Purpose: To identify predictors of reexcision findings and local recurrence in the setting of breast-conserving therapy with radiation. Methods: The records of 535 patients who underwent breast-conserving surgery followed by radiation for Stage I or II cancer between 1972 and 1996 were reviewed. The mean follow-up period for surviving patients without evidence of recurrence is 6 years. Various clinical and pathologic prognostic factors were examined for significance with regard to reexcision findings and recurrence rates. Pathologic margin status was classified as negative, close (S2 mm), positive, or indeterminate. Results: The pathologic margin status was the most important predictor of local recurrence. The freedom from local relapse (FFLR) at 6 years was 97% for patients with negative pathologic margins and 86% for all others (p < 0.0001). There was no significant difference in recurrence rates among patients with close, positive, or indeterminate margins. However, the use and sequencing of systemic therapy affected recurrence rates among these patients. For patients with close, positive, or indeterminate margins, the crude risk of local recurrence was 4% among patients who received tamoxifen or received chemotherapy integrated with or after radiation. The risk of local recurrence was 16-29% among the patients with close, positive, or indeterminate margins who did not receive systemic therapy or who received radiation after completion of chemotherapy. Local recurrence rates were low in patients with negative margins (2-8%) regardless of the use of systemic therapy or its timing. The presence or absence of residual disease at reexcision did not predict recurrence as long as the final margins were negative. Among patients who underwent reexcision before radiation, extensive intraductal component (EIC) (p = 0.0001) and young patient age (p = 0.03) were predictive of residual disease in the specimen. Patients with initially close margins and no EIC had a low risk of residual disease at the time of reexcision, as did patients older than age 65 without EIC. Conclusion: Pathologic margin status is the most important predictor of local recurrence after breast conservation with radiation. Patient age and EIC were significant predictors of residual disease at reexcision. The use and timing of systemic therapy appear to influence the risk of local recurrence in patients who do not have negative lumpectomy margins.

Predictors of reexcision findings and recurrence after breast conservation

Bilateral breast cancer

Survival of patients with bilateral versus unilateral breast cancer and impact of guideline adherent adjuvant treatment: A multi-centre cohort study of 5292 patients

Purpose
The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. We compared the characteristics and prognosis of bilateral breast cancer and unilateral breast cancer.

Comparison of clinicopathological characteristics and prognoses between bilateral and unilateral breast cancer

The Second Breast

The higher incidence of breast cancer, the improvements in diagnosis and treatment, together with the growing life expectancy have brought about an increase in the number of patients at risk for bilateral breast carcinoma. The aim of this study is to describe the characteristics of patients suffering from bilateral breast carcinoma who underwent surgery at the Breast Pathology Service of the Buenos Aires British Hospital and to analyze impact on survival. Between January 1970 and May 2007, 4,085 cases of breast carcinoma in 3,864 patients were treated at the Breast Diseases Division of the Buenos Aires British Hospital. A retrospective study of 194 patients with bilateral breast carcinoma was carried out: 80 synchronous and 114 metachronous. In order to compare survival, a group of 2,237 patients with unilateral breast carcinoma who had undergone surgery was analyzed. The risk of developing a contralateral breast carcinoma was 0.9% per year, with an accumulated risk at 15 years of 12.75%. The 5-year survival was 85.9% for unilateral carcinomas, 94.6% for metachronous carcinoma, and 63.3% for synchronous carcinoma. The 15-year survival was 65.5% for unilateral carcinomas, 52.3% for metachronous, and 37.2% for synchronous. The incidence of bilateral carcinomas is low. Survival was worse in patients with metachronous carcinoma diagnosed within 5 years of the first malignancy. Survival in patients with metachronous carcinoma diagnosed after 5 years is similar to those with unilateral carcinoma. Synchronous carcinoma was associated to worse survival, being an independent risk factor for mortality.

Bilateral Breast Carcinoma: Clinical Characteristics and Its Impact on Survival

Introduction Medical knowledge regarding preservation of fertility and pregnancy in patients with breast cancer (BC) is of interest We, therefore, decided to conduct a survey on this issue among professionals involved in the treatment of BC in Argentina Materials and methods A survey was conducted and sent by email to 3,412 contacts in the Argentine Mastology Society (Sociedad Argentina de Mastologia, or SAM) database, with responses from 396 physicians The survey design was based on the Lambertini 2017 survey To the author's knowledge, it is the first Argentine survey to address this issue Results The frequency with which the impact of cancer treatment on the fertility of young patients was addressed by the respondent and referred to a fertility specialist was 'always' and 'almost always' in 868% and 785% of cases, respectively Conclusions The level of knowledge is comparable to the data presented by other surveys Membership in a Mastology Unit was associated with more current treatment Continued work on the training of professionals is necessary to facilitate communication, information and guidance of patients of childbearing age who are going to have cancer treatment in order to advise them on fertility preservation, as well as the possibility of pregnancy after diagnosis of BC, and to be able to provide better care to those with BC associated with pregnancy

Survey of professionals on breast cancer, fertility preservation and pregnancy in Argentina

Introduction: Breast conserving surgery followed by radiation therapy in early stage breast cancer are the standard therapeutics at present. The incidence of local recurrence (LR) varies between 4,1 and 18 %. Objective: To evaluate the resection margins as LR risk factor following breast conserving treatment in patients undergoing surgery at the Breast Diseases Division of the British Hospital and to analyze the impact on overall survival. Material and Methods: 830 patients operated on between January 1988 and December 2005; 87 developing recurrences after a median time of 71,9 months were analyzed retrospectively. Results: The LR annual risk was 1,29 %. We observed LR in 15,7% in patients which resection margins were ≤ 5mm and 7,4% when resection margins were ≥ 6mm. The five year overall survival rate in LR patients was 95,2%, at ten years 86,1% and at fifteen years 78,4%. Conclusions: Margins ≤ 5mm are an independent risk factor for local recurrence. LR patients presented less survival chances and higher risk of developing distant metastasis.

Riesgo de Recidiva local en la cirugía conservadora mamaria: El problema de los márgenes

Introduction Currently, the indication for neoadjuvant chemotherapy is increasing in the treatment of breast cancer. Variability in the expression of biomarkers following neoadjuvant treatment has been observed, which could be accompanied by changes in the adjuvant treatment. Objectives The primary objective was to evaluate the variability of biomarkers prior to and following neoadjuvant therapy. Secondary objectives were to determine which tumour subtype (as determined by immunohistochemical markers) most frequently achieved pathological complete response (pCR); whether the biomarker variation resulted in a change in immunophenotype and subsequently modification to the adjuvant treatment. Materials and methods A retrospective observational analysis was carried out on patients with a diagnosis of breast cancer who had neoadjuvant therapy prior to surgery in the Breast Care Service of the Buenos Aires British Hospital between January 2009 and June 2020. Results One hundred and seventy-two patients were included. The pCR rate was 28.5%. The tumour immunophenotype that achieved pCR most frequently was the hormone receptor negative /HER2+ group with a value of 85.2%. The analysis was carried out on the 123 patients with residual disease. The observed variability for oestrogen receptors (ER) was 8.9%, for progesterone receptors (PR), 29.9% and for HER2, 13.8%. These changes were statistically significant. There were changes to the tumour immunophenotype in 26 cases (21.1%) with modifications to the adjuvant treatment in nine of these (34.6%; 7.3% of all tumours with residual disease). Conclusions In this study, we observed statistically significant variability in the expression of ER, PR and HER2 prior to and following neoadjuvant treatment, which identified modifications in the tumour immunophenotype in 21.1%, and changes to the adjuvant treatment in 7.3% of all tumours with residual disease, justifying the re-assay of biomarkers in the surgical specimen.

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Alejandra García

Papers

Bilateral Breast Carcinoma: Clinical Characteristics and Its Impact on Survival

Survey of professionals on breast cancer, fertility preservation and pregnancy in Argentina

Riesgo de Recidiva local en la cirugía conservadora mamaria: El problema de los márgenes

Impact of immunohistochemical profile changes following neoadjuvant therapy in the treatment of breast cancer