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This paper presents the results of a multi-method research project investigating the psychological distress associated with waiting for results of diagnostic investigations in a delayed-results breast clinic. A cohort of 126 women completed standardized psychometric instruments to assess anxiety, mood and coping over 3 days. Semi-structured interviews were conducted with 20 respondents. The findings indicate that waiting sustained but did not exacerbate psychological distress. Peri-diagnostic anxiety, depression, uncertainty and confusion were associated with anxiety levels immediately following triple assessment. Women leaving the clinic with low anxiety retained this composure throughout the peri-diagnostic period. Those in the moderate and high anxiety groups recorded sustained anxiety, depression, uncertainty and confusion, with mean scores comparable to and exceeding those reported by psychiatric out-patients. Coping during the waiting period was typically accomplished by emotion-focused strategies. Qualitative data suggested the delayed-results clinic structure may facilitate psychological preparation for test results.

The data on 91 patients (aged 30–78 years) with inoperable locally advanced breast cancer treated by primary chemotherapy and radiation therapy from 1980 to 1995 in the Breast Oncology Unit, Cardiff were analysed. Four chemotherapy regimens were used: 1) doxorubicin 40 mg/m 2 + vincristine 1 mg/m 2 (AV), three cycles; 2) mitozantrone 14 mg/m 2 (MZ), three cycles; 3) cyclophosphamide 600 mg/m 2 , methotrexate 40 mg/m 2 , 5-fluorouracil 600 mg/m 2 (CMF), six cycles; 4) cyclophosphamide 600 mg/m 2 , adriamycin/epirubicin 50 mg/m 2 , 5-fluorouracil 600 mg/m 2 (CAF/CEF), six cycles. The breast and glandular areas were irradiated to 40–50 Gy in 15–25 fraction (+/-5–10 Gy boost in two-to-five fractions. The overall response rate to chemotherapy was 61% (95% confidence interval 51–71%) with 13% CR (6–20%). Thirteen patients underwent mastectomy for operable persistent disease. Ten patients had uncontrolled inoperable local disease after primary therapy; 61 patients have relapsed, 69% due to metastases, (15% synchronous with local relapse), 31% local failure only. The overall 2−, 5− and 10-year survival rates are 54% (42–66%), 28% (16–40%) and 11% (1–21%) respectively. These results confirm that metastasis rather than local failure dictates the poor outcome in these patients and that breast conservation can be achieved.

To our knowledge, a chronic expanding haematoma has not been reported in a patient who received silicone gel breast prostheses for augmentation and never before at an interval as long as 12 years, as in our case. There have been occasional reports of chronic haematoma as complication of implantation of silicone breast prostheses after mastectomy for cancer, presenting 2.5-8 years later.

The value of follow-up after mastectomy for breast cancer is controversial. One reason is to detect metachronous tumour in the contralateral breast, but the optimum method for achieving this is undecided. The long-term follow-up policy of our unit is annual clinical review combined with biennial mammography. We have assessed the benefit of this policy in the detection of tumours of the contralateral breast. The case notes of 216 patients undergoing mastectomy between 1978 and 1985, under the care of one consultant surgeon (DJTW) were reviewed. Follow-up was complete to December 1997, thus allowing a minimum follow-up of 12 years. The development of a metachronous tumour was recorded as was its method of detection : either clinically, by the patient or the clinician, or by routine mammography. Two-hundred and five patients were available for follow-up of the contralateral breast. Seventeen (8.3%) developed metachronous tumours. Eight were detected by the patient, 4 by the clinician and 5 by routine follow-up mammography. Biennial mammography does not appear to be beneficial in breast cancer follow-up. More work is required to determine the benefits of more frequent mammography, with or without breast self-examination and clinical review within the hospital environment or within primary care.

Audit based on the use of case notes completed in the ordinary course of patient care has not been widely used because of concern about the completeness and adequacy of such records. This paper describes the results of a study carried out to assess whether information contained in case notes was sufficiently reliable to enable clinical effectiveness to be measured. The study examines the extent to which a radiologist and an epidemiologist agree with two experienced clinicians in making retrospective judgements on whether out-of-hours radiological investigations are worthwhile. There was a high measure of agreement; only a relatively small amount of information in the case notes is needed to make valid judgements on clinical performance. The method described here may be applicable to other diagnostic investigations and the results of the study have wide implications for more effective and efficient management of resources within the NHS.