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Breast cancer is the most common malignancy of women in the United States. Each year approximately 212,600 American women will be diagnosed with breast cancer and approximately 40,200 will die of breast cancer in 2003. At Mercy Medical Center (MMC), 230 cases of breast cancer were diagnosed in 2003. Those 230 cases are the subject of this report.
As would be expected, almost all of the breast cancer cases were in women. One of the Mercy cases involved a male. In general, men with breast cancer are treated like their female counterparts. Stage for stage, treatment results is comparable for men and women. Breast cancer can present as a number of different histologic types. All are forms of adenocarcinoma. One main distinction is between ductal carcinomas and lobular carcinoma. Within each subtype, the neoplasm may be invasive or noninvasive. Among our 2003 cases, 46.5 percent were infiltrating (invasive) ductal adenocarcinoma, 13.5 percent were intraductal (noninvasive) carcinoma and 6.5 percent were invasive lobular carcinoma. Another 2 percent were lobular carcinoma-in-situ (noninvasive) and 11 percent of the cases were mixed invasive lobular and ductal carcinoma. Historically, breast cancer treatment necessitated removal of the involved breast. This no longer represents the only treatment option for the women who will be diagnosed with early stage breast cancer in the U.S. this year. Several clinical trials conducted during the past two decades have demonstrated the efficacy of breast conservation treatment in the management of early stage breast cancer. Breast conservation treatment (also referred to as breast preservation treatment) consists of partial mastectomy (lumpectomy), axillary sampling and radiation therapy to the involved breast. The object of breast conservation treatment is to obtain local control with survival at least equivalent to modified radical mastectomy, while providing excellent cosmetic results.
We looked at the surgical treatment that our group of patients received. Forty-four percent underwent mastectomy while 53 percent underwent lumpectomy. Most of our patients (89.5 percent) presented with early stage breast cancer (Stage Group 0, I, II). They would have been potential candidates for breast conservation treatment. Fifty-three percent of the Stage 0 patients, 87 percent of the Stage I patients and 79 percent of the Stage II patients had a lumpectomy. In 1998, thirty-six percent of our patients underwent lumpectomies. At that time, we initiated education of physicians and patients regarding breast preservation. These efforts were effective. In 2003, fifty-three percent of our patients underwent lumpectomy.
In addition to surgery and radiation therapy, systemic treatment of breast cancer has been shown to improve survival in women with breast cancer. Systemic treatment consists of either chemotherapy and/or hormone therapy. It is common for patients to receive all three treatment modalities for breast cancer.
Most of our patients received multi-modality treatment. A total of 72 percent of our patients received some form of combined modality treatment. Forty-three percent received a combination of surgery, systemic treatment, and radiation therapy, while another twenty-two percent underwent surgery and systemic treatment. Seven percent of patients underwent surgery and radiation therapy.
A statistical comparison of the survival of Mercy Medical Center cases with the National Cancer Data Base (NCDB) is included. To calculate a five-year survival rate we used the data from 1998-2003. As the accompanying graphs show, the survival rate is directly related to the stage of disease. Overall, the survival rates of our patients are the same as the survival rates of the patients in the NCDB.