Is locally advanced breast cancer a neglected disease?

Akhtar, Maaz; Akulwar, Vikrant; Gandhi, D J; Chandak, Kavita

doi:10.4103/0019-509x.92254

Cited by 8 publications

(7 citation statements)

References 2 publications

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“…In the latter group there would be viable tumor cell nests outside the zone of post-NACT clinical tumor size. Although this study did not focus on the prognostic relationship among these findings, it is in consonance with other studies that have shown that the variety of pathologic responses *chi-square test; p < 0.05 significant **ANOVA one tailed; p < 0.05 significant seen indicates that the entire pre-chemotherapy tumor area should be removed [10,15]. For some authors, the diversity of pathologic findings indicates the need for mastectomy [16,17].…”

Section: Discussionsupporting

confidence: 82%

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Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

Chauhan

Sharma

Kumar

2016

Indian J Surg Oncol

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The purpose of this study was to compare early oncologic outcomes of oncoplastic breast surgery and conventional breast conservation surgery in patients of locally advanced breast cancer. A single-center, prospective, nonrandomized study enrolled select cases of locally advanced breast cancer (TNM T3/T4, N0/1/2) who after neoadjuvant chemotherapy, were considered for breast conservation surgery with oncoplasty techniques. The specimen volume resected, the mean margins and mean closest margin obtained were noted. The re-surgery rates, complication rates, and incidence of locoregional recurrence were also noted. Variables were compared with a retrospective cohort of similar patients who had undergone conventional breast conservation surgery. Fifty-seven patients underwent OBS (group 1) and were compared with 43 cases that had undergone conventional BCS (group 2). Majority of the patients in group 1 (73 %) had cT3 with N0 or N+ and a minority (17 %) were with limited skin involvement (cT4 and N0/N+). Relatively larger sized, post-NACT tumors could undergo OBS(4.4 vs 2.3 cm). Relatively greater proportion of tumors in central and lower quadrants were addressed by oncoplasty than traditional BCS (17/57, 29 % vs 4/43, 9 %, p = 0.04). The mean specimen volume excised in group 1 was more than that in group 2. (187.54 vs 125.19; p = 0.01). The mean of the margins were obtained more in group 1 (1.04 vs 0.69 cm); p < 0.01) as also the mean closest margin (0.86 vs 0.49 cm; p < 0.01). The incidence of close or involved margins was lesser in the OBS group (8 vs 24 %). Overall incidence of complications was similar in both groups (8/57, 14 % vs 4/43, 9 %; p = 0.34 NS). The median follow-up period of group 1 is 18 months (range 06-30 months) while group 2 is 34 months (14-44 months. There was no recurrence in group 1, but there were 5 cases (11 %) in group 2. Oncoplasty breast surgery offers more opportunity for breast conservation and oncologic safety than conventional breast conserving surgery.

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Section: Discussionsupporting

confidence: 82%

“…Locally advanced breast cancer (LABC) accounts for a large proportion of breast cancers in India; 40-60 % in some series. In these patients, breast conservation rates are poor [9,10]. OBS offers an attractive alternative in these cases to enable breast conservation.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

Chauhan

Sharma

Kumar

2016

Indian J Surg Oncol

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“…This advanced presentation could be due to lack of awareness which in turn cause delay in getting surgical consultation or due to aggressive tumour biology. 10 The present study correlated receptor status of the malignancy with clinical and pathological parameters to assess this factor in Indian population. It was also observed in the present study that a majority (43.54%) of these patients were TNBC which are known to have aggressive tumour biology.…”

Section: Discussionmentioning

confidence: 97%

Breast cancer: correlation of receptor status with clinical presentation, stage of disease, histopathological grade and short term outcome

Kumar¹,

Akhtar²,

Rangwala³

2019

Int Surg J

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Background: Breast cancer is the commonest female cancer representing a quarter of all cancers worldwide. An important development in breast cancer management was the realization of role of hormone receptors in disease. Thus, the present study was carried out to evaluate the receptor status and its correlation with clinical presentation, stage, grade and short term outcome.Methods: All female patients with lump in breast confirmed as breast cancer were included and their receptor status was evaluated using immunohistochemistry.Results: A total of 147 patients with a mean age of 50.16±12.08 years were enrolled. Almost half of the patients (48.3%) of the patients were found to have locally advanced breast cancer. Of the 147 patients, 91.49% tumours were either Nottingham grade 2 or 3. Triple negative breast cancer (TNBC) was the commonest subtype seen in 43.54% patients. On correlating the results with receptor status, it was found that TNBC patients were younger than HER2neu positive and ER PR positive patients. Also, TNBC patients had a longer duration of lump and the lump was of larger size at presentation. On correlating receptor status with tumour biology it was seen that more than half (54.69%) of the patients who were triple negative had a grade 3 tumour and poorer disease free survival and overall survival.Conclusions: In conclusion it is seen that TNBC forms a majority of the cases in the central Indian population with more aggressive presentations and outcomes. Absence of any targeted therapies against them leads to a worse DFS and overall survival.

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“…Lack of screening facilities and lack of infrastructure for early diagnosis is considered to be an important factor for the delay in diagnosis. Lower level of education and lack of awareness, wrong beliefs and initial treatment with traditional medicine, lower socioeconomic status and poor access to health care facility are other factors linked to the delay in diagnosis of the symptomatic disease in most of these developing countries like Pakistan (Igene 2008;Akhtar et al, 2011;Talpur et al, 2011;Khan et al, 2015). All these factors contribute to the time lag between appearance of symptoms in the patients and the time cancer is diagnosed and staged in the health care facility.…”

Section: Determinants Of Advanced Stage At Initial Diagnosis Of Breast Cancer In Pakistan: Adverse Tumor Biology Vs Delay In Diagnosismentioning

confidence: 99%

Determinants of Advanced Stage at Initial Diagnosis of Breast Cancer in Pakistan: Adverse Tumor Biology vs Delay in Diagnosis

Khokher

Qureshi²,

Mahmood³

et al. 2016

Asian Pacific Journal of Cancer Prevention

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Background: Breast cancer is the most frequent cancer of women in Pakistan with the majority presenting with stage III or IV lesionsat initial diagnosis. Patient and health system related factors are well known determinants of delay in presentation and diagnosis. Additionally, breast cancer being a heterogeneous disease, the various molecular subtypes featuring different aggressiveness also need to be considered. The present study evaluated the association of stage at initial diagnosis of breast cancer with these two factors in local women at a tertiary level health care facility in Lahore, Pakistan. Materials and Methods: Patient and tumor features were recorded separately during diagnostic workup in Breast Clinics at INMOL and at Services Hospital, Lahore. Data were entered in MS Excel and analyzed by descriptive statistics and Chi-Square test. Results: Among the 261 patients, 64% were staged as late breast cancer (LBC), the mean age was 46.8 with standard deviation of 13 years. Some 92% had invasive ductal carcinoma (IDC), 61% had luminal types (LT) of non-aggressive tumor while 39% had the non-luminal types (NLT) of of HER2-enriched or basal aggressive tumors. While 70% of patients presented within one year of symptomatic disease (early report group "ERG"), 30% reported after a mean delay of 4 years with a standard deviation of 3.75 years. The stage distribution among ERG patients was not statistically different from those reporting late (P=0.123). Statistically larger proportion of patients with NLT presented as LBC as compared to the LT (P =0.034). Among the ERG, statistically different stage distribution of disease was observed for the NLT versus LT (P=0.047). Among those presenting late, this difference was insignificant (P=0.416). Conclusions: Breast cancer is a distinct disease in Pakistan with a high frequency of aggressive molecular types affecting younger women, with the majority presenting as LBC. Association of NLT with higher stage at diagnosis is statistically significant whereas time delay in diagnosis is not. Further research is required to define the risk profile and features in local patients. The burden of LBC can be reduced by promoting breast health awareness and by establishing easily accessible dedicated breast care set ups in the hospitals.

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Is locally advanced breast cancer a neglected disease?

Abstract: LABC in the Indian scenario is an outcome of neglect due to patient and system factors. These factors offer an excellent opportunity to plan a community-oriented preventive strategy for the general population and practitioners to decrease the incidence of LABC.

Cited by 8 publications

References 2 publications

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

Breast cancer: correlation of receptor status with clinical presentation, stage of disease, histopathological grade and short term outcome

Determinants of Advanced Stage at Initial Diagnosis of Breast Cancer in Pakistan: Adverse Tumor Biology vs Delay in Diagnosis

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