Faculty Bibliography

INTRODUCTION: With the adoption of routine screening mammography, breast cancers are being diagnosed at earlier stages, with DCIS now accouting for 22.5% of all newly diagnosed breast cancers. This has been attributed to both increased breast cancer awareness and improvements in breast imaging techniques. How have these changes, including the increased use of image-guided sampling techniques, influenced the clinical practice of breast surgery? METHODS: The institutional pathology database was queried for all breast surgeries, including breast reconstruction, performed in 1995 and 2005. Cosmetic procedures were excluded. The results were analysed utilizing the Chi-square test. RESULTS: Surgical indications changed during 10-year study period, with an increase in preoperatively diagnosed cancers undergoing definitive surgical management. ADH, and to a lesser extent, ALH, became indications for surgical excision. Fewer surgical biopsies were performed for indeterminate abnormalities on breast imaging, due to the introduction of stereotactic large core biopsy. While the rate of benign breast biopsies remained constant, there was a higher percentage of precancerous and DCIS cases in 2005. The overall rate of mastectomy decreased from 36.8% in 1995 to 14.5% in 2005. With the increase in sentinel node procedures, the rate of ALND dropped from 18.3% to 13.7%. Accompanying the increased recognition of early-stage cancers, the rate of positive ALND also decreased, from 43.3% to 25.0%. CONCLUSIONS: While the rate of benign breast biopsies has remained constant over a recent 10-year period, fewer diagnostic surgical image-guided biopsies were performed in 2005. A greater percentage of patients with breast cancer or preinvasive disease have these diagnoses determined before surgery. More preinvasive and Stage 0 cancers are undergoing surgical management. Earlier stage invasive cancers are being detected, reflected by the lower incidence of axillary nodal metastases

PURPOSE: To explore the effect of providing lymphedema information on breast cancer survivors' symptoms and practice of risk-reduction behaviors. DESIGN: A cross-sectional design was used to obtain data from 136 breast-cancer survivors in New York City from August 2006 to May 2007. Descriptive statistics, t tests, chi-square tests, and correlations were calculated. METHODS: Data were collected using a demographic and medical information interview tool, two questions regarding status of receiving lymphedema information, the Lymphedema and Breast Cancer Questionnaire, and Lymphedema Risk-Reduction Behavior Checklist. FINDINGS: Fifty-seven percent of the participants reported that they received lymphedema information. On average, participants had three lymphedema-related symptoms. Only 18% of participants were free of symptoms. Participants who received information reported significantly fewer symptoms (t=3.03; p<0.00) and practicing more risk-reduction behaviors (t=2.42; p=0.01). CONCLUSIONS: Providing lymphedema information has an effect on symptom reduction and more risk-reduction behaviors being practiced among breast cancer survivors. CLINICAL RELEVANCE: In clinical practice, nurses and other healthcare professionals could consider taking the initiative to provide adequate and accurate information and engage breast-cancer survivors in supportive dialogues concerning lymphedema risk-reduction.