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Cambridge, United Kingdom

H Turner E.J.,University of Surrey | Benson J.R.,Cambridge Breast Unit | Winters Z.E.,Royal Infirmary
Future Oncology

Seromas are the most frequent complications following breast surgery, resulting in significant discomfort and morbidity with possible delays in commencing adjuvant therapies. Varied clinical practices exist in the techniques employed to prevent and manage seromata. This article assesses published literature on the techniques employed in prevention of seroma formation following breast surgery, evaluating the different methodologies used. Although prevention is the best strategy, seromata remain problematic and we consider their management. The principle findings were that prevention is key to the management of seromata. Methods employed to prevent seromata include suction drainage, shoulder immobilization, quilting sutures, fibrin sealants and innovative measures of managing the axilla, among others. The evidence demonstrated that a combination of quilting and drains significantly reduces the incidence and volumes of seromata. These effects are sustained by minimizing use of electrocautery, alongside increasing frequencies of axillary sentinel lymph node biopsies and node sampling. The efficacy data on fibrin sealants is inconclusive and consequently should not be routinely used alone or accompanied by quilting sutures. Clinically significant seromas deemed 'symptomatic' by patients and complicating infected seromas should be aspirated. There are limited data on the recommended treatment of established seromas with a paucity of high-quality studies and further research involving randomized trials are indicated. © 2014 Future Medicine Ltd. Source

Benson J.R.,Cambridge Breast Unit | Jatoi I.,University of Texas Health Science Center at San Antonio
Future Oncology

Patient selection and timing of sentinel lymph node (SLN) in the context of primary chemotherapy continues to evolve; there is some evidence that primary chemotherapy may modify lymphatic drainage patterns and cause differential downstaging between SLNs and non-SLNs. SLN biopsy undertaken prior to chemotherapy will minimize the risk of a false-negative result, may allow more accurate initial staging and provides important information on prognostication which can guide decisions about adjuvant radiotherapy. However, quantification of regional metastatic load is incomplete and some advocate SLN biopsy after primary chemotherapy to take advantage of nodal downstaging and avoidance of axillary dissection in up to 40% of patients. Initial reports on false-negative rates for SLN biopsy after primary chemotherapy in patients who had proven axillary node metastases at presentation based on needle core biopsy were relatively high and a cause for clinical concern. However, more recent data suggest that SLN biopsy is as accurate when performed post- as pre-neochemotherapy and current practice incorporates both approaches. © 2014 Future Medicine Ltd. Source

Benson J.R.,Cambridge Breast Unit | Benson J.R.,Anglia Ruskin University | Wishart G.C.,Anglia Ruskin University
The Lancet Oncology

Ductal carcinoma in situ (DCIS) constitutes a major public health problem, with up to half of screen-detected cancers representing pure forms of DCIS without evidence of invasion. A proportion of cases detected with routine screening would not have progressed to a life-threatening form of breast cancer during the patient's lifetime, and overdiagnosis of breast cancer is a cause for concern. Once DCIS has been detected, treatment is obligatory and present technologies do not allow accurate risk stratification such that intensity of treatment can be tailored to risk of recurrence and progression to invasive disease. Present management strategies are based on prognostic and predictive information derived from conventional histopathological and host factors. With increasing molecular characterisation of these preinvasive lesions, data will be available for how factors such as oestrogen receptor, progesterone receptor, HER2, and indicators of proliferative activity can provide additional information about both prognosis and benefit from adjuvant treatments such as radiotherapy and hormonal therapy. Low-risk patients are especially poorly defined in terms of need for adjuvant therapies, which can be associated with both short-term adverse sequelae and long-term effects (eg, cardiotoxicity) that can affect all-cause mortality. Optimum risk prediction in the future is likely to be achieved by integration of both conventional and molecular factors, which should be incorporated into a validated predictive model to help with clinical decision making. © 2013 Elsevier Ltd. Source

Cuzick J.,Queen Mary, University of London | Warwick J.,Queen Mary, University of London | Pinney E.,Queen Mary, University of London | Duffy S.W.,Queen Mary, University of London | And 4 more authors.
Journal of the National Cancer Institute

Background Mammographic breast density is a strong risk factor for breast cancer. Tamoxifen, which reduces the risk of breast cancer in women at high risk, also reduces mammographic breast density. However, it is not known if tamoxifen-induced reductions in breast density can be used to identify women who will benefit the most from prophylactic treatment with this drug. Methods We conducted a nested case-control study within the first International Breast Cancer Intervention Study, a randomized prevention trial of tamoxifen vs placebo. Mammographic breast density was assessed visually and expressed as a percentage of the total breast area in 5% increments. Case subjects were 123 women diagnosed with breast cancer at or after their first follow-up mammogram, which took place 12-18 months after trial entry, and control subjects were 942 women without breast cancer. Multivariable logistic regression was used to adjust for other risk factors. All statistical tests were two-sided. Results In the tamoxifen arm, 46% of women had a 10% or greater reduction in breast density at their 12- to 18-month mammogram. Compared with all women in the placebo group, women in the tamoxifen group who experienced a 10% or greater reduction in breast density had 63% reduction in breast cancer risk (odds ratio = 0.37, 95% confidence interval = 0.20 to 0.69, P =. 002), whereas those who took tamoxifen but experienced less than a 10% reduction in breast density had no risk reduction (odds ratio = 1.13, 95% confidence interval = 0.72 to 1.77, P =. 60). In the placebo arm, there was no statistically significant difference in breast cancer risk between subjects who experienced less than a 10% reduction in mammographic density and subjects who experienced a greater reduction. ConclusionThe 12- to 18-month change in mammographic breast density is an excellent predictor of response to tamoxifen in the preventive setting. © The Author 2011. Source

Jatoi I.,University of Texas Health Science Center at San Antonio | Benson J.R.,Cambridge Breast Unit
Future Oncology

36th San Antonio Breast Cancer Symposium, San Antonio, TX, USA, 10-14 December 2013 Progress in the treatment of breast cancer continues to require the thoughtful planning of new clinical trials and patient participation in those trials. During the 2013 San Antonio Breast Cancer Symposium (SABCS), the results of several clinical trials with practice-changing implications were presented. Additionally, the results of numerous interesting and provocative observational studies were reported. There were also several plenary lectures during the 2013 SABCS that addressed timely and controversial topics. The SABCS is a global forum for clinicians and scientists who are committed to eradicating the burden of breast cancer mortality worldwide. In this report, we highlight only a few of the many important studies and plenary talks presented during the 2013 SABCS. © 2014 Future Medicine Ltd. Source

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