Sciences in Iran. All patients with LABC at stages 3A, 3B, and two were evaluated for treatment with adjuvants (n = 520 female patients) and neoadjuvant (n = 320 female patients) treatment strategies. Patients were followed up for at least 120 months. The Kaplan-Meier method calculated the survival rate using SPSS version 23 software.The 5 and 10 years survival rates of neoadjuvant and adjuvant groups were 87 ± 0.04, 80 ± 0.07% and 87 ± 0.02, 83 ± 0.03%, respectively. Statistical analysis results with the mentioned treatment strategies did not show any significant difference in overall survival.The result of this study on LABC patients demonstrated that compared to surgery first following adjuvant chemotherapy, the neoadjuvant chemotherapy has several benefits, including downstaging and more BCS, with no statistically significant difference in the overall survival rate of the patients.

Pediatric sarcomas are divided into two major groups of soft-tissue sarcomas (STSs) and malignant bone tumors (MBTs).The aim of the present study was to determine the incidence and survival rate of STSs and MBTs in the Iranian population based on diagnosis date, gender, age, and histological types.Data was retrieved from Iran National Cancer Registry between 2008 and 2015. The dataset was classified according to the third edition of the International Classification of Childhood Cancer. The survival information was merely available for 291 (21% of total data), including 142 (49%) MBTs and 149 (51%) STSs. The age-standardized incidence rates (ASIRs) and five-year survival rates were calculated.The present study is the first comprehensive study of pediatric sarcomas in Iran, in which a lower incidence and survival rate of MBTs and STSs compared with high-income countries were found. However, the survival rates of these malignancies were higher in high-income countries compared to Iran. This study showed the need to improve the quantity and quality of the population-based registry in Iran for acquiring progress in the prevention and control of sarcomas.

Background: Breast sarcomas are a group of rare and non-epithelial malignancies that account for less than 1% of breast cancers. There are few epidemiologic studies on this type of cancer due to its rarity. Methods: In this study, the database of the Iran National Cancer Registry (INCR) from March 2009 to March 2014 was used to calculate the age-specific incidence rate for breast sarcoma in Iran. Moreover, age-standardized incidence rate (ASR) for pathologic subtypes, pathologic grades, and different regions of the country were determined. Results: Totally, 258 breast sarcoma patients were included in this study in Iran. The ASR of breast sarcoma was 1.17 (95% CI: 1.02, .32) and 0.60 (95% CI: 0.52, 0.67) per million person-years for women and the total population, respectively. ASR was 0.03 (95%CI: 0.01, 0.06) per million person-years for male patients. The highest age-specific incidence rate for malignant phyllodes was observed among patients aged 55 to 59 years (1.0; 95% CI: 0.5, 1.5), and for other sarcomas, it was found among those aged 70 to 74 years (0.9; 95% CI: 0.2, 1.6). The most prevalent pathologic grade of sarcoma was grade 3 with an ASR of 0.40 (95% CI: 0.34, 0.46) per million person-years. Conclusions: Compared to western countries, Iran has a lower incidence of breast sarcoma in women, a higher incidence rate in men, and older onset age. As in other countries, malignant phyllodes tumors and angiosarcomas are the most common subtypes. In addition, breast sarcoma incidence rates in different grades are similar across countries.

Background: Adequate treatment for all resectable early gastric cancers (EGCs) is gastrectomy with regional lymphadenectomy. The number of positive resected lymph nodes during lymphadenectomy can be a reliable predictor of survival of GC. Objectives: We aimed at assessing the prognostic significance of dissected lymph node count (DLNC), positive LNC (PLNC), and lymph node ratio (LNR) in patients with EGC. Methods: In the current retrospective cohort, 201 patients with resectable EGC were included. Demographic variables, clinicopathological characteristics of tumors (including numbers of total dissected nodes and positive, negative nodes), history of receiving adjuvant cancer therapies, and 1- and 5-year survivals were noted. Results: DLNC, PLNC, and LNR were associated with differentiation and depth of tumor, lymph node status, and risk of death (P-value for all < 0.05). There was no correlation between either of these measures with preoperative symptoms, lymphovascular invasion, and recurrence. DLNC, PLNC, and LNR showed prognostic significance only in patients, who did not receive comprehensive therapy (P-value < 0.001 for all). A significantly higher LNR was seen in patients with more than 1-year survival compared to others (P-value = 0.011). A significantly lower DLNC and higher PLNC were seen in patients, who survived over 5 years (P-value of 0.002 and 0.047, respectively). Conclusions: LNR, DLNC, and PLNC are significant prognostic factors for EGC. According to our findings, choosing the optimal approach, through which fewer negative lymph nodes are dissected, is crucial in increasing overall survival and extended lymphadenectomy cannot necessarily benefit patients.

Objective Circulating insulin levels have been positively associated with risk of breast cancer (BrCa); however, it remains unclear whether a diet inducing an elevated insulin response influences Breast risk. Methods In this study, 250 newly diagnosed breast cancer patients and 250 hospitalized controls were recruited using convenience sampling. The dietary insulin index (DII) was calculated by dividing the dietary insulin load by the total energy intake. Results Compared with those in the lowest tertiles of DII and dietary insulin load (DIL), subjects in the highest tertile were more likely to be overweight, have a family history of breast and other types of cancer and a history of benign breast diseases. After controlling for multiple potential confounders, a significantly increased BrCa odds was observed in the highest tertiles of DII and DIL score compared to the lowest tertiles (odds ratio (OR): 1.46; 95% CI: 0.67-3.19, p = 0.006) and (OR: 1.87; 95% CI: 0.92-3.80, p = 0.038), respectively. Conclusions Our findings suggest that a diet that induces an elevated postprandial insulin response, indicated by higher DII and DIL scores, may increase the odds of BrCa, especially among women.

Background: One of the most important alterations in breast cancer treatment is the change of view in axillary lymph node management. At the moment, sentinel lymph node biopsy (SLNB) is the standard care in axillary lymph node management. However, in patients with clinically positive lymph nodes or in patients, who have no willingness to receive radioactive drugs, axillary lymph node dissection (ALND) must be done. To the best of our knowledge, there is no overall survival (OS) benefit in ALND, especially at the early stage of breast cancer, during which this procedure is not justified. Objectives: Herein, we have reported the results of 27 years of experiments in limited axillary lymph node dissection (LALND) in comparison to ALND as well as the relationship among the number of removed lymph nodes, OS, and disease-free survival (DFS) at the early stage of breast cancer. Methods: OS and DFS for 588 cases, who were at the early stage of breast cancer and treated by LALND between 1984 and 2019, were compared with 1026 patients, who were treated by ALND during the same interval in this study. Notably, SLNB cases were excluded. Results: The results revealed no significant difference among the groups in terms of DFS (P = 0.268, 0.123, and 0.333). Also, there was no difference in terms of OS between the LALND group (1 - 4 nodes, 5 - 6 nodes, and 7 - 8 nodes) and ALND group (≥ 9 nodes) in patients without lymph node involvement (AHR less than 2). However, in the patients with axillary lymph node metastasis (N1, N2), similar results were obtained. Correspondingly, in this group, the best results were observed in those patients, whose 7 - 8 lymph nodes were removed. Conclusions: Regarding the results of the current study; it can be concluded that performing the LALND in the defined anatomic range and removing 7 - 8 lymph nodes instead of removing 10 lymph nodes are not inferior when it is not possible to do SLNB (there is no access to it) and/or being a contraindication to do it for evaluating the status of axillary lymph nodes in the patients at the early stage of breast cancer.

Background: Among different common types of cancer, Gastric cancer (GC) is a worldwide health priority in both developing and developed countries. The aim of this study was to map the distribution of incident cases of GC in Iran to provide a geographical presentation of the incidence of the disease.Methods: This study used the Iranian National Cancer Registry (INCR) data from 2004 to 2014. Excel was used to do the primary analysis including calculation of GC incidence for each province and also to provide a frequency table of the type and location of GC by the provinces. ArcGIS 10.5 (Redlands, CA, USA) mapping software was used to map the provincial age-standardized incidence rates by sex. The type and location of the GC cases were obtained from the NCR dataset.Results: According to the results of the present study, the patients were predominantly male 49,907 (70.0%). During the study period, the highest and lowest age-standardized incidence rates of GC in Iran in 2014 were reported from Ardebil (IR=30.19) and Ghom (IR=1.00) respectively. A significant difference was observed when the distribution of the location of GC tumors was compared between males and females (PConclusions: The results of the current study suggested a lower rate of GC incidence rate was reported in Iran when compared to the global figure in both females and males. The findings suggest involving different factors with different effects in GC among Iranian populations. Further studies are needed to better understand the epidemiology and etiology of the disease.

BACKGROUND: The effect of race and ethnicity on some kind of malignant bone tumors including Ewing sarcoma has been proven in different studies. In order to evaluate the latter, national cancer registries may help to increase understanding about potential cancer causes, prevention and control strategies, and apply these findings to control health problems among populations with similar characteristics. METHODS: A national population-based cancer registry study based on all patients affected by Ewing Sarcoma was registered in the Iran National Cancer Registry (INCR) between 2008 and 2015 was designed. Demographic data of microscopically confirmed cases of bone Ewing sarcoma were registered. Patients with Ewing sarcoma were divided in groups to describe the primary site of the tumor (including axial or appendicular bones) and analyzed. In order to analyze the survival rate, randomized selection of the patient through the INCR data-base was performed. RESULTS: A total of 678 cases of malignant Ewing sarcoma of the bone were identified through the INCR. The mean age of Ewing sarcoma in Iran was 21.53 years. Nearly half of patients were observed at the age group of 15-24. The total crude incidence rate of Ewing sarcoma was 1.29 in 1 million. The mean 5 year survival rate was 47%. The Mean survival rate for study population was 5.53. CONCLUSION: The crude incidence rate of Ewing sarcoma in Iran is relatively lower with respect to other registries. The majority of patients are in 15-25 years group and shows affection by Ewing sarcoma in an older age. Socioeconomic factors had direct influence on survival rate.

Introduction. Surgery has been known as the procedure of choice for breast cancer management since 1700 years before Christ. Nowadays, breast-conserving surgery and mastectomy are performed in selected cases with specific clinical criteria. Here, we compare these two procedures for breast cancer patients with variable features in Cancer Research Center, Tehran, as a single institution experience. Methods. In this 25-year follow-up retrospective cohort study, we identified breast cancer patients who had undergone breast-conserving therapy or mastectomy. Disease-free survival and overall survival were evaluated using Kaplan–Meier survival analysis and the log-rank test between the two groups. A p value less than 0.05 was considered statistically significant. Results. A total of 3358 breast cancer patients, including 61% breast-conserving therapy and 39% mastectomy cases were identified, with a mean follow-up time of 94 months. The overall survival and disease-free survival of all cases were significantly better in breast-conserved patients, particularly in early-stage breast cancer with favorable clinical, pathological, and biological features. Ten-year disease-free survival and overall survival in breast-conserving therapy and mastectomy cases were 74%, 88% and 58%, 80%, respectively. Conclusion. Breast-conserving surgery and radiation therapy prove to be an appropriate treatment option for breast cancer patients in terms of overall survival and disease-free survival when indicated.

Background: Breast cancer (BC) is the most prevalent cancer in Iranian women and the fifth most common cause of cancer-related death in Iran. Risk factors in the adult life may act during fetus life and after delivery. We conducted a case–control study to find out the relation of in utero and early life exposure and risk of BC. Methods: A structured questionnaire that covered demographic criteria and BC risk factors in utero was completed for case (732 cases) and control (584 subjects) groups, matched in terms of demographic variants, reproductive issues and socioeconomic status. Odds ratio (OR) and 95% confidence intervals (CI) were computed as measures of association from the logistic models. Results: Having been breast feed for more than 19-24 month (P

Background: Cancer is the first cause of death followed by ischemic heart disease (IHD) and stroke, worldwide, with increasing 19.5% years of life lost (YLL) due to cancer from 2007 to 2017. The cancer burden is steadily increased with decreasing 4.4% death rate from 2007 - 2017. The incidence rate of cancer is twice to 3 times higher in developed countries with low mortality due to care regarding developing countries. Objectives: Here, we report the 10 years’ incidence and mortality of malignancies in Iran with different patterns compared to the other parts of the world. Methods: Data of national cancer registry system from 2005 to 2014 were analyzed in order to find out the trend of age standardized incidence rate (ASIR)/age standardized mortality rate (ASMR)/ mortality to incidence ratio (MIR) in both sexes in Iranian population. Results: Growing trend in ASIR for both sexes in all of the cancers were seen. ASMR decreased from 2005 to 2014 in both sexes with higher rate in males. MIR decreased by half in 2014 compared to 2005 regarding the increase of cancer in Iran. Conclusions: In Iran, the incidence of cancer is increasing due to aging people and death is decreasing due to the good care of patient. So, it is a good sample of developing country, which is comparable with the developed ones.

Background: The close link between molecular subtypes and different histological types of breast cancer has recently been taken into consideration. Objectives: The present study aimed at evaluating the reproductive risk factors in relation to molecular subtypes and histological features of breast cancer in a large group of Iranian patients. Methods: This historical cohort study was conducted on 1988 women diagnosed as different subtypes of breast cancers recruited in 2011 to 2016 from cancer research center in Shahid Beheshti University of Medical Sciences, Iran. Data on molecular markers were obtained from hospital files obtaining originally from immunohistochemical staining technique. Based on the pathological reports in hospital recorded files, the histological patterns of the cancer was also determined. The patients were followed for 5 years to assess the 5-year survival and compared the survival across the different molecular subtypes. Results: The highest mean age was found for the group with HER2-overexpression and the lowest for those with luminal A (P = 0.045). The most and the least tumor size was revealed in triple negative group and luminal A group, respectively (P = 0.035). The mean number of lymph nodes involved in breast cancer was significantly higher in luminal B subtypes compared to luminal A and triple negative subtypes (P = 0.004). The tumor stages III-IV were found in 31.6% of patients with luminal A subtype, 42.2% in patients with luminal B, 34.3% in patients with HER2 overexpression, and 26.0% in those with triple negative subtype (P = 0.006). The histological patterns of the tumor were powerfully different in terms of the molecular subtypes of tumor so that luminal A subtype was found more in ILC pattern, luminal B subtype was found more in DCIS pattern, HER2-overexpression subtype was revealed more in DCIS pattern, and triple negative subtype was found more in IDC pattern. Based on the long-term survival analysis, 5-year survival was found to be 98.3% in luminal A group, 98.3% in luminal B group, 100% in HER2 overexpression, and 98.1% in triple negative with no difference between different molecular subtypes. The lowest 5-year survival was found in the patients aged higher than 30 years at first pregnancy and live birth with triple negative subtype (survival rate of 75.0%). The long-term survival was adversely associated with the tumor stage but independent to tumor molecular subtypes. Conclusions: Age at first live birth, tumor size, lymph node involvement, tumor stage, and histological pattern of breast cancer are linked to its molecular subtype. The lower long-term survival of breast cancer can be predicted by advanced age (especially in triple negative subtype) and by higher tumor stage independent to molecular subtype.

Background: Breast cancer treatment success depends upon prolonging survival with effective treatment, and constant monitoring of recurrence. Survival rate can well be improved by better understanding of prognostic factors, preventive measures, and effective treatments together with follow-up and post-treatment care. Objectives: This study is aimed to know prognostic factors effective in recurrence and death in Iranian breast cancer patients. Methods: This is a retrospective study conducted by reviewing data acquired from 1604 female breast cancer patients who were admitted to Cancer Research Center at Shahid Beheshti University of Medical Sciences between October, 1982 and March, 2014. During the follow-up, after diagnosis, 313 patients experienced recurrence then were classified into two groups: early recurrence, less than 1 year and late recurrence after 5 years. We analyzed prognostic factors of recurrence in each groups and evaluated effective factors of death in this patients. Results: Median age of patients at diagnosis was 50 years. Median follow up time was 4.33 years (range: 0.005-24.9 years). Of these patients, 210 (67.09 %) and 76 (24.28%), developed distant and loco -regional recurrence. Among 313 patients, 62 (21/60%) and 69 (24/04%) had early and late recurrence. In the univariate analysis, tumor grade, stage of disease, ER and PR status, axillary lymph node involvement and lymph vascular invasion were the prognostic factors affecting recurrence in patients, but in the multivariate analysis, ER/PR status was the most important independent prognostic factor affecting the early recurrence and stage of disease were prognostic factors in late recurrence. In all of the recurrent patients, 56.86% (178 individuals) survived and 43.13% (135 individuals) died at the end of follow-up period. The most important factors of death were histologic grade, disease free survival time, site of recurrence and age of disease. Conclusions: Biologic marker, estrogen and progesterone receptors status, had most influence in early recurrence, unlike late recurrence, stage of disease had a more important role. However, lymph vascular invasion has been an effective factor either in early or late recurrence. As a result of studying effective factors in death of these patients, recurrence site, DFS, pathologic grade and patients’ age at the time of recurrence came to be effective. Knowing more about affecting factors on recurrence and the death of patients with recurrence, one can try to enhance survival and quality of life in patients by adopting more effective treatments.

Background: Normally, surgery is the first choice of treatment for breast cancer which brings about side effects as chronic pain. Post mastectomy pain syndrome (PMPS) is one of the most prevalent side effects in breast cancer survivors as a chronic neuropathic pain lasting more than three months. The precise mechanisms and risk factors connected to chronic pain after breast surgery are not identified. Objectives: This study is aimed at identifying the effects of fertility on PMPS after breast surgery in breast cancer patients. Methods: In this case-control study, a total number of 111 women were studied. Of these, 56 women were diagnosed with positive PMPS and place in the case group, and 55 patients without pain were selected as the control group. The patients’ demographic and clinical information were collected by means of a questionaire and their medical files. Descriptive statistics and inferential statistics, chi-square, Mann-whitney U, Regression Logisitic (Backward), were used to analyze the data in SPSS 22 software. Results: According to the acquired results, the mean age of the study population was 49.77 ± 10.94, the mean weight was 69.5 ± 11.45 kg, the mean height was 160 ± 8.14 centimeter and mean BMI was 27.4 ± 5.4. All in all, the results showed that fertile women were more likely not to suffer from PMPS compared to nulipar women, and there was not a correlation between psychological disorders or other diseases, and PMPS. Conclusions: Fertility is not only a decrescent factor of breast cancer, but also reduces PMPS in breast cancer patients. Encouraging timely fertility, and pregnancy and lactation cares must be the major part of reproductive health education programs.

Background: Breast cancer is the most prevalent cancer and the fifth cause of cancer death in Iranian women. Early detection and treatment are important for appropriate management of this disease. Mammography and ultrasonography are used for screening and evaluation of symptomatic cases and the main diagnostic test for breast cancer is pathological. In this study we evaluated mammography and ultrasonography as diagnostic tools. Methods: In this cross-sectional study 384 mammography and ultrasonography reports for 255 women were assessed, divided into benign and malignant groups. Suspected cases were referred for pathology evaluation. The radiologic and pathologic reports were compared and also comparison was performed based on age groups (more and less than 50 years old), history of breastfeeding and gravidity. Statistical analysis was performed by SPSS. Results: The mean ages of malignant and benign cases were 49±11.6 and 43±11.2 years, respectively. Sensitivity and specificity for mammography were 73% and 45%, respectively. Sensitivity and specificity for ultrasonography were 69% and 49%, respectively. There were statistical differences between specificity of mammography in patients based on factors such as history of gravidity, breastfeeding and sensitivity in patients equal or more than 50 years old and less. Conclusion: Factors affecting different results in mammography and ultrasonography reports were classified into three groups, consisting of skill, experience and training of medical staff, and setting of instruments. It is recommended that health managers in developing countries pay attention the quality of setting and man power more than current status. Policy-makers and managers must establish guidelines regarding breast imaging in Iran.

Introduction: Idiopathic Granulomatous Mastitis; Despite its low incidence, is in high interest due to masquerading as carcinoma of the breast. In confirmed IGM case series, it`s been reported that more than 50% of patients were initially misdiagnosed as affecting by carcinoma of the Breast. Herein we are introducing a non-surgical management of IGM with frequently aspiration of the masses accompanied by using bacteriostatics and close regular surveillance. Material and Method: This was a before and after clinical trial looking at the effects of repeated aspirations coupled with antibiotic treatment on the natural course of IGM. Overall 55 patients met the inclusion criteria. These patients underwent clinical and imaging study as well as Core Needle Biopsy (CNB) of the lesion with a 14-16 Gauge needle. Patients` presenting sign and symptoms were categorized into six variable ones, including inflammation, Erythma, mass, pain and sinus formation. Confirmed cases of IGM were treated with antibiotic therapy (Ciprofloxacin 500 mg, or Trimethoprin-Sulfamethoxazol 400+80 mg every 12 hours) until either the relief of symptoms or a maximum of 3 weeks. One or two Weeks follow up visits were conducted in the first three months, monthly visits in the first six months, and then no matter when the last visit was done, it was recorded. Results: 44 patients (80% of cases), elucidated signs of inflammation, whereas solely 18 patients (32% of cases) were presented with inflamed breasts at final visit. (P value=0.03) 45 patients (81% of cases) presenting symptom was erythema, ultimately there were 14 cases (25%) in whom erythema persists. (p value=0.03) Mass presence was the dominant sign being discovered in 45 (72%) of enrolled cases at the time of first visit. The reported results has experienced a decline curve, finally 10 cases (18%) has remained symptomatic with a mass. (P value=0.02) Furthermore pain was elucidated in more than half of those who entered the study, 25 cases (56%). Sinus formation has complicated 14.5% (8 cases) of the patients, interestingly followed by a minimal rise at second visit during 1-3 weeks, the number of affected patients was consistently reported as 7 patients (12%) during the further visits. Discussion and Conclusion: Because of the nature of the disease which is an inflammatory reaction, any form of surgical intervention will be an unsuitable procedure and may become a disaster for both patient and the physician. As a result, the procedure of recurrent drainage may resolve the symptoms of pain, erythema and possibly the sinus formation, ultimately the mass will be resolved; therefore the recurrent drainage is highly recommended.