Archives of Breast Cancer
Volume:2 Issue: 1, Feb 2015

Oncoplastic breast surgery (OBS) has gained widespread acceptance during the last two decades as an integral component of breast cancer surgery. OBS combines oncological principles of breast cancer surgery with plastic surgery techniques to provide the best cosmetic results without compromising oncological outcome of breast cancer treatment and it has opened up the possibility to perform breast conservation in large tumors.The purpose of this review is assessment of the oncological outcome of OBS in the treatment of breast cancer. We performed an extensive search of PubMed for articles published on oncological results and safety of OBS. There are few randomized clinical trials (RCTs) comparing the results of OBS with standard breast conservation techniques; however, based on the results of several prospective studies, it can be concluded that in terms of oncological outcome, OBS is at least as safe as standard techniques for breast conservation.

Sexual dysfunction in breast cancer patients is considered as a common and distressing problem. Considering the increasing number of breast cancer survivors living for longer periods of time with the disease and the importance of their quality of life, we conducted the present study to compare the sexual functioning in breast cancer patients with their healthy counterparts. In this case-control study, breast cancer patients who completed their treatment protocol and were followed up for at least six months were included. The controls were healthy women with normal clinical breast examinations. All subjects filled-in the Persian version of Female Sexual Function Index questionnaire. A total of 165 subjects including 71 breast cancer patients and 94 healthy women were studied. The frequency of sexual dysfunction in cases and controls was 52.6% and 47.4%, respectively (P = 0.09). There were no significant differences between the two groups regarding domain scores, except for vaginal lubrication (P = 0.045). Logistic regression analysis indicated that significant determinants of sexual dysfunction in breast cancer group was patients'' age (OR = 4.0, 95%CI: 1.3 – 11.5, P = 0.01) and age of the spouse (OR= 9.8, 95% CI: 1.8-51.9, P= 0.007), while in controls, only emotional relationship with the husband was the significant predictive factor (OR = 6.3, 95%CI: 1.9 – 20.5, P = 0.002). Our findings indicated that sexual dysfunction is prevalent in Iranian women regardless of their physical health status. The frequency of vaginal dryness in breast cancer patients was significantly higher than controls. Age of the patient and the spouse (>40) were the only significant predictors of sexual dysfunction among women with breast cancer. Preventive strategies, sexual education and access to effective treatment should be planned in supportive care of breast cancer patients.

The purpose of this study was to evaluate the results of stereotactic breast core needle biopsy in a tertiary breast center of Tehran University of Medical Sciences. Patients who were candidates for mammography-guided stereotactic breast core biopsy from March 2011 to December 2013 were included in this study. Stereotactic biopsy was performed by a dedicated prone Hologic mammography unit employing an automatic biopsy device with a 14-gauge needle. Patients with malignant or premalignant biopsy results were followed up with surgical pathology reports and patients with benign core biopsy findings were followed up with mammograms. Among the 150 patients who were included in the final analyses, 30 had malignant findings on stereotactic biopsy and 10 patients had a premalignant pathology result on stereotactic biopsy. The remaining 110 patients had benign results on histopathology; however, in 30 patients, wire localization and surgery of the same area were performed due to either discordant mammography-pathology findings or clinical suspicion of malignancy and in two of them, advancing pathologic grade was witnessed. A total of 80 patients with benign histopathologic results had follow-up mammograms and the follow-up period was between 12 months to 3 years. The sensitivity and specificity of stereotactic breast core biopsy in this study was 94% and 96%, respectively. Stereotactic breast core needle biopsy is an effective and safe method in evaluation of suspicious mammography-detected lesions but caution should be warranted when taking results into account, especially in mammography-pathology discordance and in patients with premalignant pathology reports.

The Gail model has been widely used for estimation of absolute risk of breast cancer development. The original model and most of the validation studies have been performed among western populations and controversial results have been reported regarding the applicability of this model in Asian populations. Our aim was to investigate the performance of this model in Iranian women. In a cross-sectional study, a total of 280 patients with breast cancer and 280 participants with normal screening results were enrolled as case and control groups, respectively. Risk factors used in the latest version of the Gail model were compared between the two study groups. Gail score was calculated by using Breast Cancer Risk Assessment Tool and based on the cut-off point of 1.67, patients were categorized in order to assess model performance. In total, 560 patients with a mean age of 43.07±8.60 years were enrolled. Comparison of different risk factors between the two groups revealed significant associations of patients’ age (P < 0.001), age at first pregnancy (P = 0.022), previous history of breast biopsy (P < 0.001) and atypical hyperplasia (P = 0.002) with risk of breast cancer. No association was found between age at menarche (P = 0.115) or first-degree family history (P = 0.117) and increased risk. Considering the Gail score for 5-year risk of breast cancer development, the difference between the two groups failed to reach significance (P = 0.052). The sensitivity and specificity of the model were 13.9% and 94%, respectively. Based on the current findings, it can be suggested that employing the current version of the Gail model for breast cancer risk assessment will underestimate the risk of cancer development in Iranian women.

General practitioners (GPs) are usually the first-line doctors visiting patients with breast problems. Therefore, their knowledge about breast diseases is of significant importance for proper screening and referral of patients and warrants scrutiny. The purpose of this study was to assess the knowledge of GPs regarding different breast imaging modalities. In this cross-sectional study, we asked participants in an annual GP conference to complete a structured questionnaire. The questionnaire elicited information about the GP’s characteristics such as age, gender and work experience and eight multiple choice questions about how to use different imaging modalities and manage patients with breast disorders were also proposed. In total, 270 GPs completed the questionnaire (155 females and 115 males). The results showed a significant association between frequency of GPs choosing the correct imaging modality in a 50-year-old asymptomatic patient and participants'' age (≤40) and duration of work experience (≤5) (P = 0.002 and P = 0.016, respectively). Also, a significant association was revealed between gender of GPs (female) and correct answers regarding management of nipple discharge (P = 0.024). There were no significant associations between the other variables and answers to the other questions. The findings of this study highlight the importance of implementing continuous medical education for GPs in approach to breast diseases.

Cardiac risk assessment with myocardial perfusion imaging (MPI) is a common practice for some elderly breast cancer patients who are candidates for operation. In rare cases the tumor may become visible in the images. This is the report of a case with a huge slow-growing breast tumor suspicious for malignancy and presenting with methoxy-isobutyl-isonitrile (MIBI) uptake in the tumor. The patient was referred to the nuclear medicine department for preoperative cardiac risk assessment with MPI. There was high uptake in the tumor was note worthy in two different aspects: 1)high MIBI uptake in the tumor is more suggestive of malignant rather than benign tumors and thus, underscores the importance of extra-cardiac uptake sites in pre-operation MPI; and 2)high uptake in the left breast tumor may obscure the MPI image and hinder proper interpretation.