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The aim of the survey Parcours de Femmes 2001 was to evaluate at a national level, the overall management of patients with breast or gynecological cancers and to determine their needs. Eligible patients had either received at least 3 months of treatment or had completed treatment less than 1 year before the study. from February to November 2001, 2 839 questionnaires were distributed ; 1 870 were returned (66% response rate); 87% of patients had breast cancer and 76% de novo cancer (primary management). Overall, 92% of women received information/explanations with an acceptable quality. Information of patients clearly improved during last years but insufficiencies persist for two points : adverse events of treatments and disease progression, especially for recurrent patients. Fatigue (78%), anxiety (66%) and chemotherapy adverse events were the most frequent problems and were well managed by caregivers, except for fatigue due to diagnostic and treatment difficulties. Problems relating to daily life (48% of patients reported difficulty in doing housework), material and social life were poorly identified and remained largely unmanaged. Information given to female cancer patients must be improved particularly in relapsed patients. Psychosocial management requires a more holistic approach through new channels together with the coordination of existing structures.

Summary version of the standards, options and recommendations for nonmetastatic breast cancer (updated January 2001)

Six hundred seventy-six patients with ductal carcinoma in situ of the breast (DCIS) from 1971 to 1995 were included in the study. Computerized patient files were retrospectively analyzed. Clinical findings were less frequently reported to reveal DCIS after 1989. Positive mammographic findings were obtained in 87% of patients and were mainly represented by microcalcifications (79.4%). Treatment procedures were breast-conserving surgery (BCS) alone (37.5%), BCS followed by radiation (BCSR) (25.5%), or mastectomy (M) (37%). The actuarial local recurrence was 2.6% in the M group (94 months of follow-up), 14.5% in the BCS group (85,7 months of follow-up), and 7.5% in the BCSR group (78.8 months of follow-up). Predictive factors of recurrence in all patients were invaded margin status and age. In the BCS group, grade was also a predictive factor. The analysis per decade shows that the lesions currently diagnosed are less serious than those of the past. All the recurrence in patients with positive margins was in the same quadrant as the original lesion. This further emphasizes the need for clear margins.

To assess the clinical and histological characteristics of breast cancer (BC) occurring after Hodgkin's disease (HD) and give possible therapies and prevention methods.In a retrospective multicentric analysis, 117 women and two men treated for HD subsequently developed 133 BCs. The median age at diagnosis of HD was 24 years. The HD stages were stage I in 25 cases (21%), stage II in 70 cases (59%), stage III in 13 cases (11%), stage IV in six cases (5%) and not specified in five cases (4%). Radiotherapy (RT) was used alone in 74 patients (63%) and combined modalities with chemotherapy (CT) was used in 43 patients (37%).BC occurred after a median interval of 16 years. TNM classification (UICC, 1978) showed 15 T0 (11.3%), 44 T1 (33.1%), 36 T2 (27.1%), nine T3 (6.7%), 15 T4 (11.3%) and 14 Tx (10.5%). Ductal infiltrating carcinoma and ductal carcinoma in situ (DCIS) represented 81.2 and 11.3% of the cases, respectively. Among the infiltrating carcinoma, the axillary involvement rate was 50%. Seventy-four tumours were treated by mastectomy without (67) or with (ten) RT. Forty-four tumours had lumpectomy without (12) or with (32) RT. Another four received RT alone, and one CT alone. Sixteen patients (12%) developed isolated local recurrence. Thirty-nine patients (31.7%) developed metastases and 34 died; 38 are in complete remission whereas five died of intercurrent disease. The 5-year disease-specific survival rate was 65.1%. The 5-year disease-specific survival rates for the pN0, pN1-3 and pN3 groups were 91, 66 and 15%, respectively (P0.0001), and 100, 88, and 64% for the TIS, T1 and T2. For the T3 and T4, the survival rates decreased sharply to 32 and 23%, respectively. These secondary BC are of two types: a large number of aggressive tumours with a very unfavourable prognosis (especially in the case of pN3 and/or T3T4), and many tumours with a 'slow spreading' such as DCIS and microinvasive lesions. These lesions developed especially in patients treated exclusively by RT.The young women and girls treated for HD should be carefully monitored in the long-term by clinical examination, mammography and ultrasonography. We suggest that a baseline mammography is performed 5-8 years after supradiaphragmatic irradiation (complete mantle or involved field) in patients who were treated before 30 years of age. Subsequent mammographies should be performed every 2 years or each year, depending on the characteristics of the breast tissue (e.g. density) and especially in the case of an association with other BC risk factors. This screening seems of importance due to excellent prognosis in our T(1S)T(1) groups, and the possibility of offering these young women a conservative treatment.

Resume Afin d'evaluer le besoin des patients concernant l'information donnee en radiotherapie, une etude anthropologique, qualitative, a ete menee. Celle-ci s'est effectuee a partir de l'experience de la radiotherapie de 13 femmes atteintes d'un cancer du sein et de six hommes ayant un cancer des voies aerodigestives superieures. Une anthropologue a passe un an dans le service de radiotherapie de l'institut Bergonie et a recueilli les besoins des patients a travers l'observation du vecu des traitements et par des entretiens. Ceux-ci ont ete realises dans les differents lieux et pendant les differentes etapes du traitement et analyses qualitativement et quantitativement. Leurs analyses ont mis en valeur le besoin de plus d'explications concernant les differentes etapes de la radiotherapie et, surtout, le besoin d'une reconnaissance des attentes de l'autre (empathie).

Objectives: To conduct a survey of the angiosarcomas developing after breast conservation for carcinoma in the French Cancer Centers, to study the evolution of these cases in detail, and to review literature in an attempt to propose an optimal treatment scheme. Material and Methods: Eleven of the 20 French Cancer Centers agreed to research and retrospectively analyze all angiosarcomas discovered in patients previously treated by conservative treatment. The majority of the patients were node negative, T1N0M0. The mean age of the patients at the time of primary breast cancer treatment was 62.5 years, and 69 years at the diagnosis of the angiosarcoma. Results: During the last two decades, nearly 20,000 patients have been treated conservatively in these 11 centers, and only 9 cases of angiosarcoma were found. The median latency period between the treatment of the breast carcinoma and the diagnosis of the breast angiosarcoma was approximately 74 months, with a range of 57–108 months. Mastectomy was performed as the main treatment of this angiosarcoma. All recurrences after mastectomy for the angiosarcoma appeared within 16 months after the mastectomy. A median time of recurrence was found to be 7.5 months, regardless of the treatment. The angiosarcomas appeared to be very aggressive, and chemotherapy, radiotherapy, and sometimes hyperthermia could only palliate the condition for a short time. After the diagnosis of angiosarcoma, the median survival was 15.5 months, showing a particularly poor prognosis. Only 1 patient of 9 is alive without progressive disease at 32 months after salvage mastectomy for the recurrence of the angiosarcoma. Precise data obtained from 11 centers show that, of 18115 breast carcinomas treated conservatively, only 9 breast angiosarcomas are reported, which represents a prevalence of 5 cases of angiosarcoma per 10,000, which is the same prevalence for primary breast angiosarcomas occurring in healthy breasts. Conclusion: Angiosarcoma developing after breast conserving therapy for carcinoma is a rare event, and induction of it by treatment is controversial. However, early diagnosis is essential and it appears that radical mastectomy gives the highest chance of cure and the best long-term survival.

Resume Objectif de l'etude Cette etude randomisee a pour objectif d'apprecier les avantages et les inconvenients d'une chimiotherapie neo-adjuvante dans des cancers du sein operables de plus de 3 cm de diametre. Patients et methodes Cet essai pragmatique randomise a ete conduit dans un seul centre (institut Bergonie, Bordeaux): 272 malades de moins de 70 ans ont ete incluses de janvier 1985 a avril 1989. Deux attitudes therapeutiques ont ete comparees: le groupe A (138 cas) recevait le traitement classique par mastectomie et curage axillaire avec chimiotherapie adjuvante en cas d'envahissement ganglionnaire (n = 82) ou de negativite du dosage de recepteurs hormonaux (n = 22); le groupe B (134 cas) recevait la meme chimiotherapie en induction avec un traitement locoregional adapte en fonction de la reponse obtenue. La dimension tumorale clinique initiale moyenne etait de 43 mm. Resultats La duree moyenne du suivi a ete de 124 mois. Dans le groupe B, 49 malades (36,5 %) se sont averees chimioresistantes d'emblee; 84 (62,6 %) ont ete chimiosensibles et ont beneficie d'un traitement conservateur. Dans ce dernier sous-groupe, la survenue d'une rechute locale a rendu necessaire une mastectomie seconde dans 19 cas (22,6 %). Les courbes de survie ne sont pas differentes dans les groupes A et B, bien que le nombre de rechutes locoregionales ait ete plus important dans le groupe B. A10 ans, la survie globale a ete de 60 % et la moitie des patientes vivantes du groupe B ont pu conserver leur sein. Conclusion La chimiotherapie d'induction a permis de realiser deux fois sur trois un traitement conservateur du sein, initialement juge impossible au prix d'un taux de rechute locoregionale plus important que ce que l'on observe apres mastectomie et chimiotherapie adjuvante.

The relationship between pregnancy and the outcome of breast cancer remains controversial. The purpose of this study was to determine the prognostic value of pregnancy at the time of diagnosis of primary infiltrating breast cancer. In a retrospective multi-center study we compared a group of 154 patients presenting pregnancy-associated (PA) breast cancer with a control group of 308 patients presenting non-pregnancy-associated (non-PA) breast cancer. Classic prognostic factors, treatment modalities, disease-free survival and overall survival were compared in the 2 groups. The relative importance of pregnancy was assessed by Cox multivariate analysis. There was a significantly higher proportion of inflammatory breast cancer, large tumors and negative receptor status in the PA group. Five-year recurrence-free survival, metastasis-free survival and overall survival were lower both in the whole PA group and in the PA sub-group excluding patients with inflammatory breast cancer than in the corresponding non-PA groups. According to clinical stage, histoprognostic grade and microscopic lymph-node involvement, probability of 5-year metastasis-free survival and overall survival was lower in the PA group. Outcome was significantly poorer after chemotherapy for patients in the PA sub-group than in the non-PA sub-group. Multivariate analysis demonstrated that pregnancy was an independent and significant prognostic factor. Pregnancy has an adverse effect on the outcome of breast cancer. Concurrent or recent pregnancy should be taken into account in the development of new systemic therapies. Our findings have important implications for further research into the basic mechanisms of cancer.

Background and purpose : We performed a survey to evaluate the present status and means of information given to patients treated by radiotherapy. A short questionnaire was sent, with the help of ESTRO, to 746 European heads of department with a request to send specific documents used for informing the patient. Within 2 months (March and April 1996) we received 290 answers (39%) and 97 centres sent documents. Materials and methods : Analysis of the questionnaire and the documents was performed quantitatively with usual statistical methods and qualitatively with a socio-anthropological method of content analysis. Results : Analysis of the questionnaire shows the major role of the radiation oncologist in giving information and writing documents. The 298 different samples sent from 97 centres represent a wide panel with a booklet of general information (59 booklets/57 centres), practical advice and specific explanations (177 documents/49 centres) and informed consent (36 documents/28 centres). The anthropological study was centred on the way information was given, evaluation of the patient's understanding and analysis of documents sent. Conclusion : This preliminary survey needs to be completed by a study, including the patient's point of view and needs, about the information given.

The objective of this retrospective study was to identify prognostic, diagnostic, and therapeutic disparities between younger (≤ 40 years) and older (40 years) women with ductal carcinoma in situ (DCIS) of the breast.From 1971 to 2001, all patients treated for DCIS at Institut Bergonié were included in our analyses. Follow-up data was collected over 10 years. We used univariate and multivariate analyses to investigate patient-, disease-, and treatment-related factors predictive of diagnostic, histological, therapeutic, and prognostic DCIS criteria.A total of 812 patients were eligible including 731 women aged40 years and 81 women ≤40 years. Younger women with DCIS were more likely to receive a mastectomy and less likely to receive radiotherapy. Young age and initial surgical treatment (lumpectomy and especially nonfree margins) were revealed as predictive of recurrence in multivariate analyses.Young age represents a recurrence risk independent of histological and clinical characteristics of the tumor. Initial treatment, especially for nonfree margins, is also a predictive factor. Appropriate initial surgery with particularly wide margins appears essential for the treatment of young women with DCIS.

A longitudinal study enrolled 75 women with primary breast cancer. Before the confirmation of diagnosis, authors measured trait-anxiety and body satisfaction. Three weeks after diagnosis, coping strategies and state-anxiety were evaluated. The number of days of survival was measured 10 years after diagnosis. In Cox proportional-hazards models adjusting for severity of disease and age, high social support and low state-anxiety predicted an increased risk of death from breast cancer. A significant increased risk of death in women with low scores on the Body Image Questionnaire appeared only in the univariate model.

We retrospectively analysed mammographies of 909 ductal carcinoma in situ (DCIS) (1980-1999) and compared our results to those of literature. Microcalcifications were present in 75% of the cases, and soft-tissue abnormalities in 27% cases with association with calcifications in 14% of cases. Palpable masses were found in 12% of the cases and nipple discharge was present in 12% of the cases. The radiographic-pathologic correlation allowed to suspect the DCIS "aggressiveness" on radiologic signs. Granular, linear, branching and/or galactophoric topography of the microcalcifications were correlated with necrosis, grade 3, comedocarcinoma type. A number of microcalcifications higher than 20 was correlated with necrosis and grade 3. Mammographic size was correlated to histologic size. Masses were correlated with grade 1. A diagnosis strategy can be proposed with a multidisciplinar approach.

International audience; With the help of ESTRO, we performed a survey to evaluate the present status and means in information given to patients treated by radiotherapy. A short questionnaire was sent to 746 European heads of departments with a request to send specific documents used for informing the patients. Within 2 months (march and april 1996), we received 290 answers (39%) and 97 centers send 298 documents. Methods : analysis of the questionnary and the documents was performed quantitatively with uusual statistical methods and qualitatively with a socio-anthropological method of content analysis. Results : Analysis of the questionnaire shows the major role of the radiation oncologist in giving information and writing documents. The 298 different samples sent from 97 centres represent a wide panel with a booklet of general information (59 booklets /57 centers), practical advice and specific explanations (177 documents/ 49 centers) and informed consent (36 documents/28 centers). the anthropological study was centred on the way information was given, evaluation of the patient'sunderstanding and qualitative analysis of documents sent. Conclusion : the high rate of response (40 %) of this survey shows the general interest for radiation therapy staffs on patient information. However, this preliminary survey needs to be completed by a study, including the patient's point of view and needs, about the information given.

From 1960 to 1986, 397 cases of non-metastatic male breast cancer (MBC) treated in 14 French regional cancer centres were reviewed. The median age was 64 years (range 25-93). TNM classification (UICC, 1978) showed seven T0, 79 T1, 162 T2, 31 T3, 74 T4 and 44 unclassified tumours (Tx). Clinical positive lymph nodes were found in 31% of the patients. 24 patients received radiotherapy only, and 373 underwent surgery, 247 of these with postoperative irradiation. Adjuvant chemotherapy and hormonal therapy were used in 71 and 68 patients, respectively. There were 382 infiltrating carcinomas and 15 pure ductal carcinoma in situ. Lymph node involvement was found in 56% of infiltrating carcinoma. The oestrogen (ER) and progesterone (PgR) receptors were positive in 79% and 77%, respectively, of examined cases. Isolated local and regional recurrence were observed in 8.8% and 4.5% of cases, respectively and 40% of patients developed metastases. The crude survival rates by Kaplan-Meier method were 65% and 38% at 5 and 10 years, respectively, and the disease-specific survival rates (without death due to intercurrent disease or second cancer) was 74% at 5 years and 51% at 10 years. The disease-specific survival rate for pN- and pN+ groups were 77% and 39% at 10 years. The prognostic factors were clinical size (T) and histological axillary status (pN-/pN+). The relative risk of death for pN- was 1.0, 2.0 and 3.2 in the T0-T1, T2 and T3-T4 groups, respectively. For pN+, these relative risks increased 1.9, 3.9 and 6.0 in the same groups. The optimal treatment include modified radical mastectomy and irradiation for cases with risk factors of local relapse (nodal invasion, large tumour with cutaneous or muscular involvement). Locoregional failure had unfavourable prognosis. First-line adjuvant treatment seems to be tamoxifen, due to the very high rate of positive hormonal receptors and the old age of the patients, which contraindicate chemotherapy in many cases. The prognosis of patients with breast cancer is the same in male and female patients when disease-specific survival rate, tumour size and axillary involvement are compared.

Material From 1960 to 1990, 581 cases of male breast cancer (MBC) were reviewed in 19 Cancer Institutes in France. 23 (4%) were pure DCIS. The median age was 56.5 years (ext. 26–77). Five patients had less than 40 years (22%). Gynecomastia was found in 10 out of 23 patients (43%). Three had family history of B. C. According to TNM classification, we found 6 impalpable lesions (T0) discovered by serosanguineous nipple discharge, 7 T1, 6 T2, and 4 Tx. Treatment The surgery consisted of 3 lumpectomies, 16 modified, 2 subcutaneous and 2 radical mastectomies. 16 patients had axillary dissections and 6 irradiation on the chest wall. Histology All cases were pure DCIS: in 14 the subtype was clearly identified: papillary (4), papillary intracystic (3), mixed papillary and cribriform (3), comedocarcinoma (2), cribriform (1), apocrine (1). Three patients had local recurrences: two occurred in the patients initially treated by lumpectomy alone: the first was again a DCIS, but the second was an infiltrating carcinoma; this patient died by metastases. The last relapse occurred on the chest wall in a patient treated by mastectomy. One patient developed a contralateral DCIS. Two patients developed a lung and kidney cancer respectively. In the literature the rate of DCIS in man varies from 0 to 16%. The serosanguineous nipple discharge seems a frequent symptom, especially in young men. The main histologic subtype is papillary (pure or intracystic). Mastectomy is the treatment of choice.

Introduction The second cancers represents the most important problem among the survivors of HD. A possible link with chemotherapy (CT) and radiotherapy (RT) is suggested but genetic and immunologic factors may also be involved. Material In seven Cancer Centers, we found 35 women, previously treated for HD, who developed 37 BC. The median age at diagnosis of HD was 25 years, with 12 less than 20 years. HD stage was: 1 = 3, II = 21, III = 5, IV = 4, NS = 2. 33 women received supradiaphragmatic RT with doses varying from 35 to 45 Gy. 16 women received CT (mainly MOPP). The median interval between the diagnosis of HD and BC was 16 years. According to TNM, we found: 2 T0, 10 Tl, 12 T2, 4 T3, 6 T4 and 3 Tx. 32 were ductal infiltrating carcinoma, 2 medullary, 2 in situ and one fibrosarcoma. Axillary involvement was present in 51% of cases. Mastectomy was performed in 23 cases, a radiosurgical conservative treatment in 12 and exclusive radiotherapy in 2. Fourteen women underwent chemotherapy. Results 7 women had local relapse of BC and 15 had metastases (40%). Three had contralateral metachronous BC. 17 women are in complete remission for both diseases; 15 died of BC. Three women died of intercurrent disease. Conclusion The women treated for HD, especially before 20 years, seem to have an increased risk of subsequent BC. According to other reports, we confirm that these BC are frequently aggressive, with rapid evolution and high risk of bilaterality. Consequently, a regular mammographic follow-up is necessary to detect these lesions earlier, to allow a better prognosis and a possible conservative treatment.