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Year of Publication
2.  Management of Paclitaxel-Induced Hand-Foot Syndrome 
Breast Care  2013;8(3):215-217.
Summary
Background
Hand-foot syndrome (HFS), also known as acral erythema or palmoplantar dysesthesia, is a manifestation of painful erythema and dysesthesia mostly occurring in the palms and soles. Although many chemotherapeutic agents have been shown to cause HFS, it remains an uncommon adverse cutaneous manifestation of paclitaxel.
Case Report
We report a case of paclitaxel-induced grade 3 HFS in a patient with breast cancer. HFS developed after 6 weeks of paclitaxel weekly infusions. The patient was managed by avoidance of sun exposure and extensive use of sunscreen and moisturizers. The skin lesions stabilized and improved gradually. This allowed us to continue the planned necessary course of 12 weeks of paclitaxel under close surveillance.
Conclusion
Paclitaxel-induced HFS can be managed with topical creams and avoidance of sun exposure without the need to discontinue chemotherapy. However, close monitoring for any increase or change in symptoms is warranted.
doi:10.1159/000352097
PMCID: PMC3728628  PMID: 24415973
Hand-foot syndrome; Paclitaxel; Breast cancer
3.  Does Pregnancy-Associated Breast Cancer Imply a Worse Prognosis? A Matched Case-Case Study 
Breast Care  2013;8(3):203-207.
Summary
Background
Significant controversy exists in the literature regarding the role of pregnancy in the prognosis of breast cancer. We designed a matched case-case study, matching pregnancy-associated breast cancer (PABC) cases with breast cancer cases for stage, age, and year of diagnosis.
Patients and Methods
39 consecutive cases of PABC were matched with 39 premenopausal cases of breast cancer. Univariate and multivariate survival analyses followed by adjustment for stage, grade, estrogen receptor status, and age at diagnosis, were performed.
Results
Regarding overall survival (OS), univariate analysis pointed to longer OS in non-PABC cases vs. PABC cases. Accordingly, a more advanced stage predicted shorter survival. In the multivariate analysis, the independent aggravating effect mediated by pregnancy persisted. Interestingly, a post hoc nested analysis within PABC cases indicated that the 3rd trimester pointed to shorter OS. The aforementioned results on OS were also replicated during the examination of relapse-free survival.
Conclusion
Implementing a matched case-case design, the present study points to pregnancy as a poor prognostic factor for breast cancer.
doi:10.1159/000352093
PMCID: PMC3728629  PMID: 24415971
Breast cancer; Pregnancy; Survival; Prognosis
4.  Association of HER2 Overexpression and Prognosis in Small (T1N0) Primary Breast Cancers 
Breast Care  2013;8(3):208-214.
Summary
Background
There is some controversy regarding the precise role and need for adjuvant therapy in patients with pT1a/pT1bN0 breast cancer, although studies have indicated that a HER2-positive status is one of the most powerful poor prognostic factors.
Patients and Methods
We retrospectively evaluated disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) among 960 patients diagnosed between 2000 and 2008 with T1N0 primary breast cancer treated at 3 German centers, and determined prognostic risk factors. Univariate analysis was used to determine associations with potential risk factors.
Results
With a median follow-up of 23 months, DFS was 94.8%, DDFS 96.3%, and OS 97.5%. Risk factors for decreased 1-year DFS were: peritumoral lymphatic invasion (L1) (p = 0.031), negative hormone receptor status (p = 0.003), non-use of hormonal therapy (p = 0.001), and a positive HER2 status (p = 0.003). Amongst the HER2-positive patients only 2.7% (n = 1/37) of those treated with trastuzumab had a DFS event compared with 20% (n = 10/50) without trastuzumab.
Conclusion
Patients with HER2-positive T1 breast cancer should be considered for inclusion in prospective trials of trastuzumab in combination with chemotherapy to determine the risk-to-benefit ratio and association with other prognostic factors.
doi:10.1159/000352094
PMCID: PMC3728630  PMID: 24415972
Trastuzumab; High-risk breast cancer; Adjuvant treatment; HER2/neu; Disease-free survival
5.  AGO Recommendations for Diagnosis and Treatment of Patients with Advanced and Metastatic Breast Cancer: Update 2013 
Breast Care  2013;8(3):181-185.
doi:10.1159/000353590
PMCID: PMC3728631  PMID: 24415967
Guidelines; Locoregional relapse; Metastatic breast cancer; Targeted therapy
6.  Guidelines: Usefulness and Limitations 
Breast Care  2013;8(3):172-173.
doi:10.1159/000353791
PMCID: PMC3728632  PMID: 24415965
7.  Impact of Body Mass Index on Prognostically Relevant Breast Cancer Tumor Characteristics 
Breast Care  2013;8(3):192-198.
Summary
Background
This study analyzes the association of body mass index (BMI) and prognostically relevant breast cancer (BC) characteristics in a country that has been rather spared of the global obesity epidemic.
Patients and Methods
Based on 20-year data (1999-2009, n = 1,414) of the prospective relational BC database of the University Hospital Basel, Switzerland, the associations between BMI, tumor size and stage, histological subtype, grading, hormonal receptor status, HER2 status and ‘triple-negative’ status were evaluated. Multivariate analysis considered BMI and patient's age.
Results
The association between increasing BMI and the above-mentioned variables were as follows (results described in each case: Beta-coefficient or odds ratio, 95% confidence interval, p value): tumor size, (1) entire cohort: 0.03 (0.01-0.05), p < 0.001, (2) tumor found by self-palpation: 0.05 (0.03-0.07), p < 0.001, (3) tumor found by radiological examination: 0.03 (0-0.07), p = 0.044; advanced TNM stage: 1.16 (1.02-1.31), p = 0.022; histological subtype: 1.04 (0.89-1.22), p = 0.602; unfavorable grading: 1.11 (1.00-1.25), p = 0.057; positive estrogen receptor status: 0.95 (0.83-1.09), p = 0.459; positive HER2 status: 0.92 (0.74-1.15), p = 0.467; presence of a ‘triple-negative’ carcinoma: 1.19 (0.93-1.52), p = 0.165. Consideration of only postmenopausal BC patients (n = 1,063) did attenuate the results, but did not change the direction of the associations with BMI.
Conclusion
BMI was positively associated with TNM stage, grading and tumor size for tumors that were found by self-detection, as well as for those lesions detected by radiological breast examinations.
doi:10.1159/000350002
PMCID: PMC3728633  PMID: 24415969
Breast cancer; Body mass index; Tumor size; Prognostic factors; Tumor detection
8.  13th St. Gallen International Breast Cancer Conference 2013: Primary Therapy of Early Breast Cancer Evidence, Controversies, Consensus – Opinion of a German Team of Experts (Zurich 2013) 
Breast Care  2013;8(3):221-229.
Summary
The International Consensus Conference on the treatment of primary breast cancer takes place every two years in St. Gallen, Switzerland. The panel in St. Gallen is composed of international experts from different countries. From a German perspective, it seems reasonable to interpret the voting results in the light of AGO-recommendations and S3-guidelines for everyday practice in Germany. Consequently, a team of eight breast cancer experts, of whom two are members of the international St. Gallen panel, commented on the voting results of the St. Gallen Consensus Conference (2013). The main topics at this year's St. Gallen conference were surgical issues of the breast and axilla, radio-therapeutic and systemic treatment options, and the clinical relevance of tumour biology. The clinical utility of multigene assays for supporting individual treatment decisions was also intensively discussed.
doi:10.1159/000351692
PMCID: PMC3728634  PMID: 24415975
St. Gallen Consensus; Early breast cancer; Adjuvant therapy; Multigene signatures; Targeted therapy
9.  Axillary Lymph Node Status in Early-Stage Breast Cancer Patients with Sentinel Node Micrometastases (0.2-2 mm) 
Breast Care  2013;8(3):187-191.
Summary
Background
Omission of axillary lymph node dissection (ALND) is increasingly becoming the new standard of care for patients with sentinel lymph node micrometastases (SNMMs). However, a formidable proportion of patients is afflicted with non-sentinel node (NSN) macrometastatic tumor burden.
Methods
Over 1 decade 5,000 patients underwent sentinel node biopsies (SNB) at 2 certified breast cancer centers in Austria. All available cases of SNMM during this time period were reviewed. Clinical, tumor and lymph node parameters were analyzed using univariate and multivariate analysis to retrieve predictors for further NSN involvement.
Results
We identified 216 patients with SNMMs, of whom 181 subsequently underwent ALND. Of the latter patients, 16% (n = 29/181) presented with NSN axillary metastases. ALND revealed NSN macrometastases in 10.5% (n = 19/181) of all the investigated patients, and 66% of the NSN-positive patients (n = 19/29). In 28% (n = 8/29) of the NSN-positive patients, more than 1 macrometastasis was detected. The number of removed sentinel nodes was found to be a significant predictor (p = 0.007) for NSN involvement.
Conclusion
In this retrospective investigation of breast cancer patients with SNMMs, a substantial proportion exhibited involvement of NSNs. Macrometastases accounted for the largest fraction of NSN tumor burden. Refraining from ALND in the face of SNMMs may entail substantial micro- and macrometastatic tumor burden in the remaining axillary lymph node basin.
doi:10.1159/000352090
PMCID: PMC3728635  PMID: 24415968
Breast cancer; Biopsy; Lymph node: dissection, metastases, status; Micrometastases; Sentinel lymph node; Risk factors
10.  Pneumomastia: A Rare Cause of Breast Swelling 
Breast Care  2013;8(3):218-219.
Summary
Background
Pneumomastia is air within the breast parenchyma. A number of causes have been reported for this condition. This case report describes a new cause and details of the management strategy applied, together with a review of the literature.
Case Report
We describe a case of acute breast swelling in a 40-year-old woman and its subsequent successful conservative management.
Conclusion
Bronchopleural fistula after thoracotomy is a risk, and can cause pneumomastia. This is more likely to occur after redo thoracic surgery. Pneumomastia after repeat thoracotomy can be managed conservatively, even in the presence of a bronchopleural fistula.
doi:10.1159/000352098
PMCID: PMC3728636  PMID: 24415974
Pneumomastia; Emphysema; Breast; Bronchopleural fistula; Thoracotomy
11.  How Long Will I Be Blue? Prolonged Skin Staining Following Sentinel Lymph Node Biopsy Using Intradermal Patent Blue Dye 
Breast Care  2013;8(3):199-202.
Summary
Background
Blue dye used for sentinel lymph node biopsy (SLNB) in breast cancer patients may cause prolonged skin discoloration at the site of injection. The aim of this study was to assess the duration of such skin discoloration.
Patients and Methods
236 consecutive patients who had undergone breast conserving surgery and SLNB for breast cancer were reviewed prospectively from January 2007 to December 2009.
Results
Of the 236 patients, 2 had undergone bilateral surgery, and 41 had been examined in consecutive yearly reviews. Blue discoloration remained visible at the injection site after 12, 24, and > 36 months in 36.5, 23.6, and 8.6% of the patients, respectively.
Conclusion
The use of patent blue for identification of the sentinel lymph node in patients undergoing breast cancer surgery may result in prolonged discoloration of the skin at the injection site.
doi:10.1159/000352092
PMCID: PMC3728719  PMID: 24415970
Axillary staging; Sentinel lymph node biopsy; Skin discoloration; Patent blue
12.  A Brief Overview of the WHO Classification of Breast Tumors, 4th Edition, Focusing on Issues and Updates from the 3rd Edition 
Breast Care  2013;8(2):149-154.
Summary
The WHO Classification of Tumors of the Breast, 4th edition, is an update to the 3rd edition that was published in 2003, and covers all neoplastic and preneoplastic lesions of the breast. Changes to the 4th edition include new aspects and changes to the terminology that reflect our present-day knowledge of these lesions. Definitions for histopathological diagnosis are complemented by a description of clinical features, epidemiology, macroscopy, genetics, and prognostic and predictive features. In this review of the WHO classification, we have focused on invasive carcinomas, precursor lesions, and some benign epithelial proliferations.
doi:10.1159/000350774
PMCID: PMC3683948  PMID: 24415964
Diagnostic criteria; Pathology; WHO classification; Breast Cancer
13.  Correction of Poland's Syndrome: Case Report and Review of the Current Literature 
Breast Care  2013;8(2):139-142.
Summary
Background
Poland's syndrome, a rare congenital anomaly, consists of unilateral absence of the pectoralis major muscle, ipsilateral brachysyndactyly, and occasionally associated other malformations of the anterior chest wall, mamilla, and mamma.
Case Report
In the case of a 32-year-old woman, marked hypoplasia of the right breast and the right nipple, malformation of the right upper limb with brachysyndactyly and microdactyly were noted, all present since birth. This paper describes the surgical technique and possible complications of reconstruction of the chest wall deformity with a solid silicone implant and a latissimus dorsi flap. The current literature on the topic is reviewed.
Conclusion
The surgical method with autologous material and implants is a sufficient technique for chest wall reconstruction and gives a good long-term result in case of Poland's syndrome.
doi:10.1159/000350778
PMCID: PMC3683949  PMID: 24419214
Poland's syndrome; Breast hypoplasia; Breast reconstruction; Malformation
14.  Patient's Anastrozole Compliance to Therapy (PACT) Program: Baseline Data and Patient Characteristics from a Population-Based, Randomized Study Evaluating Compliance to Aromatase Inhibitor Therapy in Postmenopausal Women with Hormone-Sensitive Early Breast Cancer 
Breast Care  2013;8(2):110-120.
Summary
Background
The Patient's Anastrozole Compliance to Therapy (PACT) program is a large randomized study designed to assess whether the provision of educational materials (EM) could improve compliance with aromatase inhibitor therapy in postmenopausal women with early, hormone receptor-positive breast cancer.
Patients and Methods
The PACT study presented a large, homogeneous dataset. The baseline analysis included patient demographics and initial treatments and patient perceptions about treatment and quality of life.
Results
Overall, 4,923 patients were enrolled at 109 German breast cancer centers/clinics in cooperation with 1,361 office-based gynecologists/oncologists. 4,844 women were randomized 1:1 to standard therapy (n = 2,402) or standard therapy plus EM (n = 2,442). Prior breast-conserving surgery and mastectomy had been received by 76% and 24% of the patients, respectively. Radiotherapy was scheduled for 85% of the patients, adjuvant chemotherapy for 38%. Reflecting the postmenopausal, hormone-sensitive nature of this population, only 285 patients (7%) had received neoadjuvant chemotherapy.
Conclusions
A comparison with epidemiological data from the West German Breast Center suggests that the patients in the PACT study are representative of a general postmenopausal early breast cancer population and that the findings may be applicable to ‘real-world’ Germany and beyond. Compliance data from PACT are eagerly anticipated.
doi:10.1159/000350777
PMCID: PMC3683950  PMID: 24419247
Breast cancer; Compliance; Aromatase inhibitors; Breast-conserving surgery; Mastectomy
15.  Effect of Endocrine Therapy on Quality of Life and Cognitive Functions in Patients with Breast Cancer 
Breast Care  2013;8(2):128-132.
Summary
Background
The use of endocrine therapy (ET) in postmenopausal breast cancer patients may affect their cognitive status. This study aims to assess the effects of tamoxifen and aromatase inhibitors (Als) on quality of life (QoL) and cognitive functions in breast cancer patients.
Patients and Methods
The study included 101 patients receiving tamoxifen, 97 patients receiving Als, and 95 patients without any ET. All patients completed both the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the Short Form-12 (SF-12) questionnaires.
Results
The patients’ characteristics were similar between the groups. The mean duration of ET was 2.6 years for tamoxifen and 2.5 years for Als. EORTC QLQ-C30 global scores and cognitive functioning scores as well as SF-12 mental scorings (mcs) were found not significantly different between patients without any ET and those receiving tamoxifen or Als (p = 0.529, p = 0.333, and p = 0.452, respectively). SF-12 mcs correlated moderately with EORTC QLQ-C30 global scores for the 3 treatment groups (all p values < 0.001).
Conclusion
Our study suggests that QoL and cognitive functions are similar in patients receiving Als or tamoxifen. Moreover, it appears that these parameters also do not differ in patients with respect to the use of ET.
doi:10.1159/000350780
PMCID: PMC3683951  PMID: 24419304
Aromatase inhibitors; Breast cancer; Cognitive function; Endocrine therapy; Quality of life; Tamoxifen
16.  Trastuzumab-Induced Hepatotoxicity: A Case Report 
Breast Care  2013;8(2):146-148.
Summary
Background
Trastuzumab is a humanized monoclonal antibody approved for the treatment of breast cancer with HER2 amplification and/or overexpression. There are only 2 prior cases of trastuzumab-related hepatotoxicity reported in the literature.
Case Report
We report the case of a 60-year-old woman who was treated with trastuzumab for stage I invasive ductal carcinoma of the right breast. She successfully completed 6 months of therapy when an increase in liver transaminases was noted on routine examination. A full work-up for causes of acute and chronic liver disease was negative. After review of the patient's medication list, trastuzumab was thought to be the most likely culprit for the liver injury, based on timing of administration and rise in liver enzymes.
doi:10.1159/000346844
PMCID: PMC3683953  PMID: 24419371
Breast cancer; Trastuzumab; Liver toxicity; Hepatotoxicity
17.  Role of Galactography in the Early Diagnosis of Breast Cancer 
Breast Care  2013;8(2):122-126.
Summary
Background
The purpose of this study was to evaluate the usefulness of galactography (GL) in the early diagnosis of breast cancer in patients with pathologic nipple discharge (PND).
Patients and Methods
We retrospectively studied all galactograms obtained in 117 women with PND, who subsequently had a biopsy. The findings detected in the galactograms of the patients in this study were assigned to different categories of the Galactogram Image Classification System (GICS): GICS 2, benign; GICS 3, probably benign; GICS 4, suspicious for malignancy; and GICS 5, highly suspicious for malignancy.
Results
The galactograms were classified into GICS 2 (29 cases; 24.7%), GICS 3 (42 cases; 35.8%), GICS 4 (30 cases; 25.6%), and GICS 5 (16 cases; 13.6%). A good correlation was observed between histological diagnosis and GICS categories (p < 0.05). All cases diagnosed with carcinoma (n = 18) were classified in GICS categories 4–5: ductal carcinoma in situ in 14 cases (11.9%) and invasive carcinoma in 4 cases (3.4%).
Conclusion
GL is a useful procedure in the early diagnosis of breast cancer in patients with PND.
doi:10.1159/000350779
PMCID: PMC3683945  PMID: 24419050
Galactography; Galactogram Imaging Classification System; GICS; Pathologic nipple discharge; Histopathologic diagnosis
18.  Locoregional Recurrence and Survival Rates after Breast-Conserving Surgery and Hormonal Therapy in 70-Year-Old or Older Patients with Stage I or IIA Breast Carcinoma 
Breast Care  2013;8(2):134-137.
Summary
Background
Data for treatment of elderly women (≥ 70 years) with estrogen receptor-positive early stage breast cancer are available. We have compared different treatment options to determine whether lumpectomy (LU) plus adjuvant hormonal therapy (HT) is as effective as combined LU, HT, and radiotherapy (RT).
Method
Medical records of elderly patients over 69 years of age who had been treated for T1N0M0 (stage I) and T2N0M0 (stage IIA) at 2 different medical centers between March 2004 and January 2011 were assessed, and 35 patients were included in this study. 21 of these patients underwent only breast-conserving surgery (BCS) and HT (Group 1: T1N0M0-Group 1a, n = 16; T2N0M0-Group 1b, n = 5) and the others either BCS, HT and RT (Group 2, n = 4) or BCS, chemotherapy (CT), HT and RT (Group 3, n = 10). Adjuvant HT for all the patients comprised aromatase inhibitors.
Results
The mean follow-up period for Groups 1, 2 and 3 were 32.2, 31.3 and 20.4 months, respectively. No locoregional recurrence or cancer-specific mortality occurred in any of these patients; 1 patient from Group 1 died of a different cause.
Discussion
The BCS+HT regimen seems to be an efficient treatment option for early stage breast cancer in selected 70-year-old and older patient groups.
doi:10.1159/000350776
PMCID: PMC3683946  PMID: 24419104
Elderly; Early stage breast cancer; Treatment
19.  Extensive Multifocal Mammary Infarction – a Case Report 
Breast Care  2013;8(2):143-145.
Summary
Background
Breast infarction can occur in benign breast lesions, such as fibroadenomas, as well as healthy breast tissue, typically in the gravid or lactating patient. Few theories, however, exist to explain this unusual lesion.
Case Report
We present a very rare case of a 27-year-old female patient with extensive, multifocal, bilateral mammary infarction. A literature search was also performed to confirm its rarity. Although solitary or limited areas of spontaneous infarction have been documented, there are no documented cases where such a large, multifocal area of involvement has occurred without obvious explanation.
Conclusion
Extensive multifocal post-partum breast infarction is a rare occurrence that has potential long-term effects. This should be considered when taking patient history in post-partum patients, as well as those with extensive calcifications on mammogram years after giving birth.
doi:10.1159/000350782
PMCID: PMC3683947  PMID: 24419154
Differential diagnosis; Pregnancy; Radioimaging; Review; Screening; Ultrasound; Mammary infarction
21.  HER2 Dimerization Inhibitor Pertuzumab – Mode of Action and Clinical Data in Breast Cancer 
Breast Care  2013;8(1):49-55.
Summary
The humanized monoclonal antibody pertuzumab prevents the dimerization of HER2 with other HER receptors, in particular the pairing of the most potent signaling heterodimer HER2/HER3, thus providing a potent strategy for dual HER2 inhibition. It binds to the extracellular domain of HER2 at a different epitope than trastuzumab. Pertuzumab and trastuzumab act in a complementary fashion and provide a more complete blockade of HER2-mediated signal transduction than either agent alone. Phase II studies demonstrated that pertuzumab was generally well tolerated as a single agent or in combination with trastuzumab and/or cytotoxic agents, and implied an improved clinical efficacy of the combination of pertuzumab and trastuzumab in early and advanced HER2-positive breast cancer. Results of the pivotal phase III study CLEOPATRA in patients with HER2-positive metastatic breast cancer demonstrated that the addition of pertuzumab to first-line combination therapy with docetaxel and trastuzumab significantly prolonged progression-free and overall survival without increasing cardiac toxicity. Currently, the combination of both antibodies is being explored in the palliative setting as well as in the treatment of early HER2-positive breast cancer. Dual HER2 inhibition with the HER2 dimerization inhibitor pertuzumab and trastuzumab may change clinical practice in HER2-positive first-line metastatic breast cancer treatment.
doi:10.1159/000346837
PMCID: PMC3971793  PMID: 24715843
HER2-positive; Dual inhibition; Breast cancer, metastatic; Pertuzumab; Trastuzumab
22.  Relevance of Health Economics in Breast Cancer Treatment: Integration of Economics in the Management of Breast Cancer at the Clinic Level 
Breast Care  2013;8(1):7-14.
Summary
Since the introduction of the diagnosis-related groups (DRG) system with cost-related and entity-specific flat-rate reimbursements for all in-patients in 2004 in Germany, economics have become an important focus in medical care, including breast centers. Since then, physicians and hospitals have had to gradually take on more and more financial responsibilities for their medical care to avoid losses for their institutions. Due to financial limitations of resources, most medical services have to be adjusted to correlating revenues, which results in the development of a variety of active measures to understand, steer, and optimize costs, resources and related processes for breast cancer treatment. In this review, the challenging task to implement microeconomic management at the clinic level for breast cancer treatment is analyzed from breast cancer-specific publications. The newly developed economic management perspective is identified for different stakeholders in the healthcare system, and successful microeconomic projects and future aspects are described.
doi:10.1159/000348370
PMCID: PMC3971800  PMID: 24715837
Breast cancer; Costs of treatment; Limited resources; Microeconomic solutions; Health economics
23.  Relevance of Health Economics in the Medical Treatment of Breast Cancer: The View of the Professional Association of Practicing Gynecologic Oncologists e.V. (BNGO) 
Breast Care  2013;8(1):29-33.
Summary
In this article, the position of the Professional Association of Practicing Gynecologic Oncologists e.V. (BNGO) on the health economics of medical breast cancer therapy is presented. The BNGO unites professionals and employees whose principal activity lies in highly specialized gynecologic oncology. In Germany, 139 specialists are united in 128 professional practices. According to § 12 of the Social Code, the oncological services provided by members must be ‘sufficient, effective and economical; they must not exceed what is necessary’. People who are covered by statutory health insurance in Germany are entitled to sufficient benefits. Sufficient measures are measures that benefit the patient with breast cancer and have a positive effect on the course of the disease. In § 35b of the Social Code, the benefit of the patient is defined as ‘improvement in health, shortening of the duration of illness, lengthening of lifespan, reduction of side effects and an improvement in the quality of life’. In the adjuvant situation, the ideal goal is healing; in the palliative situation, the most basic marker is overall survival, while surrogate markers are the progression-free interval, improved quality of life, or diminished symptoms. At the same time, the law on economic assessment stipulates ‘appropriateness and reasonableness of reimbursement by the insured community’.
doi:10.1159/000346856
PMCID: PMC3971801  PMID: 24715840
Adjuvant therapy; Aromatase inhibitors; Chemotherapy; Systemic therapy; Therapy Costs
24.  A Patient with Recurrent Breast Cancer Showing Long-Term Survival after Developing Pericardial Effusion and Cardiac Tamponade Caused by Carcinomatous Pericarditis 
Breast Care  2013;8(1):71-73.
Summary
Background
Malignant pericardial effusion caused by carcinomatous pericarditis is a complication of advanced malignancy. Breast cancer is the second most important cause of malignant pericardial effusion. Malignant pericardial effusion is the end stage of breast cancer, and the prognosis is very poor. Pericardial effusion may cause cardiac tamponade and sudden death if it is not controlled properly. There is a debate on which is the best method to control pericardial effusion.
Case Report
We describe the clinical course of a 55-year-old woman with recurrent breast cancer, pericardial effusion, and cardiac tamponade caused by carcinomatous pericarditis. Thoracoscopic pericardial window was performed to control the pericardial effusion. The patient survived for about 5 years after being diagnosed with pericardial metastases.
Conclusion
The observed long-term survival in such a patient with the development of pericardial effusions and cardiac tamponade caused by carcinomatous pericarditis attributable to breast cancer is rare. Thoracoscopic pericardial window was effective in controlling the pericardial effusion.
doi:10.1159/000346831
PMCID: PMC3971803  PMID: 24715847
Breast cancer; Carcinomatous pericarditis; Pericardial effusion; Cardiac tamponade; Thoracoscopic pericardial window
25.  Health Economics in Breast Cancer 
Breast Care  2013;8(1):5-6.
doi:10.1159/000346882
PMCID: PMC3971805  PMID: 24715836

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