OBJECTIVES: This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. METHODS: This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson's index score, emergency hospitalization, the type of hospital and the hospital ownership. RESULTS: Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For all-cause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. CONCLUSIONS: The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.
Adult ; Aged ; Breast Neoplasms/diagnosis/mortality/*surgery ; Cohort Studies ; Female ; Humans ; Mastectomy, Radical/mortality ; Middle Aged ; *Mortality ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Socioeconomic Factors

PURPOSE: Male breast cancer is a rare type of neoplasm, account for 1 % of all breast tumors. A retrospective review of the clinical and histological characteristics, types of treatment, pathological staging, and adjuvant treatment was completed. The objective of this study was to make an early diagnosis of male breast cancer and reduce the mortality. METHODS: Over a 5-year period, from Oct. 1994 to July 2000, 10 male breast cancer patients were operated on in the breast cancer clinic of the Samsung Medical Center. Their duration of follow up ranged from 6 to 76 months with a mean of 26 months. The clinical and histological characteristics, associations of the risk factors, type of treatment, and results were studied. RESULTS: Their ages ranged from 40 to 67 years with a mean of 51 years, with 5, 3 and 2 cases in their 5th, 6th, and 7th decades, respectively. A palpable breast lump was the most common presenting symptom. A pathological assessment disclosed 8 infiltrating ductal carcinoma, 1 ductal carcinoma in situ, and 1 invasive adenoid cystic carcinoma. The tumor sizes ranged from 0.5 to 3.7 cm (median, 1.9 cm in diameter). Of the 10 patients, there were 3 T1b, 3 T1c, and 4 T2 in the tumor staging. 4 Patients had axillary node involvement (lymph node positivity, 40%), and of these 4, the metastasis involved 2 lymph nodes and more than 3 lymph nodes in 1 and 3 case, respectively. No distant metastasis was observed in any of the patients. Pathological stages of the patients 0, I, IIIA, and IIIB in 1, 5, 1 and 2 cases, respectively. All the patients underwent surgery, 7 with a modified radical mastectomy and 3 with a radical mastectomy, due to gross invasion of the pectoralis major muscle. CONCLUSION: A subareolar palpable breast mass was the most common presenting symptom of the male breast cancer patients. The optimal treatment for male breast cancer patients is a modified radical mastectomy, combined with radiotherapy, chemotherapy, and hormonal therapy, due to the higher hormone receptors positivity.
Breast Neoplasms ; Breast Neoplasms, Male ; Breast* ; Carcinoma, Adenoid Cystic ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Drug Therapy ; Early Diagnosis ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male* ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mortality ; Neoplasm Metastasis ; Neoplasm Staging ; Radiotherapy ; Retrospective Studies ; Risk Factors

BACKGROUND: Early detection of breast cancer is important because it can reduce morbidity and mortality. Mammography is widely used for clinical and screening purposes and was contributed to the early detection of breast cancer, even tumors less than 1 cm in size and microcalcifications without lumps. METHODS: We retrospectively analyzed the clinical records of 340 patients with clinically evident breast cancer and 55 patients with clinically occult breast cancer who were treated at the Department of Surgery, Samsung Medical Center. Preoperative mammography, ultrasonography, and cytology, as well as operative method and postoperative pathology, were compared to evaluate the clinical features of clinically occult cancer. Preoperative marking was performed in suspected lesions by means of hookwire insertion or, in case of breast conservation surgery, by means of tattooing. RESULTS: Based on mammography, malignancy was suspected in 39 out of 42 cases (92.8%). Micro calcifications were seen on the mammography in 19 patients (45.2%), a mass in 17 (40.5%), a mass with microcalcifications in 4 (9.5%), and an asymmetric increased density in 2 (4.8%). Microcalcifications were major findings in comparing with clinically evident cases (16.9%) (p=0.001). Ultrasonography detected a malignancy in 10 patients (76.9%) and a core biopsy under ultrasonography was performed in 9 of them. Among the 39 patients with a mammographically suspected malignancy, a stereotactic core biopsy was performed in 12 patients, an ultrasonography-guided core biopsy in 9, fine needle aspiration cytology in 10, and localization & excisional biopsy in 3; the remaining 5 cases underwent surgery without additional evaluation. Breast conservation surgery was performed in 23 patients (41.8%) and modified radical mastectomy in 31 (56.4%). In the breast conservation surgery, 19 patients were localized by using mammographic needle localization and 4 patients by using ultrasonographically tattooing preoperatively. A ductal carcinoma in situ (DCIS) was more frequently found in the group with clinically occult breast cancer (10 patients, 18.2%) than in the group with clinically evident breast cancer (2.6%, p<0.001). Postoperative staging was earlier in patient with clinically occult cancers than in those with clinically presenting masses (p<0.001). CONCLUSION: By using mammography and ultrasonography, breast cancer can be diagnosed before it becomes palpable, and thus it can be treated with conservative surgical procedures.
Biopsy ; Biopsy, Fine-Needle ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Mammography ; Mass Screening ; Mastectomy, Modified Radical ; Mortality ; Needles ; Pathology ; Retrospective Studies ; Tattooing ; Ultrasonography ; Ultrasonography, Mammary

PURPOSE: There is no concensus on the type of therapy useful for elderly cancer patients. Since 2000, Korea has become an elderly society. This study aims to assess clinical characteristics of elderly breast cancer women, and to evaluate determinants and effects of treatment choice for breast cancer prognosis among elderly patients. METHODS: We reviewed the clinical reports of 123 breast cancer patients aged > or =70 yr recorded at the Asan Medical Center Breast Cancer Registry between 1992 and 2002. Patient and tumor chariteristics, comorbidity, surgical method, adjuvant therapy and cause of death were taken into consideration. Survival analysis was determined according to the treatment method. RESULTS: The median time to diagnosis was 33.6 months. Only 9 patients (5.1%) were diagnosed in the screening program. A modified radical mastectomy was performed for 74 patients (60.1%), Breast conserving surgery was performed for 26 patients (24.7%), and there was no further curative therapy for 12 patients (9.7%). 32 patients (38.1%) had axillary lymph node metastasis. The median follow-up duration was 43.1 months; the overall survival rate was 71.8%, and the disease free survival rate was 65.4%. Breast cancer related mortality was 62.8%. CONCLUSION: Delayed diagnosis and infrequent screening were frequent among elderly patients. Cancer related morbidity was less than general breast cancer patients. Treatment needs to be adapted to the general health status of the patient and comorbid conditions, but has to offer the best chance of cure, regardless of age.
Aged ; Breast Neoplasms* ; Breast* ; Cause of Death ; Chungcheongnam-do ; Comorbidity ; Delayed Diagnosis ; Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Korea ; Lymph Nodes ; Mass Screening ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Mortality ; Neoplasm Metastasis ; Prognosis ; Survival Rate

OBJECTIVETo assess the clinical manifestation, management and outcome in patients with medullary carcinoma of the breast (MBC).

METHODSRetrospective analysis was carried out on patients with MBC who were admitted from January 1995 to December 1999.

RESULTSA total of 616 female patients treated for breast carcinoma, 26 cases (4.2%) were histopathologically confirmed MBC. The mean age was (45.8 +/- 10.6) years. The tumor size was among 1-5 cm and axillary lymph node involvement was 23.1%; there was no statistically significant correlation between tumor size and metastatic axillary lymph node. Estrogen receptor (ER), progesterone receptor (PR) and HER-2/neu assay were performed immunohistochemically, and the overexpression was 26.3%, 21.1% and 5.3% respectively. All patients underwent operation and polychemotherapy (5-fluorouracil, methotrexate, cyclophosphamide), hormone therapy with Tamoxifen was applied in five patients, and three cases received postoperative irradiation. The follow-up period ranged from 5 to 9 years. Overall five-year survival was 88.4%.

CONCLUSIONSMBC is a favorable histological type of breast carcinoma with good prognosis. Operation and chemotherapy are main procedures for MBC. The significance of molecular biologic parameters in the prognosis of MBC should not be overlooked.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; mortality ; therapy ; Carcinoma, Medullary ; mortality ; therapy ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Mastectomy, Radical ; methods ; Middle Aged ; Retrospective Studies ; Survival Analysis

OBJECTIVETo study clinical effects of modified radical mastectomy with preservation of major and minor pectoral muscles.

METHODSA retrospective analysis was carried out in 214 cases of breast cancer patients (including stage I 66 cases, stage II 141 cases and stage III 7 cases). Modified radical mastectomy with preservation of major and minor pectoral muscles was performed on all the patients.

RESULTSOut of 214 cases, 12 (5.6%) had subcutaneous fluid, 16 (7.4%) had skin flap margin necrosis. Upper limb lymphatic edema was found in 8 (3.7%) patients, and pectoral muscle contracture with dyspraxia of upper arm occurred in 11 (5.1%) cases. Three year survival rate was 82.3% and five year survival rate was 63.4%. For stage I patients, the five year survival rate attained to 79.6%, and stage II 56.3%.

CONCLUSIONSPreservation of lateral branch of pectoral nerve can avoid complication of pectoral muscle contracture with dyspraxia of upper arm. Early chemotherapy of postoperation prevents breast cancer occurrence and metastasis. Comprehensive treat approaches for operative wound avert subcutaneous fluid, and complex therapy improves long-term effect of breast cancer patients.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; drug therapy ; mortality ; surgery ; Female ; Follow-Up Studies ; Humans ; Mastectomy, Modified Radical ; methods ; Middle Aged ; Pectoralis Muscles ; surgery ; Retrospective Studies ; Survival Rate