Wednesday, 25 March 2009

Triple negative breast cancers are increased in black women regardless of age or body mass index

More on Triple Negative Breast Cancer amongst Black Women - OF ANY AGE
Triple negative breast cancers are increased in black women regardless of age or body mass index
Lesley Stead, Timothy L Lash, Jerome Sobieraj, Dorcas Chi, Jennifer Westrup, Marjory Charlot, Rita Blanchard, John-cho Lee, Thomas King, Carol L Rosenberg

Breast Cancer Research 2009, 11:R18doi:10.1186/bcr2242

Reported online, on the breast cancer research website. black women are three times more likely than other women to develop an aggressive form of breast cancer characterised by "triple negative tumours. The findings held true even when other risk factors such as lifestyle, age and weight were taken into account. In the United States, where the study was conducted, the overall incidence of breast cancer is lower in black women than in white women. But when black women do get breast cancer, it tends to be more advanced when diagnosed, has a higher risk of recurring, and a less favourable outcome.

Black women of diverse background have 3-fold more Tneg tumours than non-black women, regardless of age and BMI.

Researchers led by Carol Rosenberg of Boston University analysed 415 breast cancer cases and noted the number of "triple negative" tumours, so called because three critical proteins -- estrogen and progesterone receptors, and the HER2 gene -- malfunction.

"The odds of having a triple-negative tumour were three times higher for black women than for non-black women," said Rosenberg

It had been known that pre-menopausal black women were disproportionately affected by this deadly form of cancer, but the new study showed that these tumours were just as common in black women diagnosed before or after age 50, obese or not.

The higher prevalence of triple negative breast tumours in black women in all age and weight categories likely contributes to black women's unfavourable breast cancer prognosis

Early detection of second breast cancers improves prognosis in breast cancer survivors

Early detection of second breast cancers improves prognosis in breast cancer survivors
N. Houssami, S. Ciatto, F. Martinelli, R. Bonardi, and S. W. Duffy
Advanced access to the publication of this paper, published online March 19, 2009
The impact of early detection of second breast cancers in women who have survived a primary breast cancer is unknown.
The researchers looked at information on 1,044 women who were seen at a medical center in Florence, Italy, between 1980 and 2005 and who had developed a second breast cancer -- 455 with cancer in the same breast (ipsilateral) and 589 with cancer in the opposite breast (contralateral). Of the second breast cancers, 67 percent were asymptomatic, and 33 percent were symptomatic.

The study found that chances of survival improved between 27 percent and 47 percent if the second breast cancer was detected in the early, asymptomatic stage rather than at a later stage when women started to experience symptoms.

The researchers also found that mammography
was more sensitive than clinical examination for detecting second breast cancers -- 86 percent vs. 57 percent. However, 14 percent of the cancers were detected only by clinical examination.

Asymptomatic cancers were smaller than symptomatic cancers, and early-stage cancers were more common in asymptomatic women (58 percent) than in symptomatic women (23 percent). Fewer women with asymptomatic than symptomatic contralateral cancer had node metastases, an indication the cancer may have spread.

Take home message:
Early detection of second breast cancers can reduce the risk of death by as much as half

Thursday, 19 March 2009

First Report of a Necrotising Fasciitis of the Breast Following a Core Needle Biopsy

The first report of the aggressive infection, necrotising fasciitis following core biopsy of the breast has been reported by researchers in France.

In a paper published in The Breast Journal this month, the department of OB/GYN in Montpelier, France, describe the case of a 50 year old woman one week after a 14g stereotactic core biopsy for a BIRADS 4 - suspicious lesion.

This is an aggressive infection with a beta-hemolytic streptococcus, which requires aggressive surgery to clear (debride) the infected tissue. Previously only described following mastectomy or breast reduction, this has now occurred following a simple routine core biopsy.

When consenting a patient for a core biopsy, we routinely describe the complication of infection, along with bruising and non-removal of the target lesion. Based on this case, our management should not change, but it remains a salutary lesson, that the most aggressive type of infection can occur in patients attending for a routine biopsy.

Continued attention to hand hygiene, and an aseptic field during biopsy remain important. Interestingly, the staff performing the biopsy did not have their skin tested for whether they were carriers of the B-Hemolytic strep, so we wil never know whether this was a factor