Hormone Therapy Status Research Articles

The Association between Surgical Closure Type and Acute Infection, Local Recurrence, and Disease Surveillance in Patients Undergoing Breast Conserving Therapy For Early Stage Breast Cancer

Purpose/Objective: In patients undergoing breast-conserving therapy (BCT), surgical closure technique has been largely influenced by expected cosmetic outcome. However, the common practice of promoting postoperative fluid collection raises concerns about potential bacterial colonization, tumor cell migration, and impaired post-BCT surveillance. This study investigates the effect of full-thickness versus superficial closure of the breast parenchyma on the likelihood of subsequent infection and local recurrence. Materials/Methods: From 1985 through 2004, 577 women with 599 stage T0-2N0-1 breast cancers underwent BCT at our institution. Medical records were reviewed to determine surgical closure technique, incidence of post-operative infection, local recurrence (LR), and ipsilateral breast tumor recurrence (IBTR). Three surgeons performed the majority of operations. Re-excision of the tumor bed was performed in patients with close or positive margins when feasible. In all patients, radiation treatment was planned using computed tomography (CT) scans. The tumor bed target included postoperative fluid collections, tumor bed clips, and postoperative tissue changes. Acute infection was diagnosed on a clinical basis within three months of surgery. Results: Median observed follow-up was 6.4 years from the completion of radiotherapy. Surgical closure technique was determined in 514 patients. Acute infections occurred in 27/229 (11.8%) breasts known to have superficial closure compared with 15/285 (5.3%) with full-thickness closure (p=0.0091). In stage T1–2 patients, the overall 10-year actuarial rates of IBTR and LR were 5% and 3%. In this group of patients with invasive cancer, there was no difference between superficial and full-thickness closure in the rate of either IBTR 5.6% (11/195) vs. 3.5% (8/230) or LR 3.6% (7/195) vs. 1.7% (4/230). In Stage T0-T2 patients, local recurrences following superficial closure were less likely to be initially detected on mammography 29% (2/7) vs. 100% (10/10) p=0.0034 compared to local recurrences following full-thickness closure. In addition, when locally recurrent tumors were identified in mastectomy specimens of stage T0-T2 patients, 80% (4/5) of recurrent tumors after superficial closures were >1 cm compared with no (0/9) (p=0.0050) recurrent tumors after full-thickness closures. A Cox multivariate analysis was performed examining factors potentially associated with IBTR and LR including: surgical closure type, age, infection, obesity, tumor bed radiation dose, hormonal therapy, and surgical margin status. Only close (<2 mm) or positive margins were significant risk factors for both IBTR and LR (p = 0.0147 and 0.0177). Acute infection was also a significant risk factor for LR alone (p = 0.0034). Conclusions: In the University of Florida BCT experience, women with superficial closures after partial mastectomy had an increased risk of infection, which itself was associated with a higher risk of local recurrence. Additionally, local recurrences after superficial closure may be more difficult to detect on surveillance imaging, permitting the development of larger recurrent tumors.

Predicting Biopsy Outcome After Mammography: What Is the Likelihood the Patient Has Invasive or In Situ Breast Cancer?

As many as 1,000,000 breast biopsies are performed annually in the United States. Although substantial effort has been devoted to estimating breast cancer risk, there have been no studies to predict outcome in women undergoing breast biopsy. A population-based study was undertaken to develop and test models for predicting the probability of invasive breast cancer and/or ductal carcinoma-in-situ in 7670 women undergoing breast biopsy after mammography. Logistical prediction models were developed by using data from 6129 randomly selected women and tested with data from the remaining women. The overall cancer prevalence among women undergoing biopsy was 22.4%. Prevalence in women with mammograms highly suggestive of malignancy (category 5) was 84.6%, with minimal variation in individual cancer probabilities due to age. A total of 24.6% of women with suspicious mammograms (category 4) had cancer, but individual probability estimates ranged from .01 to .86, depending on age, presence of a lump, previous biopsy, menopausal status, and use of postmenopausal hormone therapy. These variables also influenced biopsy outcome in women with other mammography assessments (categories 0-3), but the overall prevalence was lower (8.6%), and estimated probabilities ranged from .01 to .45. When cancer was present, the probability of invasive disease was influenced by mammogram assessment category, absence of mammogram calcifications, and presence of a lump. The probabilities of invasive cancer and ductal carcinoma-in-situ in women undergoing biopsy can be more accurately predicted by using clinical characteristics in addition to mammography findings. This information could potentially influence decisions regarding immediate biopsy or continued surveillance.

Hormone replacement therapy and WONCA/COOP functional status: a cross-sectional population-based study of women in Israel

Background Current indications for hormone replacement therapy (HRT) for menopausal women include symptom relief, but recent studies have raised concerns about the safety of HRT. Little data are available on the effect of HRT on functional status of women taking hormonal preparations after menopause.Objective To assess the association between hormonal replacement therapy and functional status in menopausal women.Methods A cross-sectional survey, population-based study of 682 menopausal women between the ages of 50 and 70 years registered with six family physicians in central Israel. The main outcome measure was the functional status measured by the WONCA/COOP charts.Results A total of 587 women (86%) completed questionnaires. Univariate analysis showed an association between current use of HRT and improved functional status. However this association was diminished in a regression analysis which controlled for sociodemographic status and health variables. The contribution of HRT to functional status was small but was found to be significant in the domains of general health status (1.9%, p < 0.002), sleep (0.9%, p < 0.044), physical activities (2.1%, p < 0.001) and feelings (1.0%, p < 0.033). The contribution of HRT to daily activities, social activities, change in health status and pain was not significant.Conclusions HRT use had a small contribution to improved functional status in half of the domains measured by the WONCA/COOP charts.

Cyclin D1 polymorphism and the risk of endometrial cancer

Objectives The common G to A single nucleotide polymorphism (G870A) in the splice donor region of exon 4 enhances alternate splicing, and produces a longer half-life cyclin D1 (CCND1). This study was aimed at investigating the possible association between the G870A polymorphism in CCND1 and the risk of endometrial cancer. Methods We assessed the association between the CCND1 G870A polymorphism and the risk of endometrial cancer in a hospital-based case-control study among 231 Korean women (77 cases; 154 matched controls). Controls were matched to cases with respect to age, menopausal status, and hormone therapy status. Result The allele frequencies of the case subjects (A, 0.45; G, 0.55) were significantly different from those of control subjects (A, 0.58; G, 0.42) ( P = 0.008). All case and control subjects were in Hardy–Weinberg equilibrium. The AA genotype was associated with a significantly elevated odds ratio (OR) of 3.18 [95% confidence interval (CI) 1.38–7.37, P = 0.007], and the AG genotype was associated with an OR of 1.38 (95% CI 0.65–2.89). When we combined the GG and AG genotypes as a reference genotype, we found that the OR for the AA genotype was 2.53 (95% CI 1.34–4.80, P = 0.004), supporting a recessive model for the A allele. Conditional logistic regression adjusted for various risk factors of endometrial cancer revealed positive associations between the AA genotype and an increased risk of endometrial cancer (OR 3.16, 95% CI 1.18–8.43, P = 0.022). However, no significant difference in endometrial cancer stage or grade was observed between the CCND1 genotypes. Conclusion Our data suggest that the CCND1 polymorphism is associated with an increased risk of endometrial cancer. To validate this association, a large-scale population-based study is needed.

Medullary breast carcinoma: Outcomes and prognosis with the utilization of chemotherapy

671 Background: Medullary carcinoma of the breast is an uncommon histological type consisting of poorly differentiated cells surrounded by a prominent lymphoid stroma. It is also suggested that these lesions have good prognosis and therefore may not benefit from systemic therapy. We therefore report on our experience with this tumor type. Methods: 143 evaluable patients treated between 1980–2003 at UTMDACC were retrospectively reviewed on an IRB approved protocol. Pathology was reviewed. Outcomes were analyzed by administration of chemotherapy, use of hormonal therapy, pathologic size, and nodal status. Log-rank statistics were used for overall-, local-regional failure-free, and distant metastasis free- survival. Results: Mean age at diagnosis was 44 years (range 24–84)with a mean follow-up of 9 years (range 0.16- 23.3). 71% of patients recieved chemotherapy (n=102) with 88% having a doxorubicin-based regimen. 72% were ER-. 27 had positive nodes with only 6 patients having 4 or more nodes positive. 5 and 10 yr OS, LRFFS, and DMFS for all patients was 82%/75%, 86%/86%, and 84%/80% respectively. Improvement in 5 and 10 yr OS and DMFS was noted with chemotherapy (86%/79%) vs no chemoherapy (72%/66% P=.08) and ( 81%/81% vs 71%/71% P=.08). No improvement was noted with adjuvant hormonal therapy (n=21)(P=.5). 5 and 10 yr OS rates decreased with increasing tumor size with tumors 1 cm or less having 100%/100% vs tumors 1–3cm having 83%/83%, and tumors 3 cm or larger having 74%/69% values (p=.13). LN- patients likewise had improved 5 and 10 yr OS rates (87%/80% vs 75%/61%)(P=.07). No significant difference in OS, LRFFS, or DMFS was noted after stratification of lymph nodes (1–3 vs 4+). Conclusions: Patients with medullary breast cancer benefited from the use of adjuvant chemotherapy. Limited patient numbers preclude comment on adjuvant hormones. Tumors less than 1 cm were most favorable as were those without nodal metastasis. In our series, patients with + nodes and tumor size greater than 1 cm had prognosis similar to that ascribed to invasive ductal carcinoma NOS and may benefit from systemic regimens. Larger datasets should be examined to further clarify therapy recommendations. No significant financial relationships to disclose.

Normative data for tasks of executive function and working memory for Australian-born women aged 56 – 67

Normative data for tests of working memory and executive function (a term adopted to cover a range of cognitive skills) are primarily based on the U.S. population and are not always specific for gender or education levels. The diagnosis of, and research into, cognitive diseases rely on the use of relevant normative data. This study presents normative data for an ageing, female, Australian-born population, and an analysis of the factors that contribute to variation in performance. Three tasks of executive function: Trail Making Test, Part B (Trails-B); Tower of London, and the oral version of the Symbol Digit Modalities Test (SDMT), and a working memory task (Letter-Number Sequencing, LNS) were administered as part of a 14-item neuropsychological battery to 257 participants (M age = 60 years, range = 56 – 67 years), who have been participating in the Melbourne Women's Midlife Health Project. The Center for Epidemiological Studies Depression Scale (CES-D) was also administered. A regression analysis incorporating age, years of education, CES-D score, current use of hormone therapy and menopausal status as independent variables demonstrated that education and age contributed to the variation in SDMT and the LNS but not in the Tower of London. Education alone contributed to variation in Trails-B, although there was a trend for performance to decrease with age. Mood, hormone therapy use, and menopausal status were unrelated to test scores. Tables of mean scores were constructed for age ranges and level of education, for each of the tests except the Tower of London, which was presented as education groups only. Partial correlations between test performances demonstrated significant correlations between all the major components of the tests. This study provides education- and age-based normative data for tests of executive function for the ageing female, Australian-born population.

Risk factors for local recurrence after breast-conserving surgery.

It is not clear whether risk factors for local recurrence after breast-conserving surgery differ in women having surgery for in situ or invasive cancer. Furthermore, the Nottingham Prognostic Index (NPI) and Nottingham Histological Grade (NHG) have been little studied as determinants of local recurrence risk. In a case-control study (491 cases and 1098 controls) nested within a cohort of 7502 women who had surgery for in situ or invasive cancer of the breast, patient characteristics, tumour characteristics and treatment-related variables were evaluated as risk factors for local recurrence. Multivariate conditional logistic regression analyses showed that age below 40 years, tumour multicentricity and an unclear or unknown surgical margin were significant risk factors for local recurrence. Radiotherapy to the breast and adjuvant hormone therapy were protective. Cancer in situ was not associated with a higher risk of local recurrence than invasive cancer (odds ratio 1.0, 95 per cent confidence interval 0.8 to 1.3). NHG and NPI were not helpful in determining risk of local recurrence. Margin status, age, tumour multicentricity, and use of radiotherapy and adjuvant hormone therapy were important determinants of risk of local recurrence. With the exception of surgical margin, variables related to the quality of surgical management did not predict risk of local recurrence.

Tamoxifen and Chemotherapy for Axillary Node-Negative, Estrogen Receptor–Negative Breast Cancer: Findings From National Surgical Adjuvant Breast and Bowel Project B-23

Uncertainty about the relative worth of doxorubicin/cyclophosphamide (AC) and cyclophosphamide/methotrexate/fluorouracil (CMF), as well as doubt about the propriety of giving tamoxifen (TAM) with chemotherapy to patients with estrogen receptor-negative tumors and negative axillary nodes, prompted the National Surgical Adjuvant Breast and Bowel Project to initiate the B-23 study. Patients (n = 2,008) were randomly assigned to CMF plus placebo, CMF plus TAM, AC plus placebo, or AC plus TAM. Six cycles of CMF were given for 6 months; four cycles of AC were administered for 63 days. TAM was given daily for 5 years. Relapse-free survival (RFS), event-free survival (EFS), and survival (S) were determined by using life-table estimates. Tests for heterogeneity of outcome used log-rank statistics and Cox proportional hazards models to detect differences across all groups and according to chemotherapy and hormonal therapy status. No significant difference in RFS, EFS, or S was observed among the four groups through 5 years (P =.96,.8, and.8, respectively), for those aged < or = 49 years (P =.97,.5, and.9, respectively), or for those aged > or = 50 years (P =.7,.6, and.6, respectively). A comparison between all CMF- and all AC-treated patients demonstrated no significant differences in RFS (87% at 5 years in both groups, P =.9), EFS (83% and 82%, P =.6), or S (89% and 90%, P =.4). There were no significant differences in RFS, EFS, or S between CMF and AC in patients aged < or = 49 or > or = 50 years. No significant difference in any outcome was observed when chemotherapy-treated patients who received placebo were compared with those given TAM. RFS in both groups was 87% (P =.6), 87% in patients aged < or = 49 (P =.9), and 88% and 87%, respectively (P =.4), in those aged > or = 50 years. There was no significant difference in the outcome of patients who received AC or CMF. TAM with either regimen resulted in no significant advantage over that achieved from chemotherapy alone.

Internal mammary nodal irradiation in conservatively-managed breast cancer patients: is there a benefit?

Purpose: Recent randomized trials have demonstrated a significant benefit to postmastectomy radiation in node-positive breast cancer patients. The contribution of internal mammary nodal radiation (IMNR) to this benefit remains controversial, and in conservatively-treated patients (CS + RT), may compromise cosmesis and contribute to morbidity. The purpose of this retrospective analysis is to evaluate outcome as a function of IMNR in a cohort of breast cancer patients treated with CS + RT. Patients and Methods: Between January 1970 and December 1990, 984 patients with invasive breast cancer were treated at our facility with CS + RT, and serve as the base for this study. Of these patients, 399 patients had pathologically-negative lymph nodes, 167 (17%) had pathologically-involved lymph nodes, and 381 did not undergo lymph node dissection. The majority of node-positive patients received adjuvant systemic therapy (94%) and were treated with tangential fields matched to a separate supraclavicular field (95%) with or without IMNR. For this analysis, patients were divided into two groups: those treated by intentionally targeting the internal mammary nodes (IM-yes, n = 535) and without intentionally targeting the internal mammary nodes (IM-no, n = 411). In the IM-no group, the medial border was typically placed at midline. The decision not to use a separate internal mammary field was a result of a change in treatment policy over time, and generally not based on number of nodes or tumor location. Results: As of August 1998, with a median follow-up of 13 years, the overall survival at 10 years is 76%, the distant disease-free survival is 81%, and the breast relapse-free survival is 88%. There were no significant differences between the IM-yes and IM-no groups with respect to age, ER/PR status, or use of adjuvant chemotherapy or hormone therapy. There were more patients with T2 tumors, positive nodes, medial lesions, indeterminate margins, and slightly longer follow-up in the IM-yes group compared to the IM-no group. Although there was a trend toward better outcome in the IM-no group, there were no significant differences between the IM-yes and IM-no groups with respect to overall survival (72% IM-yes vs. 84% IM-no, p = NS) or distant metastasis-free survival (64% IM-yes vs. 82% IM-no, p = NS). Subset analysis showed no benefit in the IM-yes group regardless of age, number of nodes, or location. Conclusion: In this retrospective analysis, no benefit could be attributed to IMNR in conservatively-treated breast cancer patients, even if node-positive or medial in location. Until results of an ongoing EORTC randomized trial addressing this issue are available, these data suggest that it is acceptable to continue to treat node-positive conservatively-managed patients to tangential fields usually matched to a supraclavicular field, but without a separate internal mammary field.

The current status of adjuvant hormonal therapy combined with radiation therapy for localised prostate cancer.

Analysis of the results of treatment of localised prostate cancer with radiation and surgery has identified patients who are at high risk of developing metastatic dissemination. High histologic grade, serum prostate specific antigen above 20 ng/ml, extension beyond the capsule of the prostate, and involvement of lymph nodes are highly predictive of metastatic risk. Antiandrogen therapy has high rates of activity in the treatment of overt metastatic disease prompting its assessment as an adjuvant treatment added to radiation therapy. There are now major prospective randomized trials which have been completed. The current evidence indicates that a large survival benefit ensues when antiandrogen therapy is added to radiation for appropriately selected patients. This adjuvant approach is likely to become the standard of care. Strategies for further enhancement of adjuvant therapy are discussed.

Neoadjuvant Hormonal Therapy Plus Surgery for Prostate Cancer: The MSKCC Experience

This article reviews the current status of neoadjuvant hormonal therapy (NHT) in the treatment of clinically localized prostate cancer. Although significant increases in the organ confined rate and similar marked decreases in the positive margin rate are found in patients receiving NHT, to date no difference in disease free survival rate, as determined by PSA values, can be shown. However, there is a suggestion (P = 10 ng/ ml when treated with NHT compared with controls. Given the prolonged natural history of prostate cancer, longer follow-up will be required before the value of NHT can be established.

Determinants of self rated menopause status

This study, based on a population survey, examines the self ratings of progress through the menopausal transition of women in natural menopause, women using hormone therapy and women who have undergone hysterectomy. The latter two groups are usually excluded from discussions of menopausal transition, since the accepted menstrually defined criteria do not apply to them. Hysterectomised women do not differ in their self rating profile from non-hysterectomised women, after hormone therapy status is taken into account. This is surprising, since they may have been expected to see themselves as in the main postmenopausal. Use of hormone therapy is tantamount to self perception as at least perimenopausal. Among women in natural menopause there is 29% disagreement between self ratings and menstrually defined categories. On the basis of these observations it is hypothesised that experience of symptoms associated with menopause is important in determining self ratings. The good fit of logistic regression predictions of self ratings from hysterectomy status, hormone therapy status and experience of hot flushes is consistent with this hypothesis. This research indicates that it is important to take women's subjective evaluations into account in assessing progress through the menopausal transition.

Sexual orientation identities, attractions, and practices of female‐to‐male transsexuals

Some processes used by female‐to‐male transsexuals in the formation of their sexual orientation identities were investigated under the assumption that for female‐to‐male transsexuals it is not possible simply to use their own sex or gender, or the sexual orientation identities of their partners, as bases for their own sexual orientation identities. Forty‐six North American and one New Zealand female‐to‐male transsexuals from diverse backgrounds and at different stages of transition were interviewed in depth about their sexual attractions, sexual practices, and sexual orientation identities as part of a larger sociological field study. For analytic purposes, hormone therapy was assumed to initiate sufficient changes in secondary sex characteristics to ensure that female‐to‐male transsexuals could function socially as men. Hormone therapy status was thus used to classify participants into pre‐ and post‐transition groups. Prior to transition, female‐to‐male transsexuals tended to base their sexual orientatio...

Current status of hormonal therapy of fibrocystic breast disease.

Current status of hormonal therapy of fibrocystic breast disease.

Current status of gynecologic hormone therapy. Disorders of the transitional phases

Current status of gynecologic hormone therapy. Disorders of the transitional phases

Steroid-hormone receptors in breast cancer.

An obvious problem for the surgeon or oncologist treating breast cancer has been to identify the patients likely to respond to endocrine manipulation. Until recently, clinical factors such as previous response to hormone therapy, disease-free interval, age and menopausal status, and location of the dominant metastatic lesion were the principal criteria for selecting therapeutic regimens for these women. Recently, the measurement of steroid hormone receptors has become an important laboratory test. Progress during the last decade has shown that: the most reliable methods of determining estrogen receptors (ER) and progestin receptors (PR) are multipoint titration analysis using dextran-coated charcoal, and sucrose density gradient centrifugation; 55% to 65% of primary breast tumors contain more than 10 femtomole/mg cytosol protein of ER; 45% to 55% of metastatic breast tumors contain more than 10 fmol/mg cytosol protein of ER; ER are present more often in tumors of postmenopausal women compared with those of premenopausal women; benign breast lesions such as fibrocystic disease and fibroadenomas usually contain less than 10 fmol/mg cytosol protein of ER; 90% of male breast carcinomas contain ER; approximately 55% of women with breast tumors containing ER respond objectively to endocrine therapy, either additive or ablative; less than 3% of women with breast tumors lacking ER respond objectively to hormone therapy. In addition, it has been suggested that the absence of ER in a breast tumor correlates well with an increased response to cytotoxic chemotherapy; 45% to 60% of primary or metastatic breast tumors contain PR. Also, the presence of both ER and PR in a breast tumor indicates a 75% to 80% likelihood that the patient will respond to endocrine manipulation, either additive or ablative; it has been suggested that the presence of the 8 Svedberg form of ER in a breast tumor (as detected by sucrose gradient centrifugation) improves the accuracy of selecting the patient likely to respond to endocrine therapy; and there appears to be a relationship between the quantity of ER in a breast tumor and a patient's response to endocrine therapy. The incidence of response to hormone therapy increases with increasing ER levels.

Current status of chemotherapy, hormonal therapy, and immunotherapy in the treatment of renal cell carcinoma

Renal cell carcinoma is an uncommon but lethal disease. Since many patients initially present with metastatic disease and/or fail primary local therapy, therapeutic alternatives are needed. In our review of single agents none emerge as uniformly effective, although a number of chemotherapeutic agents are somewhat active, as is the hormonal agent, medroxyprogesterone. Combination chemotherapy, with and without hormonal agents and immunotherapeutics, appears to be somewhat more active, with several reports of CRs. Immunotherapeutic agents alone show promise in the limited studies reported to date. Several studies are now in progress, attempting to study new agents and combinations in this disease. Physicians are urged to participate in these studies.

Current status of chemotherapy, hormonal therapy, and immunotherapy in the treatment of renal cell carcinoma

Renal cell carcinoma is an uncommon but lethal disease. Since many patients initially present with metastatic disease and/or fail primary local therapy, therapeutic alternatives are needed. In our review of single agents none emerge as uniformly effective, although a number of chemotherapeutic agents are somewhat active, as is the hormonal agent, medroxyprogesterone. Combination chemotherapy, with and without hormonal agents and immunotherapeutics, appears to be somewhat more active, with several reports of CRs. Immunotherapeutic agents alone show promise in the limited studies reported to date. Several studies are now in progress, attempting to study new agents and combinations in this disease. Physicians are urged to participate in these studies.

Corticosteroids for elderly patients with breast cancer.

Ninety-one assessable elderly women (greater than 65 years) with advanced breast cancer were treated with prednisolone 15 mg (or cortisone 75 mg) daily after primary endocrine treatment (estrogens, androgens or tamoxifen). Thirteen (14%) achieved an objective regression, and 19 (21%) others showed no change for greater than or equal to six months. Hence, 32 patients (35%) had control of disease for about one year. Responses were mainly in soft tissue and skeletal lesions and were independent of response to prior endocrine treatment. Toxicity was low. Low-dose corticosteroid treatment is of value in controlling advanced breast cancer in elderly women.

THERAPEUTIC CASTRATION IN THE TREATMENT OF ADVANCED BREAST CANCER.

CancerVolume 17, Issue 9 p. 1197-1202 ArticleFree Access Therapeutic castration in the treatment of advanced breast cancer B. J. Kennedy M.D., B. J. Kennedy M.D. Department of Internat Medicine, University of Minnesota Medical Center, Minneapolis, Minn. 55455Search for more papers by this authorIgnacio E. Fortuny M.D., Ignacio E. Fortuny M.D. Department of Internat Medicine, University of Minnesota Medical Center, Minneapolis, Minn. 55455Search for more papers by this author B. J. Kennedy M.D., B. J. Kennedy M.D. Department of Internat Medicine, University of Minnesota Medical Center, Minneapolis, Minn. 55455Search for more papers by this authorIgnacio E. Fortuny M.D., Ignacio E. Fortuny M.D. Department of Internat Medicine, University of Minnesota Medical Center, Minneapolis, Minn. 55455Search for more papers by this author First published: September 1964 https://doi.org/10.1002/1097-0142(196409)17:9<1197::AID-CNCR2820170916>3.0.CO;2-TCitations: 36AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 Beatson, G. T.: On treatment of inoperable cases of carcinoma of mamma; suggestions for new method of treatment with illustrative cases. Lancet 2: 104– 107, 1896. 2 Block, G. E.; Lampe, I.; Vial, A. 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