Gordon F. Schwartz

Differences in breast carcinoma characteristics in newly diagnosed African-American and Caucasian patients: a single-institution compilation compared with the National Cancer Institute's Surveillance, Epidemiology, and End Results database.

Breast carcinomas in African–American patients appear to be more aggressive than in Caucasian patients due to multifactorial differences.

Induction chemotherapy followed by breast conservation for locally advanced carcinoma of the breast

Background. Few women with locally advanced breast cancer remain disease‐free, even for 2 years. Response to induction chemotherapy may be associated with longer disease‐free and overall survival rates. The role of breast conservation in selected patients with response to induction chemotherapy was evaluated.

Consensus Conference on the Classification of Ductal Carcinoma of the Breast, April 22–25, 1999

Ductal carcinoma in situ (DCIS/intraductal carcinoma/noninvasive ductal carcinoma) is a proliferation of malignant cells confined within the basement membrane of the ducts of the breast. Until the late 1970s, DCIS was detected infrequently, usually presenting as a mass or as nipple discharge. As screening mammography became almost universally accepted, the mammographic finding of calcifications leading to the diagnosis of DCIS has become commonplace. When initially described two generations ago, DCIS was considered an initial step in an inexorable progression to invasive breast carcinoma. Within the past generation, it has been documented that only a minority of patients develop invasive breast carcinoma after the excision of DCIS, so treatment options have expanded. Mastectomy had been the initial treatment for the majority of patients with DCIS, but as this additional information has become available, many physicians currently treat women with DCIS by local excision and radiation therapy or local excision alone as an alternative to mastectomy.

Subclinical ductal carcinoma in situ of the breast: Treatment by local excision and surveillance alone

Background. Mammography has led to earlier detection of subclinical ductal carcinoma in situ (DCIS) of the breast either as nonpalpable calcifications or as an incidental finding in a biopsy performed for another reason. Many women in whom DCIS was detected early may not be destined to have an invasive carcinoma. How should subclinical DCIS be treated if that is the case? What is the role of excision and surveillance only as an alternative to mastectomy or irradiation?.

Ten-year results in 1070 patients with stages I and II breast cancer treated by conservative surgery and radiation therapy

Background. One thousand seventy patients treated conservatively for Stages I and II breast cancer between the years 1982 and 1994 were reviewed. The median follow‐up was 40 months with a maximum follow‐up of 152 months.

Multicentricity of non-palpable breast cancer

One hundred eighty‐nine biopsies have been performed for clinically occult mammary lesions, detectable by mammography but not clinically apparent. Fifty‐two cancers were demonstrated within this group, including 26 invasive ductal cancers, seven micro‐invasive ductal cancers, 14 non‐invasive ductal cancers, and five lobular carcinomas in situ. All mastectomy specimens were examined for multicentric foci of breast cancer in quadrants other than that in which the primary lesion was located. Of the invasive ductal cancers, 40% were multicentric. Of the micro‐invasive ductal cancers, 57.1% were multi‐centric. Of the non‐invasive ductal cancers, 45.5% were multicentric. The one mastectomy specimen from a patient with lobular carcinoma in situ did not have evidence of residual disease. The overall incidence of multicentricity in the 43 specimens examined was 44.2%. These findings suggested that any therapeutic procedure for either invasive or non‐invasive ductal carcinoma that does not include total mastectomy may leave behind foci of cancer, which are a threat to the patient.

The number of positive margins influences the outcome of women treated with breast preservation for early stage breast carcinoma

There are conflicting reports regarding whether focally positive surgical margins influence tumor control in breast‐conservation therapy. The authors have evaluated the relation between positive surgical margins on tumor control and whether the number of positive margins affects tumor control in patients undergoing reexcision lumpectomy.

Proceedings of the consensus conference on neoadjuvant chemotherapy in carcinoma of the breast, April 26-28, 2003, Philadelphia, Pennsylvania.

The following were participants in the Consensus Conference on Neoadjuvant Chemotherapy in Carcinoma of the Breast: Co-Chairmen: Dr. Gordon F. Schwartz (Jefferson Medical College, Philadelphia, PA) and Dr. Gabriel N. Hortobagyi (M. D. Anderson Cancer Center, Houston, TX). Surgeons: Dr. Blake Cady (Brown University School of Medicine, Providence, RI), Dr. Krishna B. Clough (Institute Curie, Paris, France), Dr. Domenico M. D’Ugo (Universita Cattolica del Sacro Cuore, Rome, Italy), Dr. Laura J. Esserman (University of California San Francisco, San Francisco, CA), Professor Ian S. Fentiman (Guy’s Hospital, London, UK), Dr. Oreste Gentilini (European Institute of Oncology, Milan, Italy), Dr. Armando E. Giuliano (John Wayne Cancer Institute, Santa Monica, CA), Dr. Terry P. Mamounas (Aultman Center Center, Canton, OH), Dr. Peter I. Pressman (Weill Medical College of Cornell University, New York, NY), Dr. Emiel J. Th. Rutgers (Netherlands Cancer Institute, Amsterdam, The Netherlands), Dr. Gordon F. Schwartz (Jefferson Medical College, Philadelphia, PA), Dr. Daniela Terribile (Universita Cattolica del Sacro Cuore, Rome, Italy), Dr. Theodore N. Tsangaris (The Johns Hopkins Hospital, Baltimore MD), Dr. Michael Untch (University of Munich Klinikum Grosshadern, Munich, Germany), and Professor Cornelis J. H. van de Velde (Leiden University Medical Center, Leiden, The Netherlands). Medical Oncologists: Dr. Aman U. Buzdar (M. D. Anderson Cancer Center, Houston, TX), Dr. Daniel F. Hayes (University of Michigan Medical School, Ann Arbor, MI), Dr. Gabriel N. Hortobagyi (M. D. Anderson Cancer Center, Houston, TX), Dr. Clifford Hudis (Memorial SloanKettering Cancer Center, New York, NY), Dr. Olivier Rixe (Salpetriere Hospital, Paris, France), Professor Ian Edward Smith (The Royal Marsden NHS Trust, London, UK), and Dr. Sandra M. Swain (Cancer Therapeutics Branch, National Cancer Institute, Bethesda, MD). Radiation Oncologists: Dr. Thomas A. Buchholz (M. D. Anderson Cancer Center, Houston, TX), Dr. Lydia T. Komarnicky (Drexel University College of Medicine, Philadelphia, PA), Dr. Robert R. Kuske, Jr. (Arizona Oncology Services, Scottsdale, AZ), Dr. Beryl McCormick (Memorial SloanKettering Cancer Center, New York, NY), and Dr. Lawrence J. Solin (University of Pennsylvania School of Medicine, Philadelphia, PA). Pathologists: Dr. Fred Gorstein (Jefferson Medical College, Philadelphia, PA), Dr. Roland Holland (University Hospital Nijmegen, Nijmegen, The Netherlands), Dr. Shahla Masood (University of Florida Health Science Center, Jacksonville, FL), Dr. David L. Page (Vanderbilt University Medical Center, Nashville, TN), and Dr. Juan P. Palazzo (Jefferson Medical College, Philadelphia, PA). Breast Imagers (Radiologists): Dr. R. James Brenner (John Wayne Cancer Institute, Santa Monica, CA), Dr. Stephen A. Feig (Mt. Sinai Medical Center, New York, NY), and Dr. Daniel B. Kopans (Massachusetts General Hospital, Boston, MA).

Stromal caveolin-1 levels predict early DCIS progression to invasive breast cancer

Here, we determined the possible association of stromal caveolin-1 (Cav-1) levels with DCIS recurrence and/or progression to invasive breast cancer. An initial cohort of 78 DCIS patients with follow-up data was examined. As ER-positivity was associated with recurrence, we focused our analysis on this subset of 56 patients. In this group, we observed that DCIS progressed to invasive breast cancer in ~14% of the patient population (8/56), in accordance with an expected progression rate of 12-15%. Nearly ninety percent of DCIS patients (7/8) that underwent recurrence to invasive breast cancer had reduced or absent levels of stromal Cav-1. Remarkably, an absence of stromal Cav-1 (score = 0) was specifically associated with early disease progression to invasive breast cancer, with reduced time to recurrence and higher recurrence rate. All DCIS patients with an absence of stromal Cav-1 underwent some form of recurrence (5/5) and the majority (4/5) underwent progression to invasive breast cancer. This represents an overall cumulative incidence rate of 100% for recurrence and 80% for progression. An absence of stromal Cav-1 in DCIS lesions was also specifically associated with the presence of inflammatory cells. Conversely, ninety-seven percent of ER(+) DCIS patients (35/36) with high levels of stromal Cav-1 (score = 2) did not show any invasive recurrence over the duration of follow-up (4-208 months), and 89% of such patients are estimated to remain free of invasive recurrence, even after 15 years. Thus, determination of stromal Cav-1 levels may be a useful new biomarker for guiding the treatment of ER(+) DCIS patients.

Accuracy of Axillary Sentinel Lymph Node Biopsy Following Neoadjuvant (Induction) Chemotherapy for Carcinoma of the Breast

Abstract: Sentinel lymph node biopsy (SLNB) is widely employed to detect axillary lymph node metastases in breast cancer patients with clinically negative (N0) axillae. One of the few reported contraindications to SLNB is prior treatment with systemic chemotherapy (neoadjuvant/induction chemotherapy). Previous investigators reported difficulty identifying the sentinel node and an unacceptable false‐negative rate in this patient cohort. We present one experienced surgeons experience with SLNB following induction chemotherapy (n = 21). Following treatment with Adriamycin and Cytoxan (AC)‐based cyclic chemotherapy, patients underwent SLNB, followed by levels I and II axillary lymph node dissection (ALND). At least one sentinel node was identified in all patients (100%). With respect to metastatic disease, the status of the sentinel node(s) accurately reflected the status of the axilla in 20 of 21 patients (95%). Eleven patients (52%) had axillary metastases identified by ALND. Of this group, SLNB failed to identify metastatic disease in one patient (9%). Previous treatment with induction chemotherapy should not be considered an absolute contraindication to SLNB. An experienced surgeon may utilize the technique in these patients, sparing them the added morbidity of axillary dissection.