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1.
Cancer Prev Res (Phila) ; 14(7): 753-762, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33849913

RESUMEN

Current therapies for breast cancer prevention only prevent estrogen receptor positive (ER+) disease and toxicity limits use of these agents. Vitamin D is a potential prevention therapy for both ER+ and ER- disease and is safe with few side effects. This study evaluates the effect of 1-year of vitamin D supplementation on mammographic density (MD), a biomarker of breast cancer risk in a multicenter randomized controlled trial. Premenopausal women with ≥25% MD and no history of cancer were randomly assigned to 2,000 international units (IU) of vitamin D or placebo orally daily for 1 year. Change in percent MD was evaluated using Cumulus software after all participants completed treatment. Three hundred women enrolled between January 2011 and December 2013 with a mean age of 43 and diverse ethnicity [14% Hispanic, 12% African American (AA)]. Supplementation significantly increased vitamin D levels compared with placebo (14.5 ng/mL vs. -1.6 ng/mL; P < 0.0001) with all participants on the vitamin D arm achieving vitamin D sufficiency at 12 months. Vitamin D was safe and well tolerated. After adjustment for baseline MD, the mean between-arm difference (vitamin D vs. placebo) at 1 year was -0.75 (-0.26, 1.76; P = 0.56). A greater effect was seen for women with ≥50% MD and AA women, although neither reached significance. This randomized controlled trial demonstrated significant improvement in vitamin D levels with 2,000 IU for 1 year, with 100% of supplemented women achieving sufficiency. However, a null effect was seen regarding change in MD for premenopausal women (the primary outcome of the study). PREVENTION RELEVANCE: Current therapies for breast cancer prevention only prevent estrogen receptor positive (ER+) disease and are underutilized due to toxicity and side effects. Vitamin D is a potential prevention therapy for both ER+ and ER- disease and is safe with few side effects.


Asunto(s)
Densidad de la Mama , Neoplasias de la Mama/prevención & control , Suplementos Dietéticos , Vitamina D/administración & dosificación , Adulto , Mama/diagnóstico por imagen , Mama/patología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Método Doble Ciego , Femenino , Humanos , Mamografía/estadística & datos numéricos , Persona de Mediana Edad , Resultado del Tratamiento
2.
BMC Surg ; 17(1): 12, 2017 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-28173790

RESUMEN

BACKGROUND: The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) provide guidelines regarding axillary nodal evaluation in ductal carcinoma in situ (DCIS), but data regarding national compliance with these guidelines remains incomplete. METHODS: We conducted a retrospective review of the National Cancer Data Base (NCDB) analyzing all surgical approaches to axillary evaluation in patients with DCIS. Logistic regression analysis was used to assess the multivariate relationship between patient demographics, clinical characteristics, and probability of axillary evaluation. RESULTS: We identified 88,083 patients diagnosed with DCIS between 1998 and 2011; 31,912 (37%) underwent total mastectomy (TM) and 55,349 (63%) had breast conserving therapy (BCT). Axillary evaluation increased from 44.4% in 1998 to 63.3% in 2011. In TM patients, axillary evaluation increased from 74.3% in 1998 to 93.4% in 2011. This correlated with an increase in sentinel lymph node biopsy (SLNB) from 24.3 to 77.1%, while ALND decreased from 50.0 to 16.3% (p <0.01). In BCT patients, evaluation increased from 20.1 to 43.9%; SLNB increased from 7.2 to 39.4% and ALND decreased from 12.9 to 4.5%. Factors associated with axillary nodal evaluation in BCT patients included practice type and facility location. Among TM patients, use of axillary lymph node dissection (ALND) for axillary staging was associated with earlier year of diagnosis, black race, and older age, as well as community practice setting and practice location in the Southern US. CONCLUSIONS: Compliance with national guidelines regarding axillary evaluation in DCIS remains varied. Practice type and location-based differences suggest opportunities for education regarding the appropriate use of axillary nodal evaluation in patients with DCIS.


Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/secundario , Adhesión a Directriz , Ganglios Linfáticos/patología , Estadificación de Neoplasias , Biopsia del Ganglio Linfático Centinela/métodos , Adulto , Axila , Carcinoma Intraductal no Infiltrante/diagnóstico , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
3.
J Clin Oncol ; 34(10): 1072-8, 2016 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-26811528

RESUMEN

PURPOSE: Placing clips in nodes with biopsy-confirmed metastasis before initiating neoadjuvant therapy allows for evaluation of response in breast cancer. Our goal was to determine if pathologic changes in clipped nodes reflect the status of the nodal basin and if targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) and selective localization and removal of clipped nodes, improves the false-negative rate (FNR) compared with SLND alone. METHODS: A prospective study of patients with biopsy-confirmed nodal metastases with a clip placed in the sampled node was performed. After neoadjuvant therapy, patients underwent axillary surgery and the pathology of the clipped node was compared with other nodes. Patients undergoing TAD had SLND and selective removal of the clipped node using iodine-125 seed localization. The FNR was determined in patients undergoing complete axillary lymphadenectomy (ALND). RESULTS: Of 208 patients enrolled in this study, 191 underwent ALND, with residual disease identified in 120 (63%). The clipped node revealed metastases in 115 patients, resulting in an FNR of 4.2% (95% CI, 1.4 to 9.5) for the clipped node. In patients undergoing SLND and ALND (n = 118), the FNR was 10.1% (95% CI, 4.2 to 19.8), which included seven false-negative events in 69 patients with residual disease. Adding evaluation of the clipped node reduced the FNR to 1.4% (95% CI, 0.03 to 7.3; P = .03). The clipped node was not retrieved as an SLN in 23% (31 of 134) of patients, including six with negative SLNs but metastasis in the clipped node. TAD followed by ALND was performed in 85 patients, with an FNR of 2.0% (1 of 50; 95% CI, 0.05 to 10.7). CONCLUSION: Marking nodes with biopsy-confirmed metastatic disease allows for selective removal and improves pathologic evaluation for residual nodal disease after chemotherapy.


Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de la Mama/patología , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Terapia Neoadyuvante/métodos , Biopsia del Ganglio Linfático Centinela , Adulto , Anciano , Axila , Neoplasias de la Mama/cirugía , Quimioterapia Adyuvante , Reacciones Falso Negativas , Femenino , Humanos , Ganglios Linfáticos/cirugía , Metástasis Linfática , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasia Residual/patología , Estudios Prospectivos
4.
Cancer ; 121(19): 3422-7, 2015 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-26280679

RESUMEN

BACKGROUND: The 2015 National Comprehensive Cancer Network guidelines recommend that genetic counseling and germline BRCA mutation testing be offered to women under age 60 with triple-negative breast cancer (TNBC). As a result of the 2010 American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines for breast cancer, patients with breast cancers that are estrogen receptor (ER) or progesterone receptor (PR) low-positive (1%-9% on immunohistochemistry) are no longer strictly considered to have TNBC and may not be referred for genetic counseling. However, the incidence of BRCA mutation in patients with hormone receptor (HR) low-positive breast cancers remains unknown, and current ASCO/CAP guidelines may result in undertesting for BRCA mutations. METHODS: A prospectively maintained research database of breast cancer patients evaluated at The University of Texas MD Anderson Cancer Center between 2004 and 2014 was reviewed; 314 patients were identified with HER2/neu-negative breast cancers expressing ER and PR <10% with known BRCA mutation status. RESULTS: Three hundred fourteen patients had breast cancers expressing ER and PR <10%; 238 (75.8%) had HR-negative cancers (<1% ER and PR), and 76 (24.2%) had HR-low-positive cancers (1%-9% ER and/or PR). Among patients with HR-negative tumors, 86 of 238 (36.1%) had a BRCA1/2 mutation, whereas in the HR-low-positive group, 30 of 76 (39.5%) had a BRCA1/2 mutation. In multivariate analysis, HR status (<1% vs 1%-9%) was not significantly associated with BRCA1/2 mutations. CONCLUSIONS: The incidence of BRCA1/2 mutations is similar in patients with HR-low-positive breast cancer and patients with HR-negative breast cancer. Genetic counseling and BRCA testing should be offered to patients under age 60 who have HR-low-positive breast cancers. Cancer 2015;121:3435-43. © 2015 American Cancer Society.


Asunto(s)
Neoplasias de la Mama/genética , Receptor ErbB-2/genética , Adulto , Neoplasias de la Mama/patología , Estudios de Cohortes , Femenino , Genes BRCA2 , Asesoramiento Genético , Mutación de Línea Germinal , Humanos , Incidencia , Estudios Prospectivos
5.
Am J Surg ; 192(4): 541-4, 2006 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-16978971

RESUMEN

BACKGROUND: The risk of developing breast cancer rises with increasing age. The very elderly population (80 years of age and greater) is often excluded from both clinical trials and retrospective analyses. We performed a retrospective review of the very elderly population treated at our institution in order to assess treatment patterns and the safety of therapy in an older population. DATA SOURCES: In this institutional experience at a comprehensive cancer center, we retrospectively reviewed the charts of patients 80 years and older diagnosed with a new breast cancer between September 1, 1989, and September 1, 2004. RESULTS: Two hundred thirteen patients were identified for this study. Median age was 83 (range 80-97). Median survival was 7.28 years, with a median follow up of 4 years for patients still alive at the end of the study period. Ninety-eight percent of patients (208/213) received 1 or more components of recommended multimodality treatment. Five patients refused all treatment. Overall, complications affected 12% of patients who received treatment (26/208). There were 2 deaths, 1 after surgery and 1 related to chemotherapy. The majority, 69% (18/26), of the documented complications were classified as minor. Surgery resulted in complications in 6% (11/188) of patients. Five percent (5/112) of patients who received radiation suffered adverse effects. Chemotherapy-related complications affected 30% (6/18) of treated patients. Hormonal agents resulted in complications in 3% (3/112) of patients. No correlation between the American Society of Anesthesiologists score and incidence of complication was observed (P = .58). CONCLUSIONS: Very elderly patients can be safely treated with surgery and radiation in accordance with accepted recommendations for their stage of breast cancer. Treatment with surgery and/or radiation should be considered despite age and moderate comorbidity in order to affect locoregional control. Chemotherapy results in a significant incidence of complications and should be cautiously implemented in this age group. A prospective trial is necessary to assess the necessity of aggressive multimodality therapy in this very elderly population.


Asunto(s)
Neoplasias de la Mama/terapia , Anciano de 80 o más Años , Antineoplásicos/efectos adversos , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Moduladores de los Receptores de Estrógeno/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Mastectomía/efectos adversos , Radioterapia/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento
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