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Background: Breast cancer originates in breast epithelium and is associated with progressive molecular and morphologic changes. Women with atypical breast ductal epithelial cells have an increased relative risk of breast cancer. In this study, ductal lavage, a new procedure for collecting ductal cells with a microcatheter, was compared with nipple aspiration with regard to safety, tolerability, and the ability to detect abnormal breast ephitelial cells. Method: Women at high risk for breast cancer who had nonsuspicious mammograms and clinical breast examinations underwent nipple aspiration followed by lavage of fluid-yielding ducts. All statistical tests were two-sided. Results: The 507 women enrolled included 291 (57%) with a history of breast cancer and 199 (39%) with a 5-year Gail risk for breast cancer of 1.7% or more. Nipple aspirate fluid (NAF) samples were evaluated cytologically for 417 women, and ductal lavage samples were evaluated for 383 women. Adequate samples for diagnosis were collected from 111 (27%) and 299 (78%) women, respectively. A median of 13 500 epithelial cells per duct (range, 43-492 000 cells) was collected by ductal lavage compared with a median of 120 epithelial cells per breast (range, 10-74 300) collected by nipple aspiration. For ductal lavage, 92 (24%) subjects had abnormal cells that were mildly (17%) or markedly (6%) atypical or malignant (

Background. Breast reconstruction is performed with increasing frequency and has become important in the treatment of mastectomy patients. Methods. The development of recurrent carcinoma after a mastectomy and transverse rectus abdominus myocutaneous (TRAM) flap procedure is described. Results. The lesion was nonpalpable and was detected by mammography. Conclusion. This case raises questions about the practice of not performing postreconstruction mammography for detection of local recurrence after mastectomy. Cancer 1994; 74:2804-7.

Ductal carcinoma in situ (DCIS) is a breast cancer arising in the ducts that has not yet invaded surrounding tissue. In the past, the specter of breast cancer was sufficiently ominous that virtually all cases of DCIS were treated with mastectomy. This treatment has been reviewed in recent years, in no small part due to the fact that the growth of mammography is turning up larger numbers of DCIS than were ever diagnosed at such an early stage in the past. Breast-conserving surgery is becoming more popular, but experience with breast-conserving surgery for DCIS is still limited. For this reason, the authors report their experience treating DCIS with conservative surgery and radiation therapy during the period from 1976 to 1985. During this period, 38 patients were diagnosed at a median age of 49 years. In 20 of the patients, the tumor was detectable only by mammography. The tumor was surgically removed in all patients and the tumor bed was treated with an average dose of 6,400 cGy of radiation. An important aspect of the treatment of DCIS is the success of salvage treatment if the cancer recurs after the initial surgery and radiotherapy. In the present study, the cancer recurred in eight patients. These patients underwent mastectomy, and all but one are presently free of disease after a follow-up ranging from 1 to 73 months. Reported local recurrence rates for DCIS after mastectomy range from 0 to 2 percent. Mastectomy, therefore, remains the ''gold standard'' against which other treatments are compared. Only the patient can decide how to balance the small but real risks with the palpable benefits of breast-conserving surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

It has been well established that for women with early breast cancers of the appropriate characteristics, conservative surgery in combination with radiotherapy is as effective as mastectomy. However, numerous questions remain to be answered and many research studies are currently in progress. As might be expected, key questions involve factors that influence the risk of local recurrence of the breast cancer. The histological appearance of the cancer affects the risk of recurrence. For example, when intraductal carcinoma cells are found in grossly normal tissue outside the margin of tumor invasion, the risk of recurrence is 25 percent, in contrast to the 5 percent risk overall. Young age is also thought to be an important risk factor, with a recurrence rate of well over 50 percent among patients under 35. Since younger patients usually have riskier histological findings, it might be thought that this alone accounts for the increased risk of younger patients. However, even when the histological findings of the tumor are accounted for, age under 35 carries an increased risk of recurrence. It is well established that conservative surgery alone is far riskier for recurrence than conservative surgery with radiotherapy of the breast. All patients receiving conservative surgery may be considered to be at high risk for recurrence. Curiously, however, it is not at all clear that local recurrence has a statistically significant effect on mortality in these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

It is accepted that in some cases, breast cancer may be treated without removing the entire breast. This conservative approach removes only the tumor from the breast, while the lymph nodes of the axilla (armpit) are anatomically dissected and postoperative radiation therapy is performed. The details of treatment are still controversial. One controversy involves the extent of axillary surgery required. It has recently been shown that these lymph nodes are prognostic indicators, with limited dissection having a false negative rate of only 3 percent. Axillary dissection is also performed to control tumor in the axilla; limited dissection has previously been shown to decrease tumor recurrence. The results are reported for 259 consecutive patients who underwent breast-conserving treatment with limited axillary dissection. The average age of the patients was 50.5 years. The patients were followed for an average of 22.5 months. The average number of lymph nodes removed was nine (range 2 to 24). The most frequent complication was axillary seroma, collection of blood serum in the tissues, occurring in 11 patients, eight of whom required removal of the fluid by aspiration. Lymphedema, accumulation of lymph fluid in the soft tissue with concomitant swelling, is probably the most distressing long-term complication of axillary dissection. Complete axillary dissection (levels I, II and III) has been reported to have a 37 percent incidence of lymphedema. In the current study, lymphedema occurred in seven patients (2.7 percent). Two patients had tumor recurrence in the axilla. This procedure may be performed on an outpatient basis, and does not require the use of indwelling drains after surgery. It is concluded that limited axillary dissection is a good prognostic indicator, with a low rate of complications or recurrence. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fibrocystic disease: What's in a name? The term 'fibrocystic disease of the breast' is still widely used--even though it has so many meanings it no longer means anything at all. [...]

Nipple discharge: Is it cancer? Nipple discharge expressed by a physician during physical examination or by the woman herself during breast self-examination is neither unusual nor, in most cases, pathologic. [...]

Breast cancer expert Dr. Susan Love thinks young women worry too much about breast cancer, which is very uncommon in women in their 20s and 30s.

A family planning nurse from Walsall Community Health NHS Trust, Walsall, UK, describes her work in personal and social education lessons in schools. She works in close collaboration with school nurses and also spends time working in a clinic to ensure that her knowledge is up to date. The benefit of linking health and education is exemplified by the attendance of young people at the clinic asking for a consultation with the person whom they have met in school.