Introduction Controversy continues over the extent of surgical resection margin required to minimize the risk of local recurrence (LR) in breast conserving therapy (BCT) for stage I and II breast cancer. This thesis explores whether or not a narrow (less than or equal to 2 mm) but negative resection margin in BCT for stage I and II breast cancer affects LR. Methodology To address the question, all patients registered at the Saskatoon Cancer Center between January 1, 1991 and December 31, 2000 with a diagnosis of stage I or II invasive duct carcinoma of the breast treated with BCT were examined. All charts and pathology reports were reviewed with a review of the pathology for all cases where the resection margin was unclear in the original report. Other factors know or thought to effect LR (age, radiation boost, grade, extensive duct carcinoma in situ, ER/PR receptor status, tumor size, and systemic adjuvant therapy) were considered in the statistical analysis. Results Amongst the 200 narrow margin cases 19 LR were detected (19/200=9.5%) while 52 LR were detected in the 491 wide margin cases (52/491=10.6%). This difference was not statistically significant. Conclusions A narrow (less than or equal to 2 mm) surgical resection margin does not result in an increase in local recurrence compared to a surgical resection margin greater than 2 mm in breast conserving therapy for early stage duct carcinoma and does not warrant re-excision.

Introduction Controversy continues over the extent of surgical resection margin required to minimize the risk of local recurrence (LR) in breast conserving therapy (BCT) for stage I and II breast cancer. This thesis explores whether or not a narrow (less than or equal to 2 mm) but negative resection margin in BCT for stage I and II breast cancer affects LR. Methodology To address the question, all patients registered at the Saskatoon Cancer Center between January 1, 1991 and December 31, 2000 with a diagnosis of stage I or II invasive duct carcinoma of the breast treated with BCT were examined. All charts and pathology reports were reviewed with a review of the pathology for all cases where the resection margin was unclear in the original report. Other factors know or thought to effect LR (age, radiation boost, grade, extensive duct carcinoma in situ, ER/PR receptor status, tumor size, and systemic adjuvant therapy) were considered in the statistical analysis. Results Amongst the 200 narrow margin cases 19 LR were detected (19/200=9.5%) while 52 LR were detected in the 491 wide margin cases (52/491=10.6%). This difference was not statistically significant. Conclusions A narrow (less than or equal to 2 mm) surgical resection margin does not result in an increase in local recurrence compared to a surgical resection margin greater than 2 mm in breast conserving therapy for early stage duct carcinoma and does not warrant re-excision.

The authors report a case of fine‐needle aspiration (FNA) of a breast mass in a 36‐year‐old woman with previous history of lumpectomy and therapeutic radiation for breast carcinoma. The changes seen were interpreted as recurrent carcinoma, while subsequent biopsy showed only radiation changes. Radiation‐induced changes in breast tissue are a potential diagnostic pitfall. The characteristic cytopathologic changes and their differential diagnosis are discussed.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Para determinar a prevalÃncia de alguns fatores de risco do cÃncer de mama, quantificar os fatores de risco de maior prevalÃncia, delimitar grupos de maior risco e sugerir possÃveis medidas de intervenÃÃo para prevenÃÃo primÃria, analisou-se uma populaÃÃo de 425 funcionÃrias da Maternidade Escola Assis Chateaubriand da Universidade Federal do CearÃ, de vÃrios nÃveis sociais e padrÃes raciais, mediante a aplicaÃÃo de um formulÃrio com o levantamento de 30 variÃveis e realizou-se a mensuraÃÃo do peso, altura, circunferÃncia da cintura e do quadril.Calculou-se com estes dados a relaÃÃo cintura/quadril, o Ãndice de massa corpÃrea e o Ãndice de Gail de todas as entrevistadas. Dos fatores de risco levantados, encontrou-se em 222 (52,2%) funcionÃrias o Ãndice de massa corpÃrea acima de 25, a relaÃÃo cintura/quadril maior do que 0,8 em 391 (92,1%) e o sedentarismo em 314 (73,1%) das entrevistadas. O grupo de maior risco encontrado e que merece seguimento diferenciado à formado pelos seguintes subgrupos: as 222 (52,2%) funcionÃrias com o Ãndice de massa corpÃrea maior ou igual a 25, as 34 (11,3%) que tiveram o primeiro filho apÃs os trinta anos, as 34 (11,3%) que fazem ou fizeram terapia de reposiÃÃo hormonal, as 2 (0,5%) portadoras de cÃncer de mama e as 15 (20,8%) com parentes de primeiro grau acometidos de cÃncer de mama. SÃo medidas possÃveis de intervenÃÃo para o grupo de maior risco, para prevenÃÃo primÃria do cÃncer de mama: orientaÃÃes dietÃticas e reeducaÃÃo alimentar, com periÃdico controle das medidas biomÃtricas e um programa de condicionamento fÃsico no ambiente de trabalho. / A group of 425 female staff from the school maternity hospital Assis Chateaubriand (Federal University of CearÃ, Brazil), of varied ethnicity and socioeconomic status, were given a questionnaire containing 30 variables and subjected to weight, height, waist and hip circumference measurements in order to determine the prevalence of a number of risk factors for breast cancer, quantify the most prevalent risk factors, define high-risk groups and suggest intervention measures for primary prevention. All subjects had their waist/hip ratio, body mass index (BMI) and Gail index calculated. Within the risk factors surveyed, 222 (52.2%) subjects had a BMI of 25 or more, 391 (92.1%) presented a waist/hip ratio above 0.8, and 314 (73.1%) were found to be sedentary. The following subgroups displayed the highest risk, demanding specific follow-up measures: the 222 (52.2%) subjects with BMI≥25, 34 subjects (11.3%) who bore their first child after age 30, 34 subjects (11.3%) receiving hormone replacement therapy then or previously, 2 subjects (0.5%) diagnosed with breast cancer, and 15 subjects (20.8%) with first-degree relatives diagnosed with breast cancer. Intervention measures for primary breast cancer prevention in the highest-risk group would include dietary counseling and reeducation with periodical biometric measurements and on-the-job physical exercise programs.

Abstract The purposes of the present research were to evaluate (1) the value of ultrasonographically guided fine-needle aspiration biopsy (US-FNAB) in nonpalpable suspicious breast lesions, (2) the preoperative use of methylene blue staining in nonpalpable galactographically suspicious breast lesions, (3) the determinants of positive histologic margins and residual cancer in wire-guided biopsy (WGB) of nonpalpable breast cancer and in lumpectomy for early breast cancer and the determinants of positive radiologic margins and the correlation between radiologic and histologic margins and residual disease in WGB of nonpalpable breast cancer, (4) the assessment of lumpectomy margins by touch preparation cytology in early breast cancer, and (5) the cosmetic outcome of WGB performed for benign breast lesions. The sensitivity and specificity of US-FNAB in 90 nonpalpable breast lesions were 84% and 93%, respectively. Preoperative methylene blue staining was successful in 22 out of 30 (73%) cases, making subsequent selective minimal volume microdochectomy easy to perform. Multivariate analysis of 21 prospectively evaluated variables was done after 71 WGBs of nonpalpable breast cancer followed by 54 re-excisions. Large mammographic lesions had more often positive radiologic margins. Multifocality, large pathologic size and superficial excision were related to positive histologic margins and multifocality to residual disease in re-excisions. The sensitivity and specificity of specimen radiography for predicting histologic margins were 38% and 81% and those for residual disease 27% and 79%, respectively. The corresponding figures for histologic margins in predicting residual disease were 85% and 59%, respectively. In a prospective series of 55 consecutive lumpectomies for early breast cancer, positive histologic margins were found more often in the presence of intraductal cancer and if the pathologic size of the index tumor was large. Residual disease was found in 38% of the cases with positive and in 15% of the cases with negative histologic margins. A multifocal and nonpalpable index tumor predicted residual cancer in 34 re-excision specimens. The sensitivity and specificity of touch preparation cytology in predicting histologic margins were 38% and 85%, respectively. In WGB, the overall cosmesis 6 months after surgery was satisfactory in 75 % of the 101 prospectively evaluated patients with benign proven lesions. Cosmesis was poorer after deep excisions and complications. The results indicate that US-FNAB is a useful tool in evaluating nonpalpable suspicious breast lesions. Preoperative methylene blue staining crucially facilitates selective minimal volume microdochectomy in three-quarters of cases. To obtain free margins in WGB, mammographically and pathologically large lesions should be removed with wider excisions extending down to the fascia. However, radiologic margins in WGB and histologic margins both in WGB and in lumpectomy for early breast cancer may be misleading. Re-excision of the biopsy site of multifocal tumors after WGB and lumpectomy should be considered. This is also important after superficial excision in WGB due to the considerable risk of residual disease. Touch preparation cytology cannot be recommended for the assessment of margins in lumpectomy specimens of early breast cancer. Cosmetic outcome after WGB of benign breast lesions is satisfactory in 75 % of cases. Deep excisions and complications endanger the cosmetic outcome. Preoperative biopsy and tumor localization methods have proven their utility; nevertheless, free margins are still difficult to obtain and to evaluate accurately. The surgeon may often be forced to choose between free margins and an acceptable cosmetic outcome.

A lacuna existente na compreensão das repercussões do câncer de mama feminino para casais que vivenciaram esse processo motivou a realização deste estudo, que objetivou compreender os sentidos para o câncer de mama feminino entre casais que permaneceram unidos na vivência dessa enfermidade, por meio do referencial teórico do construcionismo social. Os dados foram coletados numa amostra de sete casais entrevistados separadamente, em entrevistas semi-estruturadas com a utilização do diário de campo. A partir disso, foram identificadas três grandes temáticas referentes aos sentidos do câncer e da conjugalidade. Os sentidos do câncer foram agrupados no item vivência da doença, que contém os temas: confirmação da doença e fase do tratamento, esta subdividida nos seguintes sub-temas: a) ficando mais em casa; b) conversando omitindo a doença; c) transportando as esposas; d) cuidado fornecido por outras mulheres; e) realização do serviço doméstico: terceirizado; f) sexualidade: afastamento. E os sentidos da conjugalidade foram agrupados na temática ser marido e ser esposa. Essas temáticas emergiram dos discursos dos entrevistados ancorados na história do câncer e na moral do modelo de conjugalidade tradicional. O câncer foi associado a uma doença com sentidos de provação e morte, que despertou nos participantes sentimentos de revolta e ansiedade e a relação com Deus. Além disso, o compromisso assumido no casamento e a não revelação dos sentimentos mais íntimos experimentados por eles em relação ao câncer de mama, possibilitou a manutenção do laço conjugal em meio à experiência dolorosa da doença. Diante disso, sugere-se a relevância da assistência interdisciplinar com o intuito de desconstruir a negatividade associada ao câncer, bem como a reflexão sobre a relevância do discurso religioso como ferramenta do cuidado assistencial a essa população. / The existent gap in the comprehension of repercussions of the feminine breast cancer for couples that lived this process motivated the accomplishment of this study, which aimed to understand the meanings for the feminine breast cancer among couples that stayed united in living of this illness, through the social construction theory. The data were collected in a sample of seven couples interviewed separately, in semi-structured interviews with the use of field notes. From this, were identified three thematic related to the meanings of cancer and related to couples\' life. The meanings of cancer were gathered in disease living item that has these themes: disease confirmation and phase of treatment. The phase of treatment was subdivided in the following sub-themes: a) staying more at home; b) talking omitting the disease; c) transporting the wives; d) care supplied by other women; e) accomplishment of the domestic service: servant; f) sexuality: stand back. And the meanings of couples\' life were gathered at the thematic to be husband and to be wife. These thematic emerged of the interviewees\' speeches anchored in the history of cancer and in the moral of traditional couples\' life model. The cancer was associated it a disease with meanings of probation and death, that emerged in the participants feelings of revolt and anxiety in relation with God. Besides, the commitment assumed in the marriage and the non revelation of the most intimate feelings experienced by them in relation to breast cancer, it made possible the maintenance of the matrimonial bow amid the painful experience of the disease. Before this, it is suggested the importance of interdisciplinary assistance with the intention to construct different meanings than negativity of cancer, as well as the reflection of the importance of the religious discourse as a tool in the care of this population.

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references.

A lacuna existente na compreensão das repercussões do câncer de mama feminino para casais que vivenciaram esse processo motivou a realização deste estudo, que objetivou compreender os sentidos para o câncer de mama feminino entre casais que permaneceram unidos na vivência dessa enfermidade, por meio do referencial teórico do construcionismo social. Os dados foram coletados numa amostra de sete casais entrevistados separadamente, em entrevistas semi-estruturadas com a utilização do diário de campo. A partir disso, foram identificadas três grandes temáticas referentes aos sentidos do câncer e da conjugalidade. Os sentidos do câncer foram agrupados no item vivência da doença, que contém os temas: confirmação da doença e fase do tratamento, esta subdividida nos seguintes sub-temas: a) ficando mais em casa; b) conversando omitindo a doença; c) transportando as esposas; d) cuidado fornecido por outras mulheres; e) realização do serviço doméstico: terceirizado; f) sexualidade: afastamento. E os sentidos da conjugalidade foram agrupados na temática ser marido e ser esposa. Essas temáticas emergiram dos discursos dos entrevistados ancorados na história do câncer e na moral do modelo de conjugalidade tradicional. O câncer foi associado a uma doença com sentidos de provação e morte, que despertou nos participantes sentimentos de revolta e ansiedade e a relação com Deus. Além disso, o compromisso assumido no casamento e a não revelação dos sentimentos mais íntimos experimentados por eles em relação ao câncer de mama, possibilitou a manutenção do laço conjugal em meio à experiência dolorosa da doença. Diante disso, sugere-se a relevância da assistência interdisciplinar com o intuito de desconstruir a negatividade associada ao câncer, bem como a reflexão sobre a relevância do discurso religioso como ferramenta do cuidado assistencial a essa população. / The existent gap in the comprehension of repercussions of the feminine breast cancer for couples that lived this process motivated the accomplishment of this study, which aimed to understand the meanings for the feminine breast cancer among couples that stayed united in living of this illness, through the social construction theory. The data were collected in a sample of seven couples interviewed separately, in semi-structured interviews with the use of field notes. From this, were identified three thematic related to the meanings of cancer and related to couples\' life. The meanings of cancer were gathered in disease living item that has these themes: disease confirmation and phase of treatment. The phase of treatment was subdivided in the following sub-themes: a) staying more at home; b) talking omitting the disease; c) transporting the wives; d) care supplied by other women; e) accomplishment of the domestic service: servant; f) sexuality: stand back. And the meanings of couples\' life were gathered at the thematic to be husband and to be wife. These thematic emerged of the interviewees\' speeches anchored in the history of cancer and in the moral of traditional couples\' life model. The cancer was associated it a disease with meanings of probation and death, that emerged in the participants feelings of revolt and anxiety in relation with God. Besides, the commitment assumed in the marriage and the non revelation of the most intimate feelings experienced by them in relation to breast cancer, it made possible the maintenance of the matrimonial bow amid the painful experience of the disease. Before this, it is suggested the importance of interdisciplinary assistance with the intention to construct different meanings than negativity of cancer, as well as the reflection of the importance of the religious discourse as a tool in the care of this population.

Orientadores: Gustavo Antonio de Souza, Maria Salete Costa Gurgel / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T02:38:19Z (GMT). No. of bitstreams: 1 Oliveira_MarianaMaiaFreirede_M.pdf: 2870270 bytes, checksum: 3cc12d99aeebd1b7364b222041edf8b1 (MD5) Previous issue date: 2007 / Resumo: A fisioterapia no pós-operatório de câncer de mama visa a prevenir as complicações e promover a independência funcional. Porém, não há dados na literatura sobre a influência da fisioterapia realizada durante a radioterapia, bem como qual a melhor abordagem. Objetivo: Avaliar a eficácia da realização da fisioterapia durante a radioterapia na prevenção das seguintes complicações físicas loco-regionais: limitação da amplitude de movimento do ombro, aumento da circunferência e incapacidade funcional do membro superior e aderência cicatricial em mulheres em tratamento por câncer de mama. Sujeitos e Métodos: Ensaio clínico controlado randomizado, realizado no Serviço de Fisioterapia do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas, com 66 mulheres em tratamento radioterápico após cirurgia para câncer de mama e fisioterapia pós-operatória. As mulheres foram alocadas no Grupo 1 (32 mulheres) que realizou fisioterapia durante a radioterapia e no Grupo 2 (34 mulheres), controle, sendo avaliadas no início e no final da radioterapia e 6 meses após seu término. A amplitude de movimento do ombro foi avaliada através da goniometria, a circunferência do braço, pela cirtometria e a aderência cicatricial, pela palpação e fricção cicatricial. A capacidade funcional foi graduada através de escore de dificuldade para movimentar o ombro. Para cálculos estatísticos foram utilizados MANOVA com estatísitca de Wilks ou Friedman e os testes de associação qui-quadrado ou exato de Fisher, assumindo nível de significância a = 5%. Resultados: A idade média foi de 52,3 ± 10,6 anos no Grupo 1 e de 48,7 ± 10,8 anos no Grupo 2. Os valores médios de amplitude de movimento do ombro para abdução e flexão observados nas três avaliações revelaram melhores resultados para Grupo1 em relação ao Grupo 2 (p= 0,0244 e 0,0044, respectivamente). Os valores médios da circunferência do braço obtidos nas avaliações não se alteraram em ambos os grupos. Há evidências de que a fisioterapia realizada durante a radioterapia possa favorecer a melhora da capacidade funcional. Na avaliação final, a freqüência de aderência cicatricial no Grupo1 foi duas vezes menor que a observada no Grupo 2 (24% e 48%, p= 0,0477). Conclusão: A fisioterapia realizada durante a radioterapia para tratamento de câncer de mama previne a limitação na amplitude de movimento do ombro e minimiza a incidência de aderência cicatricial. Os resultados sugerem também favorecer a melhora da capacidade funcional. No período estudado, não foi encontrada associação entre a realização da fisioterapia e alteração na circunferência do braço / Abstract: Physiotherapy following surgery for breast cancer is recommended for the prevention of complications and to stimulate functional independence. However, there are no data in the literature on the influence of physiotherapy carried out during radiotherapy (RT), nor on its optimal management. Objective: To evaluate the influence of physiotherapy carried out during radiotherapy on the following physical, locoregional complications: limitations in amplitude of movement and functional capacity, increased arm circumference, and the presence of scar tissue. Subjects and Methods: A randomized, controlled clinical trial was carried out in the Physiotherapy Department of the Center for Women¿s Integrated Healthcare, Universidade Estadual de Campinas, in 66 women undergoing radiotherapy following surgery for breast cancer, and postoperative physiotherapy. Women were randomized to Group 1 (G1) in which physiotherapy was provided, and Group 2 (G2), the control group. Evaluations were carried out at the beginning and at the conclusion of RT, and 6 months after its conclusion. Amplitude of shoulder movement was evaluated by goniometry; arm circumference was measured, and the presence of scar tissue was evaluated by digital palpation of the region. Functional capacity was graded according to a score evaluating difficulty of the patient in moving the shoulder. Statistical analysis was carried out using multivariate analysis of variance (MANOVA) with the Wilks or Friedman tests, and the chi-square or Fisher¿s exact tests of association. Significance level was established as a = 5%. Results: Thirty-two women were randomized to G1 and 34 to G2. Mean age was 52.3 ± 10.6 years in G1 and 48.7 ± 10.8 years in G2. The mean values of amplitude of shoulder movement with respect to abduction and flexion found at the three evaluation times indicated better results for G1 compared to G2 (p=0.0244 and 0.0044, respectively). During the period of this study, no association was found between physiotherapy and changes in arm circumference. There are evidences that the physiotherapy carried out during radiotherapy could encourage an improvement in functional capacity. At the final evaluation, the presence of scar tissue in G1 was half that found in patients in G2 (24% and 48%, p=0.0477). Conclusion: Physiotherapy carried out during radiotherapy for breast cancer prevents limitations in the amplitude of shoulder movement, minimizes the presence of scar tissue and appears to result in an improvement in functional capacity. During the period studied, no association was found between carrying out physiotherapy and changes in arm circumference / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23073号 / 医博第4700号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 溝脇 尚志, 教授 黒田 知宏, 教授 増永 慎一郎 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM