Breast Cancer and Breast Diseases

Benign disease, abnormal mammogram, breast mass, breast lump

Argy O,HughesKS,RocheCA: Management of the Patient With a BreastMass.  In: Manual of Breast Diseases, Lippincott. 2001

Buyske J,HughesKS, Tronic BS:  Adenoma of the nipple.  Surgical Rounds 1995;18(8): 323-24.

Katz M, Schapira L, Harisinghani M,HughesKS: Palpable right breast mass in a pregnant woman. Nature Clinical Practice Oncology 2005 Apr;2(4):218-221; quiz 1 p following 222.

Shi AA, Georgian-Smith D, Cornell LD, Rafferty EA, Staffa M,HughesKS, Kopans DB: Radiological reasoning: male breast mass with calcifications.  American Journal of Research 2005;185: S205-213.

Non-invasive Breast Cancer (DCIS, Ductal Carcinoma in situ) 

Hughes KS, Lee AKC, McLellan R, Mackarem G, Camus M, Joshi M, Walsh JM, Heatley GJ, Rossi RL, Munson JL, Braasch JW, Tsao J, Sanders LE, Barbarisi LJ, Lo TCM, Girshovich L, Healey GA, Buyske J:  Breast-conserving therapy for patients with ductal carcinoma in situ.  Breast Diseases1996;9:255-268 

Pandya S, Mackarem G, Lee AKC, McLellan R, Heatley GJ, Hughes KS:  Ductal carcinoma-in-situ:  the impact of screening on clinical presentation and pathologic features.  The Breast Journal  1998;4(3): 146-151

Hughes KS, Lee AK, Rolfs A:  Controversies in the treatment of ductal carcinoma in situ.  Surgical Clinics of North America 1996;76(2): 243 – 265. 

Murphy C, Jones J, Javid S, Michaelson M, Noaln M, Lipsitz S, Specht M, Lesnikoski B, Hughes KS, Gadd M, Smith S: Do Sentinel Node Micrometastases Predict Local Recurrence Risk in Ductal Carcinoma in Situ (DCIS) and Ductal Carcinoma in Situ with Microinvasion (DCISM)? American Journal of Surgery.  2008 (Epub ahead of print)

Early Breast Cancer

Lee KC, Loda M, Bosari S, Mackarem G, DeLellis RA, Heatley GJ, Hughes KS:  Node-negative invasive breast carcinoma 1cm or less in size (T1a,bNoMo) –Clinicopathologic features and outcome.  Cancer 1996;79 (4): 761-771.

Michaelson JS, Silverstein M, Wyatt J, Weber G, Moore R, Kopans DB, Hughes KS: Predicting the survival of patients with breast carcinoma using tumor size. Cancer 2002;95:713-23.

Male Breast Cancer

Camus M, Joshi M, Mackarem G, Lee A, Rossi R, Munson JL, Buyske J, Barbarisi L, Sanders L, Hughes KS:  Ductal carcinoma in situ of the male breast.  Cancer 1994;74:1289-1293.

Joshi MG, Lee AKC, Loda M, Camus MG, Pedersen C, Heatley GJ, Hughes KS:  Male breast carcinoma:  An evaluation of prognostic factors contributing to a poorer outcome.  Cancer 1996;77:490-98.

Breast conservation

Schwartz GF, Veronesi U, Clough KB, Dixon JM, Fentiman IS, Heywang-Kobrunner SH, Holland R, Hughes KS, Mansel RE, Margolese R, Mendelson EB, Olivotto IA, Palazzo JP, Solin LJ: Consensus Conference Committee.  Proceedings of the consensus conference on breast conservation, Milan, Italy, April 28-May 1, 2005: Simultaneously published in:  Int Journal Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1281-8. J Am Coll Surg. 2006 Aug;203(2):198-207.  Breast J. 2006 Jul-Aug;12(4):398-407.  Cancer. 2006 Jul 15;107(2):242-50.

K.R. Kozak, B. L. Smith, J. Adams, E. Kornmehl, A. Katz, M. Gadd, M. Specht, Hughes KS,V Gioioso, H-M Lu, K. Braaten, A. Recht, S. N. Powell, T. F. DeLaney and A. G. Taghian. Accelerated Partial Breast Irradiation Using Proton Beams: Initial Clinical Experience Int J Radiat Oncol Biol Phys, 2006 Nov 1;66 (3):691-86.

Schwartz GF, Veronesi U, Clough KB, Dixon JM, Fentiman IS, Heywang-Kobrunner SH, Holland R, Hughes KS, Mansel RE, Margolese R, Mendelson EB Olivotto IA, Palazzo JP, Solin LJ; Consensus Conference Committee: Proceedings of the consensus conference on breast conservation. Simultaneous Publications:  International Journal of Radiation Oncology Biol Phys. 1;65(5):1281-8.  J American College of Surgery. 203(2):198-207. Breast J. 12(4):398-407.  Cancer 2006:107(2):242-50.

Kirstein LJ, Taghian A, Hughes KS.  Management and Outcomes of Ipsilateral Recurrence Following Breast Conservation.  Seminars in Breast Disease 2007 (Vol 10:4) p. 169-177.

Schnaper LA, Hughes KS:  The use of radiation in the elderly. Breast Cancer Online 2007;10(1): 1-3.

Surgical Technique

Dominguez FJ, KawaguchiAL, O’Malley C, Hughes KS:  Elastic stay hooks and bookwalter retractor technique for raising mastectomy skin flaps. Surgery 2007;141(2):272-4.

Hughes, KS. Smith, BL, Wheeler, A. The Cancer and Leukemia Group B Trials. In: Breast Surgical Oncology.New York,New   York: McGraw Hill; 2010. [in press]

Prophylactic mastectomy

Black D, Specht M, Lee JM, Dominguez F, Gadd M, Hughes KS, Rafferty E, Smith B:  Detecting Occult Malignancy in Prophylactic Mastectomy: Preoperative MRI Versus Sentinel Lymph Node Biopsy.  Annual Surgical Oncology 2007;14(9):2477-84.  Epub 2007 Jun 22.

Hughes KS, Papa MZ, Whitney T, McLellan R: Prophylactic Surgery and Inherited Cancer Predisposition. In: Shaw G, Ed. Cancer Genetics for the Clinician, Plenum Publishers. 1999. p103-134.

Mackarem G, RocheCA, Silverman ML, Hughes KS: The Development of New, Primary, Noninvasive Carcinoma of the Breast 29 Years After Bilateral Radical Mastectomy. The Breast Journal 1998;4(1): 51-54

Management of lymph nodes, axillary dissection, sentinel node biopsy

Mackarem G, Barbarisi L,HughesKS:  The role of axillary dissection in early stage breast cancer.  Cancer Investigations 1992;10(5):461-470.

HughesKS:  Technique for axillary dissection:  Use of the Bookwalter retractor.  Contemporary Surgery 1993; 42(3):189-193

Dominguez F, Golshan M, Black D, Hughes KS, Gadd M, Christian R, Lesnikoski B, Specht M, Michaelson J, Smith B.  Sentinel node biopsy is important in mastectomy for ductal carcinoma in situ.  Ann Surg Oncol. 2008 Jan;15(1):268-73. Epub 2007 Sep 22.

Breast Cancer Older Women

Dr Hughes in internationally recognized as an expert in breast cancer in older women, having run one of the largest breast cancer trials in this population.  This trial identified that women age 70 and over  with small estrogen receptor positive breast cancer received little benefit from radiation therapy.

This slide set was presented by Dr Hughes at the Miami Breast Conference, 2012:

Slideset-BreastCancer in Older Women

 

His published work on this topic is listed here.  Those citations that are underlined can be ‘Clicked’ to show the entire article.

Breast Cancer In Older Women

Hughes KS, Schnaper L, Berry D, Cirrincione C, McCormick B, Smith T, Shank B, Smith BL, Shapiro C, Muss H, Winer E, Wood W, Sugarbaker D, Henderson C, Norton L: A randomized comparison of lumpectomy plus Tamoxifen with or without irradiation in women 70 years of age or older with early stage breast cancer. New England Journal of Medicine 2004;351: 971-977.

Hughes KS. Why Do We Believe That Breast Cancer in the Elderly is the Same as Breast Cancer in Young Women? Drugs Aging. 2008;25(1):47-8.

Inouye P, Schnaper, LA, Buyske J, Shank BM, Shapiro CL, Berry DA, Wilder KLM, Hughes KS: Carcinoma of the Breast in the Geriatric Population. Surgical Rounds 1997;4 (3): 146-20.

Schnaper LA, Hughes KS: Special Considerations When Treating Breast Cancer in the Elderly.  Breast Disease – An International Journal 2001;12: 83-93.

Schnaper LA, M.D.Hughes KS, M.D., for the Cancer and Leukemia Group B, Radiation Therapy, Oncology Group, and Eastern Cooperative Oncology Group: Can Radiation be Omitted Following Breast Conserving Surgery in Women Over 70 With Early Stage Breast Cancer? The American Journal of Oncology Review. In Press.  2004

Howard-McNatt M, Hughes KS, Schnaper LA, Jones JL, Gadd MA, Smith BL: Breast Cancer Treatment in Older Women. Surgical Clin NA, 2005;14(1): 85-102, vi. Review.

Hughes KS. Why Do We Believe That Breast Cancer in the Elderly is the Same as Breast Cancer in Young Women? Drugs and Aging 2008;25:47-48.

Carlson RW, Moench S, Hurria A, Balducci L, Burstein HJ, Goldstein LJ, Gradishar WJ, Hughes KS, Jahanzeb M, Lichtman SM, Marks LB, McClure JS, McCormick B, Nabell LM, Pierce LJ, Smith ML, Topham NS, Traina TA, Ward JH, Winer EP.  NCCN Task Force Report: breast cancer in the older woman.  The Journal of the National Comprehensive Cancer Network. 2008;6 Suppl 4:S1-S25.  Quiz S26-S27.

Kimmick G, Hughes KS, Muss H: Breast Cancer in Older Women.  In: Harris J, Lippman M, Morrow M, Osborne C (eds.) Diseases of the Breast, Lippincott Williams and Wilkins. 2004 and 2009

9343Page

Lumpectomy Plus Tamoxifen With or Without Irradiation in Women Age 70 Years or Older With Early Breast Cancer:  Long-Term Follow-Up of CALGB 9343

Kevin S. Hughes, Lauren A. Schnaper, Jennifer R. Bellon, Constance T. Cirrincione, Donald A. Berry,

Beryl McCormick, Hyman B. Muss, Barbara L. Smith, Clifford A. Hudis, Eric P. Winer, and William C. Wood

A B S T R A C T

Purpose

To determine whether there is a benefit to adjuvant radiation therapy after breast-conserving surgery and tamoxifen in women age _ 70 years with early-stage breast cancer.

Patients and Methods

Between July 1994 and February 1999, 636 women (age _70 years) who had clinical stage I (T1N0M0 according to TNM classification) estrogen receptor (ER) –positive breast carcinoma treated by lumpectomy were randomly assigned to receive tamoxifen plus radiation therapy (TamRT; 317 women) or tamoxifen alone (Tam; 319 women). Primary end points were time to local or regional recurrence, frequency of mastectomy, breast cancer–specific survival, time to distant metastasis, and overall survival (OS).

Results

Median follow-up for treated patients is now 12.6 years. At 10 years, 98% of patients receiving TamRT (95% CI, 96% to 99%) compared with 90% of those receiving Tam (95% CI, 85% to 93%) were free from local and regional recurrences. There were no significant differences in time to mastectomy, time to distant metastasis, breast cancer–specific survival, or OS between the two groups. Ten-year OS was 67% (95% CI, 62% to 72%) and 66% (95% CI, 61% to 71%) in the TamRT and Tam groups, respectively.

Conclusion

With long-term follow-up, the previously observed small improvement in locoregional recurrence with the addition of radiation therapy remains. However, this does not translate into an advantage in OS, distant disease-free survival, or breast preservation. Depending on the value placed on local recurrence, Tam remains a reasonable option for women age _ 70 years with ER-positive early-stage breast cancer.

J Clin Oncol 31:2382-2387. © 2013 by American Society of Clinical Oncology

HughesSchnaper2013_9343_JCO.2012.45.2615.full

Hughes KS, Schnaper L, Berry D, Cirrincione C, McCormick B, Smith T, Shank B, Smith BL, Shapiro C, Muss H, Winer E, Wood W, Sugarbaker D, Henderson C, Norton L: A randomized comparison of lumpectomy plus Tamoxifen with or without irradiation in women 70 years of age or older with early stage breast cancer.  New England Journal of Medicine 2004;351: 971-977.

Hughes KSWhy do we believe that breast cancer in the elderly is the same as breast cancer in young women?  Drugs Aging. 2008;25(1):47-8.

Inouye P, Schnaper, LA, Buyske J, Shank BM, Shapiro CL, Berry DA, Wilder KLM, Hughes KS:  Carcinoma of the breast in the geriatric population.  Surgical Rounds 1997;4 (3): 146-20.

Schnaper LA, Hughes KS: Special considerations when treating breast cancer in the elderly.  Breast Disease – An International Journal 2001;12: 83-93.

Schnaper LA, M.D.Hughes KS, M.D., for the Cancer and Leukemia Group B, Radiation Therapy, Oncology Group, and Eastern Cooperative Oncology Group: Can radiation be omitted following breast conserving surgery in women over 70 with early stage breast cancer? The American Journal of Oncology Review. In Press.  2004

Howard-McNatt M, Hughes KS, Schnaper LA, Jones JL, Gadd MA, Smith BL: Breast cancer treatment in older women. Surgical Clin NA, 2005;14(1): 85-102, vi. Review.

Hughes KS. Why do we believe that breast cancer in the elderly is the same as breast cancer in young women?  Drugs and Aging 2008;25:47-48.

Carlson RW, Moench S, Hurria A, Balducci L, Burstein HJ, Goldstein LJ,

Gradishar WJ, Hughes KS, Jahanzeb M, Lichtman SM, Marks LB, McClure JS, McCormick B, Nabell LM, Pierce LJ, Smith ML, Topham NS, Traina TA, Ward JH, Winer EP.  NCCN Task Force Report: breast cancer in the older woman.  The Journal of the National Comprehensive Cancer Network. 2008;6Suppl 4:S1-S25.  Quiz S26-S27.

Kimmick G, Hughes KS, Muss H: Breast Cancer in Older Women.  In: Harris J, Lippman M, Morrow M, Osborne C (eds.) Diseases of the Breast, Lippincott Williams and Wilkins. 2004 and 2009

 

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