PURPOSE: Misdiagnosed breast cancer on screening mammography was retrospectively reviewed in an attempt to analyze the cause for the undiscovery and to determine findings that might have been suggested on the mammographic examination. MATERIALS AND METHODS: Of the 173 breast cancers that were pathologically proven, 17 breast cancers misdiagnosed on mammogram was retrospectively analyzed for the causes of the misinterpretation and predominant secondary findings. RESULTS: Three of the 17 were negative on mammography except for dense breast. Two patients had localized asymmetricity without visible mass. Ten patients had benign-looking mass which was well-defined (n=5), partially defined(n=2), multiple (n=l), or included benign-looking calcifications(n=2). Remaining two cases were retrospectively diagnosed as misinterpreted breast cancers. Various secondary findings such as were useful in the diagnosis of breast cancer. CONCLUSION: Meticulous observation could improve the diagnostic yield of breast cancer in mammography.
Breast Neoplasms* ; Breast* ; Diagnosis ; Humans ; Mammography* ; Mass Screening ; Retrospective Studies*

PURPOSE: A specialized breast surgeon is important to give comprehensive treatments to breast cancer patients. The purpose of this study was to evaluate the characteristics and treatment results of breast cancer patients in my breast clinic, and to share the experience of clinical management and data base recording and its clinical use. MATERIALS AND METHODS: I had performed 1,018 breast cancer surgeries from Mar. 1992 to Mar. 1998 at the Breast Clinic in Asan Medical Center. RESULTS: The results were as follows; 1,008 cases were female (99.0%), and 10 cases were male (1.0%). The peak incidence was in 40~49 years of age (36.5%), followed by 30~39 years (24.0%) and 50~59 years (23.3%). 647 cases (63.6%) were under the age of 50. The most common operative method was a modified radical mastectomy in 747 cases (73.4%), and breast conserving surgery was performed in 173 cases (17.0%). Immediate breast reconstruction was performed in 63 cases (tissue expander with implant in 50 cases, direct implant in 4 cases, TRAM flap in 8 cases, and LD flap in one case), and SSM (skin-sparing mastectomy) through circumareolar incision was done in 9 cases. According to TNM classificasion, the most common was stage II in 49.2% (501 cases), and the proportion of early-breast cancer (stage 0 and I) was 33.7%. The axillary lymph node metastasis was present in 43.5%. The 5-year overall survival and disease free survival rate was 81.4% and 70.7%. There was no local recurrence in breast conserving surgery by median follow-up of 32 months. CONCLUSION: As a breast surgeon, I have tried to apply the appropriate operation methods according to the patients condition. The survival data was fairly good, and there was no local recurrence after breast conserving surgery yet. Data computerization was very useful for evaluating the characteristics of the patients.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea* ; Lymph Nodes ; Male ; Mammaplasty ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Neoplasm Metastasis ; Recurrence

No abstract available.
Breast* ; Female ; Mammaplasty* ; Mastectomy*

The purpose of this study was to compare dietary patterns, dietary behaviors and life styles before and after breast cancer surgery in Korea. The subjects were 220 females who underwent surgery for stage I-III breast cancer at general hospitals. Food intake, eating habits, snacks, eating-out, use of nutritional supplements and healthy foods, and drinking and smoking habits were studied using a questionnaire. SAS program was used for statistical analysis of the data. The results are as follows : 1) Most subjects were housewives aged more than 40 years. 2) After breast cancer surgery, intakes of fruits and vegetables were increased and those of meat, salty and spicy foods were decreased. 3) There was a significant difference in takes of caffeine beverages, snacks, fast foods and instant foods before and after breast cancer surgery. 4) There was a significant difference in meal regularity and skipping breakfast before and after breast cancer surgery. 5) The frequency of eating-out was decreased and low-fat foods, such as Japanese foods, were preferred after breast cancer surgery. 6) Nutritional supplements and natural healthy foods were used more after breast cancer surgery. 7) Most subjects were non-smokers and drank little alcohol and the rate of regular drinking significantly decreased after breast cancer surgery. Therefore, there was a significant difference in dietary patterns and behaviors resulting form breast cancer. Further more, dietary factors may be a contributing factor in the incidence at breast cancer in Korea.
Asian Continental Ancestry Group ; Beverages ; Breakfast ; Breast Neoplasms* ; Breast* ; Caffeine ; Drinking ; Eating ; Fast Foods ; Female ; Fruit ; Hospitals, General ; Humans ; Incidence ; Korea ; Life Style* ; Meals ; Meat ; Smoke ; Smoking ; Snacks ; Vegetables ; Surveys and Questionnaires

p53 plays an important function as a negative regulator of cell growth and also inhibits transformation. It has been hypothesized that p53, acting as a control gene at a G1 check point, may detect DNA damage, slow the cell devision, and allow time for DNA repair. If damage is irreparable, the cell may be driven down into the apoptotic pathway, thus preventing replication of defective cells. In this retrospective study, we investigated the correlation between p53 protein expression by IHC staining and benign breast disease with or without atypical ductal hyperplasia, DCIS and invasive breast cancer. Also We analyzed the association between p53 protein expression and the following prognostic parameters in breast cancer patients; age, tumor size, axillary node involvement, stage, histologic grade, estrogen receptor, and progesteron receptor, and DNA ploidy. And, we investigated the correlation between p53 protein expression and the proliferative index of S phase fraction in diploid breast cancer. The results were as follows ; 1) In histopathological classification, none out of ten benign breast diseases, none out of seventeen fibrocystic disease with atypical ductal hyperplasia patients were p53 protein positive, 3 out of fifteen DCIS (20%), 29 out of eighty-six (34%) invasive breast cancer patients were p53 protien positive.2) There were no significant differences between p53 positivity and age, tumor size, axillary node involvement, stage, histologic grade, ER and PGR status, and DNA ploidy by Fisher's exact test with chi-squre test for trend, in invasive breast cancer. (n=86) 3) In diploid tumor (n=35), statistically significant differences were noted such that high S-phase fraction tumor revealed increased p53 positivity. (p<0.05) We have found that immunopositivity for p53 was detected in 20% of in situ carcinoma, suggesting that p53 mutation can be acquired early in malignant progression. We have also found that there is a strong direct correlation between the amount of mutant protein and tumor proliferation rate. These results are consistent with the hypothesis that wild-type p53 is involved in suppression of the cell cycle.
Breast Diseases ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Cell Cycle ; Classification ; Diploidy ; DNA ; DNA Damage ; DNA Repair ; Estrogens ; Humans ; Hyperplasia ; Immunohistochemistry ; Mutant Proteins ; Ploidies ; Retrospective Studies ; S Phase

PURPOSE: To report the results of 134 cases in which add-on stereotactic core biopsy (ASCB) was performed in patients with mammographically detected breast lesions, and to evaluate the usefulness of this procedure. MATERIALS AND METHODS: We analyzed the results of ASCB of 134 breast lesions in 125 patients, performed during a 41-month period. The mammographic findings were suspicious malignant lesion in 38 cases, benign lesion in 18, and indeterminate lesion in 78. Surgical excision was performed in 23 cases, and follow-up mammography in 39. We analyzed the pathologic results according to each mammographic finding and correlated the results of core biopsy with those of surgical excision. We also evaluated the mammographic changes seen during follow-up, and associated complications and procedural difficulties. RESULTS: Samples were adequate for pathologic diagnosis in 95% of cases (127/134). ASCB revealed malignancy in 47% of cases (18/38) in which this was suspected on the basis of mammographic findings, and in 5% of cases (4/78) in which these findings were indeterminate. The pathologic results of core biopsy and of surgical excision agreed in 78% of cases (18/23). In two of five false-negative cases, ASCB revealed the presence of atypical ductal hyperplasia. The mammographic findings in these five cases were suspicious malignancy in three, and indeterminate in two. Specimen radiography showed calcifications in four cases. The size or extent of mammographic lesions did not change during the mean follow-up period of 17.3 months. In 13/125 patients (10%), the complications and procedural difficulties noted included arterial bleeding, dizziness, syncope, patient movement, and instrument failure. CONCLUSION: ASCB is accurate, safe and useful, but surgical excision should be considered when the ASCB result is either atypical ductal hyperplasia or benign but with mammographic diagnosis of suspicious malignant or indeterminate lesions.
Biopsy* ; Breast* ; Diagnosis ; Dizziness ; Follow-Up Studies ; Hemorrhage ; Humans ; Hyperplasia ; Mammography ; Radiography ; Syncope

PURPOSE: This study was to develop and evaluate the clinical utility of the breast and ovarian cancer genetic counselling program specific for 20 Korean women(KBOCGP). METHODS: The KBOCGP was developed using three types of approaches: an ethnography among Korean women who underwent BRCA1/2 test, designing and implementing one week clinical genetic educational course for clinical cancer nurses, educational observation visits to three American cancer genetic counselling programs. And then pre-experimental design was implicated to evaluate the change of the women's knowledge about the hereditary breast and ovarian cancer and the level of the satisfaction with genetic counselling. RESULTS: The mean score of the knowledge has significantly increased from 7.45 +/- 3.86 to 11.55 +/- 2.21(t = 5.63, p < .001). The level of the satisfaction with the counselling was very high (27.47 +/- 1.35). Because most of the subjects have young kids, they showed strong concerns about their kids' getting cancer. CONCLUSION: This new KBOCGP is the satisfactory program for the education and communication of the genetic information to the Korean women with HBOC. But it is needed more to strengthen the cultural sensitivity especially to Korean family relationships. Authors recommend that this program be provided by other nurses who are counselling women at high risk of breast cancer.
Anthropology, Cultural ; Breast ; Breast Neoplasms ; Family Relations ; Female ; Genetic Counseling ; Genetic Diseases, Inborn ; Humans ; Ovarian Neoplasms ; Personal Satisfaction

PURPOSE: This study was conducted to investigate whether breast cancer with p53 protein overexpression (p53+) and loss of p16 protein expression (p16-) shows different body size indicator (height, weight, body mass index) associations as compared with breast tumors without p53 protein overexpression and the loss of p16 expression (p53-, p16+). MATERIALS AND METHODS: A hospital based case-control study was conducted among 92 women patients and 122 control subjects. The p53 protein overexpression and loss of p16 protein expression in the tissue sections of patients with breast cancer were determined using immunohistochemistry. RESULTS: A total of 26 tumors (28%) demonstrated p53 overexpression and 35 tumors (46%) showed abnormal p16 expression. The heaviest women had a higher risk with p53- and p16+ breast tumors. The odds ratios (OR) adjusted for age, menopausal status, smoking, and drinking revealed a significant gradient of increasing risk of breast cancer with increasing BMI in p53- and p16+ breast cancer. The adjusted ORs for the highest quintile of BMI was 8.51 with p53+ tumors and 14.2 with p53- tumors, and 55.6 with p16+ tumors and 3.72 with p16- tumors. p53 protein overexpression and the loss of p16 expression did not significantly correlate with nodal status, tumor size, estrogen or progesterone receptor status. CONCLUSION: The study concluded that a strong association between p53-/p16+ tumors and BMI suggests the occurrence of p53-/p16+ tumors is related with obesity as compared to p53-/p16+ tumors.
Body Mass Index* ; Body Size ; Body Weight ; Breast Neoplasms* ; Breast* ; Case-Control Studies ; Drinking ; Estrogens ; Female ; Humans ; Immunohistochemistry ; Obesity ; Odds Ratio ; Receptors, Progesterone ; Smoke ; Smoking

A palpable breast lump is the most frequent symptom of breast cancer. At the same time, metastatic lymph nodes can be palpable in the axilla. Breast cancer can sometimes present as an isolated axillary adenopathy without any clinically detectable breast tumor. The incidence of an occult primary tumor with axillary metastases is very low, 0.4% of the breast cancer patients in the collective data. A metastatic carcinoma found in an axillary node should be treated as a breast cancer, because the breast is the most common primary site and because breast cancer is a curable disease with proper management. Between July 1993 and June 1996, 523 breast cancer patients underwent surgery in Asan Medical Center. Among them, 7 patients (1.3%, 7/523) presented with metastatic axillary lymphadenopathy without clinical evidence of a breast tumor or any other primary tumor. The median age of these 7 patients was 49 years (range 39~62 years). The mean size of palpable lymph nodes was 3.7 cm. A histological diagnosis of metastatic adenocarcinoma was obtained by excision in 5 patients and by fine needle aspiration cytology in 2 cases. The findings of the preoperative mammography was normal in 5 patients showed a dense breast in one patient was suspicious in one patient (14%, 1/7). Preoperative ultrasonography detected a suspicious tumor in two patients (28%, 2/7). The primary treatment was a modified radical mastectomy in 6 patients and an axillary dissection with whole breast radiotherapy in one patient. A breast cancer was found in the mastectomy specimen of 4 of 6 patients (66%): one invasive ductal, one invasive lobular, one DCIS, and one LCIS tumor. No tumor was found in two mastectomy samples.The median number of involved metastatic lymph nodes was 2 (range 1~25). The staging was IIA (TxN1M0, T0N1M0) in 4 patients, IIB (T2N1M0) in 2 patients, and IIIA (TxN2M0) in one patient. Four patients were positive for hormone receptors, 2 were negative, and one was unknown. All the patients were treated with postoperative adjuvant chemotherapy, radiotherapy or hormone therapy; no recurrence has been found in these patients to date. We conclude that axillary metastases without clinical evidence of a primary breast tumor represents a unique clinical entity of breast cancer, and it should be treated as a breast cancer to avoid unnecessary labaratory or radiological efforts to find the primary site.
Adenocarcinoma ; Axilla ; Biopsy, Fine-Needle ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Diagnosis ; Humans ; Incidence ; Lymph Nodes* ; Lymphatic Diseases ; Mammography ; Mastectomy ; Mastectomy, Modified Radical ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Ultrasonography

BACKGROUND: Generally, it has been thought that the prognosis of breast cancer in young women is worse than that in their older counterparts. This, however, remains controversial. The purpose of this study was to evaluate the clinicopathological characteristics and the prognosis of breast cancer in the young age group. METHODS: One hundred and thirty-three patients under 35 years of age (younger group) at the time of diagnosis were selected from among the of total 936 female breast-cancer patients treated at the Breast Cancer Clinic of Asan Medical Center from July 1989 to December 1996, and they were compared with the 803 patients over 35 years of age (older group). RESULTS: Inadequately diagnosed cases of breast cancer, including a dense breast on mammography, were more frequent among the younger group (p=0.0005). The median tumor size of invasive ductal carcinomas was larger (3.0 cm vs 2.4 cm). The rate of lymph-node metastasis was high (58.6% vs 46.1%). The rate of early breast cancer (stage 0 and I) was lower (25.3% vs 42.6%). The 5-year disease-free survival rate was less (56.6% vs 73.7%, p=0.037), but no differences in operative methods, 5-year overall survival rate, and disease-free survival rate based on the different stages were observed between the two groups. CONCLUSIONS: This study showed that in the younger group (under 35 years of age), the breast cancer was more advanced, the lymph-node metastasis rate was higher, and the 5-year disease-free survival rate was significantly lower, but the 5-year overall survival rate was not significantly different from that in the older group.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Chungcheongnam-do ; Diagnosis ; Disease-Free Survival ; Female ; Humans ; Mammography ; Neoplasm Metastasis ; Prognosis* ; Survival Rate