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Background. Recent studies indicate that breast cancer patients do not usually experience the devastating psychological consequences once viewed as inevitable. However, some adjust to the disease more poorly than others. This study examined the personality trait of optimism versus pessimism as a predictor of adjustment over the first year, postsurgery. Methods. Seventy women with early stage breast cancer reported on their general optimism-pessimism at diagnosis. One day before surgery, and at 3-month, 6-month, and 12-month follow-ups, they reported their subjective well-being (mood scales and a measure of satisfaction with life). At follow-ups, they also rated their sex lives, indicated how much physical discomfort was interfering with their daily activities, and reported on thought intrusion. Results. Pessimism displayed poorer adjustment at each time point by all measures except interference from pain. Even controlling for previous well-being, pessimism predicted poorer subsequent well-being, suggesting that pessimism represents a vulnerability to a negative change in adjustment. In contrast, effects of pessimism on quality of sex life and thought intrusion were not incremental over time. Additional analyses indicated that effects of the optimism-pessimism measure were captured relatively well by a single item from the scale. Conclusions. A sense of pessimism about one's life enhances a woman's risk for adverse psychological reactions to the diagnosis of, and treatment for, breast cancer. This finding suggests the potential desirability of assessing this quality informally in patients, to serve as a warning sign regarding the patient's well-being during the period surrounding and following surgery. Cancer 1994; 73:1213--20. Key words: breast cancer, psychosocial sequelae, psychological well-being, personality.

Background. Radioimmunodetection of cancer usingmonoclonal antibody fragments offers certain potentialadvantages over that with whole monoclonal antibodies,including the ability to image early (i.e., to provideimages at an early time after injection of the radio- antibody) while minimizing the incidence of human antimouseantibody response. This paper reports a prospectivetrial comparing radioimmunodetection withIMMU-4 (a murine anti-CEA monoclonal antibody)[Tc.sup.99m]-labeled Fab' fragments to conventional imaging in 35 colorectal cancer patients.Methods. All patients were investigated by conventionaldiagnostic methods (CDM) within 4 weeks ofradioimmunodetection. Surgical corroboration of findingswas obtained in 26 patients (15 with evidence of diseaseon CDM [CDM+] and 11 with abnormal serum CEA[CDM-] as the only evidence for recurrence). After 1 mgIMMU-4 [Tc-.sup.99m]-Fab' was injected (19.3 mCi on average), patients underwent planar/SPECT radioimmunodetection2-5 hours later and planar radioimmunodetection18-24 hours later. Three patients underwent a secondradioimmunodetection study 16, 20 and 23 months afterthe first.Results. Radioimmunodetection was superior toCDM, accurately predicting disease distribution in sixnonsurgical and ten CDM+ surgical patients, and wascomplementary to computed tomography in two nonsurgicaland two CDM+ surgical patients. Radioimmunodetectionwould have directed or changed management decisionsin 6 of the 15 (40%) CDM+ surgical patients.Radioimmunodetection correctly identified all recurrenttumor in 8 of 11 CDM- surgical patients and was negativein one patient with cirrhosis and no recurrence, representing a potential clinical benefit of 82%. Analyzed ona regional basis, radioimmunodetection was found to besuperior to CDM in extrahepatic abdomen and pelvisimaging and was complementary to (although not as accurateas) CDM in the liver. Human anti-mouse antibodydid not develop in any of the patients, including threewho were injected twice.

The single most important indicator of outcome for women with early breast cancer is whether or not the cancer has spread to the axillary (armpit) lymph nodes. There is controversy over the best method of treating the axilla. Current treatment includes node biopsy or sampling, partial removal of axillary nodes, total axillary node removal, and radiation therapy to the nodes with or without surgical removal and staging of the progression of the cancer. Those who favor partial resection suggest that the degree of illness associated with routine total lymph node removal, particularly swelling of the arm, is too high. A review was undertaken of 264 breast cancer patients who underwent 278 total axillary lymph node removals with mastectomy (either segmental or total), to evaluate the usefulness of total node removal in controlling cancer, and the morbidity of the procedure. The average patient age was 59.4 years, and average follow-up was 50 months. To date there have been no recurrences of cancer in the axilla (two patients developed cancer elsewhere and died 21 and 55 months after surgery). There were 24 patients (8.6 percent) who required aspiration of fluid collections following drain removal; six patients (2.2 percent) developed wound infection; these morbidity rates are similar to those reported for partial lymph node removal. It is concluded that total axillary lymphadenectomy can prevent recurrence of cancer, and the morbidity associated with the removal of the lymph nodes is tolerable, so long as radiation to the area is not necessary. (Consumer Summary produced by Reliance Medical Information, Inc.)

Small or moderately-sized adenocarcinomas (cancers) of the breast are now treated with segmental mastectomy (SM), the removal of a segment of the breast, as opposed to radical mastectomy, the removal of virtually the entire breast. Postoperative adjuvant radiotherapy (XRT, radiation treatment performed in absence of any remaining disease) can also be used. Treatment results from 111 patients who underwent SM over a period of 11 years are evaluated. All but five of these women also underwent removal of the lymph glands under the arm on the affected side. Patients with metastasis (spread) to the lymph nodes received chemotherapy. XRT was optional for patients who met certain criteria, including small tumor size, adequate margins on the resected tissue, no lymphatic or blood vessel invasion within the resected tissue, and minimal in situ cancer, usually of the ductal type. Sixty-four patients met these criteria; of these, 51 elected observation only (NXRT), and 13 elected radiotherapy (EXRT). Of the remaining 47 patients, radiotherapy was considered mandatory (MXRT) due to their disease state for 41, of whom 38 complied. Nine patients refused radiotherapy (RXRT). Patients were followed-up for a median time of six years. Results indicate that the overall five-year survival for the NXRT group was 94 percent; for the EXRT group, 83 percent; for the MXRT group, 85 percent; and for RXRT patients, 53 percent. The five-year recurrence rate for NXRT patients was six percent; for MXRT patients, seven percent; and for RXRT, 33 percent. When tumors were inspected microscopically, 24/102 were high-grade, and 7/8 patients with local recurrence had high-grade tumors. Overall, results suggest that careful screening may aid in detection of those patients who could forego adjuvant radiotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

The current widespread use of mammography has created some confusion and controversy regarding the optimal treatment of certain noninvasive breast cancers. Previously, only palpable tumors were being detected and treated. Now, smaller tumors are being diagnosed, and the appropriate course of action is far from clear. The diagnosis of ductal carcinoma or lobular carcinoma in situ is becoming far more common; in situ refers to the fact that the tumor cells have not yet migrated beyond their original basement membrane boundaries. The treatment options include observation, wide area excision with or without radiotherapy, and total mastectomy. The incidence of invasive cancer after local excision of ductal carcinoma in situ is from 4 to 15 percent. The degree to which radiotherapy might reduce this rate is uncertain. Some consider total mastectomy the treatment of choice, but even with this approach, recurrence and death are not necessarily prevented. Patients with ductal or lobular carcinoma in situ are at high risk for the development of cancer in the other breast, and although prophylactic breast removal is popular with neither physicians nor patients, it is, somewhat paradoxically, more prevalent in the treatment of disease which has not yet spread to surrounding tissue. In the absence of detailed factual data, the patient should be told what is known about the relative benefits and disadvantages of each approach, and these options should be evaluated in light of the patient's own priorities and preferences. The patient might also be encouraged to participate in the National Surgical Adjuvant Breast and Bowel Project, and it is hoped that as this study progresses, solid data will permit more objective decision-making about the treatment of breast cancers in situ. (Consumer Summary produced by Reliance Medical Information, Inc.)