Nihon Geka Gakkai Zasshi
· 2016 Nov · PMID 30173477
The decision to use adjuvant therapy for breast cancer takes into account tumor biology and tumor stage. Because there have been no effective predictive factors for chemotherapy, current guidelines generally recommend ch...The decision to use adjuvant therapy for breast cancer takes into account tumor biology and tumor stage. Because there have been no effective predictive factors for chemotherapy, current guidelines generally recommend chemotherapy for high-risk breast cancer. Multigene assays may predict the benefit from chemotherapy. With the recognition that estrogen has an important role in the promotion and progression of hormone receptor-positive breast cancer, endocrine therapy is a principle component in the treatment of hormone-sensitive breast cancer. The endocrine treatment of breast cancer utilizes strategies that reduce or halt estrogen production, block signaling through the estrogen receptor (ER), or antagonize the ER itself. Tamoxifen has been recommended for premenopausal women with hormone receptor-positive breast cancer during the past 15 years. The value of adding luteinizing hormone-releasing hormone in premenopausal women who receive tamoxifen should be considered in the high-risk premenopausal cohort. For most women with postmenopausal breast cancer, aromatase inhibitors are recommended. The extension of treatment with endocrine treatment to 10 years could improve the prognosis of hormone receptor-positive breast cancer patients. The benefit of adjuvant trastuzumab was established for human epidermal growth factor type 2-overexpressing breast cancer patients.
Nihon Geka Gakkai Zasshi
· 2016 Nov · PMID 30173476
The estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor type 2 (HER2), and Ki67 are biomarkers for early breast cancer. These markers are usually examined by immunohistochemistry (...The estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor type 2 (HER2), and Ki67 are biomarkers for early breast cancer. These markers are usually examined by immunohistochemistry (IHC), and positive is defined as more than 1％ for ER or PgR, and a score of 3+ or 2+ with in situ hybridization positivity for HER2. Indications for endocrine therapy and anti-HER2 therapy are determined according to these cutoff values. These markers are also clinically useful for classifying IHC-based subtypes. Although a cutoff value for Ki67 has yet to be determined, ER-positive/HER2-negative breast cancer is further divided into luminal A or B using Ki67 and PgR expression levels. In addition, multigene assays are clinically available to assess the indications for chemotherapy. Since a discordance in biomarkers between primary and metastatic cancer occurs in some cases, rebiopsy is recommended. It is also important to take measures to ensure the accuracy of IHC procedures because the results can easily be affected by a number of factors. The appropriate treatment should be selected by taking the clinical significance of these biomarkers into consideration.
Nihon Geka Gakkai Zasshi
· 2016 Nov · PMID 30173475
Dr. William Stewart Halsted first advocated performing total mastectomy with pectoral muscle resection and axillary lymph node dissection as the standard surgery for breast cancer. The effectiveness of the sentinel lymph...Dr. William Stewart Halsted first advocated performing total mastectomy with pectoral muscle resection and axillary lymph node dissection as the standard surgery for breast cancer. The effectiveness of the sentinel lymph node biopsy was confirmed 100 years later. When a sentinel lymph node biopsy shows no cancer cells in the lymph node, the standard method is to omit axillary dissection. In recent years, there have been some reports of the validity of omitting axillary dissection when sentinel lymph node biopsy is positive for metastasis. When micrometastasis is present in sentinel lymph nodes, it is reasonable to omit axillary dissection. However, when macrometastasis is present, it is necessary to determine whether axillary dissection should be omitted by referring to the inclusion criteria of the Z0011 study. Complications of axillary lymph node dissection may include upper arm edema, glenohumeral joint excursion obstacles, and neuropathy. Early rehabilitation regimens can maintain glenohumeral joint excursion. Good sanitation including the nails, the use of moisturizers, and early administration of antiinflammatory agents for injuries can prevent lymphedema. If lymphedema develops, the wearing of an elastic bandage or sleeve, manual lymph drainage, and kinesiology exercises with a qualified instructor are effective.
Kijima Y, Shinden Y, Hirata M
… +1 more, Natsugoe S
Nihon Geka Gakkai Zasshi
· 2016 Nov · PMID 30173474
Surgical treatment offering both cure and good cosmetic outcomes is important in patients with breast cancer. Mastectomy followed by breast reconstruction is performed with a combination of autologous tissue or implant a...Surgical treatment offering both cure and good cosmetic outcomes is important in patients with breast cancer. Mastectomy followed by breast reconstruction is performed with a combination of autologous tissue or implant and can be immediate or delayed in one stage or two stages, respectively. Breast surgeons and plastic surgeons should understand the characteristic indications for surgery and select the appropriate procedure for each patient. Oncoplastic breast surgery (OBS) at the time of breast-conserving surgery is classified into two main methods, volume replacement and volume displacement. It is necessary for clinicians to understand both the advantages and disadvantages of oncoplastic procedures. The problem of some OBS methods remaining ineligible for coverage by national health insurance in Japan remains unresolved, but OBS will become more important as a novel method offering a balance between cancer curability and excellent cosmetic results in the near future.
Nihon Geka Gakkai Zasshi
· 2016 Nov · PMID 30173473
Breast-conserving therapy was introduced in Japan in the 1980s as a local treatment for early-stage disease used under cautiously developed criteria. Its indications have gradually been expanded by, for example, the addi...Breast-conserving therapy was introduced in Japan in the 1980s as a local treatment for early-stage disease used under cautiously developed criteria. Its indications have gradually been expanded by, for example, the addition of concomitant preoperative chemotherapy. More than half of breast cancer patients currently benefit from this treatment. Recently, nonsurgical ablative therapies have been tested as a definitive conservative treatment. Clinical studies on high-intensity focused ultrasound (HIFU) and cryoablation began in 2004 and 2006, respectively. Phase I and phase II multicenter clinical trials of radiofrequency ablation (RFA) as a treatment for early-stage breast cancer were started in 2006 under the Evaluation System of Investigational Medical Care. A prospective phase III trial was started in 2013 under the Advanced Medical Service System. Data on nonsurgical ablative therapies including RFA, cryoablation, and HIFU are steadily accumulating. We believe that these therapies can replace lumpectomy, the current standard treatment for early breast cancer, in the near future.
Nihon Geka Gakkai Zasshi
· 2016 Nov · PMID 30173472
Mastectomy and breast-conserving surgery (BCS) are common procedures for treating breast cancer at present. The discovery rate of tumors 2 cm or less in size has risen with the increase in the number of women who receive...Mastectomy and breast-conserving surgery (BCS) are common procedures for treating breast cancer at present. The discovery rate of tumors 2 cm or less in size has risen with the increase in the number of women who receive breast physical examinations, and because of the wider usage of preoperative chemotherapy, BCS has become possible. As a result, the number of women undergoing BCS has increased, whereas the number of those undergoing mastectomy has decreased. However, if radical cure or good cosmetic results cannot be achieved, mastectomy is often offered to patients. Recently, patients have come to expect good cosmetic results after BCS, and because breast reconstruction with implants is now covered by health insurance, it is possible to perform it with mastectomy with the help of plastic surgery if patients desire. Oncoplastic surgery is now the focus of public attention, because it differs from conventional BCS in that it results in no deformity, since the defect created by wide resections is filled with a local tissue flap. It is psychologically important for patients to have satisfactory cosmetic results after BSC.
Nihon Geka Gakkai Zasshi
· 2016 Nov · PMID 30173471
Breast cancer is the most frequent cancer in Japanese women. As breast density increases, the detection rate of breast cancer by mammography (MMG) decreases. Breast density notification laws have been enacted in several...Breast cancer is the most frequent cancer in Japanese women. As breast density increases, the detection rate of breast cancer by mammography (MMG) decreases. Breast density notification laws have been enacted in several states in the USA. Supplemental screening tools for women with dense breasts are needed. The results of a large randomized trial to compare the sensitivity, specificity, and cancer detection rate of MMG and adjunctive ultrasonography (US) to screen for breast cancer in Japan (J-START) were reported last year. More than 70,000 women aged 40 to 49 years were enrolled. The sensitivity and cancer detection rate were significantly higher in the MMG+US group than in the MMG-alone group. Automated breast ultrasonography is a tool to overcome the operator dependency of hand-held US and low reproducibility. Digital breast tomosynthesis, referred to as 3D MMG, offers higher sensitivity and specificity than MMG. Contrast-enhanced spectral MMG is an MMG scan using contrast medium to detect breast cancer more clearly even in dense breasts. It is often used for women at high risk for cancer and substituted for magnetic resonance imaging. A dedicated breast positron-emission tomography (PET) system has been available in Japan with insurance coverage since 2013. More cases of cancer were detected using breast PET than whole-body PET. Additional studies including mortality rates are needed.
In the surgical field, the percentage of female doctors to male doctors has been low; among interns who are just starting their careers, there are few female doctors who want to become surgeons. However, in the case of m...In the surgical field, the percentage of female doctors to male doctors has been low; among interns who are just starting their careers, there are few female doctors who want to become surgeons. However, in the case of mammary gland diseases and anal diseases, female patients often express a desire to be examined by female doctors; thus, it can be said that there is a high demand for the surgical department to find more female doctors. It is important for senior female doctors to advise younger doctors on how to deal with personal events, including marriage, pregnancy and childbirth, so that female doctors continue to work actively in the surgical field. Furthermore, male doctors, including senior doctors and doctors in supervising positions, should understand this situation and not reject cooperation with female doctors. There is an urgent need for the promotion of gender equality in the surgical field. We launched the “Women surgeonʼs meet”. We hope that this meeting, which started as a social gathering place, will become a place of information exchange and mutual aid, which will help encourage female doctors to enter the surgical department. I would like to express my personal opinions with respect to gender equality in the surgical field.