http://repub.eur.nl/res/aut/12777/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/33310/ 2011-09-01T00:00:00Z http://repub.eur.nl/res/pub/30034/ 2008-04-01T00:00:00Z Introduction: Although the status of the regional lymph nodes is an important determinant of prognosis in breast cancer, harvesting sentinel nodes (SN) detected in the internal mammary chain (IMC) is still controversial. Aims: To determine in how many patients a positive IMC-SN might change the systemic or locoregional adjuvant therapy, with a possible benefit in outcome. Patients and methods: During 6 frac(1, 2)years data of T1-2 breast cancer patients, having an SN procedure, were prospectively collected. Our policy was not to explore the IMC even if it was the only localization of an SN. Results: In 86 of 571 patients lymphoscintigraphy showed an IMC-SN. In 64 of these, the axillary SN was negative and only 25 of these patients did not have an indication for adjuvant systemic treatment based on their tumor characteristics. In the literature, IMC metastases are found in 0-10% of axillary negative patients. Routine IMC-SN biopsies would have resulted in an indication for adjuvant systemic therapy in 2-3 of our patients. Four parasternal recurrences were found during a median follow-up of 51 months. Conclusions: Harvesting IMC-SNs is a procedure of which only a limited number of patients have therapeutical benefit. Even with a thorough selection of patients, the extra morbidity of the procedure should be weighed against the potential benefit for the patient. http://repub.eur.nl/res/pub/30841/ 2003-10-01T00:00:00Z In western countries breast cancer affects approximately 1 in every 10 to 12 women. It is the leading cause of cancer death in women in these countries and the leading cause of overall mortality in women aged 35 to 55 years. Many risk factors for breast cancer have been identified including menstrual history. reproductive behavior, exogenous hormones, and a positive family history for the disease. Although most of these factors have only a small impact on breast cancer risk, the role of familial susceptibility can increase the risk for breast cancer up to a lifetime risk of close to 50% (Claus et al, 1994 ). Genetic susceptibility for breast cancer obtained attention and practical relevance upon the identification of the first two major breast cancer susceptibility genes, BR(east)CA(ncer)1 and BRCA2 (Miki et al, 1994; Wooster et al, 1995). Breast cancer, like all cancers, is a 'genetic' disease, as it results from an accumulation of somatic mutations in genes or the altered expression of genes in the absence or presence of germline mutations. http://repub.eur.nl/res/pub/9688/ 2001-01-01T00:00:00Z BACKGROUND: Women with a BRCA1 or BRCA2 mutation have a high risk of breast cancer and may choose to undergo prophylactic bilateral total mastectomy. We investigated the efficacy of this procedure in such women. METHODS: We conducted a prospective study of 139 women with a pathogenic BRCA1 or BRCA2 mutation who were enrolled in a breast-cancer surveillance program at the Rotterdam Family Cancer Clinic. At the time of enrollment, none of the women had a history of breast cancer. Seventy-six of these women eventually underwent prophylactic mastectomy, and the other 63 remained under regular surveillance. The effect of mastectomy on the incidence of breast cancer was analyzed by the Cox proportional-hazards method in which mastectomy was modeled as a time-dependent covariate. RESULTS: No cases of breast cancer were observed after prophylactic mastectomy after a mean (+/-SE) follow-up of 2.9+/-1.4 years, whereas eight breast cancers developed in women under regular surveillance after a mean follow-up of 3.0+/-1.5 years (P=0.003; hazard ratio, 0; 95 percent confidence interval, 0 to 0.36). The actuarial mean five-year incidence of breast cancer among all women in the surveillance group was 17+/-7 percent. On the basis of an exponential model, the yearly incidence of breast cancer in this group was 2.5 percent. The observed number of breast cancers in the surveillance group was consistent with the expected number (ratio of observed to expected cases, 1.2; 95 percent confidence interval, 0.4 to 3.7; P=0.80). CONCLUSIONS: In women with a BRCA1 or BRCA2 mutation, prophylactic bilateral total mastectomy reduces the incidence of breast cancer at three years of follow-up.