Lege Artis Medicinae

[Postoperative care of breast cancer patients]

CZINKOTSZKY Jenő1

MARCH 31, 1993

Lege Artis Medicinae - 1993;3(03)

[The author reports on the aspects of postoperative care of breast cancer patients . He points out the difficulties and the crucial importance of the psychical leading. Premenopausal patients should be differentieted from post menopausal ones. Patients having got over a radical operation call for different strategy than those with reduced radical operation. The author points out that the whole body should always be examined. The proposed methods of examination and the time of necessary control examination are reported. The plastic surgery for breast reconstruction is proposed only after a 3 year symptom-free period. ]

AFFILIATIONS

  1. Fehér Megyei Szent György Kórház Onkológiai Gondozó Intézet, Székesfehérvár

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[In 1987 breast cancer occupied the 3rd place among female cancers in the world. In Hungary, 13.577 women died due to cancer in 1990, 15,4% from breast cancer. The author uses international, and Hungarian data (at the country and county level) and also the data from his own research results. Incidence of breast cancer has risen continuously and shows a wide range in different parts of the world from 14,1 %000/year to 121,2%8000/year. The 5 year crude survival rate is between 40–65% and is slowly improving. In addition to the well-known risk-factors, the author emphasizes the role of mastopathy because in his patient group of 843 cases 2,3%, but in the mastopathy group 4,1% developed cancer. Therefore, this alteration should be considered as a high risk factor. Among close female relatives of breast cancer patients breast and other cancer has occurred much more frequently, than in that of a control group. Prostate cancer occurs significantly more frequently among 1 st degree male relatives. Therefore it is necessary to study the risk factors with epidemiologic methods and to broaden screening, detection and therapy in order to reduce the incidence and mortality of breast cancer. ]

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[There is no data in the medical literature concerning the late results of breast physical exam by paramedical personnel as a screening test. In a population screening for breast cancer in Debrecen, nearly 70 thousand women were observed from 1981 to 1985 and 298 new breast cancer patients were detected. 198 patients were from the screened population and 100 patients from the non screened population. All of the breast cancer patients were followed up, and the analysis was completed on 31st December 1991 with the help of statistical methods. The author analysed the overall survival, cumulative death rate and relative risk of dying according to age group. The difference of overall survival was 29% for the screened group. This result is nearly the same as that produced by mammographic screening.]

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[The author interpretes and evaluates the diagnostic methods of breast cancer. Detailed description is given on physical examination, mammography, ultrasound examination, cytology, histology and miscellaneous methods, expressing their advantages and drawbacks. On clinical experience nowadays the combinative application of these by the same expert seems to be the most effective method, possibly in large breast clinic centres.]

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TÓTH József, SÁPI Zoltán

[Prognosis prediction of breast cancers is difficult, particularly in early clinical stage (1) or in tumors with practically identical histological structure and degree of differentiation (invasive ductal NOS cancer) because node negative tumors of early developmental stage or with identical structure may demonstrate different clinical course. In such cases the steroid hormone receptor content, the prolife rating capacity of the tumor and the so called independent prognostic factors like the onco gene and supressor gene expression (c-myc, C-erbB–2, p53), the growth factor receptor content (EGFr) and the so called differentiation antigens accompanied by low metastatising capacity (MAM–6, nm23) may help the pathologist in diagnostics. Examinations of these markers are planned to be introduced in future diagnostics and contribute to the elaboration of effective treatment schedules.]

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[The surgery of breast cancer]

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[The incidence of breast cancer in Hungary is gradually increasing, not only in the elderly due to the increasing average age, but in younger women as well. In the operative stadia (St I-II), the best results can be achieved by a radical surgical intervention and an adjuvant radio-chemo-hormone therapy. The formerly routine radical mastectomies are being replaced by breast conserving procedures which remove the tumour and sacrife only the most necessary surrounding tissues to achieve the best local tumour control. The fundamental basis for this procedure was established by the clinical trials of B. Fisher and U. Veronesi. The practical basis is the circumstance, that owing to better propaganda, more frequent breast self examinations, and better mammographic and cytological facilities, more breast cancer will be recognized in an earlier stage.]

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