Overview of the Main Outcomes in Breast Cancer Prevention Trials

Abstract

This study was conducted to investigate the risk factors associated with peripartum hysterectomy in women who had either vaginal or cesarean delivery. The study subjects were women (n ϭ 101) who had a peripartum hysterectomy at the authors' institution from January 1986 to April 2001. Seventy-two of the 101 patients had delivered at Yonsei University Medical Center and 29 were referred from other hospitals. Of the total 31,044 deliveries at Yonsei during this time period, 11,924 were performed by cesarean section. Fifty-four of these women (0.45%) and 28 of the 19,080 who had a vaginal delivery (0.09%) underwent peripartum hysterectomy. Five of the 29 referred patients had a cesarean section and 24 had a vaginal delivery. The average time from delivery to hysterectomy was significantly longer in the vaginal group than in the cesarean section group (169 min vs. 49 min; P Ͻ.05). Also, women who had a vaginal delivery required significantly more blood (1908 ml) than those who had a cesarean section (1536 ml)(P Ͻ.05), although the average length of hospital stay was similar for both groups. Uterine atony was the most common indication for peripartum hysterectomy (42 of 101; 41.6%). Placenta previa accreta, placenta accreta, and placenta previa was the diagnosis in 23.8%, 16.7% and 11.9% of patients, respectively. Among the 29 women who had a previous cesarean section, the indications were uterine atony (n ϭ 10; 34.5%), placenta previa accreta (n ϭ 13; 44.8%), placenta previa (n ϭ 4; 13.8%), and placenta accreta (n ϭ 2; 6.9%). Blood loss was more highly associated with placenta previa accreta than with placenta previa or accreta alone (1734 ml vs. 16,58 ml and 1084 ml, respectively; P Ͻ.05). The only complications recorded were bladder injury in one woman with placenta previa, one disseminated intravascular coagulopathy in the placenta accreta group, and one case of sepsis among patients with placenta previa accreta. Of the 59 peripartum hysterectomies associated with cesarean section, 26 were in women undergoing elective cesarean section (44.1%) and 33 were after emergency cesarean section (55.9%). Blood loss was similar in both groups. The women who had emergency surgery experienced a higher complication rate than those undergoing elective cesarean section. Two patients sustained bladder injury, one had ureteral injury, one had bowel injury, one developed acute hepatitis, and one had disseminated intravascular coagulopathy. In the elective surgery group, there was a bladder laceration in one patient and another patient had disseminated intravascular coagulopathy. GYNECOLOGYVolume 58, Number 7 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT This paper presents the results of an investigation of the force required to insert a laparoscopic trocar into the abdominal cavity. Both disposable and reusable laparoscopic trocar systems were studied. Study subjects were 20 consecutive women who were scheduled to undergo routine diagnostic and laparoscopic surgery and were randomly selected for either the disposable trocar device...

Effects of oestrogens and anti-oestrogens on normal breast tissue from women bearing BRCA1 and BRCA2 mutations

“…A number of trials have now shown that endocrine agents such as tamoxifen (TAM) or raloxifene can prevent breast cancer in women at increased risk of the disease (Cuzick et al, 2003). The question arises as to whether agents such as these can be used for prevention specifically in women bearing BRCA1 or BRCA2 mutations.…”

Impact of screening for breast cancer in high-risk women on health-related quality of life

“…About 5 -10% of all breast cancer cases occur in women with a strong family history, and in the Netherlands approximately 25% of these cases may be attributed to the BRCA1 and BRCA2 breast cancer susceptibility gene mutations . Several strategies to reduce the risk of breast cancer or breast cancer death may be discussed with BRCA 1/2 mutation carriers and women with a strong family history, such as intensive surveillance, chemoprevention (Cuzick et al, 2003) and prophylactic mastectomy . Guidelines for surveillance of these women mostly consist of biannual clinical breast examination (CBE), annual mammography and recommendation for monthly breast self-examination (BSE) (Vasen et al, 1998).…”

Tamoxifen: Catalyst for the change to targeted therapy

“…Indeed, the fact that tamoxifen is cheap and accessible to under-funded healthcare systems worldwide means that this form of targeted therapy continues to save lives. However, unlike the targeted therapies of today that usually have a single anticancer application, tamoxifen became the gold standard for the targeted therapy of all stages of breast cancer (including male breast cancer), the treatment of ductal carcinoma in situ (69), a pioneering agent for the chemoprevention of breast cancer in high risk women (45,70,71) and the lead compound for the new drug group, the SERMs (72-76).…”

“…Indeed, the fact that tamoxifen is cheap and accessible to under-funded healthcare systems worldwide means that this form of targeted therapy continues to save lives. However, unlike the targeted therapies of today that usually have a single anticancer application, tamoxifen became the gold standard for the targeted therapy of all stages of breast cancer (including male breast cancer), the treatment of ductal carcinoma in situ (69), a pioneering agent for the chemoprevention of breast cancer in high risk women (45,70,71) and the lead compound for the new drug group, the SERMs (72-76).The extensive laboratory studies of tamoxifen and the related nonsteroidal antioestrogen LY156,758 (keoxifene) undertaken as a prelude to initiating major trials in breast cancer prevention, described the pharmacology of SERMs that switch on and switch off target sites throughout the body. As an example of the immediate translation of the discovery of SERM action, tamoxifen was noted to block breast cancer growth but enhances the growth of endometrial cancer growth under laboratory conditions (77).…”