Treatment of patients with isolated axillary nodal metastases from an occult primary carcinoma consistent with breast origin

Article Abstract:

In the overwhelming majority of cases of breast cancer, the primary tumor within the breast is detected, either by physical examination or mammography, prior to the identification of any metastatic tumors (representing spreading of the primary tumor) which might be present. However, in rare cases, lymph nodes of the armpits may be found to contain cancer cells prior to the identification of any primary cancer. The axillary (armpit) lymph nodes are generally the first site affected as breast cancer begins to spread, and when the cancer cells in the lymph nodes are consistent with breast cancer, that is, not clearly melanoma or some other cancer, the clinician has a dilemma. Should the patient be treated as having breast cancer, or should the patient be watched for the appearance of other signs before treatment is begun? In a review of records of cancer patients, 42 cases were identified in which axillary lymph nodes were found to have cancer cells consistent with breast cancer prior to the observation of any primary cancer in the breast itself. Mammography was performed in 40 cases, and in 37 of these, no tumor could be identified. In 13 cases, mastectomy (removal of the breast) was performed, and a primary tumor could be identified in only one. Among the remaining cases, 16 were given radiotherapy of the breast and 13 were given no treatment but were observed for signs of tumor development. Within five years, primary tumors developed in 17 percent of the patients who had radiotherapy and in 57 percent of those who had been observed only. The results suggest that when a patient has metastatic cancer cells in the axillary lymph nodes which are consistent with breast cancer, the treatment should be the same as it would be if a primary tumor had been found in the breast. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Metastasis, Cancer metastasis, Lymphatic metastasis

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Cost-effectiveness analysis of mass screening for breast cancer in Japan

Article Abstract:

In many developed countries, breast cancer is the most common form of cancer among women. In Japan, however, breast cancer, though still common, ranks only fifth among cancers in women. The rate of breast cancer in Japan is increasing, and some estimates suggest that by the year 2000 it will be the most common cancer among Japanese women. This prediction raises questions about the most appropriate method for early detection. In the US, regular mammography is the recommended procedure, while in Japan, physical examination by a physician remains the officially recommended form of breast cancer screening. To determine whether the costs of routine mammography would be justified by improvements in diagnosis and patient survival, investigators conducted a detailed analysis comparing physical examination with mammography within Japan. The cost of screening by physical examination only was calculated to be $412 per patient, while the cost of mammographic screening was calculated to be $517 per patient. Some cost per patient could be saved by using mammography to follow-up patients with abnormal findings on physical examination. However, using only physical examination results in a greater loss of life to breast cancer, and the total cost for saving a year of human life is in fact greater with this screening method. Physical examination only was estimated to cost $49,700 per year of life saved. Mammography, on the other hand, costs only $14,300 per year of additional life saved. Therefore, the official Japanese recommendation of screening by physical examination should be changed to a recommendation of routine mammography for Japanese women. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Japan, Finance, Medical care, Cost of, Health care costs, Examinations, Test validity, Mammography

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Report on the International Workshop on Information Systems in Breast Cancer Detection

Article Abstract:

In December of 1988, a workshop on information systems in breast cancer detection was held; eleven countries participated, along with the World Health Organization and the International Union Against Cancer. A tremendous amount of information is required to evaluate the effectiveness of screening programs for breast cancer, to project the future needs of the community, and to detect changing trends within the community. Part of the function of the workshop was to focus on methods of data collection and analysis which would provide uniformity of data, make sure the minimum required data is collected, and to suggest appropriate statistical methods for the measurement of regional or national changes. The participants focused on four areas of data collection and analysis: the background and descriptive information which is necessary to interpret progress in screening and detection programs; data on the effectiveness by which screening programs are reaching various members of the population; data on the effectiveness of the screening programs; and data on the methodology of the data collection itself, which is key to making comparisons between different sets of data. The United States should establish the necessary provisions to meet these data requirements within its borders, as well as to provide other relevant information, such as the access to health services, the effect of ethnic and economic factors, and the role of health insurance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Analysis, Women, Information management, Medical research, Women's health, Medical statistics

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