Additional Information
Book Details
Abstract
The Breast: Comprehensive Management of Benign and Malignant Diseases, 4th Edition, by Kirby I. Bland, MD, and Edward M. Copeland, III, MD, is a surgical reference that offers the most comprehensive, up-to-date resource on the diagnosis and management of, and rehabilitation following, surgery for benign and malignant diseases of the breast. With its multidisciplinary approach, sweeping updates, new contributors, and authoritative guidance, you’ll have exactly what you need to inspire patient confidence and provide the best possible outcomes.
- Features multidisciplinary advice from experts in surgery, radiation and medical oncology, pathology, molecular biology, pharmacokinetics, and genetics for a well-rounded perspective to enhance patient outcomes.
- Includes more than 1,500 figures and tables that offer high quality depictions of surgery and treatment procedures.
- Offers step-by-step guidance through both text and clinical boxes that makes the material relevant to everyday practice.
- Provides cross-referencing between chapters, as well as references to carefully selected journal articles, that makes further research easier.
- Uses a new full-color design to highlight key areas of the text and help you focus on important concepts.
- Presents updated coverage including an expanded section on pathology...and new chapters on granular cell tumors, targeted therapies, integration of radiotherapy and chemotherapy to keep you current.
- Includes revised chapters on the psychosocial consequences of breast cancer, lifestyle interventions for breast cancer patients, and patient and family resources that equip you to offer complete and compassionate care.
- Provides additional information on genetics to keep you up to date with the latest genetic discoveries linked to breast cancer and breast diseases.
- Features the work of many new contributors who provide the latest and freshest perspectives.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| The Breast: Comprehensive Management of Benign and Malignant Diseases | iii | ||
| Dedication | v | ||
| Copyright | vi | ||
| Associate Editors | vii | ||
| Contributors | ix | ||
| Preface | xix | ||
| Acknowledgments | xxi | ||
| Foreword | xxiii | ||
| Contents | xxv | ||
| Section I: History of the Therapy of Breast Cancer | 1 | ||
| Chapter 1: History of the Therapy of Breast Cancer | 3 | ||
| Ancient Civilizations | 3 | ||
| Middle Ages | 5 | ||
| Renaissance | 6 | ||
| Eighteenth Century | 7 | ||
| Nineteenth Century | 9 | ||
| Twentieth Century | 12 | ||
| References | 17 | ||
| Section II: Anatomy and Physiology of the Normal and Lactating Breast | 19 | ||
| Chapter 2: Anatomy of the Breast, Axilla, Chest Wall, and Related Metastatic Sites | 21 | ||
| Gross Anatomic Structure-Surface Anatomy | 21 | ||
| Microscopic Anatomic Structure | 22 | ||
| Thoracic Wall | 25 | ||
| Axilla | 27 | ||
| Fascial Relationships of the Breast | 29 | ||
| Innervation of the Breast | 30 | ||
| Lymphatic Drainage of the Breast | 31 | ||
| Venous Drainage of the Mammary Gland | 37 | ||
| References | 38 | ||
| Chapter 3: Breast Physiology: Normal and Abnormal Development and Function | 39 | ||
| Embryology to Childhood | 39 | ||
| Puberty | 42 | ||
| Pregnancy | 49 | ||
| Lactation | 51 | ||
| Menopause | 54 | ||
| References | 54 | ||
| Chapter 4: Discharges and Secretions of the Nipple | 59 | ||
| Introduction and Definitions | 59 | ||
| Clinical Evaluation and Management of the Patient with Nipple Discharge | 68 | ||
| Diagnosis and Surgical Intervention | 77 | ||
| Summary | 81 | ||
| References | 81 | ||
| Section III: Benign and Premalignant Lesions | 85 | ||
| Chapter 5: Etiology and Management of Benign Breast Disease | 87 | ||
| Breast Pain | 87 | ||
| Pathophysiology of Mastalgia | 88 | ||
| Management of Mastalgia | 90 | ||
| Disorders of Development | 96 | ||
| Pathology of Benign Breast Disorders | 97 | ||
| Clinical Features of Benign Breast Disorders | 100 | ||
| Treatment of Benign Breast Disease | 101 | ||
| References | 102 | ||
| Chapter 6A: Subareolar Breast Abscess: The Penultimate Stage of the Mammary Duct-associated Inflammatory Disease Sequence... | 107 | ||
| Historical Perspective and Terminology | 107 | ||
| Pathogenesis and Clinical Correlates | 111 | ||
| Genesis of Mammary Duct-associated Inflammatory Disease Sequence | 114 | ||
| Pathology of Mammary Duct-associated Inflammatory Disease Sequence | 116 | ||
| Clinical Overview of Mammary Duct-associated Inflammatory Disease Sequence | 117 | ||
| Clinical Features Related to Management of Mammary Duct-associated Inflammatory Disease Sequence | 119 | ||
| Operative Techniques | 136 | ||
| Peripheral Breast Abscess in Comparison to Mammary Duct-associated Inflammatory Disease Sequence | 137 | ||
| Idiopathic Granulomatous Mastitis | 139 | ||
| Summary | 141 | ||
| Acknowledgments | 141 | ||
| References | 141 | ||
| Chapter 6B: Clinical Management of Mastitis and Breast Abscess and Idiopathic Granulomatous Mastitis | 145 | ||
| Mastitis and Breast Abscess | 145 | ||
| Special Considerations for Lactational Mastitis and Abscesses | 147 | ||
| Chronic Subareolar Abscess | 147 | ||
| Authors' Recommendation for Breast Abscess Management | 147 | ||
| Idiopathic Granulomatous Mastitis | 148 | ||
| References | 148 | ||
| Chapter 7: Gynecomastia | 151 | ||
| Prevalence | 151 | ||
| Clinical Presentation | 151 | ||
| Physiology | 151 | ||
| Histopathology | 154 | ||
| Pathophysiology | 156 | ||
| Management of Gynecomastia | 162 | ||
| Summary | 163 | ||
| References | 165 | ||
| Chapter 8: Benign, High-Risk, and Premalignant Lesions of the Breast | 169 | ||
| Benign Lesions without Cancer Risk Implications | 169 | ||
| Epithelial Hyperplasia and Proliferative Breast Disease | 172 | ||
| Atypical Hyperplasia | 174 | ||
| Localized Sclerosing Lesions | 177 | ||
| Duct Ectasia and Fat Necrosis | 179 | ||
| Fibroadenoma and Phyllodes Tumor | 179 | ||
| References | 186 | ||
| Chapter 9: Congenital and Acquired Disturbances of Breast Development and Growth | 189 | ||
| Development of the Breast | 189 | ||
| Amastia | 190 | ||
| Unilateral Congenital Defects of the Breast with associated Defects of the Chest Wall, Ipsilateral Musculature, Subcutaneous T. | 192 | ||
| Iatrogenic Factors That Initiate Breast Hypoplasia | 193 | ||
| Premature Thelarche | 195 | ||
| Juvenile (Adolescent, Virginal) Hypertrophy of the Female Breast | 197 | ||
| Tuberous Breast Deformity | 198 | ||
| Drug Induction of Gigantism | 199 | ||
| Breast Hypertrophy with Pregnancy (Gigantomastia) | 199 | ||
| Symmastia: Medial Confluence of the Breast | 200 | ||
| Supernumerary Nipples (Polythelia) and Supernumerary Breast (Polymastia) | 201 | ||
| Accessory (Ectopic) Axillary Breast Tissue | 204 | ||
| Acknowledgments | 205 | ||
| References | 205 | ||
| Section IV: Pathology of Malignant Lesions | 209 | ||
| Chapter 10: In Situ Carcinomas of the Breast: Ductal Carcinoma in Situ and Lobular Carcinoma in Situ | 211 | ||
| Recent Insights into the Unique Biology of Ductal Carcinoma in Situ and Lobular Carcinoma in Situ | 212 | ||
| Pathology of Ductal Carcinoma in Situ | 214 | ||
| Classification of Ductal Carcinoma in Situ | 219 | ||
| Extent of Disease | 220 | ||
| Extensiveness, Multicentricity, and Multifocality | 220 | ||
| Distribution | 220 | ||
| Mammographic Correlation | 221 | ||
| Margin Status | 221 | ||
| Risks of Evolution and Recurrence from Ductal Carcinoma in Situ | 222 | ||
| Receptor Proteins, Oncogenes, Tumor Suppressor Genes, and Ploidy | 222 | ||
| Special Types of Ductal Carcinoma in Situ with Special Implications | 224 | ||
| Pathology of Lobular Carcinoma in Situ | 225 | ||
| References | 226 | ||
| Chapter 11: Infiltrating Carcinomas of the Breast: Not One Disease | 231 | ||
| Overview | 231 | ||
| Historical Pathologic Classification | 231 | ||
| Emerging Molecular Classification | 239 | ||
| Emerging Pharmacogenomic Classification | 241 | ||
| References | 244 | ||
| Chapter 12: Extent and Multicentricity of in Situ and Invasive Carcinoma | 249 | ||
| In Situ Lesions | 253 | ||
| Invasive Lesions | 253 | ||
| Combined Invasive and in Situ Carcinoma | 254 | ||
| Associated Factors | 254 | ||
| Clinical Implications of Multicentricity | 256 | ||
| References | 257 | ||
| Chapter 13: Mesenchymal Neoplasms of the Breast | 261 | ||
| Fibroepithelial Neoplasms | 261 | ||
| Fibroblastic and Myofibroblastic Neoplasms | 263 | ||
| Vascular Neoplasms | 264 | ||
| Lipomatous Neoplasms | 266 | ||
| Neural Neoplasms | 267 | ||
| Myogenic Neoplasms | 267 | ||
| Osseous Neoplasms | 267 | ||
| References | 267 | ||
| Chapter 14: Paget's Disease of the Breast | 271 | ||
| Clinical Presentation | 271 | ||
| Radiologic Findings | 271 | ||
| Histopathology | 272 | ||
| Pathogenesis | 273 | ||
| Differential Diagnosis | 274 | ||
| Management | 275 | ||
| Prognosis | 276 | ||
| References | 276 | ||
| Chapter 15: Primary and Secondary Dermatologic Disorders of the Breast | 279 | ||
| Overview | 279 | ||
| Primary Breast Dermatologic Disorders | 279 | ||
| Secondary Breast Dermatologic Disorders | 288 | ||
| References | 296 | ||
| Chapter 16: Digital Automation of Breast Biomarker Immunocytochemistry | 301 | ||
| High Throughput Approaches to Tissue Microarrays | 301 | ||
| Clinical Applications | 302 | ||
| Significance and Future Importance of Digital Image Analysis | 311 | ||
| Conflict (Duality) of Interests | 312 | ||
| References | 312 | ||
| Chapter 17: Breast Lymphoma | 315 | ||
| Clinical Features | 315 | ||
| Radiologic Features | 317 | ||
| Pathologic Features | 317 | ||
| Staging | 318 | ||
| Treatment and Prognosis | 318 | ||
| References | 319 | ||
| Chapter 18: Breast Implants and Related Methods of Breast-Modifying Surgery | 321 | ||
| Overview | 321 | ||
| Historical Background | 321 | ||
| Silicone and Breast Implants | 324 | ||
| Clinical Use of Breast Implants | 325 | ||
| Complications of Breast Implants | 326 | ||
| References | 328 | ||
| Section V: Natural History, Epidemiology, Genetics, and Syndromes of Breast Cancer | 331 | ||
| Chapter 19: Epidemiology of Breast Cancer | 333 | ||
| Traditional Risk Factors for Breast Cancer | 333 | ||
| Newer Risk Factors for Breast Cancer | 336 | ||
| References | 344 | ||
| Chapter 20: Primary Prevention of Breast Cancer | 349 | ||
| Identifying Women at Risk | 349 | ||
| Chemoprevention | 350 | ||
| Chemoprevention Risk Reduction Trials | 352 | ||
| Significance of Tamoxifen | 358 | ||
| Clinical Data with Raloxifene | 362 | ||
| Study of Tamoxifen and Raloxifene Trial | 365 | ||
| Future Strategies: AromataseInhibitors | 365 | ||
| References | 367 | ||
| Chapter 21: Breast Cancer Genetics: Syndromes, Genes, Pathology, Counseling, Testing, and Treatment | 371 | ||
| Genetic Predisposition to Breast Cancer | 372 | ||
| Hereditary Breast and Ovarian Cancer Syndrome and BRCA1 and BRCA2 Mutations | 376 | ||
| Heterogeneity: Multiple Breast Cancer Syndromes | 394 | ||
| Diagnostic Considerations and Implications | 399 | ||
| Treatment Interventions | 401 | ||
| Racial and Sociocultural Variation in Breast Cancer Rates | 404 | ||
| Psychological Aspects of Familial Breast Cancer | 404 | ||
| The Decision-Making Process and Genetic Testing | 406 | ||
| Future of Research in Genetics in Hereditary Cancer | 407 | ||
| Acknowledgments | 408 | ||
| References | 408 | ||
| Chapter 22: Patterns of Recurrence in Breast Cancer | 417 | ||
| Importance of Minimizing Local Recurrence | 417 | ||
| Local Recurrence Patterns and Risk Factors | 418 | ||
| Local Recurrence following Breast Conservation Therapy | 418 | ||
| Local Recurrence following Mastectomy | 419 | ||
| Regional Recurrences | 421 | ||
| Systemic Recurrences | 422 | ||
| Time of Recurrence | 424 | ||
| References | 425 | ||
| Section VI: Staging of Breast Cancer | 427 | ||
| Chapter 23: Assessment and Designation of Breast Cancer Stage | 429 | ||
| Staging: Past, Present, and Future | 429 | ||
| Clinical, Pathologic, and Biologic Markers and Factors in Determining Prognosis | 430 | ||
| Evolution of Staging Systems | 442 | ||
| Current Staging System | 444 | ||
| References | 447 | ||
| Section VII: Prognostic Factors for Breast Cancer | 453 | ||
| Chapter 24: Clinically Established Prognostic Factors in Breast Cancer | 455 | ||
| Nomenclature | 455 | ||
| Prognostic Factors | 457 | ||
| Predictive Factors | 460 | ||
| Summary | 460 | ||
| References | 461 | ||
| Chapter 25: Investigational Molecular Prognostic Factors for Breast Carcinoma | 463 | ||
| Prognostic and Predictive Factors | 463 | ||
| Development of Biomarkers | 463 | ||
| Breast Cancer Tumorigenesis | 465 | ||
| Investigational Molecular Markers | 465 | ||
| Stromal Gene Expression | 467 | ||
| Markers of Proliferation | 467 | ||
| HER2/neu | 467 | ||
| Molecular Profiling | 468 | ||
| Gene Expression Signatures: Top Down | 468 | ||
| Prognostic Gene Signatures: Bottom Up | 469 | ||
| Concordance | 470 | ||
| Predictive Gene Signatures | 470 | ||
| Pharmacogenomics | 471 | ||
| Summary | 472 | ||
| References | 472 | ||
| Chapter 26: Risk Factors for Breast Carcinoma in Women with Proliferative Breast Disease | 477 | ||
| Nashville Studies | 477 | ||
| Evaluation of Page's Histologic Classification Scheme by Other Authors | 480 | ||
| Relationship between the Histologic Classification Schemes of Different Authors | 480 | ||
| Complex Fibroadenoma and Proliferative Breast Disease | 481 | ||
| Effect of Time since Biopsy on Risk of Breast Cancer | 482 | ||
| References | 484 | ||
| Chapter 27: Steroid Receptors in Breast Cancer | 485 | ||
| Estrogen Receptors in Breast Cancer | 485 | ||
| Expression of Estrogen Receptors in Breast Cancer | 486 | ||
| Molecular Cloning and Characterization of the Estrogen Receptors | 486 | ||
| Transcriptional Regulation by Estrogen Receptors | 487 | ||
| Genomic Estrogen Receptor Signal Transduction | 487 | ||
| Estrogen Receptor Inhibition by Tamoxifen and Its Metabolites in Premenopausal Women | 488 | ||
| E2 Synthesis and the Role of Aromatase Inhibitors in Postmenopausal Women | 489 | ||
| Selective Estrogen Receptor Modulator Inhibition of Estrogen Signaling | 491 | ||
| Nongenomic Estrogen Receptor Signal Transduction | 492 | ||
| Cross-Talk between Growth Factor Receptors and Estrogen Receptorα Function | 492 | ||
| Clinical Evidence for Estrogen Receptorα and Growth Factor Signaling Interaction | 492 | ||
| Clinical Trials Designed to Examine Interactions between Growth Factor Signaling and Estrogen Receptor Inhibition... | 493 | ||
| Progesterone Receptor and Breast Cancer | 494 | ||
| References | 494 | ||
| Section VIII: Molecular Biology of Breast Carcinogenesis | 499 | ||
| Chapter 28: Molecular Oncology of Breast Cancer | 501 | ||
| Introduction | 501 | ||
| Role of Endogenous Hormones in Breast Development and Carcinogenesis | 505 | ||
| Important Molecular Markers in Current Clinical Management of Breast Cancer Patients | 508 | ||
| Sporadic Breast Cancer and Somatic Genetic Alterations | 514 | ||
| Clinical Applications of Multigene Assessment Methods | 523 | ||
| Hereditary Breast Cancer | 524 | ||
| Tumor Microenvironment | 526 | ||
| Conclusions | 527 | ||
| References | 528 | ||
| Chapter 29: Stem Cells, the Breast, and Breast Cancer | 533 | ||
| Overview | 533 | ||
| Stem Cells in the Normal Breast | 533 | ||
| Stem Cells in Breast Cancer | 535 | ||
| Can the Stem Cell Paradigm Shift Result in Improved Cancer Treatment and Survival? | 545 | ||
| References | 547 | ||
| Chapter 30: Concepts and Mechanisms of Breast Cancer Metastasis | 549 | ||
| Pathogenesis of Metastasis | 549 | ||
| Patterns of Metastasis | 556 | ||
| Biologic Diversification and Heterogeneity of Metastatic Cancers | 558 | ||
| Conclusions | 560 | ||
| References | 561 | ||
| Chapter 31: Gene Therapy for Breast Cancer | 565 | ||
| Gene Therapy Strategies | 565 | ||
| Vectors for Gene Transfer | 568 | ||
| Breast Cancer Gene Therapy: Clinical Experience | 568 | ||
| Conclusions | 569 | ||
| Acknowledgments | 570 | ||
| References | 570 | ||
| Chapter 32: Angiogenesis in Breast Cancer | 571 | ||
| Tumor Angiogenesis: Biologic Basis | 571 | ||
| Angiogenesis in Human Breast Cancer | 577 | ||
| Principles of Antiangiogenic Therapy in the Clinic | 580 | ||
| Conclusions and Future Directions | 584 | ||
| Acknowledgments | 585 | ||
| References | 585 | ||
| Chapter 33: Immune Recognition of Breast Cancer | 589 | ||
| Basics of Immune Recognition of Breast Cancer | 589 | ||
| Breast Cancer Antigens | 591 | ||
| Endogenous Immune Responses Directed against Breast Cancer | 591 | ||
| Role of the Immune Microenvironment in Limiting the Breast Cancer-associated Immune Response | 592 | ||
| Summary and Future Directions | 593 | ||
| References | 593 | ||
| Chapter 34: Immunology and the Role of Immunotherapy in Breast Cancer: Human Clinical Trials | 595 | ||
| Breast Cancer Immunotherapy in Perspective | 595 | ||
| Vaccine Therapy | 596 | ||
| Breast Cancer Vaccines in Evolution | 597 | ||
| Cytokine Therapy | 598 | ||
| Adoptive T-Cell Therapy | 599 | ||
| Summary | 599 | ||
| References | 599 | ||
| Section IX: Screening and Diagnosis of Breast Disease | 603 | ||
| Chapter 35: Examination Techniques: Roles of the Physician and Patient in Evaluating Breast Disease | 605 | ||
| Breast Self-Examination | 605 | ||
| Clinical Breast Examination | 606 | ||
| Imaging Modalities | 608 | ||
| Invasive Diagnostic Procedures | 609 | ||
| References | 610 | ||
| Chapter 36: Breast Imaging | 613 | ||
| Mammography | 613 | ||
| Other Breast Imaging Techniques | 639 | ||
| Imaging-Guided Interventional Procedures | 643 | ||
| Staging and Follow-Up of Women with Breast Cancer | 646 | ||
| References | 651 | ||
| Chapter 37: Interval Breast Cancer: Clinical, Epidemiologic, and Biologic Features | 657 | ||
| Interval Breast Cancer: Definition of the Problem | 657 | ||
| Epidemiologic, Clinical Features, and Outcomes of Interval Breast Cancer Compared with Screen-Detected Breast Cancer... | 659 | ||
| Clinical Features and Outcomes of Interval Breast Cancer Compared with Breast Cancer Detected in Control Populations... | 660 | ||
| Biologic Features of the Interval Breast Cancers | 661 | ||
| Conclusions and Future Directions | 663 | ||
| References | 665 | ||
| Chapter 38: Stereotactic Breast Biopsy | 667 | ||
| Indications for Stereotactic Biopsy | 667 | ||
| Contraindications to Stereotactic Biopsy | 667 | ||
| Equipment | 667 | ||
| Stereotactic Biopsy Procedure | 670 | ||
| Potential Problems and Pitfalls | 671 | ||
| Imaging-Pathology Correlation | 672 | ||
| Summary | 673 | ||
| References | 673 | ||
| Chapter 39: Cytopathology of the Breast | 675 | ||
| Diagnosis | 675 | ||
| Prognosis and Prediction of Response to Therapy | 684 | ||
| Risk Prediction | 687 | ||
| Future Perspectives | 690 | ||
| References | 693 | ||
| Chapter 40: Breast Ductoscopy | 697 | ||
| References | 700 | ||
| Section X: Clinical Trials: Biostatistical Applications | 701 | ||
| Chapter 41: Design and Conduct of Clinical Trials for Breast Cancer | 703 | ||
| What Are Clinical Trials? | 703 | ||
| Trial Design for Phase I Oncology Studies | 704 | ||
| Trial Design for Phase II Oncology Studies | 704 | ||
| Trial Design for Phase III Randomized Controlled Studies | 707 | ||
| Randomization Process | 707 | ||
| Sample Size Determination and Power Analysis | 710 | ||
| Monitoring Response Variables | 711 | ||
| Conclusions | 713 | ||
| Acknowledgments | 713 | ||
| References | 713 | ||
| Section XI: Surgery for Benignand MalignantDiseases ofthe Breast | 715 | ||
| Chapter 42: Evolution of the Surgical Management of Breast Cancer | 717 | ||
| Antiquity | 717 | ||
| Medieval Ages and the Renaissance | 718 | ||
| Pre-Modern Era | 718 | ||
| Modern Era | 719 | ||
| Current Evolutionary Progress | 731 | ||
| References | 732 | ||
| Chapter 43: Indications and Techniques for Biopsy | 737 | ||
| Nonpalpable Abnormalities | 737 | ||
| Palpable Abnormalities | 741 | ||
| Choice of Anesthesia | 744 | ||
| References | 744 | ||
| Chapter 44: General Principles of Mastectomy: Evaluation and Therapeutic Options | 747 | ||
| Topographical Surgical Anatomy | 749 | ||
| Evolution of Surgical Techniques for Mastectomy | 752 | ||
| Design of Incisions for Mastectomy in the Treatment of Breast Cancer | 757 | ||
| Skin-Sparing Mastectomy | 758 | ||
| Overview | 768 | ||
| References | 777 | ||
| Chapter 45: Halsted Radical Mastectomy | 779 | ||
| Historical Aspects for Development of Radical Mastectomy | 779 | ||
| Breast Cancer Treatment in the United States | 779 | ||
| Indications for Use of the Halsted Radical Mastectomy | 794 | ||
| Technique of Radical Mastectomy | 795 | ||
| References | 801 | ||
| Chapter 46: Modified Radical Mastectomy and Total (Simple) Mastectomy | 803 | ||
| Modified Radical Mastectomy | 803 | ||
| Total Mastectomy | 808 | ||
| Modified Radical Mastectomy Technique | 816 | ||
| References | 819 | ||
| Chapter 47: Breast Conservation Therapy for Invasive Breast Cancer | 823 | ||
| Historical Perspective | 823 | ||
| Survival | 824 | ||
| Local Recurrence | 826 | ||
| Cosmetic Outcome | 827 | ||
| Patient Selection | 827 | ||
| Magnetic Resonance Imaging | 828 | ||
| Operative Technique | 828 | ||
| Axilla | 830 | ||
| Radiation Therapy | 831 | ||
| References | 834 | ||
| Section XII: Breast Reconstruction | 837 | ||
| Chapter 48: Breast Reconstruction following Mastectomy | 839 | ||
| Role of Reconstruction in Breast Cancer Treatment | 839 | ||
| Definition of the Mastectomy Deformity | 840 | ||
| Reconstructive Surgical Methods | 848 | ||
| Surgical Technique | 860 | ||
| Conclusions | 873 | ||
| References | 873 | ||
| Chapter 49: Macromastia and Reduction Mammaplasty | 877 | ||
| Anatomy | 877 | ||
| Pathophysiology | 878 | ||
| History | 878 | ||
| Indications | 879 | ||
| Surgical Treatment | 879 | ||
| Discussion | 883 | ||
| References | 884 | ||
| Section XIII: Complications of Breast Surgery | 887 | ||
| Chapter 50: Wound Care and Complications of Mastectomy | 889 | ||
| Care of the Postmastectomy Wound | 889 | ||
| Complications of Mastectomy | 889 | ||
| References | 895 | ||
| Chapter 51: Lymphedema in the Postmastectomy Patient: Pathophysiology, Prevention, and Management | 897 | ||
| History | 897 | ||
| Etiologic Factors and Incidence | 898 | ||
| Lymphedema and Sentinel Lymph Node Mapping | 898 | ||
| Lymphedema from Radiation Treatment | 899 | ||
| Anatomy | 900 | ||
| Pathophysiology | 902 | ||
| Classification | 904 | ||
| Patient History and Measurement of Lymphedema | 905 | ||
| Preoperative Lymphoscintigraphy | 906 | ||
| Nonoperative Management of Lymphedema | 907 | ||
| Operative Management of Lymphedema | 909 | ||
| Lymphangiosarcoma: A Rare but Fatal Complication of Long-Standing Lymphedema | 911 | ||
| Prevention | 911 | ||
| Summary | 911 | ||
| References | 912 | ||
| Section XIV: Current Concepts and Management of Early Breast Carcinoma (Tis, Tmic, T1) | 915 | ||
| Chapter 52: Biology and Management of Lobular Carcinoma in Situ of the Breast (Lobular Neoplasia) | 917 | ||
| Incidence and Pathologic Anatomy | 918 | ||
| E-Cadherin | 919 | ||
| Other Immunohistochemical Tests | 920 | ||
| Pleomorphic Lobular Carcinoma in Situ | 920 | ||
| Core Biopsy Specimens: A Difficult Situation | 920 | ||
| Clinical Considerations | 921 | ||
| Natural History: Risk of Invasive Carcinoma | 921 | ||
| Family History and Genetics | 922 | ||
| Chemoprevention | 923 | ||
| Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ and Breast Conservation | 923 | ||
| Summary | 924 | ||
| Acknowledgments | 924 | ||
| References | 924 | ||
| Chapter 53: Ductal Carcinoma in Situ: Treatment Controversies and Oncoplastic Surgery | 927 | ||
| Changing Nature of Ductal Carcinoma in Situ | 927 | ||
| Pathology | 928 | ||
| Detection and Diagnosis | 930 | ||
| Treatment | 932 | ||
| Distant Disease and Death | 934 | ||
| Prospective Randomized Trials | 934 | ||
| Limitations of the Prospective Randomized Trials | 935 | ||
| Predicting Local Recurrence in Conservatively Treated Patients with Ductal in Situ Carcinoma | 936 | ||
| Current Treatment Trends | 939 | ||
| Use of Margin Width as the Sole Predictor of Local Recurrence | 940 | ||
| Treatment of the Axilla for Patients with Ductal Carcinoma in Situ | 941 | ||
| Oncoplastic Breast Surgery | 941 | ||
| Oncoplastic Resection | 941 | ||
| Oncoplastic Steps | 942 | ||
| Oncoplastic Excisions | 943 | ||
| Summary | 949 | ||
| The Future | 950 | ||
| References | 950 | ||
| Chapter 54: Therapeutic Value of Axillary Node Dissection and Selective Management of the Axilla in Small Breast Cancers... | 953 | ||
| Lymphatic Function and Nodal Metastases | 953 | ||
| Axillary Anatomy and Evaluation | 955 | ||
| Axillary Radiotherapy | 960 | ||
| Therapeutic Role of Axillary Node Dissection | 961 | ||
| Selective Management of Axilla | 964 | ||
| References | 967 | ||
| Chapter 55: Lymphatic Mapping and Sentinel Lymphadenectomy for Breast Cancer | 971 | ||
| History of Sentinel Node Concept in Breast Cancer | 971 | ||
| Evolution of Dye-Directed Sentinel Lymphadenectomy for Breast Cancer at the John Wayne Cancer Institute | 972 | ||
| Complete Nonsentinel Node Staging and Proof of Principle | 973 | ||
| Prospective Study of Sentinel Lymphadenectomy Alone for a Tumor-Free Sentinel Node | 974 | ||
| Identification of the Sentinel Node in Breast Cancer by Radiolocalization | 974 | ||
| Identification of the Sentinel Node with Preoperative Lymphoscintigraphy and Intraoperative Radioguided Surgery | 975 | ||
| Combined Technique of Vital Dye and Radioisotope | 975 | ||
| Global Experience with Sentinel Lymphadenectomy in Breast Cancer | 975 | ||
| Multicenter Lymphatic Mapping Trials | 976 | ||
| Clinical, Pathologic, and Technical Aspects of Sentinel Lymphadenectomy | 977 | ||
| Technical Considerations | 984 | ||
| Radiolocalization and Lymphatic Mapping with Isotopes | 988 | ||
| Histopathologic Evaluation | 991 | ||
| Morbidity of Sentinel Lymphadenectomy | 994 | ||
| Learning Curve | 995 | ||
| Immunologic Role of the Sentinel Node | 996 | ||
| Prospective Randomized Clinical Trials | 999 | ||
| Summary | 1001 | ||
| References | 1001 | ||
| Chapter 56: Detection and Significance of Axillary Lymph Node Micrometastases | 1007 | ||
| Definition and Classification of Axillary Lymph Node Micrometastases | 1007 | ||
| Frequency and Prognostic Significance of Axillary Lymph Node Micrometastases | 1008 | ||
| Ludwig Studies of Axillary Lymph Node Micrometastases | 1010 | ||
| Logistical Hurdles in the Detection of Axillary Lymph Node Micrometastases | 1010 | ||
| Enhanced Pathologic Techniques and the Evolution of Sentinel Lymph Node Biopsy | 1011 | ||
| Memorial Sloan-Kettering Cancer Center Micrometastasis Study | 1011 | ||
| Selected Controversies | 1012 | ||
| Conclusions and Future Directions | 1013 | ||
| References | 1014 | ||
| Chapter 57: Intraoperative Evaluation of Surgical Margins in Breast-Conserving Therapy | 1017 | ||
| Frequency of Margin-Positive Partial Mastectomy | 1019 | ||
| Pathologic Assessment of Margin Status and Specimen Handling | 1019 | ||
| Summary and Conclusions | 1022 | ||
| References | 1022 | ||
| Chapter 58: Surgical Management of Early Breast Cancer | 1027 | ||
| Preoperative Evaluation | 1028 | ||
| Surgical Options for Early Breast Cancer | 1028 | ||
| Breast Conservation Surgery | 1029 | ||
| Mastectomy | 1033 | ||
| Axillary Evaluation | 1034 | ||
| Adjuvant Radiotherapy | 1034 | ||
| Outcome after Surgical Management of Breast Cancer | 1036 | ||
| Minimally Invasive Ablative Therapies | 1039 | ||
| References | 1039 | ||
| Chapter 59: Percutaneous Ablation: Minimally Invasive Techniques in Breast Cancer Therapy | 1043 | ||
| General Considerations | 1044 | ||
| Radiofrequency Ablation | 1044 | ||
| Cryoablation | 1045 | ||
| Interstitial Laser Therapy | 1047 | ||
| Microwave Ablation | 1047 | ||
| High-Intensity Focused Ultrasound Ablation | 1048 | ||
| Conclusions | 1049 | ||
| References | 1049 | ||
| Section XV: Radiation Therapy for Stages 0, I, and II Breast Cancer | 1051 | ||
| Chapter 60: Radiotherapy Techniques | 1053 | ||
| Interstitial Implantation | 1053 | ||
| External-Beam Treatment Modalities | 1054 | ||
| External-Beam Techniques | 1055 | ||
| Radiation Doses | 1056 | ||
| Innovative Approaches | 1057 | ||
| Conclusions | 1058 | ||
| References | 1058 | ||
| Chapter 61: Radiation Therapy for Locally Advanced Disease | 1061 | ||
| Radiation Therapy following Mastectomy and Adjuvant Systemic Therapy | 1061 | ||
| Radiation Therapy following Primary Systemic Therapy and Mastectomy | 1062 | ||
| Inflammatory Breast Cancer | 1063 | ||
| Radiation Therapy following Neoadjuvant Chemotherapy and Breast-Conserving Surgery | 1064 | ||
| Radiation Therapy for Inoperable Disease following Primary Systemic Therapy | 1065 | ||
| Radiation Therapy without Surgery | 1066 | ||
| Radiation Volumes and Doses | 1066 | ||
| Conclusions | 1067 | ||
| References | 1067 | ||
| Chapter 62: Radiotherapy and Ductal Carcinoma in Situ | 1069 | ||
| Randomized Trials of the Role of Radiotherapy | 1069 | ||
| Results with Excision Alone in Selected Patients | 1069 | ||
| Factors associated with Local Recurrence | 1070 | ||
| Tamoxifen and Radiotherapy | 1072 | ||
| Radiation Treatment Techniques | 1073 | ||
| Patterns of Recurrence and Results of Salvage Treatment | 1073 | ||
| Radiation Therapy after Mastectomy | 1073 | ||
| Conclusions | 1073 | ||
| References | 1074 | ||
| Chapter 63: Radiotherapy and Regional Nodes | 1077 | ||
| Supraclavicular Nodes | 1077 | ||
| Internal Mammary Nodes | 1077 | ||
| Axillary Nodes | 1079 | ||
| Arm Edema and Nodal Irradiation | 1081 | ||
| Conclusions | 1081 | ||
| References | 1081 | ||
| Chapter 64: Postmastectomy Radiotherapy | 1083 | ||
| Randomized Trials of Postmastectomy Radiotherapy | 1083 | ||
| Factors Influencing the Risk of Local-Regional Failure | 1084 | ||
| Integration of Postmastectomy Radiotherapy and Reconstructive Surgery | 1087 | ||
| Conclusions | 1088 | ||
| References | 1089 | ||
| Chapter 65: Breast-Conserving Therapy for Invasive Breast Cancers | 1091 | ||
| Randomized Trials Comparing Breast-Conserving Surgery and Radiation Therapy with Mastectomy | 1091 | ||
| Patient Selection for Breast-Conserving Surgery and Radiation | 1091 | ||
| Timing of Radiation Therapy in Relation to Surgery and Systemic Therapy | 1097 | ||
| Characteristics and Management of Local Failure after Breast-Conserving Surgery and Radiation Therapy | 1097 | ||
| Breast-Conserving Surgery without Radiation Therapy | 1099 | ||
| Conclusions | 1100 | ||
| References | 1101 | ||
| Chapter 66: Accelerated Partial Breast Irradiation | 1105 | ||
| Multicatheter Interstitial Brachytherapy | 1106 | ||
| Balloon Catheter Brachytherapy | 1107 | ||
| Three-Dimensional Conformal Radiation Therapy | 1108 | ||
| Intraoperative Treatment | 1109 | ||
| Trials Comparing Accelerated Partial Breast Irradiation with Conventional Radiotherapy | 1109 | ||
| Uncertainties in Patient Selection and Treatment Delivery | 1110 | ||
| Conclusions | 1111 | ||
| References | 1111 | ||
| Chapter 67: Radiation Complications and Their Management | 1113 | ||
| Fatigue and Myelosuppression | 1113 | ||
| Radiation Dermatitis and Infections | 1113 | ||
| Cosmesis and Breast Symptoms | 1114 | ||
| Chest Wall Complications | 1116 | ||
| Brachial Plexopathy | 1116 | ||
| Pulmonary Complications | 1116 | ||
| Cardiac Complications | 1117 | ||
| Second Malignancies | 1118 | ||
| Complications in Patients with Collagen Vascular Disease | 1119 | ||
| Conclusions | 1119 | ||
| References | 1119 | ||
| Section XVI: Adjuvant Systemic Modalities for Therapy of Stages I and II Breast Cancer | 1123 | ||
| Chapter 68: Adjuvant Chemotherapy for Early-Stage Breast Cancer | 1125 | ||
| St. Gallen and the National Comprehensive Cancer Network Guidelines | 1125 | ||
| Early Breast Cancer Trialists' Collaborative Group Systematic Review on Polychemotherapy (Oxford Overview) | 1126 | ||
| Adjuvant Chemotherapy | 1126 | ||
| Future Directions | 1138 | ||
| Ongoing and Future Trials | 1141 | ||
| References | 1141 | ||
| Section XVII: Management of Advanced Local and Regional Disease | 1145 | ||
| Chapter 69: Surgical Procedures for Advanced Local and Regional Malignancies of the Breast | 1147 | ||
| Staging System Revisions and Implications | 1147 | ||
| Unimodality Treatment Approaches | 1148 | ||
| Multimodality Approaches | 1149 | ||
| Breast Conservation Surgery in Locally Advanced Breast Cancer | 1151 | ||
| Axillary Staging | 1151 | ||
| Timing of Therapies | 1153 | ||
| Full-Thickness Chest Wall Resection Revisited | 1155 | ||
| Reconstructive Techniques | 1155 | ||
| Options for Chest Wall Closure | 1157 | ||
| Full-Thickness Chest Wall Defects and Prosthetic Materials | 1167 | ||
| Radiotherapy and Reconstruction | 1167 | ||
| Multidisciplinary Approach | 1169 | ||
| Algorithm for Chest Wall Reconstruction | 1169 | ||
| Acknowledgments | 1171 | ||
| References | 1171 | ||
| Chapter 70: Solitary Metastases | 1175 | ||
| Liver | 1175 | ||
| Lung | 1176 | ||
| Bone | 1176 | ||
| Brain | 1177 | ||
| Summary | 1178 | ||
| References | 1178 | ||
| Chapter 71: Locoregional Recurrence after Mastectomy | 1181 | ||
| Presentation | 1181 | ||
| Natural History | 1181 | ||
| Prognosis | 1182 | ||
| Pretreatment Evaluation | 1183 | ||
| Treatment and Results | 1183 | ||
| Conclusions and Recommendations | 1185 | ||
| References | 1186 | ||
| Chapter 72: Locally Advanced Breast Cancer | 1189 | ||
| Epidemiology | 1189 | ||
| Survival | 1189 | ||
| Diagnosis and Staging | 1190 | ||
| Prognostic Factors | 1191 | ||
| Evolution of Local Therapy | 1191 | ||
| Combined Modality Treatment | 1191 | ||
| Neoadjuvant Chemotherapy | 1193 | ||
| Neoadjuvant Trastuzumab-Based Therapy | 1194 | ||
| Neoadjuvant Hormonal Therapy | 1194 | ||
| Assessment of Response to Neoadjuvant Chemotherapy | 1195 | ||
| Predictors of Response to Neoadjuvant Therapy | 1196 | ||
| Breast-Conserving Surgery | 1196 | ||
| Treatment Summary | 1197 | ||
| References | 1197 | ||
| Sectin XVIII: Management of Systemic Disease | 1201 | ||
| Chapter 73: Detection and Clinical Implications of Occult Systemic Micrometastatic Breast Cancer | 1203 | ||
| Circulating Tumor Cells | 1203 | ||
| Cancer Stem Cells | 1204 | ||
| Detection and Characterization of Circulating Tumor Cells | 1204 | ||
| Clinical Significance and Prognostic Value of Circulating Tumor Cells in Patients with Metastatic Breast Cancer | 1206 | ||
| Clinical Application of Circulating Tumor Cells | 1207 | ||
| Future Clinical Uses of Circulating Tumor Cells | 1208 | ||
| Conclusions | 1208 | ||
| References | 1208 | ||
| Chapter 74: Local Therapy for the Intact Breast Primary in the Presence of Metastatic Disease | 1211 | ||
| Data Sources for Retrospective Analyses | 1212 | ||
| Patterns of Care in Women Presenting with Metastatic Breast Cancer | 1213 | ||
| Impact of Surgical Therapy on Overall Survival | 1215 | ||
| Nonsurgical Factors Affecting Survival | 1216 | ||
| Other Local Therapy Aspects | 1216 | ||
| Timing of Surgery | 1217 | ||
| Does Locoregional Control Affect Survival in Patients with Known Metastases? | 1217 | ||
| What is a Reasonable Clinical Approach to the Patient with De Novo Metastatic Disease? | 1218 | ||
| Is a Randomized Trial Required to Establish the Role of Local Therapy in Metastatic Breast Cancer? | 1218 | ||
| Biologic Explanations for a Possible Benefit of Primary Tumor Therapy in Metastatic Disease | 1219 | ||
| Conclusions | 1220 | ||
| References | 1220 | ||
| Chapter 75: Management of Bone Metastases in Breast Cancer | 1223 | ||
| Pathophysiology | 1223 | ||
| Clinical Presentation | 1224 | ||
| Diagnosis | 1224 | ||
| Surgical Management | 1224 | ||
| Radiotherapy | 1226 | ||
| Bisphosphonates | 1228 | ||
| New Treatment Modalities | 1229 | ||
| Conclusions and Recommendations | 1229 | ||
| References | 1230 | ||
| Chapter 76: Chemotherapy for Metastatic Breast Cancer | 1233 | ||
| Epidemiology | 1233 | ||
| Therapy Goals | 1233 | ||
| Prognostication | 1233 | ||
| Medical Evaluation in the Metastatic Setting | 1234 | ||
| Local Therapy for Metastatic Breast Cancer | 1235 | ||
| Selecting Therapy for Metastatic Breast Cancer | 1235 | ||
| Chemotherapy for Metastatic Breast Cancer | 1238 | ||
| Treatment of HER2-Positive Metastatic Breast Cancer | 1245 | ||
| Novel Agents in Metastatic Breast Cancer | 1250 | ||
| Autologous Stem Cell Transplantation | 1250 | ||
| Treatment of Metastatic Bone Disease | 1251 | ||
| Special Considerations | 1252 | ||
| Monitoring Response to Therapy | 1255 | ||
| Future of Chemotherapy for Metastatic Breast Cancer | 1256 | ||
| References | 1256 | ||
| Chapter 77: Endocrine Therapy for Breast Cancer | 1263 | ||
| Historical Background of Endocrine Therapy for Breast Cancer | 1263 | ||
| General Therapeutic Strategies | 1264 | ||
| Current Endocrine Therapies for Breast Cancer | 1265 | ||
| Molecular Predictors of Sensitivity to Hormonal Therapy | 1277 | ||
| Conclusions | 1280 | ||
| References | 1280 | ||
| Chapter 78: Diagnosis and Management of Pleural Metastases in Breast Cancer | 1287 | ||
| Clinical Presentation | 1287 | ||
| Diagnosis | 1288 | ||
| Treatment: Indications, Approaches, and Complications | 1292 | ||
| Prognosis and Future Developments | 1294 | ||
| Summary | 1294 | ||
| References | 1294 | ||
| Chapter 79: Management of Central Nervous System Metastases in Breast Cancer | 1297 | ||
| Incidence | 1297 | ||
| Risk Factors | 1297 | ||
| Clinical Presentation | 1298 | ||
| Diagnostic Evaluation | 1299 | ||
| Treatment | 1301 | ||
| References | 1314 | ||
| Chapter 80: Management of Pericardial Metastases in Breast Cancer | 1321 | ||
| Pericardial Effusion in Breast Cancer | 1322 | ||
| Pericardial Constriction in Breast Cancer | 1325 | ||
| References | 1326 | ||
| Section XIX: Special Presentations of Breast Cancer | 1327 | ||
| Chapter 81: Bilateral Breast Cancer | 1329 | ||
| Risk Factors for Bilateral Breast Cancer | 1329 | ||
| Prognosis of Bilateral Breast Cancer | 1333 | ||
| Impact of Breast Imaging and Adjuvant Therapy on Bilaterality | 1333 | ||
| Management Options for the Normal Contralateral Breast | 1334 | ||
| Recommendations and Future Directions | 1335 | ||
| References | 1335 | ||
| Chapter 82: Cancer of the Male Breast | 1339 | ||
| Detection and Presentation | 1339 | ||
| Differential Diagnosis | 1340 | ||
| Epidemiology, Risk Factors, and Genetics | 1341 | ||
| Pathology | 1343 | ||
| Diagnostic Evaluation | 1344 | ||
| Treatment | 1344 | ||
| References | 1345 | ||
| Chapter 83: Local Recurrence, the Augmented Breast, and the Contralateral Breast | 1349 | ||
| Locoregional Recurrence after Mastectomy | 1349 | ||
| Recurrence in the Reconstructed Breast | 1353 | ||
| Recurrence after Breast-Conserving Therapy | 1355 | ||
| Breast Cancer in the Augmented Breast | 1357 | ||
| Breast Cancer after Subcutaneous Mastectomy | 1359 | ||
| Cancer Risk in the Contralateral Breast | 1360 | ||
| References | 1361 | ||
| Chapter 84: Carcinoma of the Breast in Pregnancy and Lactation | 1365 | ||
| Prognosis and Historical Perspective | 1365 | ||
| Diagnostic Evaluation and Staging during Pregnancy | 1365 | ||
| Treatment | 1367 | ||
| Special Issues | 1369 | ||
| Conclusions | 1370 | ||
| References | 1370 | ||
| Chapter 85: Unknown Primary Presenting with Axillary Lymphadenopathy | 1373 | ||
| Diagnosis | 1373 | ||
| Gross and Microscopic Anatomy | 1375 | ||
| Local Therapy | 1377 | ||
| Systemic Therapy | 1378 | ||
| Prognosis | 1378 | ||
| Conclusions for Clinical Practice | 1378 | ||
| References | 1379 | ||
| Chapter 86: Clinical Management of the Patient at Increased or High Risk | 1381 | ||
| Breast Cancer Risk Assessment | 1381 | ||
| Breast Cancer Risk Counseling | 1384 | ||
| Breast Cancer Risk Management | 1385 | ||
| Conclusions | 1390 | ||
| References | 1390 | ||
| Chapter 87: Inflammatory Breast Cancer | 1393 | ||
| Why Acknowledge Inflammatory Breast Cancer as a Unique Form of Breast Cancer? | 1393 | ||
| Definition of Inflammatory Breast Cancer | 1394 | ||
| Epidemiology and Natural History of Inflammatory Breast Cancer | 1394 | ||
| Therapy for Inflammatory Breast Cancer | 1395 | ||
| Signature of Inflammatory Breast Cancer | 1397 | ||
| Animal Models of Inflammatory Breast Cancer | 1398 | ||
| Molecular and Biologic Insights into Inflammatory Breast Cancer | 1399 | ||
| Unanswered Questions in Inflammatory Breast Cancer | 1399 | ||
| References | 1400 | ||
| Section XX: Follow-Up Care and Rehabilitation of the Breast Cancer Patient | 1403 | ||
| Chapter 88: General Considerations for Follow-Up | 1405 | ||
| Surveillance for Locoregional Recurrences or New Primary Disease | 1405 | ||
| Detecting Distant Relapse | 1406 | ||
| Managing Long-Term and Late Effects of Cancer Treatment | 1407 | ||
| Non-Cancer-Related Care | 1413 | ||
| Survivorship Care Planning | 1413 | ||
| Conclusions and Future Directions | 1414 | ||
| References | 1414 | ||
| Chapter 89: Management of Menopause in the Breast Cancer Patient | 1419 | ||
| Background | 1419 | ||
| What Is the Experience of Menopause in Women with Breast Cancer? | 1419 | ||
| Is Hormone Therapy an Option for Women with Breast Cancer? | 1420 | ||
| Alternatives to Hormone Therapy for Management of Vasomotor Symptoms | 1421 | ||
| Are Topical Estrogens an Option for Women with Breast Cancer? | 1424 | ||
| Alternatives to Topical Estrogens for Vulvovaginal Atrophy | 1424 | ||
| Depression | 1424 | ||
| Osteoporosis | 1425 | ||
| Cardiovascular Disease | 1427 | ||
| Conclusions | 1428 | ||
| References | 1428 | ||
| Chapter 90: Rehabilitation | 1431 | ||
| Physical Rehabilitation | 1432 | ||
| Sexual Rehabilitation | 1435 | ||
| Vocational Rehabilitation | 1438 | ||
| Practical Aspects of Care | 1438 | ||
| Team Approach | 1439 | ||
| Acknowledgments | 1439 | ||
| References | 1439 | ||
| Chapter 91: Psychosocial Consequences and Lifestyle Interventions | 1443 | ||
| Psychosocial Aspects of Breast Cancer | 1443 | ||
| Lifestyle and Breast Cancer | 1448 | ||
| References | 1452 | ||
| Chapter 92: Patient and Family Resources | 1455 | ||
| Understanding Online Resources | 1457 | ||
| General Information | 1457 | ||
| Treatment and Survivorship | 1459 | ||
| Resources for Special Populations | 1459 | ||
| Clinical Research Participation: Online Resources | 1461 | ||
| Genetic and Hereditary Issues: Organizations | 1461 | ||
| Fertility: Organizations | 1462 | ||
| Sexuality: Books | 1462 | ||
| Reconstruction | 1462 | ||
| Social Services and Access: Organizations | 1462 | ||
| Palliative and End-of-Life Care | 1462 | ||
| Regional Support Groups | 1462 | ||
| References | 1472 | ||
| Section XXI: Medical and Legal Issues Specific to the Care of Breast Cancer | 1473 | ||
| Chapter 93: Medical-Legal Aspects of Breast Care | 1475 | ||
| Scope and Demographics of Medical-Legal Activity in Breast Care | 1475 | ||
| General Principles of Medical Malpractice | 1476 | ||
| Lost Chance Doctrine | 1480 | ||
| References | 1482 | ||
| Chapter 94: Delayed Diagnosis of Symptomatic Breast Cancer | 1483 | ||
| Magnitude of the Problem | 1483 | ||
| Definition of Delayed Diagnosis of Breast Cancer | 1486 | ||
| Patient-associated Delays in Diagnosis | 1486 | ||
| Physician-associated Delays in Diagnosis | 1487 | ||
| Influence of Delayed Diagnosis of Breast Cancer on Survival | 1496 | ||
| Conclusion: How to Prevent the Delayed Diagnosis of Breast Cancer-Synopsis of Clinical Risk Prevention | 1506 | ||
| References | 1507 | ||
| Index | I-1 |