The surgical range of breast cancer that shows pathologic complete response (pCR) without change in microcalcifications after neoadjuvant chemotherapy (NAC) is controversial. This study examined whole breast specimens to evaluate the necessity of mastectomy in those cases. The viability of cancer cells around the residual microcalcification was assessed using prospectively collected breast samples to confirm the presence or absence of cancer cells. A total of 144 patients with breast cancer and diffuse microcalcifications were classified into the reduced mass with no change in residual microcalcification (RESMIN, n = 49) and non-RESMIN (n = 95) groups. Five specimens were prospectively evaluated to assess the presence of viable cancer cells around the microcalcification. Tumor responses to NAC were significantly better with high pCR rates in the RESMIN group (p = 0.005 and p = 0.002). The incidence of human epidermal growth factor receptor 2-positive and triple-negative breast cancers was significantly high in the RESMIN group (p = 0.007). Although five (10.2%) patients had locoregional recurrence in the RESMIN group, no local recurrence in the breast was reported. Although pCR was highly estimated, residual cancers, including ductal carcinoma in situ, remained in 80% cases. Therefore, given the weak scientific evidence available currently, complete removal of residual microcalcifications should be considered for oncologic safety.
Purpose: Tamoxifen and aromatase inhibitor (AI) are used for hormone therapy for hormone-positive breast cancer, and AI is well known to decrease bone mineral density (BMD). The authors compared the serial BMD of patients with hormone-positive breast cancer to evaluate the preventive effect of AI combined with calcium and vitamin D (Ca/Vit D) supplements.Methods: A total of 249 women with hormone-positive breast cancer who underwent serial BMD assessments between 2011 and 2015 were included. The patients were classified as the tamoxifen alone group (n=23), AI with Ca/Vit D group (n=139), and extended regimen from tamoxifen to AI with Ca/Vit D group (n=87). Moreover, osteoporosis was diagnosed based on the World Health Organization guideline.Results: The incidence of osteoporosis was highest in the AI with Ca/Vit D group (n=50, 36.0%) and lowest in the tamoxifen only group (n=4, 17.4%). Furthermore, it showed statistical difference between the three groups (p=0.003). However, considering the baseline of initial BMD in each patient, the mean change value did not show any statistical difference between the three groups (p=0.498). Moreover, the lumbar T-scores were lower than that of the total hip T-scores in each patient.Conclusion: Although it has been reported that osteoporosis is common in patients treated with AI, the decreased BMD was not significantly severe compared to that in the tamoxifen alone group if Ca/Vit D was administrated with AI. Therefore, Ca/Vit D has some preventive effect for osteoporosis in patients treated with AI.
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