PURPOSE: Systematic educational programs and genetic counseling certification courses for hereditary breast/ovarian cancer (HBOC) have not yet been introduced in Korea. We provided and evaluated the effects of genetic counseling education on Korean healthcare providers' knowledge, awareness, and counseling skills for patients at high risk of HBOC. METHODS: A 3-day educational program was conducted for healthcare providers who were interested in genetic counseling for patients at high risk of HBOC. Participants who completed a knowledge test and satisfaction questionnaire were included in the present sample. Pre-post comparisons were conducted to determine the effects of the intervention. RESULTS: Significant differences between preprogram and postprogram knowledge scores were observed (p=0.002). Awareness (p<0.001) and confidence (p<0.001) regarding genetic counseling significantly increased after the training. Doctors and participants with fewer years of work experience performed well on the knowledge test. Previous educational experience was correlated with increased confidence in knowledge and counseling skills. CONCLUSION: Genetic counseling education regarding HBOC improved knowledge and awareness of HBOC and enhanced confidence in the counseling process. The effects varied according to occupation and participants' previous education. The implementation of systematic educational programs that consider participant characteristics may improve the effects of such interventions.
Breast ; Breast Neoplasms ; Certification ; Counseling ; Delivery of Health Care ; Genetic Counseling ; Health Personnel ; Humans ; Korea ; Neoplastic Syndromes, Hereditary ; Occupations ; Surveys and Questionnaires

PURPOSE: B-cell lymphoma (bcl)-2 is an anti-apoptotic gene, and it is a poor prognostic factor in various malignant tumors. However, the prognostic significance of bcl-2 expression in breast cancer remains controversial. We investigated the prognostic significance of bcl-2 according to cancer molecular subtype. METHODS: We analyzed 411 patients with primary invasive breast cancer who underwent surgery at our institution between 1999 and 2001. The subtypes were classified as luminal (estrogen receptor [ER]+ and/or progesterone receptor [PR]+, irrespective of human epidermal factor receptor 2 [HER2]), triple-negative (ER-, PR-, and HER2-), or HER2 (ER- ,PR-, and HER2+). RESULTS: A total of 236 (57.4%) cases were positive for bcl-2, and bcl-2 expression was significantly associated with earlier stage, lower grade, expression of hormone receptor positivity, and HER2 negativity. No difference in disease-free survival (DFS) was observed based on bcl-2 expression. However, the prognostic significance of bcl-2 varied with subtype; bcl-2 was not a prognosticator in patients with the luminal and HER2 subtypes. However, patients with bcl-2(+) tumors of the triple-negative subtype showed significantly worse DFS than those with bcl-2(-) tumors (p=0.048). In a multivariate analysis, bcl-2 expression remained a significant predictor of recurrence in patients with the triple-negative subtype (hazard ratio, 3.26; 95% confidence interval, 1.40-7.59; p=0.006). CONCLUSION: The prognostic significance of bcl-2 varied with molecular subtype; bcl-2 expression was a poor prognosticator in patients with the triple-negative subtype, but not in those with the luminal and HER2 subtypes.
Humans ; Breast Neoplasms

PURPOSE: Although adjuvant chemotherapy improves the survival of premenopausal breast cancer patients, it could induce the premature menopause. The objective of this study was to investigate the incidence and risk factors of chemotherapy-induced amenorrhea (CIA) and recovery for young (< 45-year-old) breast cancer patients. METHODS: We examined patients with primary invasive breast cancer who had been treated with surgery and adjuvant chemotherapy from January 2003 to June 2006. All of the patients were younger than 45 year and they had regular menstruation at the time of diagnosis. Amenorrhea was defined as the absence of menstruation for three consecutive months or a serum follicular stimulating hormone level > 30 mIU/mL. RESULTS: A total of 324 patients were included in this study. Of these patients, 261 patients (80.6%) developed amenorrhea just after the completion of chemotherapy. During follow-up, 77 patients (29.5%) resumed menstruation. Amenorrhea rates at 6, 12, 24, and 36 months after chemotherapy were 72.2%, 66.6%, 58.1%, and 55.5%. Women who recovered from amenorrhea were significantly younger than the women who did not recover (p<0.001). Patients treated with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) less frequently recovered from amenorrhea than patients who were treated with anthracycline or taxane-based chemo- therapy (p<0.001). CONCLUSION: The age of the patient was the most important factor for the development of CIA. Patients treated with a CMF regimen and older patients showed poor recovery from CIA. These results could be helpful to make decisions about the treatment strategies for premenopausal young women.
Amenorrhea ; Antineoplastic Combined Chemotherapy Protocols ; Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Cyclophosphamide ; Female ; Fluorouracil ; Follow-Up Studies ; Humans ; Incidence ; Menopause, Premature ; Menstruation ; Methotrexate ; Risk Factors

INTRODUCTION: The prognosis of peri-ampullary cancer is poor because of its low respectability and high recurrence rate. Yet cancer of the Ampulla of Vater(AOV) has a relatively good prognosis. The aim of this study is to investigate the outcomes and to determine the factors that affect the survival rate of patients who underwent curative resection for AOV cancer. METHODS: From August 1988 to January 2008, 54 patients underwent curative resection for AOV cancer. We retrospectively reviewed the clinocopathologic data. The median follow up period was 45 months. RESULTS: Twenty-seven pancreaticoduodenectomies (PD) and 27 pyrolus-preserving pancreaticoduodenectomies (PPPD) were performed. There was no hospital mortality, but 25 out of 54 patients (47.3%) experienced postoperative complications. The 5-year overall survival (OS) rate was 53.97% and the 5-year disease free survival (DFS) rate was 51.75%. On multivariate analysis, the variables that affected the overall survival rate and the disease free survival rate was poor histologic differentiation (p<0.001). CONCLUSIONS: Although the AOV cancer is one of the periampullary cancers that have a very poor outcome, long-term survival and favorable outcomes can be achieved after a curative resection. In this study, poor-histologic differentiation was the only independent factor for a poor prognosis.
Ampulla of Vater ; Disease-Free Survival ; Follow-Up Studies ; Hospital Mortality ; Humans ; Multivariate Analysis ; Pancreaticoduodenectomy ; Postoperative Complications ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: False negative results obtained with the use of a sentinel lymph node biopsy (SLNB) can result in down staging of tumors, whereas the use of a more elaborated pathological examination of sentinel lymph nodes might lead to upstaging of tumors. The purpose of this study was to compare results after performing only an SLNB as compared with performing conventional axillary lymph node dissection (ALND) without an SLNB in pathologically node negative (pN0) breast cancer patients. METHODS: From April 2004 to June 2007, SLNBs were performed for patients with primary breast cancer who had no clinical evidence of a lymph node metastasis. A total of 272 patients were treated with only an SLNB. During the same period, 278 patients were confirmed as pN0 after conventional ALND without an SLNB. A prospectively collected database and medical records of these patients were reviewed. RESULTS: For patients that had undergone only an SLNB, there was no local or regional recurrence. A distant metastasis developed in four patients (1.5%). In patients that had undergone ALND without an SLNB, a recurrence was found in 13 patients (4.7%). Patients that had undergone only an SLNB showed significantly better disease-free survival as compared to patients that had undergone ALND without an SLNB (p=0.032). CONCLUSION: pN0 patients treated with only an SLNB showed a significantly better outcome as compared to patients treated with conventional ALND without an SLNB. These results suggest that performing an SLNB might result in the upstaging of a subset of patients who would have been understaged by the use of conventional ALND.
Breast ; Breast Neoplasms ; Disease-Free Survival ; Humans ; Lymph Node Excision ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Nitriles ; Prospective Studies ; Pyrethrins ; Recurrence ; Sentinel Lymph Node Biopsy

PURPOSE: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). MATERIALS AND METHODS: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+beta lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a 2.5~3.0 cm pyloric cuff and maintaining a 3.0~4.0 cm distal margin for the resection. RESULTS: The mean age for patients who underwent LAPPG and LADGBI were 59.9+/-9.4 year-old and 64.1+/-10.0 year-old, respectively. The sex ratio was 1.3:1.0 (male 5, female 4) in the LAPPG group and 2.6:1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes (28.3+/-11.9 versus 28.1+/-8.9), operation time (269.0+/-34.4 versus 236.3+/-39.6 minutes), estimated blood loss (191.1+/-85.7 versus 218.3+/-150.6 ml), time to first flatus (3.6+/-0.9 versus 3.5+/-0.8 days), time to start of diet (5.1+/-0.9 versus 5.1+/-1.7 days), and postoperative hospital stay (10.1+/-4.0 versus 9.2+/-3.0 days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. CONCLUSION: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.
Arteries ; Diet ; Female ; Flatulence ; Gastrectomy ; Gastroparesis ; Humans ; Korea ; Length of Stay ; Liver ; Lymph Node Excision ; Lymph Nodes ; Postgastrectomy Syndromes ; Postoperative Complications ; Seroma ; Sex Ratio ; Stomach ; Stomach Neoplasms ; Vagus Nerve

PURPOSE: Gastric cancer is the most common malignant tumor in Korea. We reviewed the cases at our institution to identify the survival rates and clarify the prognostic factors of patients with gastric cancer. MATERIALS AND METHODS: We conducted a retrospective study of 6,918 patients who had received a diagnosis of gastric cancer, and they underwent surgery at Korea Cancer Center Hospital during a 15-year period from 1991 to 2005. RESULTS: The overall 5-year survival rate was 66.8%. The univariate analysis revealed that age, location of tumor, gross type of tumor, the histology according to the WHO classification, the Lauren classification, depth of invasion (T stage), lymph node metastasis (N stage), distant metastasis (M stage), the type of surgery, the UICC TNM stage, postoperative complications, adjuvant chemotherapy, lymphatic invasion, venous invasion and perineural invasion were the significantly different factors of the survival rates. The multivariate analysis revealed that age , Borrmann type 4, the histology according to the WHO classification, depth of invasion (T stage), lymph node metastasis (N stage), distant metastasis (M stage), the type of surgery, UICC TNM stage, postoperative complications, adjuvant chemotherapy and lymphatic invasion were the independent prognostic factors. CONCLUSION: We have shown a statistically significant association between the survival rates after operation for gastric cancer and the clinicopathologic factors. Early diagnosis of gastric cancer, appropriate surgeryand adjuvant therapy might improve the quality of life and the survival rates of gastric cancer patients.
Chemotherapy, Adjuvant ; Early Diagnosis ; Humans ; Korea ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Postoperative Complications ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

PURPOSE: Apocrine carcinoma of the breast, a specific histologic type of human breast cancer, is a rare malignant tumor. Because of the rarity of apocrine carcinoma and lack of a standardized definition, the clinicopathologic features have not been definitively determined. In this study, we present a single institution analysis of the clinicopathologic features of 19 cases of apocrine carcinoma and contrast them with those seen in infiltrating ductal carcinoma, not otherwise specified (NOS). METHODS: We respectively reviewed the records of 19 patients with apocrine carcinoma who underwent surgery at Korea Cancer Center Hospital between October 1997 and April 2007. RESULTS: The mean patient age was 52.8 years. Eight patients (42.1%) were under 50 years of age. In all patients, the initial symptom was a breast mass. Twelve (63.2%) of 19 tumors were located in the right breast and the other 7 cases (36.8%) were located in the left breast. The average tumor size was 2.19 cm (range 0.7-7 cm). Two patients had axillary lymph node metastasis. Estrogen receptor (ER) was positive in 3 cases (16.7%). The HER-2 overexpression rate was 35.3%. There was no locoreginal recurrence, distant metastasis, or death during the median follow-up period of 35.4 months (range 4-114 months). CONCLUSION: Compared with the alleged characteristics seen in Korean breast cancer patients, apocrine carcinoma was characterized by an older age at the time of diagnosis and a higher incidence of hormone receptor negatively. The HER-2 overexpression rate was similar to the rate for other tumors. Although there was a relatively low incidence ER positivity, there was no recurrence or death. Therefore, apocrine carcinoma appears to be clinically distinct from infiltrating ductal carcinoma, NOS.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Estrogens ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence

PURPOSE: The role and safety of aromatase inhibitors (AIs) in young breast cancer patients with chemotherapy-induced amenorrhea (CIA) has not been established. The goal of this study was to investigate the safety and efficacy of AIs in young breast cancer patients with CIA. METHODS: From December 2000 to December 2006, 58 patients with hormone receptor positive breast cancer under the age of 45 were treated with AIs as adjuvant therapy. All patients had amenorrhea for more than three consecutive months at the time of treatment. We evaluated the rates of recovery of ovarian function during the treatment, and analyzed the association of the recovery of ovarian function with age, body mass index (BMI), chemotherapy regimen, radiation therapy, and the use of tamoxifen. RESULTS: Recovery of ovarian function was observed in 16 patients (27.6%). The univariate analysis showed that ovarian function was more frequently recovered in patients younger than 40 yr of age, treated with chemotherapy regimens other than Cyclophosphamide, Methotrexate, 5-Flurouracil (CMF), without a history of tamoxifen therapy, and with a higher BMI. The multivariate analysis confirmed that the type of chemotherapy (p=0.034) and the history of tamoxifen therapy (p=0.043) were independent factors significantly associated with the restoration of ovarian function. CONCLUSION: The results of this study suggest that AIs should be considered, with caution in young women with CIA; these agents may promote the unwanted recovery of ovarian function. Especially, in those patients who were not treated with CMF chemotherapy or tamoxifen, where the rates of recovery of ovarian function were higher.
Amenorrhea ; Aromatase ; Aromatase Inhibitors ; Body Mass Index ; Breast ; Breast Neoplasms ; Cyclophosphamide ; Female ; Humans ; Methotrexate ; Multivariate Analysis ; Tamoxifen

PURPOSE: Sentinel lymph node (SLN) biopsy has been shown to be accurate in axillary node staging in early breast cancer. If any SLN is positive, the standard care remains completion axillary node dissection (ALND). However over 50% of the patients with metastatic SLNs do not show other non-SLN metastasis. The purpose of this study was to identify predictors of non-SLN tumor involvement in patients with metastatic SLNs. METHODS: We reviewed 387 breast cancer patients in whom an SLN biopsy was successfully performed using a subareolar injection of 99mTc-Tin colloid. RESULTS: Among the reviewed patients, 83 patients showed positive SLNs, and subsequently underwent ALND. In 47 of 83 patients (56.6%), SLNs were the only metastatic nodes. The following factors were assessed for predictors of non- SLN metastasis: age of the patient, size, grade, histologic type, multicentricity of the primary tumor, number of SLNs removed, number of ositive SLNs, number of negative SLNs, size of the SLN metastasis, percentage of SLNs replaced by metastasis, and extracapsular extension (ECE). By multi-variate analysis, the size of SLN metastasis (<2 mm), absence of ECE, and the percent replacement (.10%) were negative predictors of non-SLN metastasis. Among 18 cases in which micrometastasis were found in the SLNs, additional metastasis in non-SLN has been found in 3 cases. This result suggests that micro-metastasis in a SLN is not a sufficient condition for not performing ALND. However, in 9 cases, in which all of three factors (micrometastasis, absence of ECE, no more than 10% replacement of SLNs by tumor cells) were present, additional metastasis had not been found in the non-SLNs. CONCLUSION: Although further study is needed to verify the result, it would seem that the presence of all three factors (micrometastasis, absence of ECE, no more than 10% replace- ment of SLNs by tumor cells) in combination might be sufficient to safely omit ALND.
Biopsy ; Breast Neoplasms* ; Breast* ; Colloids ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Neoplasm Micrometastasis