RESUMEN
Post-breast cancer treatment-related angiosarcomas were first observed in lymphedematous extremities after mastectomy and are now being reported with increasing frequency after lumpectomy and radiation. A case history is presented of a BRCA2 carrier who had a postmastectomy chest wall angiosarcoma but had neither therapeutic radiation nor clinically evident lymphedema. The absence of established risk factors led to speculation that the BRCA2 germline mutation could be a causative factor in the development of this patient's angiosarcoma. A literature review supported this concept.
Asunto(s)
Proteína BRCA2/genética , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Mutación de Línea Germinal , Hemangiosarcoma/genética , Neoplasias Primarias Secundarias/genética , Neoplasias Cutáneas/genética , Adulto , Neoplasias de la Mama/genética , Carcinoma Ductal de Mama/genética , Femenino , Predisposición Genética a la Enfermedad , Humanos , Mastectomía , Recurrencia Local de NeoplasiaRESUMEN
Approximately 100 cases of angiosarcoma following breast-conserving therapy have been reported. The prevalence of angiosarcoma following breast conservation has not been accurately established and optimal treatment has not been defined. The goal of this article is to clarify both issues. The Fisher's exact test was used to compare the prevalence of postirradiation angiosarcoma seen in our private practice to the prevalence reported from the two largest national database studies. A literature review was performed to determine optimal treatment guidelines. The results of the comparison indicated that the prevalence of postirradiation angiosarcoma seen in our practice was significantly higher than that reported in the two national database studies at p-values of 0.0124 and 0.0080. Also, results from the literature review suggest that early detection and aggressive treatment lead to improved outcomes. The data are insufficient to draw firm conclusions, but suggest that the current literature underestimates the prevalence of angiosarcoma following breast-conserving therapy. Since elderly women derive less benefit from radiation and may be more prone to develop postirradiation angiosarcoma, confirmation of our findings could lead to a reappraisal of the management of elderly patients with early stage breast cancer.
Asunto(s)
Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/terapia , Hemangiosarcoma/epidemiología , Hemangiosarcoma/etiología , Mastectomía Segmentaria , Neoplasias Inducidas por Radiación/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Inducidas por Radiación/etiología , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Primarias Secundarias/etiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
The recent transition to managed care has intensified the public's concerns about the quality of medical care. In response, payers, who until recently seemed preoccupied with costs, are demonstrating a renewed interest in value, which in turn could lead to an expansion of negotiations with physicians to include the tracking of such issues as physician performance, patient satisfaction, and patient outcomes. As a response to public concern and demand for accountability, the medical establishment must develop methods to assist payers in estimating relative value of competing medical services. In anticipation of a values transition in their specialty, breast care, the authors established a performance-oriented database which facilitated assessments of their performance in relation to community standards, and enhanced efforts to identify and correct performance deficiencies. Year-end results were summarized in a report-card format that improved marketability. The author's experiences should be of interest to physicians who are attempting to respond to changes in the rapidly evolving medical marketplace.