- Email: [email protected]
365 POSTER Heredity and stressful life event in breast cancer
S108
Poster session: Breast cancer
lignant tumor, 5 patients with in situ or pTmic carcinoma (15%), and 6 patients (18,18%) with invasive carcinoma. In 5 patients distance from resection margin was less than 5mm and further lumpectomy was performed. When invasive carcinoma was diagnosed on frozen section (3 patients) and margins were measurable, while in 2 patients with non-comedoDCIS with margins 3,5 and 4mm underwent lumpectomy in the second act. All patients with diagnosed malignancy underwent axillary dissection. Four patients (12,0%) had lymph node metastases, (2 patients with pN1a, one with 2 and one with more than 4 metastases). Conclusion: Demonstrated results were acceptable in comparison with results obtained in large series with tolerable accuracy in diagnosis of malignant lesions. Low incidence of lymph node metastases (with dominant pNo stage) implies introduction of possible axillary sparing surgery with previous sentinel lymph node labeling. Continuation of WGE in diagnosis and treatment of breast cancer is necessary within internationally monitored trials, in order to improve accuracy and disease control. 362
POSTER
Complications related to the radical mastectomy M. Sasic, M. Inic, D. Vukotic, M. Buta, M. Jevric, J. Sasic. Institute of Oncology and Radiology of Serbia, Surgery, Beograd, Serbia Aim: Although complications after radical breast cancer surgery are cut to minimum rate by performing modified radical mastectomy, they are still observed and affect mostly quality of life and duration of post operative recovery. Patients and Methods: During the years 2003 and 2004 total of 1310 modified radical mastectomies were performed at the Institute of Oncology and Radiology of Serbia, in Belgrade. We analyzed the group of 479 breast cancer patients who had modified radical mastectomy during that period. We observed the following complications in patients who had modified radical mastectomy: mortality, infections, bleeding, seroma, neuropathy, lymphoedema of the arm. Results: The data we obtained showed that these were the complications our patients had after modified radical mastectomy: mortality – none (0%), infection – 35 patients (7.3%), hematoma – 48 patients (10.0%), seroma – 209 patients (43.6%), neuropathy - 57 patients (11.9%), lymphoedema – 14 patients (2.9%) and no complications in 116 patients (24.3%). Conclusion: We are still not satisfied with relatively high percentage of post operative seroma, which could be explained by the large number patients who had axillary lymphadenoctomy. This might be avoided by performing sentinel lymph node biopsy (SLNB) and limited axillary dissection of level I and II only. 363
Conclusion: The results obtained meet the international standards as far as indications for quandrantectomy with axillary dissection are concerned. We are still not satisfied with a large number of mastectomies performed at our Institute and we think that we should set up higher standards that must be followed more strictly during the process of decision-making in setting up an indication to perform a mastectomy. 364
POSTER
The prescription of adjuvant endocrine therapies for breast cancer in the clinical setting S.J. Amonkar 1 , H.J. Cain 1 , D. Hemming 2 , W. Cunliff 1 , K. Clark 1 , D. Browell 1 . 1 Queen Elizabeth Hospital Gateshead, Department of Surgery, Tyne and Wear, United Kingdom; 2 Queen Elizabeth Hospital Gateshead, Department of Pathology, Tyne and Wear, United Kingdom Introduction: There is extensive research into the proven benefits of adjuvant endocrine therapies in breast cancer. There is however little published on the completion of a 5 year course of these endocrine therapies in the clinical setting. We have assessed the completion of endocrine therapy protocols for patients with invasive breast cancer treated in this unit. Method: Case notes of 168 patients diagnosed with invasive breast cancer in 1999 who commenced adjuvant endocrine therapy were retrospectively reviewed (168 female: ages 27-87, mean 58.2 yrs). The intended endocrine regime for these patients was 5yrs Tamoxifen, or 5yrs total endocrine treatment, Tamoxifen switched to Anastrazole. Results: 106 patients completed 5yrs Tamoxifen, 10 of whom were recruited into the ATTOM trial (3 continuing Tamoxifen). 2 patients commenced Letrozole after 5yrs. 8 further patients had 5yrs total endocrine treatment, treatment being switched due to side effects of Tamoxifen (hot flushes[4], PV bleeding[2], weight gain[1] & nausea[1]). Thus 114 patients completed their intended endocrine treatment. 3 have since died of unrelated causes and 4 patients had breast cancer recurrence after 5yrs, 1 of which subsequently died. 39 patients (23.2%) failed to complete their intended endocrine therapy due to disease recurrence within 5yrs, 34 of whom died. 7 unrelated deaths also occurred within 5 yrs. 8 patients, however, failed to complete endocrine therapy specifically due to side effects (hot flushes [3], nausea [3], DVT [1], weight gain [1]) and declined further treatment. Conclusion: We have shown that 6.6% of our patients failed to complete endocrine therapy due to side effects of the medication. Although a small proportion, it is worth remembering that some patients are unable to tolerate endocrine treatment despite its proven benefit. Further work is required to assess the actual compliance of patients who are prescribed this therapy.
POSTER
Our selection criteria for conservative vs. radical surgical treatment of breast cancer D. Vukotic, M. Sasic, M. Inic, M. Buta, D. Petkovic, M. Jevric. Institute of Oncology and Radiology of Serbia, Surgery, Beograd, Serbia Introduction: Our goal is to evaluate the outcome of operations we performed at the Dept. of Breast Cancer Surgery at the Institute of Oncology and Radiology of Serbia in relation to the tumor size and the type of surgical procedure in breast cancer patients. Patients and Methods: During the years 2003 and 2004 we performed 1310 modified radical mastectomies (Madden) and 356 quadrantectomies with axillary dissection. We analyzed 137 randomly chosen patients who had quadrantectomy with axillary dissection and 132 randomly chosen patients who had modified radical mastectomy. According to our protocol at the Institute of Oncology and Radiology of Serbia, indications for quadrantectomy with axillary dissection are tumors less than 30 mm in diameter with clinically negative axillary lymph nodes. The average age of our breast cancer patients was 55.9 years (range 40-80). Results: Our analysis shows that 83.2% of the patients who had quadrantectomy with axillary dissection had tumor less than 20 mm and 97.1% had tumor less than 30 mm in diameter. Out of 132 patients who had mastectomy 45.4% had a tumor less than 20 mm and 81.8% had tumor less than 30 mm in diameter, meaning that they were good candidates for quadrantectomy with axillary dissection.
365
POSTER
Heredity and stressful life event in breast cancer K. Maravegias 1 , P. Diamanti 1 , P. Kalogianni 1 , I. Kabouris 2 , I. Kostis 1 . 1 Hospital of Volos - Greece, Surgical Department, Volos, Greece; 2 Hospital of Volos - Greece, Psychiatry Department, Volos, Greece In the last 15 years, the development of biopsycosocial model and psychosomatic syndromes theory in psychiatry tries to attribute a psycopathological interpretation in many diseases. Thus, in this contest we investigate the probability certain forms of cancer to be related with mental stress. On the other hand, it is widely known that a lot of forms of cancer (colorectal cancer, MEN 1 & 2) etc are more or less hereditary transmitted. In the past few years, the interest has also been focused in breast cancer with the discovery of gene mutations (i.e. BRCA1 and 2) that were found to be frequent in breast cancer patients. Aiming at the investigation of heredity and the repercussion of mental stress in the breakthrough of breast cancer, we analyzed 50 patients with breast cancer and 50 control cases. Familial anamnesis was taken down and afterwards we counted the cases of cancer and breast cancer in the family, pondered with the grade of kinship. We also investigated the presence of stressful life events in each patient in order to be assessed. In this assessment we scored with linear analogue the subjective opinions of the interviewed and the physician’s opinion and gave an order to the stressful life events using the Holmes’ scale. 100 interviews were registered in an electronic sheet and were submitted to statistical analysis with the χ2 method for the
Poster session: Breast cancer average score of doctor and interviewed, as well as univariate analysis with ANOVA. We found a statistically significant difference in the average of the subjective score between cancer patients and control patients (p<0.005) as well as significance trend in the objective score (p=0.02). Similarly, the score of patient and doctor was found to be statistically significant to univariate analysis [objective score (p<0.05) and subjective score (p<0.005)]. To conclude, this work in the first place consists of a motive to wider future studies, which will aim to show the strong relation between stressful life events in our patients’ lives and the growth of various forms of cancer. 366
POSTER
Prospective evaluation of peri-operative anxiety in women undergoing mastectomy for breast cancer W.M. Wysocki, A.L. Komorowski, J. Mitus, K. Herman. Maria Sklodowska-Curie Institute of Oncology, Department of Surgical Oncology, Krakow, Poland Introduction: Preoperative anxiety is particularly important in women undergoing mastectomy for breast cancer. Unfortunately this factor is often neglected by surgeons. It was showed that elevated preoperative anxiety may have adverse effect on peri-operative period and long-term subsequences to patient physical and psychical health and quality of life. Material: The consecutive group of 29 patients admitted for mastectomy due to breast cancer, with no neoadjuvant treatment and no prior treatment for other malignancy (with exception for basal cell carcinoma of the skin) were included in this clinical trial. Methods: The peri-operative anxiety level was measured on four occasions: the afternoon on the day before the scheduled operation (after obtaining informed consent), the day after operation, ca. 7 days after operation and ca. 30 days after operation. The anxiety level was measured by means of previously validated tool - visual analogue scale (the scale had 100 mm in length; 0 meant “I feel no anxiety at all”, 100 meant “I feel maximal imaginable anxiety”). Results: The mean age of 29 included women was 55,1 yrs, 45% has elementary education, 60% was married at the time study was conducted, 12% was childless, 34% lived in rural areas. The mean VAS anxiety level in the following time-points was as follows: a day before operation - 58,1 mm; a day after operation - 46,0 mm; ca. 7 days after surgery - 39,8 mm; ca. 30 days after operation - 46,9 mm. Data gathered during the study show, that anxiety level in women awaiting for mastectomy is the highest before the surgery and subsequently decreases over time. The anxiety level in women undergoing mastectomy is higher compared to similar studies on non-breast cancer patients. Ca. 30 days after surgery there is an increase in anxiety level; this time point in our institution represents average time of initiation of adjuvant treatment. Conclusion: The anxiety level in women undergoing mastectomy is significant despite providing them with preoperative information in the standard manner and obtaining informed consent. The additional tools for relieving (decreasing) peri-operative level should be searched for. 367
POSTER
Pre-operative management, decision making and surgical technique in several European breast cancer units A. Celebic 1 , M. Halaska 2 , O. Kosovac 1 , D. Stojiljkovic 1 , Z. Milovanovic 3 , N. Miletic 1 , O. Celebic 4 , R. Dzodic 1 . 1 Institute of Oncology and Radiology of Serbia, Dept. of Surgery, Belgrade, Serbia; 2 Hospital Motol of 2nd Medical Faculty of Charles University, Dept. of Gynaecology, Prague, Czech Republic; 3 Institute of Oncology and Radiology of Serbia, Dept. of Pathology, Belgrade, Serbia; 4 Medical School, University in Pristina, Kosovska Mitrovica, Serbia Introduction: The aim of this paper was to compare differences in preoperative management, surgical decision making and technical approach for breast cancer in several big European Breast Cancer Units in Italy, France, Czech Republic and Serbia, and to discuss eventual impact of detected differences on outcome of the disease. Methods: The authors of this paper, who have been for the first time in their career as young visiting/observing/training guests invited by four prestigious European Breast Cancer Units in Italy and France (National Cancer
S109
Institute - Milan, European Institute of Oncology – Milan, Institute Gustave Roussy - Villejuif, Institute Curie - Paris) as fellows of different European and international institutions (EUSOMA, EACR, ESSO, UICC, ESO, FECS, French Government) in the period from July 2003 – June 2006 and who are employed as surgeons/pathologists at Institute of Oncology and Radiology of Serbia in Belgrade and in Hospital Motol of 2nd Medical Faculty of Charles University in Prague, tried to detect and compare differences in several parameters regarding pre-surgical evaluation, decision making and surgical approach for breast cancer in those centres as well as to discuss the impact of identified changes on outcome of the disease. The special attention has been directed to inspection of such small details as waiting list for consultation and hospitalisation/surgical intervention, way of decision for surgical intervention (individual or oncology meeting/staff), horizontal or oblique incision for mastectomy, duration of hospital stay, sentinel node procedure (blue dye, radioactive tracer or both, one or twodays protocol, imunochistochemistry examinations during frozen section or not), preferred way of breast reconstruction, number of assistants during operation, drainage, preservation of intercostobrachial nerve during axillary surgery, suture, etc. The data were collected according to personal presence in different institutes, observation, asking the questions and mutual discussion. The remaining information has been obtained by asking the surgical staff with a poll consisting of different questions. Descriptive statistics were used to show the differences among the parameters under comparison. Results: This study which involved relatively small, but important series of breast cancer departments throughout Europe, with some of them very famous, clearly showed a great range of differences, sometimes very significant, in parameters regarding pre-surgical evaluation and surgical treatment of breast cancer. However, results obtained suggest that there is no great impact of identified differences on the outcome of the disease. The latter has been discussed in this paper. Conclusions: Our study clearly showed that the observed differences in several parameters regarding pre-operative evaluation and surgical treatment of breast cancer in six European breast cancer units - although being found, and sometimes significant - do not have influence on outcome of the breast cancer. 368
POSTER
Long-term follow-up study of serum tumor markers CEA and CA 15-3 in patients with breast cancer F. Lumachi 1 , M. Ermani 2 , L. Di Cristofaro 1 , U. Basso 3 . 1 University of Padua, School of Medicine, Dept of Surgery & Gastroenterological Sciences, Padova, Italy; 2 University of Padua, School of Medicine, Section of Biostatisctics, Dept of Neurosciences, Padova, Italy; 3 Azienda Ospedaliera, Division of Medical Oncology, Padova, Italy Background: In patients with breast cancer (BC) several serum markers have been studied, but unfortunately their sensitivity or specificity are limited in demonstrating relapse of the disease. The aim of this study was to evaluate the usefulness of serum tumor markers CEA and CA 15-3 after curative surgery in patients with BC who underwent five-year follow-up. Patients and Methods: Charts of 182 women (median age 58 years, range 30-83 years) with confirmed BC were reviewed, and CEA and CA 15-3 serum levels were measured before operation and every 6 months during follow-up. Conditions for entry in the study were: (1) size of the tumor <5 cm (pT1-2), (2) absence of distant metastases at pre-operative staging (M0), and (3) follow-up for at least 5 years. Patients were divided in three groups: Group A, pT1pN0 (61 patients, 33.5%, median age 57 years, range 31-74), Group B, pT2pN0 (94 patients, 51.7%, median age 62 years, range 38-80), Group C, pT2pN1 (27 patients, 14.8%, median age 58 years, range 4683). Both CEA and CA 15-3 were determined by a two-site enzyme-linked immunosorbent assay (ELISA, monoclonal antibody), and a cut-off limit of 10 ng/mL (CEA) and 30 U/mL (CA 15-3) was taken as recommended by the kit producer. Results: There was no significant difference in age (p=NS) among the three groups. Basal CEA serum levels were elevated (>10 ng/ml) in 11/61 (Group A), 15/94 (Group B) and 14/27 (Group C) patients and marker sensitivity was 18.9%, 16.0%, and 51.8% respectively. Basal CA 15-3 serum levels were elevated (>30 U/ml) in 28/61 (Group A), 17/94 (Group B), and 16/27 (Group C) patients and marker sensitivity was 45.9%, 18.1%, and 59.2% respectively. Overall sensitivity was 22.0% (CEA) and 33.5% (CA 15-3). Only 23 (12.6%) patients had both markers above the cut-off, and the sensitivity of combined CEA and CA 15-3 was 39.5% (p=NS, chi-square
Poster session: Breast cancer
lignant tumor, 5 patients with in situ or pTmic carcinoma (15%), and 6 patients (18,18%) with invasive carcinoma. In 5 patients distance from resection margin was less than 5mm and further lumpectomy was performed. When invasive carcinoma was diagnosed on frozen section (3 patients) and margins were measurable, while in 2 patients with non-comedoDCIS with margins 3,5 and 4mm underwent lumpectomy in the second act. All patients with diagnosed malignancy underwent axillary dissection. Four patients (12,0%) had lymph node metastases, (2 patients with pN1a, one with 2 and one with more than 4 metastases). Conclusion: Demonstrated results were acceptable in comparison with results obtained in large series with tolerable accuracy in diagnosis of malignant lesions. Low incidence of lymph node metastases (with dominant pNo stage) implies introduction of possible axillary sparing surgery with previous sentinel lymph node labeling. Continuation of WGE in diagnosis and treatment of breast cancer is necessary within internationally monitored trials, in order to improve accuracy and disease control. 362
POSTER
Complications related to the radical mastectomy M. Sasic, M. Inic, D. Vukotic, M. Buta, M. Jevric, J. Sasic. Institute of Oncology and Radiology of Serbia, Surgery, Beograd, Serbia Aim: Although complications after radical breast cancer surgery are cut to minimum rate by performing modified radical mastectomy, they are still observed and affect mostly quality of life and duration of post operative recovery. Patients and Methods: During the years 2003 and 2004 total of 1310 modified radical mastectomies were performed at the Institute of Oncology and Radiology of Serbia, in Belgrade. We analyzed the group of 479 breast cancer patients who had modified radical mastectomy during that period. We observed the following complications in patients who had modified radical mastectomy: mortality, infections, bleeding, seroma, neuropathy, lymphoedema of the arm. Results: The data we obtained showed that these were the complications our patients had after modified radical mastectomy: mortality – none (0%), infection – 35 patients (7.3%), hematoma – 48 patients (10.0%), seroma – 209 patients (43.6%), neuropathy - 57 patients (11.9%), lymphoedema – 14 patients (2.9%) and no complications in 116 patients (24.3%). Conclusion: We are still not satisfied with relatively high percentage of post operative seroma, which could be explained by the large number patients who had axillary lymphadenoctomy. This might be avoided by performing sentinel lymph node biopsy (SLNB) and limited axillary dissection of level I and II only. 363
Conclusion: The results obtained meet the international standards as far as indications for quandrantectomy with axillary dissection are concerned. We are still not satisfied with a large number of mastectomies performed at our Institute and we think that we should set up higher standards that must be followed more strictly during the process of decision-making in setting up an indication to perform a mastectomy. 364
POSTER
The prescription of adjuvant endocrine therapies for breast cancer in the clinical setting S.J. Amonkar 1 , H.J. Cain 1 , D. Hemming 2 , W. Cunliff 1 , K. Clark 1 , D. Browell 1 . 1 Queen Elizabeth Hospital Gateshead, Department of Surgery, Tyne and Wear, United Kingdom; 2 Queen Elizabeth Hospital Gateshead, Department of Pathology, Tyne and Wear, United Kingdom Introduction: There is extensive research into the proven benefits of adjuvant endocrine therapies in breast cancer. There is however little published on the completion of a 5 year course of these endocrine therapies in the clinical setting. We have assessed the completion of endocrine therapy protocols for patients with invasive breast cancer treated in this unit. Method: Case notes of 168 patients diagnosed with invasive breast cancer in 1999 who commenced adjuvant endocrine therapy were retrospectively reviewed (168 female: ages 27-87, mean 58.2 yrs). The intended endocrine regime for these patients was 5yrs Tamoxifen, or 5yrs total endocrine treatment, Tamoxifen switched to Anastrazole. Results: 106 patients completed 5yrs Tamoxifen, 10 of whom were recruited into the ATTOM trial (3 continuing Tamoxifen). 2 patients commenced Letrozole after 5yrs. 8 further patients had 5yrs total endocrine treatment, treatment being switched due to side effects of Tamoxifen (hot flushes[4], PV bleeding[2], weight gain[1] & nausea[1]). Thus 114 patients completed their intended endocrine treatment. 3 have since died of unrelated causes and 4 patients had breast cancer recurrence after 5yrs, 1 of which subsequently died. 39 patients (23.2%) failed to complete their intended endocrine therapy due to disease recurrence within 5yrs, 34 of whom died. 7 unrelated deaths also occurred within 5 yrs. 8 patients, however, failed to complete endocrine therapy specifically due to side effects (hot flushes [3], nausea [3], DVT [1], weight gain [1]) and declined further treatment. Conclusion: We have shown that 6.6% of our patients failed to complete endocrine therapy due to side effects of the medication. Although a small proportion, it is worth remembering that some patients are unable to tolerate endocrine treatment despite its proven benefit. Further work is required to assess the actual compliance of patients who are prescribed this therapy.
POSTER
Our selection criteria for conservative vs. radical surgical treatment of breast cancer D. Vukotic, M. Sasic, M. Inic, M. Buta, D. Petkovic, M. Jevric. Institute of Oncology and Radiology of Serbia, Surgery, Beograd, Serbia Introduction: Our goal is to evaluate the outcome of operations we performed at the Dept. of Breast Cancer Surgery at the Institute of Oncology and Radiology of Serbia in relation to the tumor size and the type of surgical procedure in breast cancer patients. Patients and Methods: During the years 2003 and 2004 we performed 1310 modified radical mastectomies (Madden) and 356 quadrantectomies with axillary dissection. We analyzed 137 randomly chosen patients who had quadrantectomy with axillary dissection and 132 randomly chosen patients who had modified radical mastectomy. According to our protocol at the Institute of Oncology and Radiology of Serbia, indications for quadrantectomy with axillary dissection are tumors less than 30 mm in diameter with clinically negative axillary lymph nodes. The average age of our breast cancer patients was 55.9 years (range 40-80). Results: Our analysis shows that 83.2% of the patients who had quadrantectomy with axillary dissection had tumor less than 20 mm and 97.1% had tumor less than 30 mm in diameter. Out of 132 patients who had mastectomy 45.4% had a tumor less than 20 mm and 81.8% had tumor less than 30 mm in diameter, meaning that they were good candidates for quadrantectomy with axillary dissection.
365
POSTER
Heredity and stressful life event in breast cancer K. Maravegias 1 , P. Diamanti 1 , P. Kalogianni 1 , I. Kabouris 2 , I. Kostis 1 . 1 Hospital of Volos - Greece, Surgical Department, Volos, Greece; 2 Hospital of Volos - Greece, Psychiatry Department, Volos, Greece In the last 15 years, the development of biopsycosocial model and psychosomatic syndromes theory in psychiatry tries to attribute a psycopathological interpretation in many diseases. Thus, in this contest we investigate the probability certain forms of cancer to be related with mental stress. On the other hand, it is widely known that a lot of forms of cancer (colorectal cancer, MEN 1 & 2) etc are more or less hereditary transmitted. In the past few years, the interest has also been focused in breast cancer with the discovery of gene mutations (i.e. BRCA1 and 2) that were found to be frequent in breast cancer patients. Aiming at the investigation of heredity and the repercussion of mental stress in the breakthrough of breast cancer, we analyzed 50 patients with breast cancer and 50 control cases. Familial anamnesis was taken down and afterwards we counted the cases of cancer and breast cancer in the family, pondered with the grade of kinship. We also investigated the presence of stressful life events in each patient in order to be assessed. In this assessment we scored with linear analogue the subjective opinions of the interviewed and the physician’s opinion and gave an order to the stressful life events using the Holmes’ scale. 100 interviews were registered in an electronic sheet and were submitted to statistical analysis with the χ2 method for the
Poster session: Breast cancer average score of doctor and interviewed, as well as univariate analysis with ANOVA. We found a statistically significant difference in the average of the subjective score between cancer patients and control patients (p<0.005) as well as significance trend in the objective score (p=0.02). Similarly, the score of patient and doctor was found to be statistically significant to univariate analysis [objective score (p<0.05) and subjective score (p<0.005)]. To conclude, this work in the first place consists of a motive to wider future studies, which will aim to show the strong relation between stressful life events in our patients’ lives and the growth of various forms of cancer. 366
POSTER
Prospective evaluation of peri-operative anxiety in women undergoing mastectomy for breast cancer W.M. Wysocki, A.L. Komorowski, J. Mitus, K. Herman. Maria Sklodowska-Curie Institute of Oncology, Department of Surgical Oncology, Krakow, Poland Introduction: Preoperative anxiety is particularly important in women undergoing mastectomy for breast cancer. Unfortunately this factor is often neglected by surgeons. It was showed that elevated preoperative anxiety may have adverse effect on peri-operative period and long-term subsequences to patient physical and psychical health and quality of life. Material: The consecutive group of 29 patients admitted for mastectomy due to breast cancer, with no neoadjuvant treatment and no prior treatment for other malignancy (with exception for basal cell carcinoma of the skin) were included in this clinical trial. Methods: The peri-operative anxiety level was measured on four occasions: the afternoon on the day before the scheduled operation (after obtaining informed consent), the day after operation, ca. 7 days after operation and ca. 30 days after operation. The anxiety level was measured by means of previously validated tool - visual analogue scale (the scale had 100 mm in length; 0 meant “I feel no anxiety at all”, 100 meant “I feel maximal imaginable anxiety”). Results: The mean age of 29 included women was 55,1 yrs, 45% has elementary education, 60% was married at the time study was conducted, 12% was childless, 34% lived in rural areas. The mean VAS anxiety level in the following time-points was as follows: a day before operation - 58,1 mm; a day after operation - 46,0 mm; ca. 7 days after surgery - 39,8 mm; ca. 30 days after operation - 46,9 mm. Data gathered during the study show, that anxiety level in women awaiting for mastectomy is the highest before the surgery and subsequently decreases over time. The anxiety level in women undergoing mastectomy is higher compared to similar studies on non-breast cancer patients. Ca. 30 days after surgery there is an increase in anxiety level; this time point in our institution represents average time of initiation of adjuvant treatment. Conclusion: The anxiety level in women undergoing mastectomy is significant despite providing them with preoperative information in the standard manner and obtaining informed consent. The additional tools for relieving (decreasing) peri-operative level should be searched for. 367
POSTER
Pre-operative management, decision making and surgical technique in several European breast cancer units A. Celebic 1 , M. Halaska 2 , O. Kosovac 1 , D. Stojiljkovic 1 , Z. Milovanovic 3 , N. Miletic 1 , O. Celebic 4 , R. Dzodic 1 . 1 Institute of Oncology and Radiology of Serbia, Dept. of Surgery, Belgrade, Serbia; 2 Hospital Motol of 2nd Medical Faculty of Charles University, Dept. of Gynaecology, Prague, Czech Republic; 3 Institute of Oncology and Radiology of Serbia, Dept. of Pathology, Belgrade, Serbia; 4 Medical School, University in Pristina, Kosovska Mitrovica, Serbia Introduction: The aim of this paper was to compare differences in preoperative management, surgical decision making and technical approach for breast cancer in several big European Breast Cancer Units in Italy, France, Czech Republic and Serbia, and to discuss eventual impact of detected differences on outcome of the disease. Methods: The authors of this paper, who have been for the first time in their career as young visiting/observing/training guests invited by four prestigious European Breast Cancer Units in Italy and France (National Cancer
S109
Institute - Milan, European Institute of Oncology – Milan, Institute Gustave Roussy - Villejuif, Institute Curie - Paris) as fellows of different European and international institutions (EUSOMA, EACR, ESSO, UICC, ESO, FECS, French Government) in the period from July 2003 – June 2006 and who are employed as surgeons/pathologists at Institute of Oncology and Radiology of Serbia in Belgrade and in Hospital Motol of 2nd Medical Faculty of Charles University in Prague, tried to detect and compare differences in several parameters regarding pre-surgical evaluation, decision making and surgical approach for breast cancer in those centres as well as to discuss the impact of identified changes on outcome of the disease. The special attention has been directed to inspection of such small details as waiting list for consultation and hospitalisation/surgical intervention, way of decision for surgical intervention (individual or oncology meeting/staff), horizontal or oblique incision for mastectomy, duration of hospital stay, sentinel node procedure (blue dye, radioactive tracer or both, one or twodays protocol, imunochistochemistry examinations during frozen section or not), preferred way of breast reconstruction, number of assistants during operation, drainage, preservation of intercostobrachial nerve during axillary surgery, suture, etc. The data were collected according to personal presence in different institutes, observation, asking the questions and mutual discussion. The remaining information has been obtained by asking the surgical staff with a poll consisting of different questions. Descriptive statistics were used to show the differences among the parameters under comparison. Results: This study which involved relatively small, but important series of breast cancer departments throughout Europe, with some of them very famous, clearly showed a great range of differences, sometimes very significant, in parameters regarding pre-surgical evaluation and surgical treatment of breast cancer. However, results obtained suggest that there is no great impact of identified differences on the outcome of the disease. The latter has been discussed in this paper. Conclusions: Our study clearly showed that the observed differences in several parameters regarding pre-operative evaluation and surgical treatment of breast cancer in six European breast cancer units - although being found, and sometimes significant - do not have influence on outcome of the breast cancer. 368
POSTER
Long-term follow-up study of serum tumor markers CEA and CA 15-3 in patients with breast cancer F. Lumachi 1 , M. Ermani 2 , L. Di Cristofaro 1 , U. Basso 3 . 1 University of Padua, School of Medicine, Dept of Surgery & Gastroenterological Sciences, Padova, Italy; 2 University of Padua, School of Medicine, Section of Biostatisctics, Dept of Neurosciences, Padova, Italy; 3 Azienda Ospedaliera, Division of Medical Oncology, Padova, Italy Background: In patients with breast cancer (BC) several serum markers have been studied, but unfortunately their sensitivity or specificity are limited in demonstrating relapse of the disease. The aim of this study was to evaluate the usefulness of serum tumor markers CEA and CA 15-3 after curative surgery in patients with BC who underwent five-year follow-up. Patients and Methods: Charts of 182 women (median age 58 years, range 30-83 years) with confirmed BC were reviewed, and CEA and CA 15-3 serum levels were measured before operation and every 6 months during follow-up. Conditions for entry in the study were: (1) size of the tumor <5 cm (pT1-2), (2) absence of distant metastases at pre-operative staging (M0), and (3) follow-up for at least 5 years. Patients were divided in three groups: Group A, pT1pN0 (61 patients, 33.5%, median age 57 years, range 31-74), Group B, pT2pN0 (94 patients, 51.7%, median age 62 years, range 38-80), Group C, pT2pN1 (27 patients, 14.8%, median age 58 years, range 4683). Both CEA and CA 15-3 were determined by a two-site enzyme-linked immunosorbent assay (ELISA, monoclonal antibody), and a cut-off limit of 10 ng/mL (CEA) and 30 U/mL (CA 15-3) was taken as recommended by the kit producer. Results: There was no significant difference in age (p=NS) among the three groups. Basal CEA serum levels were elevated (>10 ng/ml) in 11/61 (Group A), 15/94 (Group B) and 14/27 (Group C) patients and marker sensitivity was 18.9%, 16.0%, and 51.8% respectively. Basal CA 15-3 serum levels were elevated (>30 U/ml) in 28/61 (Group A), 17/94 (Group B), and 16/27 (Group C) patients and marker sensitivity was 45.9%, 18.1%, and 59.2% respectively. Overall sensitivity was 22.0% (CEA) and 33.5% (CA 15-3). Only 23 (12.6%) patients had both markers above the cut-off, and the sensitivity of combined CEA and CA 15-3 was 39.5% (p=NS, chi-square