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This review examines the symptoms, need for referral and management of the benign breast conditions which afflict males, together with the steps that are necessary to exclude or confirm male breast cancer. The most common complaint is gynaecomastia, either true or pseudo, and the majority of these cases need reassurance without over-investigation. Drugs that induce breast enlargement are described in order that, when possible, a medication switch can be made. Men receiving endocrine therapy for prostate cancer may develop painful gynaecomastia and this can be relieved with tamoxifen. All men with breast cancer need mammography as part of their work-up but this should not be used as a screening technique for symptomatic males. Because of lack of lobular development, both cysts and fibroadenomas are very rare in men; but those with nipple discharge need referral and investigation as some will have underlying malignancy. [ABSTRACT FROM AUTHOR]

Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) have received considerable interest as potential chemopreventive agents. The aim of this review is to summarize the accumulated knowledge on the effect of NSAIDs on breast cancer incidence and natural history, and the underlying pathophysiology. NSAIDs mainly block inflammation by inhibiting cyclooxygenase enzymes, leading to lower prostaglandin synthesis. The latter has been reported to affect breast cancer risk through hormonal and inflammation-related pathways. Intensity, dose, frequency, duration, and timing of administration may also be significant. There is currently enough evidence to support a role of NSAIDs in breast cancer prevention and relapse, which deserves further large-scale experimental and clinical investigation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Breast Health International and the Kimmel Cancer Center of Thomas Jefferson University cosponsored a consensus conference that included an international group of experts. METHODS: Since the adoption of adjuvant chemotherapy for stage I, lymph node-negative breast cancers in 1988, investigators have tried to 'fine-tune' the treatment criteria. At this consensus conference, the group debated recommendations for adjuvant hormone and cytotoxic chemotherapy in stage I breast cancers. RESULTS: Discussions during the conference addressed issues of adjuvant therapy for stage I breast cancer and the influence of multigene analyses and molecular phenotyping. The panelists discussed various demographic, morphologic, biologic, and genetic factors expressed by individual tumors and their influence on treatment decisions. CONCLUSIONS: The panel tried to create guidelines for the consideration of adjuvant treatment of these patients, including both hormone and cytotoxic regimens. They also encouraged further research into the molecular analysis of breast cancers and the introduction of clinical trials based on current data, although they concluded that it is too early to add any of those analyses into the decision-making algorithms of recommendations for the treatment of stage I breast cancer. Cancer 2012;. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]

A consensus conference including thirty experts was held in April, 2007, to discuss risk factors for breast cancer and their management. Four categories of risk were outlined, from breast cancer “average” through “very high” risk, the latter including individuals with high penetrance BRCA1/2 gene mutations. Guidelines for management of patients in each of these categories were discussed, with the major portion of the conference being devoted to individuals with BRCA1/2 mutations. Prevalence of these mutations in the general populations was estimated to be 1 in 250–500 individuals, with an increased prevalence in Ashkenazic Jews and other founder groups. Risk reduction strategies for these individuals include surveillance, with or without chemoprevention drugs, or surgical procedures to remove the organs at risk, i.e., bilateral mastectomy and/or bilateral salpingo-oophorectomy. These risk reduction strategies were evaluated fully, and recommendations were made for the care of patients in each of the risk categories. These guidelines for patient care were approved by the entire group of experts. [ABSTRACT FROM AUTHOR]

Information about several topics discussed at the Sixth International Consensus Conference on Breast Cancer Risk, Genetics, & Risk Management in Philadelphia, Pennsylvania on April 26-29, 2007 is presented. Topics include risk factor for breast cancer, chemoprevention drugs, and the surgical treatment of cancer. The conference featured several notable individuals including Gordon F. Schwartz, Kevin S. Hughes, and Henry T. Lynch.

The authors reflect on the potential of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing breast cancer in older women in Great Britain. They cite that NSAID use in patients with a diagnosis of osteoarthritis (OA) and it was associated with a 15% reduction in odds of developing colorectal carcinoma. They suggest that NSAID might be an effective and acceptable approach to CANCER risk reduction in older women.

There is evidence that certain connective tissue diseases such as scleroderma are associated with an increased risk of malignancy. Although it has been claimed that systemic lupus erythematosus (SLE) carries an increased risk of breast cancer, review of the available literature suggests that this is not the case, or, any increase is very small. Women with SLE do not need to be under close surveillance for breast cancer. In patients suffering from both SLE and breast cancer, radiotherapy has been regarded as relatively contraindicated because of fears concerning early and late complications. This view is not supported by the available literature and the majority of such cases can be treated by standard breast-conserving therapy, including breast irradiation. [ABSTRACT FROM AUTHOR]

An increasing proportion of patients with breast cancer are aged above 70 at the time of diagnosis and yet this particular age group has been underserved in terms of clinical research. Good communication between a doctor and a patient implies giving the advice and treatment most appropriate to that particular individual’s needs, based upon their health and the tumor characteristics in the framework of their experience and belief system. Doctors need to be able to pick up both verbal and nonverbal cues and whenever possible to place the needs of the patient rather than her relatives as paramount. Consultations may be blighted at the onset by delays, unsympathetic staff, and patronizing doctors. Many older patients will wish to avoid mastectomy and for those with hormonally sensitive tumors wide excision and tamoxifen without axillary clearance or breast irradiation may provide a safe option. Undertreatment of those with hormonally insensitive cancer may lead to an increased risk of recurrence and premature death from breast cancer. Although there is an increasing realization of the need for clinical studies in older patients this group are grossly under-represented in trial portfolios [ABSTRACT FROM AUTHOR]

The article offers information on male breast cancer (MBC). This condition was first described in the 14th century by John of Arderne. Its prevalence in the western world is approximately 1/100,000. There are several risk factors associated with MBC such as genetics and endocrine factors. The treatment of MCS are similar as those in female patients.

Ductal carcinoma in situ (DCIS) is responsible for 25% of screen-detected breast cancers. Various prognostic classifications are in use, including the Van Nuys Prognostic Index and the European Organisation for Research and Treatment of Cancer grading system (well, intermediate or poorly differentiated) based on cytonuclear pattern. This has been modified in screening programs to low, intermediate and high grade. In comparison with normal epithelium, DCIS has a tenfold increase in growth and 15-fold increase in apoptosis. Patients with extensive or multifocal DCIS need mastectomy and sentinel node biopsy, together with reconstruction, if requested. Microinvasion associated with DCIS is an indication for sentinel node biopsy. Randomized trials have confirmed the value of breast irradiation after wide excision, in terms of DCIS relapse and progression to invasive disease. Patients with estrogen receptor-positive DCIS benefit from adjuvant tamoxifen after breast-conserving surgery. [ABSTRACT FROM AUTHOR]

Although the relationship between breast cancer and hormones has been known for almost two centuries, it is only during the last 16 years that evidence suggesting the hormonal profile of the patient at the time of surgery can affect the outcome, came to light. A series of studies investigated the hypothesis that unopposed estrogen (observed during the follicular phase of the cycle) may adversely affect the overall and/or disease-free survival of women operated on at that time. The findings have been, at times, contradictory. The retrospective nature of the studies, poor recording of last menstrual period, small study size, and the possible effect of the timing of the diagnostic procedures (cytology or core biopsy) on the outcome may be responsible for the conflicting results. Despite this, more sophisticated studies based on pathological or hormonal observations/measurements, confirmed the relation of luteal phase surgery to better outcome. Estrogen-induced increased protease activity activates a cascade of proteolysis and allows the more discohesive tumor cells to gain access to the circulation. Moreover, disseminated cells might be able to proliferate easier because of several estrogen-dependent growth factors. Diminished immune function during the follicular phase, because of natural killer cell activity and mononuclear cell phagocytic activity down-regulation may also be implicated in the dissemination of viable tumor cells. Taken together these findings provide a framework for explaining the observation that luteal phase surgery can lead to an improved outcome. By altering the perioperative hormonal milieu it may be possible to reduce deaths from breast cancer in a simple and nontoxic manner. [ABSTRACT FROM AUTHOR]

Sentinel node biopsy (SNB) has become accepted for staging the axilla in early breast cancer with avoidance of axillary lymph node dissection (ALND) in patients with negative SNB. For those with positive SNB, the standard surgical management is ALND; however, this approach is increasingly being challenged. The central problem is that it is not possible to preoperatively predict whether the SNB will be positive, and it is even more difficult to determine the likelihood of nonsentinel node positivity. Various histopathological features indicate increased risk of nonsentinel node metastasis, including size of SNB metastasis, presence of lymphovascular invasion, multifocality, number of involved sentinel nodes and, conversely, the number of negative sentinel nodes. These features have been combined to produce predictive nomograms but, understandably, these still lack precision. Presently, the decision to avoid ALND will depend upon both the clinician and the patient's impression of risk, but if either requires assurance that no residual axillary disease remains, a completion clearance will be required. [ABSTRACT FROM AUTHOR]

The article reports on the staging of the Consensus Conference on Breast Conservation in Milan, Italy from April 28, 2005 to May 1, 2005. It includes information on keynote speakers, as well as the range of issues and subject matter relevant to breast cancer and breast-conserving therapy that were discussed during the event.

Focuses on the treatment of the patients with breast cancer in Great Britain. Induction of apoptotic cells; Assessment on the size of the tumor mass; Reduction on the level of mortality rate.

Background and purpose: Clinical trials have indicated the need for irradiation of the tumour-bearing quadrant in patients with operable breast cancer treated by conservation therapy even under circumstances where there has been complete pathologic clearance. The aim of this phase II trial was to replace whole breast irradiation with brachytherapy to the tumour bed.Patients and methods: A series of 50 patients with operable breast cancers measuring ≤4 cm diameter were treated by combination therapy comprising tumour excision axillary clearance and synoperative insertion of a rigid implant to the tumour bed. The implant was after-loaded with medium dose rate Cs137 sources giving a dose of 45 Gy in daily four fractions of about 6 h duration. No external beam radiotherapy was given.Results: After a median follow-up of 6.3 years, of the 49 evaluable patients, 80% were alive without relapse. Of the 9 patients (18%) who developed a breast relapse, the site of recurrence was in the index quadrant in 7 cases (78%). Of the series, 26 (81%) gave a subjective rating of cosmetic outcome which was excellent or good. Objectively the treated breast was deemed to be normal in 11 (42%) and abnormal in 15 (58%).Conclusions: This phase II study suggests that in a selected group of patients with early breast cancer, external whole breast radiotherapy can be replaced by interstitial irradiation to the tumour bed without compromising local disease control and giving an excellent or good cosmetic outcome in the majority of cases. [Copyright &y& Elsevier]

Background: Experimental data from animals suggest a protective role for the pineal hormone melatonin in the etiology of breast cancer, but results from the few retrospective case-control studies that examined the association in humans have been inconsistent. To determine whether low levels of endogenous melatonin are associated with an increased risk for developing breast cancer, we conducted a prospective nested case-control study among British women.Methods: Concentrations of 6-sulfatoxymelatonin, the main metabolite of melatonin in urine and a validated marker of circulating melatonin levels, were measured by radioimmunoassay in 24-hour urine samples collected from women shortly after enrollment in the prospective Guernsey III Study. Levels of 6-sulfatoxymelatonin were compared among 127 patients diagnosed with breast cancer during follow-up and among 353 control subjects, matched for age, recruitment date, menopausal status, and day of menstrual cycle for premenopausal women or number of years postmenopausal for postmenopausal women. Associations were examined by analyses of covariance and conditional logistic regression. All tests of statistical significance were two-sided.Results: No statistically significant differences in urinary 6-sulfatoxymelatonin concentrations were observed between women who developed breast cancer and control subjects among premenopausal or postmenopausal women (P=.8 and P=.9, respectively). When data from premenopausal and postmenopausal women were combined in a multivariable analysis adjusted for potential confounders and grouped into three categories defined by 6-sulfatoxymelatonin tertiles of control subjects, the level of 6-sulfatoxymelatonin excreted was not statistically significantly associated with the risk of breast cancer (odds ratio [OR] for breast cancer = 0.95, 95% confidence interval [CI] = 0.55 to 1.65, comparing the middle category with the lowest category of 6-sulfatoxymelatonin concentration, and OR = 0.99, 95% CI = 0.58 to 1.70, comparing the highest category with the lowest category).Conclusion: We found no evidence that the level of melatonin is strongly associated with the risk for breast cancer. [ABSTRACT FROM AUTHOR]

Breast cancer usually develops after a series of epithelial changes in the terminal ductolobular unit. There are multiple benign causes of breast lumps, the majority of which are not associated with an increased risk of breast cancer. Histological changes of pre-malignancy such as atypical hyperplasia andin situcarcinoma can be identified, and these are indications for either close surveillance or further surgery. At the time of diagnosis, breast cancers can be staged both clinically and pathologically, and this facilitates international comparisons of results of treatment. [ABSTRACT FROM AUTHOR]

The pathologist examines biopsy material obtained at surgery or preoperatively by core biopsy to make a definitive diagnosis of malignancy and to determine the type and grade of the tumour. Additional prognostic information is provided to the clinician, and this includes the true tumour size and the relative contribution of thein situand invasive components. Other important factors include multifocality, vascular invasion and the presence and extent of axillary nodal metastases. For optimal use of this important information, close cooperation between the members of the multidisciplinary team is essential. [ABSTRACT FROM AUTHOR]

Between July 1989 and December 2002, 172 women with Stage I/II breast cancer were treated by breast conservation therapy (BCT). All underwent quadrantectomy and axillary node clearance. Minimum follow-up was 5 years and 79 (52%) were followed for >10 years. At 5 years, local relapse-free and overall survival rates were 98.3% and 98.3%. The 10-year rates were 95% and 94%, respectively. The 10-year local recurrence rate was higher in patients with involved margins (33.3% versus 2.7%, p = 0.0272). Furthermore 10-year death rates in margin positive patients were higher (18.2% versus 2.5%, p = 0.0486). Excellent or good cosmetic results were achieved in 54%. BCT is a reasonable option for early stage breast cancer in Chinese women but margin status is the most important determinant of local recurrence. Negative margins are required for optimal local control and minimization of distant metastasis. [ABSTRACT FROM AUTHOR]

The article focuses on recent studies about surrogate measures of quality of breast cancer surgery. According to a group of Korean researchers, readmission rates are a true surrogate measure of surgical expertise. Moreover, a recent Swiss study showed that breast cancer patients who had surgery in low-volume hospitals had an increased risk of dying. In addition, length of stay, postoperative complications and readmission occurred with significantly less frequency in patients of high-volume hospitals.

Background: Ductal carcinoma in situ (DCIS) of the breast is a disorder that has become more common since it may manifest as microcalcifications that can be detected by screening mammography. Since selected women with invasive cancer can be treated safely with breast conservation therapy it is paradoxical that total mastectomy has remained the standard treatment for DCIS. We did a randomised phase III clinical trial to investigate the role of radiotherapy after complete local excision of DCIS.Methods: Between 1986 and 1996, women with clinically or mammographically detected DCIS measuring less than or equal to 5 cm were treated by complete local excision of the lesion and then randomly assigned to either no further treatment (n=503) or to radiotherapy (n=507; 50 Gy in 5 weeks to the whole breast). The median duration of follow-up was 4.25 years (maximum 12.0 years). All analyses were by intention to treat.Findings: 500 patients were followed up in the no further treatment group and 502 in the radiotherapy group. In the no further treatment group 83 women had local recurrence (44 recurrences of DCIS, and 40 invasive breast cancer). In the radiotherapy group 53 women had local recurrences (29 recurrences of DCIS, and 24 invasive breast cancer). The 4-year local relapse-free was 84% in the group treated with local excision alone compared with 91% in the women treated by local excision plus radiotherapy (log rank p=0.005; hazard ratio 0.62). Similar reductions in the risk of invasive (40%, p=0.04) and non-invasive (35%, p=0.06) local recurrence were seen.Conclusions: Radiotherapy after local excision for DCIS, as compared with local excision alone, reduced the overall number of both invasive and non-invasive recurrences in the ipsilateral breast at a median follow-up of 4.25 years. [ABSTRACT FROM AUTHOR]