Mastectomy - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

MASTECTOMY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N...

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MASTECTOMY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Mastectomy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00707-X 1. Mastectomy-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on mastectomy. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON MASTECTOMY ........................................................................................... 3 Overview........................................................................................................................................ 3 Federally Funded Research on Mastectomy................................................................................... 3 E-Journals: PubMed Central ....................................................................................................... 25 The National Library of Medicine: PubMed ................................................................................ 26 CHAPTER 2. NUTRITION AND MASTECTOMY ................................................................................. 73 Overview...................................................................................................................................... 73 Finding Nutrition Studies on Mastectomy.................................................................................. 73 Federal Resources on Nutrition ................................................................................................... 74 Additional Web Resources ........................................................................................................... 74 CHAPTER 3. ALTERNATIVE MEDICINE AND MASTECTOMY ........................................................... 77 Overview...................................................................................................................................... 77 National Center for Complementary and Alternative Medicine.................................................. 77 Additional Web Resources ........................................................................................................... 83 General References ....................................................................................................................... 84 CHAPTER 4. DISSERTATIONS ON MASTECTOMY ............................................................................. 85 Overview...................................................................................................................................... 85 Dissertations on Mastectomy ...................................................................................................... 85 Keeping Current .......................................................................................................................... 86 CHAPTER 5. PATENTS ON MASTECTOMY........................................................................................ 87 Overview...................................................................................................................................... 87 Patents on Mastectomy................................................................................................................ 87 Patent Applications on Mastectomy .......................................................................................... 115 Keeping Current ........................................................................................................................ 118 CHAPTER 6. BOOKS ON MASTECTOMY ......................................................................................... 119 Overview.................................................................................................................................... 119 Book Summaries: Online Booksellers......................................................................................... 119 CHAPTER 7. PERIODICALS AND NEWS ON MASTECTOMY ........................................................... 121 Overview.................................................................................................................................... 121 News Services and Press Releases.............................................................................................. 121 Academic Periodicals covering Mastectomy .............................................................................. 123 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 127 Overview.................................................................................................................................... 127 NIH Guidelines.......................................................................................................................... 127 NIH Databases........................................................................................................................... 129 Other Commercial Databases..................................................................................................... 131 APPENDIX B. PATIENT RESOURCES ............................................................................................... 133 Overview.................................................................................................................................... 133 Patient Guideline Sources.......................................................................................................... 133 Finding Associations.................................................................................................................. 136 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 139 Overview.................................................................................................................................... 139 Preparation................................................................................................................................. 139 Finding a Local Medical Library................................................................................................ 139 Medical Libraries in the U.S. and Canada ................................................................................. 139 ONLINE GLOSSARIES................................................................................................................ 145 Online Dictionary Directories ................................................................................................... 146 MASTECTOMY DICTIONARY ................................................................................................. 147

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INDEX .............................................................................................................................................. 187

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with mastectomy is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about mastectomy, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to mastectomy, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on mastectomy. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to mastectomy, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on mastectomy. The Editors

1 From

the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON MASTECTOMY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on mastectomy.

Federally Funded Research on Mastectomy The U.S. Government supports a variety of research studies relating to mastectomy. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to mastectomy. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore mastectomy. The following is typical of the type of information found when searching the CRISP database for mastectomy: •

Project Title: 3D BREAST MODELING USING PATIENT SPECIFIC 3D IMAGES Principal Investigator & Institution: Feng, Yuanming; Genex Technologies, Inc. 10605 Concord St, Ste 500 Kensington, Md 20895 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2003 Description (provided by applicant): One in every 8 American women develops breast cancer at some point in their lifetime. With many advances in microsurgical technique

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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and implantable prostheses, breast reconstruction can offer a nearly identical restoration of the breast while helping to diminish the emotional and psychological trauma breast cancer sufferer?s experience from the loss of a breast, thus enhancing the quality of life of cancer survivors. In current clinical practices of breast reconstruction, there exists no accurate and easy-to-perform method of measuring, quantifying or assessing breast shape or volume; There is no method available to accurately predict the surgical result of breast reconstruction based on volume to breast tissue added or removed. Genex Technologies, Inc. has recently developed a novel 3D camera that is able to acquire both 2D and 3D images of a breast with high precision and speed. Using the 3-D camera, we can accurately record the 3D shape and appearance of the breast to be removed by mastectomy or reduced by lumpectomy. We propose this SBIR program to demonstrate the feasibility of a breast modeling technique and software, dubbed as the 3DBREAST(TM) based on patient-specific 3D images. Phase 1 project will focus on developing the framework of the 3D-BREAST software and investigating breast deformation model. A prototype of the 3D-BREAST system will be demonstrated with limited verification tests using 3D breast image database we have collected in the past at Johns Hopkins Hospital. The Phase 2 project will demonstrate a fully functional 3DBREAST system. The Phase 2 system will be field-tested in multiple clinical sites to obtain feedback for improvement. Specifically, in the proposed 6-month Phase 1 program, we will investigate the following issues: 1. Develop 3D aboutBREASrM software framework and implement an interactive GUI. 2. Develop a geometric model of 3D breast deformation. 3. Verify the correctness and effectiveness of the breast deformation model using 3D pre- and post operative breast images. 4. Prepare Phase 2 work plan. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: A HER-2/NEU PULSED DC1 VACCINE FOR PATIENTS WITH DCIS Principal Investigator & Institution: Czerniecki, Brian J.; Assistant Professor of Surgery; Surgery; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 19-JUN-2003; Project End 31-MAY-2006 Summary: (provided by applicant): The recently acquired ability to culture large numbers of human dendritic cells (DC), the most effective antigen-presenting cell for the sensitization of T lymphocytes, has provided an important resource for the formulation of active immunization strategies against cancer. The success of previous vaccine trials has probably been limited in part by the reliance on short synthetic peptide immunogens that cannot elicit CD4+ T cell help, the use of incorrectly cultured or administered DC that has failed to harness their full potential as APC, and the enrollment of patients who, because of their advanced metastatic disease and previous treatment with chemo- or radio-therapy make them inherently poor prospects for active immunotherapy. This proposed study is designed to circumvent these previous shortcomings by taking advantage of recent advances in our understanding of DC development, function, and administration, as well as the careful selection of both disease model and appropriate immunogen. High-grade ductal carcinoma in situ (DCIS) is a pre-invasive malignancy of the breast that often expresses the tumor-associated antigen her-2/neu. The proposed study will enroll her-2/neu-positive DCIS patients, who have localized disease and no previous experience with immunosuppressive therapies. These patients will receive a vaccine composed of autologous DC pulsed with multiple her-2/neu-derived peptides. These DC will be cultured in a manner proven to maximize their effectiveness in sensitizing tumor-recognizing T lymphocytes, and administered by the intra-nodal route, which has been demonstrated superior to other

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tested routes of delivery. The specific aims of this study are first to determine the feasibility and safety of administering an autologous DC1 vaccine pulsed with her2/neu peptides. Second, to determine the rate of sensitization of CD4+ and CD8+ T cells to her-2/neu after intra-nodal administration of the vaccine. Finally, the response in the peritumoral area following vaccination will be determined histopathologically and radiologically. The vaccine, if successful, will not only provide needed treatment options in addition to the current standard of care (mastectomy or lumpectomy) but may also prove useful for actually preventing invasive disease in patients judged at high risk for developing breast malignancies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANATOMIC AND BIOLOGIC STAGING OF BREAST DISEASE WITH MRI Principal Investigator & Institution: Hylton, Nola M.; Professor; Radiology; University of California San Francisco 3333 California Street, Suite 315 San Francisco, Ca 941430962 Timing: Fiscal Year 2002; Project Start 15-JAN-1997; Project End 31-DEC-2005 Summary: Preoperative or neoadjuvant chemotherapy is now the standard of care for treatment of patients with locally advanced breast cancer and is being evaluated in patients with earlier stage disease. Neoadjuvant chemotherapy can achieve tumor downstaging and allow breast conservation in patients for whom initially, mastectomy was the only option. Response to chemotherapy is assessed clinically and clinical assessment of response of the primary tumor has been shown to be associated with improved disease-free survival. Nonetheless, clinical response does not accurately reflect pathologic response. MRI can accurately assess the extent of cancer in the breast and may be more effective than clinical exam at measuring changes in tumor size and distribution in response to neoadjuvant chemotherapy. Additionally, early tumor changes measured by MRI could be meaningful predictors of survival. More importantly, if MRI can identify those patients who are unlikely to respond to treatment, a change in management can be introduced at an earlier time. This study proposes to investigate these possibilities by using MRI to non-invasively measure tumor changes in patients with Stage III/IV breast cancer during neoadjuvant treatment. The goal is to design and validate MRI methods for measuring treatment response and predicting patient outcome. A high spatial resolution three time-point method was previously developed and evaluated for characterization of breast disease. This technique will be used to measure morphologic and enhancement properties of tumors and monitor their change over treatment. The effectiveness of MRI methods for measuring tumor response and predicting disease-free survival will be investigated in a group of 75 patients with locally-advanced breast cancer who are undergoing neoadjuvant chemotherapy. Clinical investigations will be supported by studies in model systems. Experimental models of breast cancer will be used to study the effects of tumor properties and treatment parameters on treatment response. These results will be used to guide the design of clinical studies. Experimental model studies will be used to study the anti-angiogenic properties of anti-VEGF and anti-FLKI, both being introduced into clinical trials for breast cancer. A third agent to be studied is an anti-body labeled immunoliposome agent containing doxorubicin and targeted against HER2, which has demonstrated superior therapeutic results to both free doxorubicin and non-targeted doxorubicincontaining liposomes. MRI methods will be developed using both standard gadoliniumDTPA and gadolinium-encapsulating immunoliposomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BREAST CANCER RISK MODIFIERS IN BRCA MUTATION CARRIERS Principal Investigator & Institution: Whittemore, Alice S.; Professor; Health Research and Policy; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2003; Project Start 20-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Lifetime breast cancer risks among carriers of mutations of the genes BRCA1 and BRCA2 have been estimated at 40-80%. Thus some 20-60% of carriers live to advanced ages without developing the disease, which suggests that other genes or personal attributes may modify carriers' risks. At present however, title is known about such personal characteristics. There is urgent need to determine which, if any, modifiable lifestyle characteristics may alter a carrier's risk of developing breast cancer, to assist her in making rational, informed choices about such preventive options as prophylactic mastectomy. We propose to use uniformly collected data from young (aged < 50 years) case (N=425) and control (N=352) carriers of deleterious BRCA1 or BRCA2 mutations to evaluate associations between breast cancer risk and five modifiable characteristics. These are: history of oral contraceptive use, history of diagnostic or therapeutic chest irradiation prior to diagnosis, alcohol consumption, cigarette smoking, and physical activity patterns during puberty, young adulthood and middle age. We will focus on carriers under age 50 years at diagnosis (cases) or interview (controls) who have participated in an international Collaborative Family Registry for Breast Cancer Studies (CFRBCS) and in clinical studies in New York, Ontario and Australia. We will use unconditional logistic regression to estimate oddsratios relating these attributes to breast cancer risk while controlling for potential confounders, and use robust variance estimators to account for any correlation present in attributes of related carriers. These data on modifiable characteristics from a large group of young carriers of BRCA1 or BRCA2 mutations represent a unique resource for advancing our knowledge about breast cancer prevention in premenopausal women at high risk for the disease. The proposed analysis will provide new information on alternatives to mastectomy as a preventive strategy for these women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BREAST CANCER TREATMENT EFFECTIVENESS IN OLDER WOMEN Principal Investigator & Institution: Silliman, Rebecca A.; Professor; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2003; Project Start 10-FEB-2003; Project End 31-DEC-2006 Summary: (provided by investigator): An estimated 192,200 women were diagnosed with breast cancer in 2001, more than half of whom were 60 years of age or older. Of concern is that while breast cancer-specific mortality rates have declined among women less than 70 years old, they are either stable (70-79 year olds) or are increasing (80+ year olds) among those 70 years or older. One explanation for this is that older women receive less than standard therapy more frequently than younger women. Neither efficacy nor effectiveness data to date justify this pattern of care. Taking advantage of the Health Maintenance Organization (HMO) Cancer Research Network, we propose to conduct a historical cohort study of an unselected group of older women (>65 years of age) newly diagnosed with early stage breast cancer (stages I-II) between 1990 and 1994. Specifically, we will (1) Compare the effectiveness of standard primary tumor therapy (breast conserving surgery, axillary dissection, and radiation therapy or modified radical mastectomy) versus other than standard therapy in preventing breast cancer

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recurrences and mortality, adjusting for co-morbidity, tumor characteristics, geographic site, and demographic characteristics; (2) Determine the extent to which the addition of systemic adjuvant therapy (chemotherapy, hormonal therapy, or the combination of chemotherapy and hormonal therapy) modifies the effectiveness of standard and other than standard primary tumor therapy in preventing breast cancer recurrences and mortality; (3) Describe patterns of surveillance testing for breast cancer recurrence and determine the extent to which surveillance testing is associated with a reduction in breast cancer-specific mortality; and (4) Identify provider, tumor, and patient characteristics associated with the receipt of standard primary tumor therapy and systemic adjuvant therapy in older women with newly diagnosed early stage disease in the HMO setting. Six sites from throughout the United States will together identify and follow 2180 women for ten years. Both electronic and medical record data sources will be used to collect information that will allow us to characterize the separate and joint effects of treatment, tumor, and patient characteristics on breast cancer recurrence and mortality. Findings from this study will inform clinical practice, particularly the care of older women with co-morbidities who are unlikely to participate in clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL/PATHOLOGIC PREDICTORS FOR RECURRENCE AFTER DCIS Principal Investigator & Institution: Habel, Laurel A.; Center for Health Studies Seattle, Wa 98101 Timing: Fiscal Year 2003; Project Start 03-JUN-2003; Project End 28-FEB-2007 Summary: Approximately 10-20% of women with ductal carcinoma in situ (DCIS) will have recurrent breast cancer, either in situ or invasive, within 5 years of their initial diagnosis. While every year in the U.S. more than 47,000 women are diagnosed with DClS, our ability to accurately predict which patients are most likely to have a recurrence is quite poor. Consequently, treatment decisions are difficult and up to 40% of DCIS patients will have a mastectomy. We propose to conduct a nested case-control study to identify clinical and pathologic factors that could be used to accurately identify DClS patients at high and low risk of a recurrence. The study population will come from the memberships of three Cancer Research Network (CRN) sites, Kaiser Permanente Northern California (KPNC), Kaiser Permanente Southern California (KPSC), and Harvard Pilgrim Health Care (HPHC). DCIS patients diagnosed between 1990 and 2001 and treated with breast-conserving surgery will be identified (N=3,700) and followed for recurrence. Diagnostic slides from patients with a recurrence (N=490) and from matched controls will be retrieved and reviewed by an expert DClS pathologist. One control will be selected for each recurrence (case), matched on health plan, calendar year of the initial diagnosis, age, and follow-up time. Pathology review will be conducted on the slides from the initial and recurrent tumors of cases and from the initial tumors of controls. Data on clinical factors will also be obtained. We aim to do the following: 1) Estimate and compare the risk of recurrence associated with several pathologic features (either alone or combined according to various classification systems) of the index DClS, and compare features of the index DCIS to those in recurrent lesions; 2) Estimate and compare the risk of recurrence associated with several clinical factors, such as age, menopausal status, obesity, and family history of breast cancer; and 3) Evaluate the relation between clinical and pathologic factors, and determine which combination of these factors best identifies subgroups of women at very high and low risk of recurrence. This will be the largest and most comprehensive study to date on prognostic factors for DClS. Our results will provide information on the natural history of this

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heterogeneous group of lesions, and in the future may help in the development of individually tailored treatment strategies for patients with DCIS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COMMUNITY CLINICAL ONCOLOGY PROGRAM Principal Investigator & Institution: Locker, Gershon Y.; Chief; Evanston Northwestern Healthcare Evanston, Il 60201 Timing: Fiscal Year 2002; Project Start 01-SEP-1983; Project End 31-MAY-2003 Summary: (Applicant's Description) Evanston Hospital Corporation which has been renamed as Evanston Northwestern Health care (ENH), has been a CCOP since 1093 and has participated in studies of the Eastern Cooperative Oncology Group (ECOG), the National Surgical Adjuvant Breast and Bowel Program (NSABP), and propose to accrue patients to the Gynecology Oncology Group (GOG). It accrued 259 patients with 272 credits to therapeutic trials between June of 1992 to May of 1997. ENH also contributed non-COP patients to NIH-sponsored studies on brain tumors. ENH investigators have chaired ECOG protocols in genitourinary, breast, and hematologic malignancies. They have also chaired steering committees and served in leadership roles in these groups. Currently, Dr. Ann Thor is on the Executive and directs the ECOG Pathology Coordination Office. Dr. David Calls chains the Health Behavior and Practices Committee and the Outcomes Subcommittee. The CCOP has participated in approved cancer control projects in the NSABP-sponsored breast cancer prevention trial with tamoxifen, the Prostate Cancer Prevention Trial, and other cancer control studies. During the 5 years, 279.5 cancer control credits were awarded. ENH investigators have been active in several cancer control projects outside the CCOP pertaining to epidemiology, diagnosis, "diagnostic marker" and dietary manipulation. These include a NCI funded study of low- fat diet in post-menopausal breast cancer, and the Women's Health Initiative, treatment of post-mastectomy arm lymphedema. The CCOP has been reorganized to increase accrual by: recruitment of new investigators, adding Swedish Covenant Hospital as an affiliate, and GOG as a research base. Efforts are underway to encompass minority enrollment. A 24-bed Clinical Pharmacology Unit sponsored by Searle is operation, with the PI on the advisory committee. We have expanded our education activities through Grand Rounds and lecture series. In the last 4 years, ENH investigators published 63 papers and 10 abstracts pertaining to clinical cancer treatment and control. A research effort in cellular and molecular biology has been developed with the establishment of a program in molecular genetics. Thus, a vertical integration, e.g., from laboratory studies to delivery of care in the local community is being sought. Support is asked for ENH's continued participation in the CCOP. Funding is sought for continued accrual of patients to cancer therapy and cancer control studies of the ECG, NSABP, and GOG. Thus, our participation in cancer control and therapeutic trials will promoter medical advances as well as stimulate better patient care. These in turn will impact favorably on the level of knowledge of staff and physicians within the community. Since 1983, we have successfully participated in the CCOP program, and our record and proposed changes promise continued success in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COST-EFFECTIVENESS--TREATMENTS--DUCTAL CARCINOMA IN SITU Principal Investigator & Institution: Dick, Andrew W.; Assistant Professor; Community and Prev Medicine; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627

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Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2005 Summary: (provided by applicant): The incidence of ductal carcinoma in situ (DCIS) of the breast, a non-invasive form of breast cancer, has increased dramatically in the last 15 years. Its burden both on patients and on society has grown correspondingly. The optimal management of DCIS remains controversial because of the heterogeneity of the disease, the lack of randomized clinical trials comparing treatment strategies for women diagnosed with DCIS, the importance of patient preferences for possible outcomes and the uncertainty surrounding its natural history. Variations in the treatment of DCIS highlight the gaps in knowledge about the optimal management of the disease, gaps that have become increasingly important as the incidence of DCIS has increased. The cost implications of treatment variations also become substantial as DCIS is diagnosed more frequently. Ultimately, the variations in treatment result in differences in outcomes, including life expectancy, quality of life, and cost-effectiveness. We will examine the effects of various treatment strategies, including mastectomy with and without tamoxifen, and breast-conserving surgery with and without radiation and tamoxifen, on the following patient outcomes: DCIS recurrence rates, survival, costs, and quality of life. Decision analytic models will be used to estimate the costeffectiveness and cost-utility of the various treatment strategies. Models will include patient preferences for DCIS and associated treatments obtained from primary data collection. Transition probabilities for the decision analytic models wilt be estimated from primary data using duration models and supplemented from the literature as necessary. Potential endogeneity in treatment selection will be corrected using instrumental variable techniques. The linked Medicare-SEER data will be used to examine the generalizability of our estimated transition probabilities. DCIS treatment costs will be estimated using Medicare data. Sensitivity analyses will be used to test the robustness of our models. The ultimate goal of our project is to identify the most costeffective approaches to manage DCIS, taking into account a variety of clinical presentations and patient preferences, thus improving patient care and reducing the burden of the illness on society. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEFINING SIGNATURES OF BREAST CANCER CELLS BY HRMAS MRS Principal Investigator & Institution: Cheng, Leo L.; Assistant Professor; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2007 Summary: (provided by applicant):Breast cancer is the most commonly diagnosed malignancy and second leading cause of cancer death among American women. Mammography has contributed to early detection, and thus new treatments, of breast tumors, but has also generated controversies. Many patients now diagnosed at very early, symptom free stages of the disease may be likely candidates for breast-conserving treatment (BCT), but some will experience a morbid disease course and die if not promptly treated with radical intervention (mastectomy, chemo- and radiation therapies). Morphology-based histopathology has to date served effectively in assessing breast cancer patients, particularly in the age dominated by mastectomy, but it is insensitive in guiding treatment plans with BCT. In addition to morphological evaluation, a method that directly evaluates the biological behavior of individual tumors and predicts potential aggressiveness is now needed for optimal breast cancer management. To achieve this, we will test the efficacy of an ex vivo spectroscopic method of identifying cellular metabolic signatures. By providing a new paradigm for

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the biochemical diagnosis of breast cancer, this method can assist in the diagnosis and prognostication of breast tumors in the era of BCT. We will quantify cellular metabolic changes in the development and progression of breast cancer with high-resolution magic angle spinning (HRMAS) proton magnetic resonance spectroscopy (1HMRS). HRMAS 1HMRS can measure cellular metabolites in intact human tissue specimens, while preserving histopathological structures. We will test the ability of HRMAS 1HMRS to quantify breast cancer metabolites, correlate metabolic concentrations obtained with histopathological features measured in the same intact tissue samples, define and evaluate metabolic signatures for breast cancer according to type, grade and histopathologic stage, perform molecular biology analyses of tumor signatures at the cellular level with laser capture microdissection (LCM), reverse transcription polymerase chain reaction (RT-PCR), and establish biochemical databases that help predict tumor pathologies and patient outcome, independently of pathology. Initially, we will quantify tissue metabolites of new surgical specimens, as well as stored frozen tissues, with HRMAS 1HMRS. Observed metabolites that correlate with histopathology will then be used to create a database of breast cancer metabolite signatures. These signatures should be useful in clinical care of women with breast cancer by identifying less aggressive tumors as candidates for breast-conserving treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIGENETIC MODIFIERS OF BREAST CANCER RISK Principal Investigator & Institution: Swift-Scanlan, Theresa; None; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2003; Project Start 29-SEP-2003; Project End 28-SEP-2007 Summary: (provided by applicant): Breast cancer (BC) is a complex disease with both genetic and environmental causes, and is the second leading cause of cancer death in women. Most women who develop breast cancer (approximately 70%) have no known family history or obvious risk factors. The remaining 30% of cases tend to aggregate in families, and 5-7% of these are heritable through BRCA1 and BRCA2 mutations, the only gene tests currently available for breast cancer. Recent molecular studies of breast ductal epithelial cells and tumor tissue have demonstrated the presence of several DNA repair and tumor control genes whose expression into functional proteins is effectively shut down or silenced via DNA methylation. It is hypothesized that the presence of silenced tumor control genes in breast epithelial cells may presage the eventual development of BC in women with such molecular modifications. The specific aims of this research are: 1) to identify methylation suppressed tumor control genes in DNA isolated from breast tumor tissue and surrounding healthy breast tissue in a cohort of women at high risk for BC, as compared to a case-matched control cohort of women at average risk for BC, and 2) to determine the predictive contributions of family and personal factors on breast cancer outcome, such as a history of BC, age-of-onset, parity, age at menarche, previous breast biopsies, endogenous and exogenous hormone exposure, screening history, and BRCA mutation status. This research has implications for improving risk assessment, and may ultimately aid women in the decision-making process regarding screening and risk reduction prophylactic measures such as risk reduction mastectomy and chemoprevention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FASTING GLUCOSE IN LONG-TERM BREAST CANCER SURVIVAL Principal Investigator & Institution: Muti, Paola C.; Associate Professor; Social and Preventive Medicine; State University of New York at Buffalo Suite 211 Ub Commons Buffalo, Ny 14228 Timing: Fiscal Year 2004; Project Start 23-AUG-2004; Project End 30-JUN-2006 Summary: (provided by applicant): There is epidemiological evidence of a close association between major alteration in glucose metabolism and breast cancer risk. In three prospective studies there was a doubling of breast cancer risk for women who had a diagnosis of diabetes at baseline. In a recent prospective cohort study, we found a strong association of fasting glucose with risk of breast cancer. Overweight and obese women with breast cancer have poorer survival compared with thinner women. A recent study conducted at three Toronto hospitals observed that fasting insulin was associated with breast cancer outcomes in 512 women with early stages of the disease. The aim of the proposed study is to evaluate the long term prognostic significance of fasting glucose in primary breast cancer. The study will be conducted on 20,432 women admitted to the Istituto Nazionale per lo Studio e la Clara dei Tumori (Italian National Cancer Institute) in Milan, Lombardy Region, Italy between 1991 and 2002 for surgical treatment of a primary breast cancer. Women included in this study will be residents of the Lombardy Region (Northern Italy), who received complete resection of the neoplastic lesion (lumpectomy with margin clear of invasive cancer or mastectomy). We will derive information on pre-treatment serum fasting glucose levels from a computerized file of the Clinical Laboratory of the Italian National Cancer Institute in Milan. Personnel of the Lombardy Cancer Registry (LCR) will carry out the complete follow-up of the study participants for breast cancer recurrence and death. In addition to serum glucose, we will be able to collect individual information on total and HDLeholesterot, triglycerides, and serum uric acid from the same Clinical Laboratory file. These factors are, together with serum glucose, constituents of the Syndrome X, a condition defined by a cluster of metabolic factors and indicated to be a marker of insulin resistance and impaired glucose metabolism. Thus, we also propose to study the potential relation of individual pre-treatment baseline exposure to Syndrome X and breast cancer outcomes. Body weight and age, menopausal status, presence of diabetes at admission, traditional prognostic factors, such as tumor size, nodal stage, estrogenprogesterone receptor status and treatment related variables will also be available in the clinical chart and reported in the file together with the Clinical Laboratory data and they will be included in the analysis as potential confounders, or effect modifiers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FEASIBILITY OF CT IN HIGH RISK BREAST CANCER PATIENTS Principal Investigator & Institution: Boone, John M.; Professor; Radiology; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 956165200 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 30-JUN-2004 Summary: Mammography is used to screen asymptomatic women for breast cancer, and typical breast cancer found using mammography is approximately 11 mm in diameter. At this small size, removal of lesion results in breast cancer cure in the majority of women. However, there is a small class of women (about 5% of all breast cancers) who are genetically predisposed to breast cancer (BRCA1 and BCRA2 genes), and in these women, more aggressive detection methods are needed. In addition to BRCA1 and BRCA2 carriers who are at extraordinary risk of breast cancer, women with extremely dense breasts are at higher risk from breast cancer (by virtue of their dense breasts with

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odds ratio from 4 to 6), and mammography is less sensitive in these women. For women in these high-risk categories, most of whom have dense breasts that are poorly imaged by mammography, an imaging modality with better lesion detectability performance (contrast resolution) is needed. While ultrasound rely on contrast mechanisms that are less reliable than X-ray contrast-that is why they are not used for screening. However, computed tomography (CT) does depend upon x-ray contrast mechanisms, but has about 10 times the contrast resolution as projection mammography. CT is very capable of identifying soft tissue lesions in the 3-5mm range- Such lesions are 10 to 50 times smaller in volume than the average 11mm lesion found by mammography. Therefore, CT has great potential for much earlier detection of breast cancer than mammography for high-risk patients. In this feasibility study, we propose to throughly investigate the potential of dedicated breast CT using computer simulation techniques coupled with CT of cadaver breasts and mastectomy specimens. Monte Carlo studies will be used to fully evaluate the glandular dose of breast CT, and imaging studies will be used to define the requirements of optimal CT acquisition. Using CT scans of breast lesions from about 10 mastectomy specimens, a breast tumor model will be developed. The tumor model will be used with a series of about 20 cadaver breast CT data sets to conduct extensive ROC studies. Computer observers will be used to define the Az versus tumor diameter curves for both CT and mammography. Human observers will be used to validate and calibrate the more extensive computer observer results. The results of this investigation should provide a clear understanding of the potential of breast CT as a tool to reduce breast cancer mortality in the population of women with dire risk of breast cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FEASIBILITY OF OPTOACOUSTIC TOMOGRAPHY IN BACKWARD MODE Principal Investigator & Institution: Oraevsky, Alexander A.; Vice President of Reserch Develoment; Ophthalmology and Visual Scis; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2002; Project Start 14-DEC-2001; Project End 30-NOV-2002 Summary: (provided by applicant) Development of a novel optoacoustic imaging system for detection of early breast cancer is the main goal of the parent NIH grant. Comprehensive tests in phantoms resembling properties of the breast with tumors, extensive studies in mastectomy specimen surgically excised from the breast cancer patients and pilot clinical studies on breast cancer patients performed with laser optoacoustic imaging system (LOIS) developed at UTMB demonstrated high sensitivity of the system based on exceptional optical contrast between tumors and normal breast tissues combined with ultrawide-band detection of ultrasonic profiles induced by laser pulses in tumors. The resolution of LOIS matches the resolution of the state-of-the-art ultrasound systems (approximately 1-mm). Presently, two-dimensional optoacoustic images of the breast segments are being acquired with a system with optical fibers delivering laser pulses to one surface of the breast and an arc-shaped array of acoustic transducers receiving signals on the opposite surface of the breast (i.e. optoacoustic detection in so-called forward mode). The experience acquired with LOIS in the course of our project supported by NCI resulted in new ideas on the system modification in order to improve convenience for both, the operator and the patient. In particular, we propose a modification of LOIS to incorporate fiberoptic light delivery system and ultrasonic detectors in one compact hand-piece, with electronics allowing acquisition of breast images in real time and in a fusion similar to ultrasound imaging. Such a novel optoacoustic transducer (OAT) will operate in so-called backward detection mode. In

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order to perform feasibility studies of the LOIS in backward mode, we propose to enhance infrastructure at Moscow State University (MSU) enabling our collaborators to effectively participate in joint research and development projects on optoacoustic tomography, thereby enhancing the research of US Investigator. MSU group possesses a strong expertise in optoacoustics, nonlinear and ultrawide-band ultrasonics, and laser optics. Such a unique expertise will be very useful for expansion of the scope of the parent NIH grant. Specifically, the goals of the MSU group will be as follows: (1) to perform basic modeling and experimental studies of the optoacoustic tomography in backward mode using a single-element optoacoustic transducer, (2) design, fabricate and test in breast phantoms a hand-held optoacoustic transducer array with multiple optical fibers for illumination and multiple piezoelectric transducers for detection of ultrasonic waves at one and the same site on tissue surface. This project requires funding for equipment and supplies necessary for the MSU group to undertake proposed experiments. Joint feasibility studies in breast phantoms will be carried out at UTMB employing multi-element OAT to be developed at MSU and a multi-channel electronic data acquisition system developed at UTMB. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMRT IN THE TREATMENT OF NODE-POSITIVE BREAST CANCER Principal Investigator & Institution: Pierce, Lori J.; Radiation Oncology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2004; Project Start 01-SEP-2004; Project End 30-JUN-2007 Summary: (provided by applicant): Radiotherapy (RT) is an integral component in the management of early stage breast cancer following breast conservation and following mastectomy in high-risk patients. Previous reports have clearly documented, however, the potential for cardiac and pulmonary toxicity secondary to radiation injury, particularly in patients treated comprehensively to the regional nodes. Intensity modulated radiotherapy (IMRT) is a new treatment delivery technique that uses a variable intensity pattern determined with the aid of a computerized optimization algorithm. Preliminary results with IMRT in treatment of the breast only are promising with respect to improved target coverage and sparing of normal tissue. No studies to date, however, have prospectively compared the use of IMRT with the best standard three-dimensional (3-D) planning technique, with respect to cardiac and pulmonary exposure, in patients comprehensively treated to the breast/chest wall and regional nodes. Therefore, the long-term objective of the proposed research plan is to study comprehensive RT delivered using IMRT versus the best 3-D standard treatment technique (Partially Wide Tangential Fields (PWTF)). Quantitative indicators of potential cardiac and lung toxicity will be compared to determine the improvements that may be achieved with the new approach. Specific Aims: (1) Determine a static IMRT plan that significantly spares the heart and lung compared to the best static standard 3D plan PWTF; (2) Evaluate the effect of delivery-related issues, such as respiratory motion and setup uncertainty, on static PWTF and IMRT plans from Aim 1, and produce plans that compensate for motion. Determine the optimal motion corrected plan between delivery-optimized PWTF and delivery-optimized IMRT. (3) Compare the best delivery-optimized technique from Aim 2 with the best standard 3-D technique, PWTF, in a prospective trial. With the pilot data generated through this proposal, a randomized trial will ultimately be performed comparing these two treatment delivery techniques. Study Design: (1) Establish cost functions that drive the optimization to develop the IMRT plan using heart, lung, opposite breast, and spinal cord constraints while maximizing target coverage to the breast/chest wall and nodes. Optimize the best

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IMRT plan for 20 static cases and compare the static IMRT plan with PWTF using heart and lung metrics. (2) Measure the distribution of setup errors and motion of target volumes in a cohort of 20 patients. Determine the effect of motion on static IMRT and PWTF dose distributions, and then correct/adjust for motion to determine the best delivery-optimized plan. (3) Study 60 patients treated with either the best deliveryoptimized motion corrected plan from Aim 2 or PWTF and compare plans using heart and lung metrics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERACTIVE DECISION AID FOR BRCA 1/2 MUTATION CARRIERS Principal Investigator & Institution: Schwartz, Marc D.; Associate Professor of Oncology / Co-Dir; Lombardi Comprehensive Cancer Center; Georgetown University Washington, Dc 20057 Timing: Fiscal Year 2002; Project Start 15-SEP-1999; Project End 30-JUN-2004 Summary: (adapted from investigator's abstract): Since the identification of the BRCA1 and BRCA2 breast cancer susceptibility genes, genetic testing has become increasingly widespread. Women who inherit a BRCA1/2 mutation have a 55-85 percent lifetime risk of breast cancer. The primary medical decision facing these women is whether to have a prophylactic mastectomy (breast removal) or to receive yearly mammograms. Because limited data favor one of these options or the other, women are informed about the benefits and limitations of each and counseled to select an option consistent with their personal preference and values. Although a specific recommendation for surgery versus surveillance is not generally made, BRCA1/2 carriers who do not elect surgery are advised to obtain annual mammograms. Given the lack of clear guidelines, it is not surprising that medical decision-making is reported to be one of the most challenging and stressful consequences of receiving a positive BRCA1/2 gene test result, and many carriers fail to adopt either option. The goal of this project is to develop and evaluate an interactive CD-ROM-based decision-aid for women who have recently received a positive BRCA1/2 gene test result. We propose a randomized trial among BRCA1 and BRCA2 mutation carriers in which we will compare standard genetic counseling (SGC) to an enhanced genetic counseling condition that consists of the individualized decisionaid (IDA) delivered in conjunction with standard genetic counseling. The IDA will be based, in part, on Subjective Expected Utility theory. Utility theory suggests that in making choices, people select the option that maximizes positive outcomes and minimizes negative outcomes. The value that an individual places on a particular health outcome is referred to as her preference or utility. Literature on decision-making in other medical contexts suggests that decision-aid interventions guided by Utility theory can promote informed decision-making and enhance psychological well being. If effective, the IDA can easily be disseminated to BRCA1/2 carriers across the country and adapted for use with other populations with inherited risk for cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LUTEAL ADJUVANT OOPHORECTOMY IN VIETNAMESE BREAST CANCER Principal Investigator & Institution: Love, Richard R.; Professor; Medicine; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2004; Project Start 01-MAY-2004; Project End 30-APR-2009

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Summary: (provided by applicant): In a randomized clinical trial of adjuvant oophorectomy and tamoxifen in 709 premenopausal Vietnamese and Chinese women with breast cancer, the proposers have demonstrated overall benefit (increased 5-year disease-free and overall survival) and specific benefit only to hormone receptor-positive tumor-bearing patients. Morbidity and symptomatic toxicity of this therapy were low; a cost-effectiveness analysis, assuming costs in Vietnam, shows a cost per life-year gained of $351. In detailed secondary analyses, benefit from adjuvant therapy was significantly greater in women undergoing simultaneous mastectomy and oophorectomy in the history-estimated luteal phases of their menstrual cycles. Analyses of axillary nodepositive and younger (<= 44) patient subsets further support a novel hypothesis that adjuvant luteal phase surgical oophorectomy is more effective than this surgery performed in the follicular phase. The investigators propose a new randomized, controlled trial to investigate this hypothesis in 510 Vietnamese and Filipino premenopausal women, <= 44 years old with regular menstrual cycles and hormone receptor-positive tumors, undergoing adjuvant surgical oophorectomy followed by tamoxifen therapy. Participants will be stratified according to their likelihood of being in luteal phase of the menstrual cycle for the entire following 1-6 days, and those so unlikely will be randomized to scheduled mid-luteal phase oophorectomy or immediate oophorectomy. Blood samples for later hormonal assays will be taken on the day of oophorectomy. With accrual over 2 to 3 years and follow-up of 3 additional years, the study has 0.78-0.86 power to demonstrate disease-free survival differences which are two-thirds of those observed in the original study. The US investigators are experienced in conducting clinical trials and have proven track records for completing and publishing useful data from their work. The collaborating institutions and investigators are also clinical trial-experienced and have the patients and systems to ensure compliance with the protocol, complete pathology specimen collection and follow-up. The investigators will meet accepted and new ethical requirements for this research. A multidisciplinary data monitoring committee will oversee the study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MANAGED CARE PENETRATION AND CANCER CARE Principal Investigator & Institution: Guadagnoli, Edward; Associate Professor; Health Care Policy; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 31-AUG-2004 Summary: Recent evidence suggests that as the market share of managed care increases, expenditures in the fee-for-service sector decrease. This observation demonstrates managed care's extensive effect on the entire health care system and is referred to as a "spillover" effect. It is not known; however, whether quality of care in the fee-for-service sector varies as function of managed care penetration. If lower expenditures in markets with higher penetration result from reductions in the provision of needed services, quality of care in these markets will either decline or improve at a slower rate than in other markets. We propose to examine whether managed care penetration is associated with the quality of care and choice of treatments provided to Medicare patients diagnosed with breast, colorectal, or prostate cancer. We will (1) examine the association between managed care penetration and the quality of care (annual mammography following initial therapy for women diagnosed with early-stage breast cancer; adjuvant chemotherapy for patients diagnosed with stage III colon cancer; adjuvant chemotherapy and radiation therapy for patients diagnosed with stage II or III rectal cancer; recommended surveillance activities (for example, colonoscopy within one year

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of diagnosis) for patients diagnosed with colorectal cancer; and PSA testing within one year of diagnosis for men diagnosed with localized prostate cancer; (2) examine the association between managed care penetration and the use of treatments that are equally effective but that differ in cost for breast cancer (mastectomy versus breast conserving surgery) and prostate cancer (conservative management versus surgery or radiation therapy); and (3) examine mechanisms by which changes in managed care penetration may lead to changes in patterns of care. That is, whether the influence of managed care on the provider specialty composition within a market and on the availability of technologies within a market will partially explain variations in care associated with changes in managed care penetration. We will use SEER-Medicare data to identify patients diagnosed between 1992 and 1996. We will obtain data from the Health Care Financing Administration and from InterStudy to construct measures of managed care penetration at the county, Health Care Resource Area, and Metropolitan Statistical Area level. We will conduct our analyses within each of these levels using hierarchical regression models. Efforts to reduce cancer- related morbidity and mortality depend upon the provision of services known to be effective. In cases where one effective treatment has not been identified, quality of life can be improved by providing services that are congruent with patients' preferences. This project seeks to determine whether market forces influence the patterns of cancer care. If managed care penetration is negatively associated with the delivery of care, interventions targeted toward policymakers, providers, and patients will be needed to counteract the effects of market forces. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NIS REGULATION IN BREAST CANCER Principal Investigator & Institution: Jhiang, Sissy M.; Professor; Physiology and Cell Biology; Ohio State University 1960 Kenny Road Columbus, Oh 43210 Timing: Fiscal Year 2004; Project Start 01-JUL-2004; Project End 30-JUN-2006 Summary: (provided by applicant): The long-term objective of this research proposal is to develop a novel approach to detect and to treat breast cancer. Na+/I- symporter (NIS) is a transmembrane glycoprotein that mediates active iodide uptake in thyroid follicular epithelial cells. Selectively increased NIS expression/function in thyroid tissue is the molecular basis of effective radioiodine treatment for patients with thyroid cancers. Since NIS is highly expressed in lactating breast tissues and the majority of human breast tumors express NIS, we hypothesize that NIS expression/function can be upregulated in breast tumors enabling targeted radionuclide imaging and therapy. Three specific aims are proposed to identify the factor(s) that will selectively increase NIS expression in breast tumors: Aim 1. Determine the mechanism of NIS up-regulation by human chorionic gonadotropin (hCG), trans-retinoic acid (tRA), and cyclooxygenase-2 (Cox-2) in human breast cancer cells; Aim 2. Investigate NIS regulation by downstream effectors of ras in human breast cancer cells; and Aim 3. Establish pre-clinical mouse models to perform high throughput screening for the factor(s) that will selectively increase NIS expression/function in breast tissues. The success of the proposed study will take us one step closer to proceed to human clinical trials using identified compound(s) to increase NIS expression and function in breast tumors enabling radionuclide to localize and ablate residual breast cancer following mastectomy, such that recurrence and metastasis of the disease can be prevented. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OUTCOMES OF SCREENING MAMMOGRAPHY IN ELDERLY WOMEN Principal Investigator & Institution: Smith-Bindman, Rebecca; Radiology; University of California San Francisco 3333 California Street, Suite 315 San Francisco, Ca 941430962 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 29-SEP-2004 Summary: Dr. Smith-Bindman is an Assistant Professor in Radiology, and recently completed a two year fellowship in epidemiology, biostatistics, and research design sponsored jointly by the Departments of Epidemiology and Biostatistics and the General Internal Medicine Section, University of California, San Francisco. Her broad research interest is in performing outcome assessment of diagnostic imaging tests in areas targeted to women's health. Specifically her research interest is in evaluating the outcomes of performing mammographic screening in elderly women. A more thorough understanding of the relationship between screening mammography, breast cancer detection and treatment, and breast cancer mortality is critical to the planning of public policy regarding who should undergo mammographic screening. The proposed study involves the design and implementation of a data analysis of California Health Care Financing Administration Medicare billing claims that have been linked with tumor registry data from the California Cancer Registry on breast cancer stage and treatment. The data will be analyzed at the California Medical Review Incorporated, a Medicare quality improvement organization. Similar data has been successfully analyzed by this investigator previously. The specific aims will focus on the outcome of performing screening mammography in women older than age 65 years. The proposal will evaluate the following: 1) differences in breast cancer mortality, 2) differences in breast cancer treatment rates including mastectomy, lumpectomy and radiation and 3) difference in breast cancer tumor attributes including size and stage between women who were previously screened with mammography and women who were not. She will also evaluate if women with co-morbidities have different outcomes from undergoing screening as women without co-morbidities. For the training component of the award, she will take additional course work in biostatistical methods to develop expertise in adjustment for confounding, and she will meet regularly with her sponsors. Dr. SmithBindman has assembled a multidisciplinary team of nationally recognized clinical researchers. They are enthusiastic about her research plan and are dedicated to assisting her in developing outstanding research skills and successfully completing the planned research. The Career Development Award will provide five years of supervised experience to enable Dr. Smith-Bindman to become an independent investigator in the area of mammographic screening in elderly women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PATIENT MASTECTOMY

ORIENTED

OUTCOMES

OF

PROPHYLACTIC

Principal Investigator & Institution: Geiger, Ann M.; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 946123433 Timing: Fiscal Year 2002; Project Start 01-JAN-2002; Project End 31-DEC-2003 Summary: (provided by applicant): Women at increased risk for breast cancer face a difficult decision about the role of prophylactic mastectomy in their effort to prevent breast cancer. While evidence suggests a substantial reduction in breast cancer risk occurs after prophylactic mastectomy, its effect on other patient-oriented outcomes is unclear. This is particularly true for women undergoing prophylactic mastectomy after breast cancer occurred in the contralateral breast. The proposed study will address this

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deficiency by gathering information on patient-oriented outcomes from women identified for an ongoing study of the efficacy of prophylactic mastectomy in six HMO community-based populations across the United States. The study includes 321 women with bilateral prophylactic mastectomy done for a family history of breast cancer or a personal history of benign breast disease and 1,161 women with breast cancer who underwent unilateral prophylactic mastectomy of the contralateral breast. Using focus groups and a mailed survey, the study will investigate five outcomes important to women considering prophylactic mastectomy: willingness to recommend prophylactic mastectomy to similar women; breast cancer risk-related stress; body image; sexual activity and satisfaction; and health perception, Important covariates that will be considered in the analyses include time since and complications after prophylactic mastectomy and demographic characteristics such as age and education. Results of the survey will be compared to those in similar women who have not undergone prophylactic mastectomy but who are at increased risk for breast cancer due to family or personal history of breast cancer or personal history of benign breast disease. This study will provide critical information for women and their health care providers considering prophylactic mastectomy, a decision currently based on a dearth of information on longterm patient-oriented outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRESURGERY HYPNOSIS IN BREAST CANCER: BENEFITS ANALYSIS Principal Investigator & Institution: Montgomery, Guy; Ruttenberg Cancer Center; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2004; Project Start 01-AUG-2004; Project End 31-JUL-2007 Summary: (provided by applicant): Over 90% of the 211,300 women diagnosed with breast cancer in 2003 will undergo surgery as part of their curative treatment. Despite improvements in pharmacological management, surgical procedures under general anesthesia continue to be associated with clinically significant side effects, chief among which are pain and nausea. These clinical problems are particularly severe following surgical treatment for breast cancer and can require additional pharmacologic intervention, prolong recovery room stay, delay discharge, and lead to unanticipated readmission. Clinical research with other patient populations has indicated that presurgery hypnosis reduces intraoperative complications, postoperative symptoms, and enhances recovery. Preliminary data with breast surgery patients has revealed that a brief presurgery hypnosis with a psychologist can significantly improve post-surgery recovery relative to an attention control condition. Yet to be formally examined is the need for a "live" intervention by a professional: a critical question before translation to everyday clinical practice can be accomplished. Furthermore, the intervention may have long term "side benefits." The study goal is to establish the relative efficacy and cost of "live" and recorded presurgical hypnosis interventions in mastectomy patients. Study innovations include investigation of the effects of moderators and mediators on the differential group effects, as well as an exploration of the side benefits of the intervention for 12 months following surgery. The results of this original research proposal will speak to both clinical application and scientific understanding. The Specific Aims, are to: 1) Investigate the beneficial impact of "live" and recorded presurgical hypnosis interventions in women scheduled for breast cancer surgery; 2) Examine the effects of potential moderating variables of the hypnosis interventions on post-surgery side effects and recovery; 3) Determine whether the beneficial effects of the hypnosis intervention are accounted for (mediated) by differences in presurgery

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cognitive expectations and emotional distress; and 4) Investigate the possibility that the hypnosis intervention has side benefits for women facing breast cancer and its treatment. To achieve these Aims, 125 breast cancer mastectomy patients will be randomly assigned to 5 Groups. Groups differ on Surgery Day intervention (3 levels: "live" hypnosis session; recorded hypnosis session; control) and Hypnosis Practice Period (2 levels: Yes; No - Controls exempted) to determine the relative contributions of "live," recorded, and practice period presurgery hypnosis to reducing side effects and enhancing recovery. The design allows direct comparisons of both clinical impact and cost effectiveness of these interventions in a randomized clinical trial. Mediators and moderators (e.g., hypnotizability) of hypnosis effects will be determined, as well as long-term side benefits of the intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMARY HORMONAL THERAPY FOR DCIS OF THE BREAST Principal Investigator & Institution: Hwang, E Shelley.; Surgery; University of California San Francisco 3333 California Street, Suite 315 San Francisco, Ca 941430962 Timing: Fiscal Year 2004; Project Start 01-AUG-2004; Project End 31-JUL-2009 Summary: (provided by applicant): This Mentored Career Development Award will provide the essential support for a fellowship-trained surgical oncologist to conduct a translational research study evaluating nonsurgical options for preinvasive breast cancer. Patients will be accrued from a tertiary care multidisciplinary breast clinic housed within an NIH designated comprehensive cancer center as well as from an affiliated urban county hospital. Ductal carcinoma in situ (DCIS) will be diagnosed in over 50,000 women in the United States this year. Current breast surgery for DCIS does not differ from that undertaken for invasive breast cancer, despite the minimal metastatic potential for DCIS. A nonsurgical approach in patients with DCIS has previously not been possible as there has been no tool with which to follow DCIS. This prospective clinical trial will determine whether a course of preoperative hormonal therapy with an aromatase inhibitor (AI) in postmenopausal women results in a decrease in DCIS tumor volume as assessed by MRI. Secondary endpoints will consist of changes in immunohistochemical (IHC) and genomic markers of response. 40 postmenopausal patients diagnosed with DCIS on core biopsy without concurrent invasive cancer will be recruited for the study. Eligible women will undergo baseline mammography and MR] at study initiation and again following 3 months of treatment with an AI. Primary endpoints will be tumor volume and tumor diameter, as measured by MRI. Biomarkers consisting of IHC and genomic characteristics of the tumor will be assessed at baseline and at surgical excision to identify predictive and prognostic markers of response. While the current invasive treatments for DCIS are effective, they could represent overtreatment of at least half the women with DCIS who might never progress to invasive cancer. The long-term goal of this proposal is to effectively alter the treatment algorithm of DCIS so that nonsurgical interventions such as hormonal therapy could be instituted in the place of lumpectomy and radiation or mastectomy for at least a subset of patients. This project will provide a rare opportunity to directly evaluate both the clinical and biological response of DCIS to therapy without compromising patient safety or cancer treatment. Through patient participation in such studies, we can establish a foundation from which to plan novel, less aggressive treatment algorithms for patients with the earliest manifestations of breast cancer. We believe that a more tailored strategy for this group of patients is not only possible, but more appropriate than currently offered treatments. If patients could safely be spared from cancer

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progression while avoiding the morbidity of surgery and radiation for DCIS, the full benefit of early breast cancer detection could be realized. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROPHYLACTIC MASTECTOMY: THE PATIENT EXPERIENCE Principal Investigator & Institution: Patenaude, Andrea F.; Director; Dana-Farber Cancer Institute 44 Binney St Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 12-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Prophylactic mastectomy (PM) has been shown to reduce the risk of breast cancer 90% in women at high and moderate risk, but its use is limited by low acceptability. Researchers caution that this is a highly personal decision, but patients and providers have little data about psychosocial outcomes of PM. Project goals are: a. To describe the self-perceived benefits of PM and the physical, emotional, and interpersonal impacts; b. To describe the impact of cancer family history and family communication on decision-making for and outcomes of PM; c. To utilize case comparisons to assess the relative influence of medical, psychological, and family factors in determining positive or adverse outcomes of PM; and, d. To produce a monograph based on the qualitative analysis and emphasizing first-person narratives for use by women considering PM and as a tool for health care providers in advising their patients. This project will qualitatively analyze 108 interview narratives from a previouslyfunded research project on psychological consultation needs of women considering or recovering from PM. The sample includes women with cancer who underwent unilateral PM (n=50), unaffected women who chose bilateral PM (n=21), and women considering PM (n=37). Analysis will utilize issue-oriented and cross-case research methods. Modal and exceptional cases will be developed. A monograph utilizing the narratives and organizing them into user-friendly topic areas for patients will be developed. Reports for providers will also hopefully enhance advice to patients. Future research may assess utility of this material for women considering PM and for health care providers. Data from the project will inform hypothesis formation for future studies of PM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PROPHYLACTIC SURGERY IN CARRIERS OF BRCA1 AND BRCA2 Principal Investigator & Institution: Rebbeck, Timothy R.; Associate Professor; Biostatistics and Epidemiology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 15-SEP-2000; Project End 31-AUG-2005 Summary: (Adapted from the Investigator's Abstract) The availability of genetic testing for inherited mutations in the BRCA1 and BRCA2 genes provides potentially valuable information to women at high risk of breast or ovarian cancer. Unfortunately, carriers of these mutations have relatively few clinical management options to reduce their cancer risk. The investigators propose a study in response to the NCI's program announcement "Clinical Epidemiology Studies in Hereditary Breast/Ovarian Cancer". They propose to evaluate the role of prophylactic surgery in reducing breast and ovarian cancer risk and mortality in BRCA1 and BRCA2 mutation carriers. Specifically, they propose: 1) to estimate the reduction in cancer risk following prophylactic surgery; 2) to estimate the reduction in cancer mortality following prophylactic surgery; 3) to evaluate differences in type of prophylactic mastectomy in breast cancer risk reduction; and 4) evaluate the psychosocial implications of prophylactic mastectomy or prophylactic oophorectomy,

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including measurement of mental health, satisfaction and quality of life. Two groups of women will be studied. Surgical subjects are those women who have undergone a bilateral prophylactic mastectomy (BPM) or prophylactic oophorectomy (BPO). Women will be followed-up over the course of this project to identify new occurrences of cancer surgery, or other relevant events. This follow-up will also yield longitudinal information about psychosocial adjustment to surgery including distress, depression, quality of life, satisfaction, and vulnerability to subsequent events. The risk of cancer in women who have undergone prophylactic surgery will be compared with cancer risk in controls that have no history of BPM or BPO. All study participants will carry documented diseasecausing germline BRCA1/2 mutations. Analyses will be undertaken to specifically evaluate risk and mortality reduction following surgery. As recognized by this program announcement, women who have inherited germline BRCA1/2 mutations and are at extremely high risk of breast and ovarian cancer "must make decisions about managing their cancer risk Ywith only limited scientific information about Ythe efficacy of prophylactic surgery". The announcement further recognizes that "While prospective studies will eventually provide definitive answers to these question, there is an immediate need to address these issues through retrospective studies based on existing resources such as tissue banks and high-risk clinic registries and research projects". This proposal will address that immediate and important clinical need. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROPHYLCTIC MASTECTOMY IN HEREDITARY BREAST CANCER Principal Investigator & Institution: Hartmann, Lynn C.; Professor of Oncology; Mayo Clinic Coll of Medicine, Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 31-JUL-2004 Summary: (Adapted from the Investigator's Abstract) Women with hereditary breast cancer risk have limited options for management. Close cancer screening or prophylactic mastectomy (PM) is most commonly utilized. Chemoprevention with tamoxifen is another option, but data regarding long-term risk reduction are incomplete and conflicting. Unfortunately, there are insufficient data regarding the expected outcomes with either surveillance or PM. Breast cancers on the chest wall have been documented following PM, developing in residual glandular epithelium. Thus, the extent of risk reduction with PM, if any, has been questioned. The program announcement "Clinical Epidemiology Studies in Hereditary Breast/Ovarian Cancer" describes the "immediate need to address these issues through retrospective studies based on existing resources". The Mayo Clinic has served as a referral center for specialized surgeries, including PM, for many years. They have access to two groups of high-risk women who elected PM: unaffected women who have elected contralateral PM and women treated with therapeutic mastectomy for their first breast cancer who elected contralateral, unilateral PM. With the work proposed, the investigators will clarify the magnitude of breast cancer risk reduction with PM using a combination of methods, including standardized morbidity ratios using the Gail and Anderson models to predict the expected number of events, and a relative risk using sisters of women who had PM as a reference group. We will also define short- and long-term complications following PM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SCREENING FOR BREAST CANCER USING MOLECULAR SIGNATURES Principal Investigator & Institution: Yeatman, Timothy J.; Professor of Surgery, Biochemistry and m; H. Lee Moffitt Cancer Ctr & Research Ins and Research Institute, Inc. Tampa, Fl 336129497 Timing: Fiscal Year 2003; Project Start 18-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Currently, there are no molecular screening tools available that can identify the patients at high risk for breast cancer development or local recurrence. Of interest, however, is that numerous studies have suggested the existence of genetic alterations (LOH, chromosomal abnormalities, specific gene mutations) in histological non-malignant breast tissue, identical to those found in adjacent tumor, in up to 60% of patients. These data suggest that there are numerous genetic alterations that accumulate prior to the histological development of cancer, although the frequency, identity, and location of these alterations within the normal appearing breast are still poorly understood. We hypothesize that genetic alterations exist in non-malignant breast tissue and that they will produce phenotypic alterations in gene expression that may be useful in predicting breast cancer risk. cDNA microarrays will be used to identify a set of genes whose expression profile predicts cancer risk in histologically non-malignant breast tissue. As a first step towards the detection of molecular screening markers for sporadic breast cancer, we plan to investigate the nonmalignant breast tissue adjacent to cancer in patients known to be at increased risk for cancer recurrence both in the ipsilateral and contralateral breasts. This will be accomplished by a comprehensive analysis of genetic, epigenetic and gene expression alterations performed simultaneously on breast tumors and normal associated breast tissue. Whereas the principal goal is identifying a gene expression pattern for normal tissues at high risk for developing cancer, we will also develop rich databases to decipher patterns characterizing breast tumors and their clinicopathologic features (including survival and recurrence data) as well as benign breast pathology. We then plan to evaluate the behavior of these high-risk genes in patients undergoing adjuvant therapy to reduce cancer risk. Specific Aim I. To identify the frequency and geographic distribution of abnormal genetic (DNA), epigenetic (DNA methylation) and molecular (RNA) signatures, within zones of histologically non-malignant breast tissue adjacent to invasive cancer derived from mastectomy specimens (n = 100). Specific Aim II. Determine if genetic and epigenetic alterations as well as gene expression alterations identified in Aim I can be detected in the contralateral normal breast in patients undergoing bilateral mastectomy for ipsilateral cancer(n = 50). Specific Aim III. To identify genetic, epigenetic and gene expression alterations in normal and tumor tissues from patients undergoing mastectomy for intraductal neoplasia (n = 50). Specific Aim IV. Determine if the expression of high-risk gene sets (identified in Aims I, II, and III) in the contralateral, untreated breast are affected by adjuvant chemotherapy and/or hormonal therapy in serial biopsy specimens (n = 50) taken pre- and post- therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SURGICAL TREAMENT FOR EARLY STATE BREAST CANCER Principal Investigator & Institution: Katz, Steven J.; Associate Professor; Internal Medicine; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 10-MAY-2001; Project End 30-APR-2004

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Summary: (provided by applicant): The incidence of ductal carcinoma in situ of the breast (DCIS) has risen dramatically among women in the United States since the early 1980's. Survival for DCIS is very high regardless of the type of surgical treatment and, for patients with favorable histopathology, the risk of local recurrence post-lumpectomy is very low. There are, however, large variations in the surgical management of DCIS patients. Although many women with DCIS appear to be ideal candidates for breast conserving therapy, mastectomy rates for this particular form of breast cancer remain high. This has led to concerns about "over treatment" among clinicians and patient advocacy groups alike. Unfortunately, we do not know enough about the factors that influence breast cancer surgery choice and the processes by which complex treatment decisions are made to fully inform these debates. Furthermore, we have little information about outcomes such as patient satisfaction or subsequent quality of life for women with DCIS, and to what extent these important outcomes may differ between women with DCIS and those with invasive breast cancer. We propose a multi-center population-based study to examine a broad array of determinants (external influences, clinical factors, predisposing/enabling factors, and patient knowledge and attitudinal factors) that are associated with three outcomes for women recently diagnosed with breast cancer: 1) surgical treatment choice (mastectomy vs lumpectomy with or without radiation); 2) short-term patient satisfaction with the treatment decision and the treatment-making process; and 3) health-related quality of life. The study will be conducted using a population-based sample of breast cancer patients in three racially and socioeconomically diverse urban areas in the United States (Detroit, Los Angeles and Atlanta). An initial sample of 2900 women recently diagnosed will be selected prospectively from three Surveillance, Epidemiology and End Results (SEER) catchment areas over a 15-month period using a rapid case ascertainment process. This sample will be stratified by level of disease (1450 women with DCIS and 1450 with invasive disease), and we will oversample African-American women. Eligible women consenting to be in the study will receive a standardized survey questionnaire in the mail for selfadministration. Based on our pilot experience in the Detroit SEER site, we expect that approximately 75 percent of patients eligible for the study will complete questionnaires (N=l880). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SIGNALING

TRAUMATIC

PAINFUL

NEUROPATHY

AND

CALCIUM

Principal Investigator & Institution: Hogan, Quinn H.; Anesthesiology; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532260509 Timing: Fiscal Year 2002; Project Start 15-JUL-2001; Project End 30-JUN-2005 Summary: Nerve injury results in chronic pain following surgery, such as amputation, thoracotomy and mastectomy, as well as in cancer, degenerative conditions and metabolic diseases. The pain is typically intense, persistent and poorly responsive to currently available therapies. Significant progress has been made in understanding the pathophysiology of neuropathic pain, but there has been minimal direct examination of cell membrane and ion channel mechanisms. Increased excitability of neuronal somata of primary afferent neurons is a component of the pain generating process following nerve injury. Intracellular Ca2+ is the dominant second messenger regulating neural activity including electrogenesis, synaptic transmission, gene expression, and cell growth and death, yet no studies of membrane Ca2+ current (ICa) and intracellular Ca2+ levels following nerve injury have been reported. Using tissue from animals showing neuropathic pain behavior following nerve trauma, our novel preliminary

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findings from whole-cell patch clamp experiments reveal decreased membrane ICa in dorsal root ganglion (DRG) neurons with axons projecting to a sciatic nerve injury site. We have also confirmed in intact DRGs that decreased ICa substantially elevates neuronal excitability. The aim of this proposal is to examine cellular mechanisms of neuropathic pain by determining the effects of nerve injury on ICa and intracellular Ca2+ in primary afferent neurons that may mediate hyperalgesia. We will employ a clinically relevant model of pain following nerve injury to characterize altered calcium channel function in sensory neurons, identify the channel subtype affected by injury, describe the changes in calcium channel expression with immunocytochemistry, examine intracellular Ca2+ regulation in spatial and temporal detail using Ca2+ microfluorimetry, and demonstrate the effect of decreased Ca2+ flux on membrane excitability in dissociated cells and intact tissue. The proposed studies will test the hypothesis that, in a subgroup of DRG neurons, axonal injury decreases inward Ca2+ current, which in turn decreases intracellular Ca2+ concentration both directly and through diminished Ca2+-induced Ca2+ release. The decrease in intracellular Ca2+ diminishes the Ca 2+-activated K+ current, thereby decreasing membrane afterhyperpolarization and ultimately producing elevated primary afferent excitability. Decreased ICa has not previously been explored as a mechanism of sensory change following nerve injury. This translational research will be valuable in identifying pharmacologically and anatomically specific sites for application of agents to treat neuropathic pain while preserving desired sensory and motor function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: USE OF REGRESSION MODELS IN COST-EFFECTIVENESS ANALYSIS Principal Investigator & Institution: Gardiner, Joseph C.; Epidemiology; Michigan State University 301 Administration Bldg East Lansing, Mi 48824 Timing: Fiscal Year 2004; Project Start 01-MAY-2004; Project End 30-APR-2007 Summary: (PROVIDED BY APPLICANT): In an era of economic constraints, methods for assessing costs and outcomes of health care programs, and comparing costs with outcomes of competing interventions have come to the forefront in the pursuit of optimizing health benefits from a specified budget, or in finding the lowest cost strategy for a specified health effect. The objective of this research is to develop, test, and apply innovative statistical methods for analyses of health care costs, utilization, and outcomes with the goal of informing decision-making in the allocation of health care resources. We propose a unified stochastic framework in which costs of an intervention are incurred dynamically through resource use as a patient's health history unfolds over time. Our models recognize limitations in data that are typically present in epidemiologic and clinical studies. We incorporate observable characteristics of patients, such as demographics and comorbid conditions, and account for unmeasured variables that might influence both cost and health outcomes. We estimate summary measures commonly used in economic evaluations (e.g., life expectancy, quality-adjusted life years, net present value, net health benefit, and cost-effectiveness ratios) and derive the basis for statistical inference on these measures. We then test the performance and sensitivity of our procedures with both real and simulated data. We propose applications of our methods using national state databases and ongoing clinical studies. 1) Using the Nationwide Inpatient Sample (NIS), we will estimate inpatient costs in relation to comorbidity, patient demographics, and clinical attributes: (a) for patients with acute myocardial infarction (AMI) undergoing cardiac procedures (coronary artery bypass surgery, percutaneous coronary intervention); (b) for women with breast cancer,

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undergoing mastectomy or lumpectomy; (c) for patients with colorectal cancer undergoing colectomy. 2) Using the Michigan Medicaid and Medicare claims database for 1996 to 2000, we examine the impact of treatments, cancer stage at diagnosis, patient demographics, and comorbid illnesses on cost and survival in patients with breast, colorectal, lung, and prostate cancer. 3) In a trial of a nurse-managed protocol emphasizing strong patient-provider relationships in high-utilizing patients with no evidence of organic disease, we will estimate costs and cost-effectiveness in relation to improvements in quality of life (QOL), mental and physical health functioning and patient satisfaction. 4) In a trial of an intervention in women undergoing surgery for breast cancer, we assess costs, health care utilization, QOL, and return to presurgery physical and mental health functioning. 5) In the Heart After Hospital Recovery Planner study of patients after AMI, we examine the impact on QOL of an intervention aimed at efficient use of resources in health education and management. This application contributes to an international research effort to develop rigorous methods for analyses of health care costs and outcomes, and, applied to clinical and epidemiologic studies, it directly translates research into practice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “mastectomy” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for mastectomy in the PubMed Central database: •

Clinical practice guidelines for the care and treatment of breast cancer: Mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer (summary of the 2002 update). by Scarth H, Cantin J, Levine M.; 2002 Jul 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=117094

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Expression of LRP and MDR1 in locally advanced breast cancer predicts axillary node invasion at the time of rescue mastectomy after induction chemotherapy. by Schneider J, Gonzalez-Roces S, Pollan M, Lucas R, Tejerina A, Martin M, Alba A.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=30705

3 Adapted 4

from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with mastectomy, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “mastectomy” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for mastectomy (hyperlinks lead to article summaries): •

A 40-year delayed locoregional recurrence of breast carcinoma following mastectomy. Author(s): Joseph KA, El-Tamer M, Ditkoff BA, Komenaka I, Horowitz L, Schnabel F. Source: The American Surgeon. 2003 November; 69(11): 1015-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14627268

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A comparative study of modified radical mastectomy using harmonic scalpel and electrocautery. Author(s): Deo SV, Shukla NK, Asthana S, Niranjan B, Srinivas G. Source: Singapore Med J. 2002 May; 43(5): 226-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12188072

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A positive margin is not always an indication for radiotherapy after mastectomy in early breast cancer. Author(s): Truong PT, Olivotto IA, Speers CH, Wai ES, Berthelet E, Kader HA. Source: International Journal of Radiation Oncology, Biology, Physics. 2004 March 1; 58(3): 797-804. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14967436

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A qualitative study looking at the psychosocial implications of bilateral prophylactic mastectomy. Author(s): Bebbington Hatcher M, Fallowfield LJ. Source: Breast (Edinburgh, Scotland). 2003 February; 12(1): 1-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14659349

6

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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•

A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Author(s): Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. Source: Anesthesiology. 2002 September; 97(3): 560-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12218520

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A study of the patient factors affecting reconstruction after mastectomy for breast carcinoma. Author(s): Panieri E, Lazarus D, Dent DM, Hudson DA, Murray E, Werner ID. Source: The American Surgeon. 2003 February; 69(2): 95-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12641345

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Acceptability of prophylactic mastectomy in cancer-prone women. Author(s): Eisinger F, Julian-Reynier C, Sobol H, Stoppa-Lyonnet D, Lasset C, Nogues C. Source: Jama : the Journal of the American Medical Association. 2000 January 12; 283(2): 202-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10634335

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Adjuvant radiation after modified radical mastectomy for breast cancer fails to prolong survival. Author(s): Geisler DP, Boyle MJ, Malnar KF, Melichar RM, McGee JM, Nolen MG, Broughan TA. Source: The American Surgeon. 2000 May; 66(5): 452-8; Discussion 458-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10824745

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Adjuvant radiation therapy following mastectomy for breast cancer. Author(s): Hiraoka M, Mitsumori M, Shibuya K. Source: Breast Cancer. 2002; 9(3): 190-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12185328

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Adjuvant radiotherapy after mastectomy for pT1-pT2 node negative (pN0) breast cancer: is it worth the effort? Author(s): Voordeckers M, Van de Steene J, Vinh-Hung V, Storme G. Source: Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology. 2003 September; 68(3): 227-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13129629

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Ambulatory mastectomy. Author(s): Dooley WC. Source: American Journal of Surgery. 2002 December; 184(6): 545-8; Discussion 548-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12488162

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An application of the LeJour vertical mammaplasty pattern for skin-sparing mastectomy: a preliminary report. Author(s): Malata CM, Hodgson EL, Chikwe J, Canal AC, Purushotham AD. Source: Annals of Plastic Surgery. 2003 October; 51(4): 345-50; Discussion 351-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14520058

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An approach to the repair of partial mastectomy defects. Author(s): Clough KB, Kroll SS, Audretsch W. Source: Plastic and Reconstructive Surgery. 1999 August; 104(2): 409-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10654684

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Anaesthesia for bilateral mastectomy in a Jehovah's Witness patient with epilepsy and review of alternatives to homologous blood transfusion. Author(s): Adudu OP. Source: Middle East J Anesthesiol. 2002 February; 16(4): 443-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11949206

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Analysis of nipple/areolar involvement with mastectomy: can the areola be preserved? Author(s): Simmons RM, Brennan M, Christos P, King V, Osborne M. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 2002 March; 9(2): 165-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11888874

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Approaching the dilemma between prophylactic bilateral mastectomy or oophorectomy for breast and ovarian cancer prevention in carriers of BRCA1 or BRCA2 mutations. Author(s): Roukos DH, Agnanti NJ, Paraskevaidis E, Kappas AM. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 2002 December; 9(10): 941-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12464584

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Are breast cancer screening programmes increasing rates of mastectomy? Observational study. Author(s): Paci E, Duffy SW, Giorgi D, Zappa M, Crocetti E, Vezzosi V, Bianchi S, Cataliotti L, del Turco MR. Source: Bmj (Clinical Research Ed.). 2002 August 24; 325(7361): 418. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12193357

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Areola-sparing mastectomy with immediate breast reconstruction. Author(s): Simmons RM, Hollenbeck ST, Latrenta GS. Source: Annals of Plastic Surgery. 2003 December; 51(6): 547-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14646645

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Assessment of utility of ductal lavage and ductoscopy in breast cancer-a retrospective analysis of mastectomy specimens. Author(s): Badve S, Wiley E, Rodriguez N. Source: Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc. 2003 March; 16(3): 206-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12640099

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Axillary lymph node status, but not tumor size, predicts locoregional recurrence and overall survival after mastectomy for breast cancer. Author(s): Beenken SW, Urist MM, Zhang Y, Desmond R, Krontiras H, Medina H, Bland KI. Source: Annals of Surgery. 2003 May; 237(5): 732-8; Discussion 738-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12724640

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Benefit of prophylactic mastectomy for women with BRCA1 or BRCA2 mutations. Author(s): Swanson GP. Source: JAMA: the Journal of the American Medical Association. 2000 June 21; 283(23): 3070-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10865296

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Benefit of prophylactic mastectomy for women with BRCA1 or BRCA2 mutations. Author(s): Miller LA, Singer ME. Source: Jama : the Journal of the American Medical Association. 2000 June 21; 283(23): 3070; Author Reply 3071-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10865295

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Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment. Author(s): Cocquyt VF, Blondeel PN, Depypere HT, Van De Sijpe KA, Daems KK, Monstrey SJ, Van Belle SJ. Source: British Journal of Plastic Surgery. 2003 July; 56(5): 462-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12890459

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Bilateral brachial plexus palsy after a right-side modified radical mastectomy with immediate TRAM flap reconstruction. Author(s): Grunwald Z, Moore JH, Schwartz GF. Source: The Breast Journal. 2003 January-February; 9(1): 41-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12558670

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Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. Author(s): Rebbeck TR, Friebel T, Lynch HT, Neuhausen SL, van 't Veer L, Garber JE, Evans GR, Narod SA, Isaacs C, Matloff E, Daly MB, Olopade OI, Weber BL. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2004 March 15; 22(6): 1055-62. Epub 2004 February 23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14981104

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Breast cancer after bilateral subcutaneous mastectomy in a female-to-male transsexual. Author(s): Burcombe RJ, Makris A, Pittam M, Finer N. Source: Breast (Edinburgh, Scotland). 2003 August; 12(4): 290-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14659317

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Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. Author(s): Meijers-Heijboer H, van Geel B, van Putten WL, Henzen-Logmans SC, Seynaeve C, Menke-Pluymers MB, Bartels CC, Verhoog LC, van den Ouweland AM, Niermeijer MF, Brekelmans CT, Klijn JG. Source: The New England Journal of Medicine. 2001 July 19; 345(3): 159-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11463009

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Breast cancer pathology practices among Medicare patients undergoing unilateral extended simple mastectomy. Author(s): Imperato PJ, Waisman J, Wallen M, Llewellyn CC, Pryor V. Source: Journal of Women's Health & Gender-Based Medicine. 2002 July-August; 11(6): 537-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12225627

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Breast cancer presenting with the syndrome of inappropriate secretion of antidiuretic hormone after simple mastectomy. Author(s): Hashida H, Honda T, Morimoto H, Sasaki T, Aibara Y, Yamanaka M. Source: Intern Med. 2001 September; 40(9): 911-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11579955

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Breast cancer risk perception among women who have undergone prophylactic bilateral mastectomy. Author(s): Metcalfe KA, Narod SA. Source: Journal of the National Cancer Institute. 2002 October 16; 94(20): 1564-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12381709

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Breast conservation, mastectomy and axillary surgery in New South Wales women in 1992 and 1995. Author(s): Kricker A, Haskill J, Armstrong BK. Source: British Journal of Cancer. 2001 September 1; 85(5): 668-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11531249

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Breast reconstruction after mastectomy: a survey of general surgeons in Singapore. Author(s): Lim J, Low SC, Hoe M. Source: Anz Journal of Surgery. 2001 April; 71(4): 207-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11355726

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Breast reconstruction after subcutaneous mastectomy for extensive benign masses. Author(s): Aygit AC, Altan A, Afsar Y. Source: The Breast Journal. 2004 March-April; 10(2): 163-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15009050

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Breast reconstruction by tissue expansion. A retrospective technical review of 197 two-stage delayed reconstructions following mastectomy for malignant breast disease in 189 patients. Author(s): Collis N, Sharpe DT. Source: British Journal of Plastic Surgery. 2000 January; 53(1): 37-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10657447

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Breast reconstruction following mastectomy. Author(s): Ross DA. Source: Anz Journal of Surgery. 2003 September; 73(9): 673-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12956777

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Breast reconstruction following mastectomy: current status in Australia. Author(s): Sandelin K, King E, Redman S. Source: Anz Journal of Surgery. 2003 September; 73(9): 701-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12956785

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Breast reconstruction with TRAM flap after subcutaneous mastectomy for injected material (siliconoma). Author(s): Lai YL, Weng CJ, Noordhoff MS. Source: British Journal of Plastic Surgery. 2001 June; 54(4): 331-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11355989

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Breast surgery in the 'Arimidex, Tamoxifen Alone or in Combination' (ATAC) trial: American women are more likely than women from the United Kingdom to undergo mastectomy. Author(s): Locker GY, Sainsbury JR, Cuzick J; ATAC Trialists' Group. Source: Cancer. 2004 August 15; 101(4): 735-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15305403

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Breast-conserving surgery has equivalent effect as mastectomy on stage I breast cancer prognosis only when followed by radiotherapy. Author(s): Rapiti E, Fioretta G, Vlastos G, Kurtz J, Schafer P, Sappino AP, Spiliopoulos A, Renella R, Neyroud-Caspar I, Bouchardy C. Source: Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology. 2003 December; 69(3): 277-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14644487

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Breast-conserving therapy versus modified radical mastectomy in the treatment of early breast cancer in Japan. Author(s): Horiguchi J, Iino Y, Koibuchi Y, Yokoe T, Takei H, Yamakawa M, Nakajima T, Oyama T, Ando T, Ishida T, Endo K, Takai Y, Suzuki H, Fujii T, Yokomori T, Morishita Y. Source: Breast Cancer. 2002; 9(2): 160-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12016396

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Change in serum oestradiol and testosterone concentrations after mastectomy for breast cancer with high aromatase activity. Author(s): Tsunoda Y, Shimizu Y, Tsunoda A, Kamiya K, Sawada T, Kusano M, Ohta H. Source: The European Journal of Surgery = Acta Chirurgica. 2001 March; 167(3): 234-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11316415

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Chest wall recurrence after mastectomy does not always portend a dismal outcome. Author(s): Chagpar A, Meric-Bernstam F, Hunt KK, Ross MI, Cristofanilli M, Singletary SE, Buchholz TA, Ames FC, Marcy S, Babiera GV, Feig BW, Hortobagyi GN, Kuerer HM. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 2003 July; 10(6): 628-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12839847

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Circumareolar mastectomy in female-to-male transsexuals and large gynecomastias: a personal approach. Author(s): Colic MM, Colic MM. Source: Aesthetic Plastic Surgery. 2000 November-December; 24(6): 450-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11246435

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Clinical experience of prophylactic mastectomy followed by immediate breast reconstruction in women at hereditary risk of breast cancer (HB(O)C) or a proven BRCA1 and BRCA2 germ-line mutation. Author(s): Contant CM, Menke-Pluijmers MB, Seynaeve C, Meijers-Heijboer EJ, Klijn JG, Verhoog LC, Tjong Joe Wai R, Eggermont AM, van Geel AN. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2002 September; 28(6): 627-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12359199

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Clinical follow-up after bilateral risk reducing ('prophylactic') mastectomy: mental health and body image outcomes. Author(s): Hopwood P, Lee A, Shenton A, Baildam A, Brain A, Lalloo F, Evans G, Howell A. Source: Psycho-Oncology. 2000 November-December; 9(6): 462-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11180581

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Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy. Author(s): Truong PT, Olivotto IA, Whelan TJ, Levine M; Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2004 April 13; 170(8): 1263-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15078851

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Clinical practice guidelines for the care and treatment of breast cancer: mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer (summary of the 2002 update). Author(s): Scarth H, Cantin J, Levine M; Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 July 23; 167(2): 154-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12160123

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Clinical, pathological and genetic features of women at high familial risk of breast cancer undergoing prophylactic mastectomy. Author(s): Scott CI, Iorgulescu DG, Thorne HJ, Henderson MA, Phillips KA; Kathleen Cuningham Foundation Consortium for Familial Breast Cancer (kConFab). Source: Clinical Genetics. 2003 August; 64(2): 111-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12859406

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Comparison of remifentanil and fentanyl in patients undergoing modified radical mastectomy or total hysterectomy. Author(s): Guo X, Yi J, Ye T, Luo A, Huang Y, Ren H. Source: Chinese Medical Journal. 2003 September; 116(9): 1386-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14527372

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Comparison of two radiation dose schedules in post mastectomy carcinoma of the breast. Author(s): Goel A, Kaushal V, Hooda HS, Das BP. Source: Indian Journal of Medical Sciences. 2000 July; 54(7): 278-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11143847

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Complex regional pain syndrome post mastectomy. Author(s): Graham LE, McGuigan C, Kerr S, Taggart AJ. Source: Rheumatology International. 2002 January; 21(4): 165-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11843174

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Conservative treatment vs. mastectomy without radiotherapy in aged women with breast cancer--a prospective and randomized trial. Author(s): Gori J, Castano R, Engel H, Toziano M, Fischer C, Maletti G. Source: Zentralblatt Fur Gynakologie. 2000; 122(6): 311-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10904994

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Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy. Author(s): Doss NW, Ipe J, Crimi T, Rajpal S, Cohen S, Fogler RJ, Michael R, Gintautas J. Source: Anesthesia and Analgesia. 2001 June; 92(6): 1552-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11375845

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Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Author(s): Peralta EA, Ellenhorn JD, Wagman LD, Dagis A, Andersen JS, Chu DZ. Source: American Journal of Surgery. 2000 December; 180(6): 439-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11182394

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Controversies regarding the use of radiation after mastectomy in breast cancer. Author(s): Buchholz TA, Strom EA, Perkins GH, McNeese MD. Source: The Oncologist. 2002; 7(6): 539-46. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12490741

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Conventional or adhesive external breast prosthesis? A prospective study of the patients' preference after mastectomy. Author(s): Thijs-Boer FM, Thijs JT, van de Wiel HB. Source: Cancer Nursing. 2001 June; 24(3): 227-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11409067

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Cost comparison of mastectomy versus breast-conserving therapy for early-stage breast cancer. Author(s): Barlow WE, Taplin SH, Yoshida CK, Buist DS, Seger D, Brown M. Source: Journal of the National Cancer Institute. 2001 March 21; 93(6): 447-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11259470

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Current status of prophylactic mastectomy. Author(s): Ghosh K, Hartmann LC. Source: Oncology (Huntingt). 2002 October; 16(10): 1319-25; Discussion 1325, 1329-30, 1332. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12435203

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Cyclooxygenase-2 expression correlates with diminished survival in invasive breast cancer treated with mastectomy and radiotherapy. Author(s): O'Connor JK, Avent J, Lee RJ, Fischbach J, Gaffney DK. Source: International Journal of Radiation Oncology, Biology, Physics. 2004 March 15; 58(4): 1034-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15001242

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Cystosarcoma phyllodes: mastectomy, lumpectomy, or lumpectomy plus irradiation. Author(s): August DA, Kearney T. Source: Surgical Oncology. 2000 August; 9(2): 49-52. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11094322

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Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive or BRCA2-positive patients. Author(s): Grann VR, Panageas KS, Whang W, Antman KH, Neugut AI. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1998 March; 16(3): 979-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9508180

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Decision analysis--effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations. Author(s): Schrag D, Kuntz KM, Garber JE, Weeks JC. Source: The New England Journal of Medicine. 1997 May 15; 336(20): 1465-71. Erratum In: N Engl J Med 1997 August 7; 337(6): 434. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9148160

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Defining the role of post-mastectomy radiotherapy: the new evidence. Author(s): Pierce LJ, Lichter AS. Source: Oncology (Huntingt). 1996 July; 10(7): 991-1002; Discussion 1006-7, 1011. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8837118

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Delayed infection of a lymphocele following mastectomy with immediate breast reconstruction: report of a case. Author(s): Yamada T, Morita K, Yamamura K, Yagi S, Morishita M, Kitagawa S, Nakagawa M. Source: Surgery Today. 2000; 30(10): 914-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11059732

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Delayed shoulder exercises in reducing seroma frequency after modified radical mastectomy: a prospective randomized study. Author(s): Schultz I, Barholm M, Grondal S. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 1997 June; 4(4): 293-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9181227

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Deltopectoral flap for reconstruction of male breast after radical mastectomy for cancer in a patient on hemodialysis. Author(s): Nakao A, Saito S, Naomoto Y, Matsuoka J, Tanaka N. Source: Anticancer Res. 2002 July-August; 22(4): 2477-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12174947

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Despite efficacy of prophylactic mastectomy, procedure finds few enthusiasts. Author(s): Newman L. Source: Journal of the National Cancer Institute. 2001 March 7; 93(5): 338-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11238690

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Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. Author(s): Voogd AC, Nielsen M, Peterse JL, Blichert-Toft M, Bartelink H, Overgaard M, van Tienhoven G, Andersen KW, Sylvester RJ, van Dongen JA; Danish Breast Cancer Cooperative Group. Breast Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2001 March 15; 19(6): 1688-97. Erratum In: J Clin Oncol 2001 May 1; 19(9): 2583. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11250998

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Dissemination of clinical results. Mastectomy versus lumpectomy and radiation therapy. Author(s): Young WW, Marks SM, Kohler SA, Hsu AY. Source: Medical Care. 1996 October; 34(10): 1003-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8843927

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DNA ploidy and cytonuclear area of peritumoral and paratumoral samples of mastectomy specimens: a useful prognostic marker? Author(s): Chavez-Uribe EM, Vinuela JE, Cameselle-Teijeiro J, Forteza J, Punal JA, Otero JL, Puente-Dominguez JL. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(1): 37-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12022369

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Do surgical oncologists achieve lower rates of local-regional recurrence in node positive breast cancer treated with mastectomy alone? Author(s): Latosinsky S, Bear HD. Source: Journal of Surgical Oncology. 2001 September; 78(1): 2-7; Discussion 8-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11519060

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Does intraductal breast cancer spread in a segmental distribution? An analysis of residual tumour burden following segmental mastectomy using tumour bed biopsies. Author(s): Jenkinson AD, Al-Mufti RA, Mohsen Y, Berry MJ, Wells C, Carpenter R. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2001 February; 27(1): 21-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11237487

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Does open biopsy before mastectomy affect the prevalence of so-called axillary lymph node micrometastases detected immunohistochemically. Author(s): De Petris G, Gnepp DR, Henley JD. Source: Archives of Pathology & Laboratory Medicine. 1999 February; 123(2): 140-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10050787

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Does prophylactic mastectomy in women at high risk for breast cancer provide a psychological benefit? Author(s): Bielanski TE. Source: The Journal of Family Practice. 2001 April; 50(4): 366. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11300990

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Dora's story. Dora Paraskevopoulou, president of the Hellenic Society of Mastectomy, Greece. Author(s): Paraskevopoulou D. Source: European Journal of Cancer Care. 1996 March; 5(1 Suppl): 4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8715515

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Dormancy of mammary carcinoma after mastectomy. Author(s): Karrison TG, Ferguson DJ, Meier P. Source: Journal of the National Cancer Institute. 1999 January 6; 91(1): 80-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9890174

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Double-peaked time distribution of mortality for breast cancer patients undergoing mastectomy. Author(s): Demicheli R, Valagussa P, Bonadonna G. Source: Breast Cancer Research and Treatment. 2002 September; 75(2): 127-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12243505

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Drive-through mastectomy and breast reconstruction. Author(s): Kroll SS. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 2000 July; 7(6): 399-401. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10894132

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Ductal carcinoma in situ recurrent on the chest wall after mastectomy. Author(s): Deutsch M. Source: Clin Oncol (R Coll Radiol). 1999; 11(1): 61-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10194590

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Ductal lavage in patients undergoing mastectomy for mammary carcinoma: a correlative study. Author(s): Brogi E, Robson M, Panageas KS, Casadio C, Ljung BM, Montgomery L. Source: Cancer. 2003 November 15; 98(10): 2170-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14601086

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Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer. Author(s): Kitamura K, Ishida M, Inoue H, Kinoshita J, Hashizume M, Sugimachi K. Source: Surgery. 2002 January; 131(1 Suppl): S324-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11821832

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Eccentric skin resection and purse-string closure for skin reduction with mastectomy for gynecomastia. Author(s): Smoot EC 3rd. Source: Annals of Plastic Surgery. 1998 October; 41(4): 378-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9788217

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Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma. Author(s): Kroman N, Holtveg H, Wohlfahrt J, Jensen MB, Mouridsen HT, Blichert-Toft M, Melbye M. Source: Cancer. 2004 February 15; 100(4): 688-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14770422

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Effect of fibrin glue on lymphatic drainage after modified radical mastectomy: a prospective randomized trial. Author(s): Dinsmore RC, Harris JA, Gustafson RJ. Source: The American Surgeon. 2000 October; 66(10): 982-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11261630

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Effect of fibrin glue on lymphatic drainage and on drain removal time after modified radical mastectomy: a prospective randomized study. Author(s): Ulusoy AN, Polat C, Alvur M, Kandemir B, Bulut F. Source: The Breast Journal. 2003 September-October; 9(5): 393-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12968960

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Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. Author(s): Hartmann LC, Sellers TA, Schaid DJ, Frank TS, Soderberg CL, Sitta DL, Frost MH, Grant CS, Donohue JH, Woods JE, McDonnell SK, Vockley CW, Deffenbaugh A, Couch FJ, Jenkins RB. Source: Journal of the National Cancer Institute. 2001 November 7; 93(21): 1633-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11698567

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Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. Author(s): Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold PG, Petty PM, Sellers TA, Johnson JL, McDonnell SK, Frost MH, Jenkins RB. Source: The New England Journal of Medicine. 1999 January 14; 340(2): 77-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9887158

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Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. Author(s): McDonnell SK, Schaid DJ, Myers JL, Grant CS, Donohue JH, Woods JE, Frost MH, Johnson JL, Sitta DL, Slezak JM, Crotty TB, Jenkins RB, Sellers TA, Hartmann LC. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2001 October 1; 19(19): 3938-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11579114

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Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy. Author(s): Goh BK, Yong WS. Source: Cancer. 2004 April 15; 100(8): 1766; Author Reply 1767. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15073868

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Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Author(s): Poggi MM, Danforth DN, Sciuto LC, Smith SL, Steinberg SM, Liewehr DJ, Menard C, Lippman ME, Lichter AS, Altemus RM. Source: Cancer. 2003 August 15; 98(4): 697-702. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12910512

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Electrocautery as a factor in seroma formation following mastectomy. Author(s): Porter KA, O'Connor S, Rimm E, Lopez M. Source: American Journal of Surgery. 1998 July; 176(1): 8-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9683123

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Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Author(s): Pomel C, Missana MC, Atallah D, Lasser P. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2003 March; 29(2): 127-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12633554

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Endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer. Author(s): Ho WS, Ying SY, Chan AC. Source: Surgical Endoscopy. 2002 February; 16(2): 302-6. Epub 2001 November 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11967683

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Envelope mastectomy with immediate reconstruction (EMIR). Author(s): Sufi PA, Gittos M, Collier DS. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2000 June; 26(4): 367-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10873357

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Epidural analgesia compared with intravenous morphine patient-controlled analgesia: postoperative outcome measures after mastectomy with immediate TRAM flap breast reconstruction. Author(s): Correll DJ, Viscusi ER, Grunwald Z, Moore JH Jr. Source: Regional Anesthesia and Pain Medicine. 2001 September-October; 26(5): 444-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11561265

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Epithelial lesions in prophylactic mastectomy specimens from women with BRCA mutations. Author(s): Kauff ND, Brogi E, Scheuer L, Pathak DR, Borgen PI, Hudis CA, Offit K, Robson ME. Source: Cancer. 2003 April 1; 97(7): 1601-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12655515

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Esthetic reconstruction after mastectomy for inflammatory breast cancer: is it worthwhile? Author(s): Chin PL, Andersen JS, Somlo G, Chu DZ, Schwarz RE, Ellenhorn JD. Source: Journal of the American College of Surgeons. 2000 March; 190(3): 304-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10703855

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Evaluation of a local anaesthesia regimen following mastectomy. Author(s): Talbot H, Hutchinson SP, Edbrooke DL, Wrench I, Kohlhardt SR. Source: Anaesthesia. 2004 July; 59(7): 664-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15200541

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Evaluation of arm and shoulder mobility and strength after modified radical mastectomy and radiotherapy. Author(s): Blomqvist L, Stark B, Engler N, Malm M. Source: Acta Oncologica (Stockholm, Sweden). 2004; 43(3): 280-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15244252

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Expression of LRP and MDR1 in locally advanced breast cancer predicts axillary node invasion at the time of rescue mastectomy after induction chemotherapy. Author(s): Schneider J, Gonzalez-Roces S, Pollan M, Lucas R, Tejerina A, Martin M, Alba A. Source: Breast Cancer Research : Bcr. 2001; 3(3): 183-91. Epub 2001 February 01. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11305953

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Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Author(s): Medina-Franco H, Vasconez LO, Fix RJ, Heslin MJ, Beenken SW, Bland KI, Urist MM. Source: Annals of Surgery. 2002 June; 235(6): 814-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12035037

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Factors influencing a woman's choice to undergo breast-conserving surgery versus modified radical mastectomy. Author(s): Nold RJ, Beamer RL, Helmer SD, McBoyle MF. Source: American Journal of Surgery. 2000 December; 180(6): 413-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11182389

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Factors influencing choice between mastectomy and lumpectomy for women in the Carolinas. Author(s): Benedict S, Cole DJ, Baron L, Baron P. Source: Journal of Surgical Oncology. 2001 January; 76(1): 6-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11223818

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Factors influencing local recurrence of cancer after partial mastectomy. Author(s): Crile G Jr, Esselstyn CB Jr. Source: Cleve Clin J Med. 1990 March-April; 57(2): 143-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2157559

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Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and II breast cancer. Author(s): van Dongen JA, Bartelink H, Fentiman IS, Lerut T, Mignolet F, Olthuis G, van der Schueren E, Sylvester R, Tong D, Winter J, et al. Source: European Journal of Cancer (Oxford, England : 1990). 1992; 28A(4-5): 801-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1524898

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Fibrin adhesive in radical mastectomy. Author(s): Uden P, Aspegren K, Balldin G, Garne JP, Larsson SA. Source: The European Journal of Surgery = Acta Chirurgica. 1993 May; 159(5): 263-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8103359

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Fibrin glue reduces seroma formation in the rat after mastectomy. Author(s): Harada RN, Pressler VM, McNamara JJ. Source: Surg Gynecol Obstet. 1992 November; 175(5): 450-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1440175

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Finance issue brief: mandated benefits: inpatient mastectomy length of stay & breast reconstructive surgery coverage requirements: year end report-2003. Author(s): Plaza CI. Source: Issue Brief Health Policy Track Serv. 2003 December 31; : 1-10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14870748

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Finance issue brief: women's health: inpatient mastectomy length of stay & breast reconstructive surgery coverage requirements: year end report-2002. Author(s): Plaza CI. Source: Issue Brief Health Policy Track Serv. 2002 December 31; : 1-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12901354

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Finance issue brief: women's health: minimum inpatient mastectomy length of stay & breast reconstruction coverage. Author(s): Plaza CI. Source: Issue Brief Health Policy Track Serv. 2000 July 3; : 1-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11073437

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Fine needle aspiration biopsy diagnosis of Sister Mary Joseph's nodule 13 years after mastectomy. Author(s): de la Cruz Mera A, Vargas-Castrillon J, de Agustin de Agustin P, PerezBarrios A. Source: Acta Cytol. 1991 November-December; 35(6): 790. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1950336

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First isolated locoregional recurrence following mastectomy for breast cancer: results of a phase III multicenter study comparing systemic treatment with observation after excision and radiation. Swiss Group for Clinical Cancer Research. Author(s): Borner M, Bacchi M, Goldhirsch A, Greiner R, Harder F, Castiglione M, Jungi WF, Thurlimann B, Cavalli F, Obrecht JP, et al. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1994 October; 12(10): 2071-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7931476

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Fish-tail plasty: a safe technique to improve cosmesis at the lateral end of mastectomy scars. Author(s): Hussien M, Daltrey IR, Dutta S, Goodwin A, Prance SE, Watkins RM. Source: Breast (Edinburgh, Scotland). 2004 June; 13(3): 206-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15177423

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Five-year results of a randomized clinical trial comparing modified radical mastectomy and extended radical mastectomy for stage II breast cancer. Author(s): Morimoto T, Monden Y, Takashima S, Itoh S, Kimura T, Yamamoto H, Kitamura M, Inui K, Tanaka N, Nagano T, et al. Source: Surgery Today. 1994; 24(3): 210-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8003862

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Florid juvenile (cellular) fibroadenomatosis in the adolescent: a case for subcutaneous mastectomy? Author(s): Silfen R, Skoll PJ, Hudson DA. Source: Aesthetic Plastic Surgery. 1999 November-December; 23(6): 413-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10629297

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Flow cytometric detection of multifocal DNA aneuploid cell populations in mastectomy specimens containing a primary breast carcinoma. Author(s): van Dam PA, Van Bockstaele DR, Keersmaeckers GH, Uyttenbroeck FL. Source: Cytometry : the Journal of the Society for Analytical Cytology. 1990; 11(2): 300-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2318083

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Flow cytometry DNA analysis and prediction of loco-regional recurrences after mastectomy in breast cancer. Author(s): Ewers SB, Attewell R, Baldetorp B, Borg A, Ferno M, Langstrom E, Ryden S, Killander D. Source: Acta Oncologica (Stockholm, Sweden). 1992; 31(7): 733-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1476753

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French National Ad Hoc Committee strongly resists prophylactic mastectomy. Author(s): Newman L. Source: Journal of the National Cancer Institute. 2001 March 7; 93(5): 339. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11238691

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Frequency of prophylactic contralateral mastectomy among breast cancer patients. Author(s): Polednak AP. Source: Journal of the American College of Surgeons. 2001 June; 192(6): 804-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11400978

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Galactorrhea after radical mastectomy. Author(s): Fukunishi H, Takeda Y, Saitoh H. Source: The Kobe Journal of Medical Sciences. 1984 December; 30(5-6): 89-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6543561

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Genetic counselling and the intention to undergo prophylactic mastectomy: effects of a breast cancer risk assessment. Author(s): van Dijk S, Otten W, Zoeteweij MW, Timmermans DR, van Asperen CJ, Breuning MH, Tollenaar RA, Kievit J. Source: British Journal of Cancer. 2003 June 2; 88(11): 1675-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12771979

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Geriatrics photo quiz. Radical mastectomy for breast cancer. Author(s): Shua-Haim JR, Ross JS. Source: Geriatrics. 1999 April; 54(4): 19, 34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10212624

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Glandular excision in total glandular mastectomy and modified radical mastectomy: a comparison. Author(s): Barton FE Jr, English JM, Kingsley WB, Fietz M. Source: Plastic and Reconstructive Surgery. 1991 September; 88(3): 389-92; Discussion 393-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1871214

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Granular cell traumatic neuroma: a lesion occurring in mastectomy scars. Author(s): Rosso R, Scelsi M, Carnevali L. Source: Archives of Pathology & Laboratory Medicine. 2000 May; 124(5): 709-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10782152

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Granulomas in mastectomy scars. Author(s): Jackson R. Source: Archives of Dermatology. 1979 January; 115(1): 111. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=760650

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Granulomatous lesions of the homolateral limb after previous mastectomy. Author(s): Virgili A, Maranini C, Califano A. Source: The British Journal of Dermatology. 2002 May; 146(5): 891-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12000391

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Group intervention for reinforcing self-worth following mastectomy. Author(s): Rice MA, Szopa TJ. Source: Oncology Nursing Forum. 1988 January-February; 15(1): 33-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3344244

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Gynaecomastia. Subcutaneous mastectomy with adipose tissue flap. Author(s): Steitiyeh MR, al-Amer AF, al-Amad HE. Source: Int Surg. 1990 January-March; 75(1): 15-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2318569

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Gynecomastia. Treatment by liposuction subcutaneous mastectomy. Author(s): Dolsky RL. Source: Dermatologic Clinics. 1990 July; 8(3): 469-78. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2199107

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Gynecomastia: complications of the subcutaneous mastectomy. Author(s): Steele SR, Martin MJ, Place RJ. Source: The American Surgeon. 2002 February; 68(2): 210-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11842972

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Haemorrhagic effects of sodium heparin and calcium heparin prophylaxis in patients undergoing mastectomy. Author(s): Lee RE, Ho KN, Karran SJ, Taylor I. Source: Journal of the Royal College of Surgeons of Edinburgh. 1989 June; 34(3): 149-151. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2681717

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Her2/neu-positive disease does not increase risk of locoregional recurrence for patients treated with neoadjuvant doxorubicin-based chemotherapy, mastectomy, and radiotherapy. Author(s): Buchholz TA, Huang EH, Berry D, Pusztai L, Strom EA, McNeese MD, Perkins GH, Schechter NR, Kuerer HM, Buzdar AU, Valero V, Hunt KK, Hortobagyi GN, Sahin AA. Source: International Journal of Radiation Oncology, Biology, Physics. 2004 August 1; 59(5): 1337-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15275718

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Histogenesis of post-mastectomy angiosarcoma--an ultrastructural study. Author(s): McWilliam LJ, Harris M. Source: Histopathology. 1985 March; 9(3): 331-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4039701

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Histopathology reporting of mastectomy specimens--an assessment of inter-hospital variation. Author(s): van der Walt JD, Baithun SI, Berry CL. Source: Journal of Clinical Pathology. 1983 November; 36(11): 1276-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6313771

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Home healthcare for patients receiving one-day mastectomy. Author(s): Jeffries E. Source: Home Healthcare Nurse. 1997 January; 15(1): 30-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9052081

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How to draw the ellipse of skin for a mastectomy. Author(s): Peach AH, Smith M, Devaraj VS. Source: Annals of the Royal College of Surgeons of England. 2000 September; 82(5): 358; Author Reply 358-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11041046

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How to draw the ellipse of skin for a mastectomy. Author(s): Parkinson E, Laidlaw IJ. Source: Annals of the Royal College of Surgeons of England. 2000 September; 82(5): 3578; Author Reply 358-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11041045

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How to draw the ellipse of skin for a mastectomy. Author(s): Wharton SM, Timoney N, Waters R. Source: Annals of the Royal College of Surgeons of England. 2000 September; 82(5): 357; 358-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11041044

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How to draw the ellipse of skin for a mastectomy. Author(s): Weight SC, Stotter AT. Source: Annals of the Royal College of Surgeons of England. 2000 September; 82(5): 357; Author Reply 358-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11041043

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How to draw the skin ellipse for a mastectomy. Author(s): Coombs NJ, Royle GT. Source: Annals of the Royal College of Surgeons of England. 1999 July; 81(4): 248-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10615191

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Immediate and delayed two-stage post-mastectomy breast reconstruction with implants. Our experience of general surgeons. Author(s): Racano C, Fania PL, Motta GB, Belloni C, Lazzarini E, Isoardi R, Boccu C, Duodeci S, D'Agosto M, Ragni L. Source: Minerva Chir. 2002 April; 57(2): 135-49. English, Italian. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11941289

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Immediate breast reconstruction after skin-sparing mastectomy for the treatment of advanced breast cancer: radiation oncology considerations. Author(s): Buchholz TA, Kronowitz SJ, Kuerer HM. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 2002 October; 9(8): 820-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12374667

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Immediate breast reconstruction with anatomical permanent expandable implants after skin-sparing mastectomy: aesthetic and technical refinements. Author(s): Salgarello M, Seccia A, Eugenio F. Source: Annals of Plastic Surgery. 2004 April; 52(4): 358-64; Discussion 365-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15084878

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Immediate breast reconstruction with the transverse rectus abdominis musculocutaneous flap after skin-sparing mastectomy. Author(s): Gherardini G, Thomas R, Basoccu G, Zaccheddu R, Fortunato L, Cortino P, Evans GR, Matarasso A, D'Aiuto M, D'Aiuto G. Source: Int Surg. 2001 October-December; 86(4): 246-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12056470

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Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapy. Author(s): Allweis TM, Boisvert ME, Otero SE, Perry DJ, Dubin NH, Priebat DA. Source: American Journal of Surgery. 2002 March; 183(3): 218-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11943114

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Impact of immediate reconstruction on the local recurrence of breast cancer after mastectomy. Author(s): Murphy RX Jr, Wahhab S, Rovito PF, Harper G, Kimmel SR, Kleinman LC, Young MJ. Source: Annals of Plastic Surgery. 2003 April; 50(4): 333-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12671371

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Impact of skin-sparing mastectomy with immediate reconstruction and breast-sparing reconstruction with miniflaps on the outcomes of oncoplastic breast surgery. Author(s): Gendy RK, Able JA, Rainsbury RM. Source: The British Journal of Surgery. 2003 April; 90(4): 433-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12673744

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Important technical considerations for skin-sparing mastectomy with sentinel lymph node dissection. Author(s): Kuerer HM, Krishnamurthy S, Kronowitz SJ. Source: Archives of Surgery (Chicago, Ill. : 1960). 2002 June; 137(6): 747. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12049553

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Improved subcutaneous mastectomy with hydrodissection of the subcutaneous space. Author(s): Samper A, Blanch A. Source: Plastic and Reconstructive Surgery. 2003 August; 112(2): 694-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12900642

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Improvements in breast cancer pathology practices among medicare patients undergoing unilateral extended simple mastectomy. Author(s): Imperato PJ, Waisman J, Wallen MD, Llewellyn CC, Pryor V. Source: American Journal of Medical Quality : the Official Journal of the American College of Medical Quality. 2003 July-August; 18(4): 164-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12934953

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Incidence of nodes in completion mastectomy specimens following breast conservation and axillary clearance. Author(s): Khonji NI, Edwards R, Sweetland HM, Monypenny IJ, Mansel RE, Webster DJ. Source: The British Journal of Surgery. 2002 October; 89(10): 1294-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12296900

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Incidence of the superficial fascia and its relevance in skin-sparing mastectomy. Author(s): Beer GM, Varga Z, Budi S, Seifert B, Meyer VE. Source: Cancer. 2002 March 15; 94(6): 1619-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11920520

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Influence of some anthropometric parameters on the risk of development of distal complications after mastectomy carried out because of breast carcinoma. Author(s): Kopanski Z, Wojewoda T, Wojewoda A, Schlegel-Zawadzka M, Wozniacka R, Suder A, Kosciuk T. Source: Am J Hum Biol. 2003 May-June; 15(3): 433-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12704719

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Initial experiences of women from hereditary breast cancer families after bilateral prophylactic mastectomy: a retrospective study. Author(s): Josephson U, Wickman M, Sandelin K. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2000 June; 26(4): 351-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10873354

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Insurance reimbursement for risk-reducing mastectomy and oophorectomy in women with BRCA1 or BRCA2 mutations. Author(s): Kauff ND, Scheuer L, Robson ME, Glogowski E, Kelly B, Barakat R, Heerdt A, Borgen PI, Davis JG, Offit K. Source: Genetics in Medicine : Official Journal of the American College of Medical Genetics. 2001 November-December; 3(6): 422-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11715007

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Intention to undergo prophylactic bilateral mastectomy in women at increased risk of developing hereditary breast cancer. Author(s): Meiser B, Butow P, Friedlander M, Schnieden V, Gattas M, Kirk J, Suthers G, Haan E, Tucker K. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2000 June; 18(11): 2250-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10829045

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Intraoperative topical tetracycline sclerotherapy following mastectomy: a prospective, randomized trial. Author(s): Rice DC, Morris SM, Sarr MG, Farnell MB, van Heerden JA, Grant CS, Rowland CM, Ilstrup DM, Donohue JH. Source: Journal of Surgical Oncology. 2000 April; 73(4): 224-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10797336

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Invited discussion: immediate breast reconstruction with expandable permanent anatomical implants after skin-sparing mastectomy: aesthetic and technical refinements. Author(s): Toth BA, Le HN. Source: Annals of Plastic Surgery. 2004 April; 52(4): 365-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15084879

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Is mastectomy overused? A call for an expanded research agenda. Author(s): Lantz PV, Zemencuk JK, Katz SJ. Source: Health Services Research. 2002 April; 37(2): 417-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12036001

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Issues in bilateral prophylactic mastectomy. Author(s): Bucholtz JD. Source: Cancer Practice. 2001 January-February; 9(1): 6-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11879267

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Kaposi's sarcoma on a lymphedematous arm after mastectomy. Author(s): Ron IG, Amir G, Marmur S, Chaitchik S, Inbar MJ. Source: American Journal of Clinical Oncology : the Official Publication of the American Radium Society. 1996 February; 19(1): 87-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8554044

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Kaposi's sarcoma on a lymphedematous arm following radical mastectomy. Author(s): Merimsky O, Chaitchik S. Source: Tumori. 1992 December 31; 78(6): 407-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1297238

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Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients. Author(s): Arriagada R, Le MG, Guinebretiere JM, Dunant A, Rochard F, Tursz T. Source: Annals of Oncology : Official Journal of the European Society for Medical Oncology / Esmo. 2003 November; 14(11): 1617-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14581268

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Local recurrence after mastectomy and adjuvant CMF: implications for adjuvant radiation therapy. Author(s): Rangan AM, Ahern V, Yip D, Boyages J. Source: The Australian and New Zealand Journal of Surgery. 2000 September; 70(9): 64955. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10976894

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Local recurrence after mastectomy or breast-conserving surgery and radiation. Author(s): Freedman GM, Fowble BL. Source: Oncology (Huntingt). 2000 November; 14(11): 1561-81; Discussion 1581-2, 15824. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11125941

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Local recurrence after skin-sparing mastectomy: a manifestation of tumor biology or surgical conservatism? Author(s): Carlson GW. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 1998 October-November; 5(7): 571-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9831102

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Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism? Author(s): Carlson GW, Styblo TM, Lyles RH, Bostwick J, Murray DR, Staley CA, Wood WC. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 2003 March; 10(2): 108-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12620903

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Local recurrence and survival among black women with early-stage breast cancer treated with breast-conservation therapy or mastectomy. Author(s): Newman LA, Kuerer HM, Hunt KK, Singh G, Ames FC, Feig BW, Ross MI, Taylor S, Singletary SE. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 1999 April-May; 6(3): 241-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10340882

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Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up. Author(s): Kroll SS, Khoo A, Singletary SE, Ames FC, Wang BG, Reece GP, Miller MJ, Evans GR, Robb GL. Source: Plastic and Reconstructive Surgery. 1999 August; 104(2): 421-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10654685

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Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. Author(s): Recht A, Gray R, Davidson NE, Fowble BL, Solin LJ, Cummings FJ, Falkson G, Falkson HC, Taylor SG 4th, Tormey DC. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1999 June; 17(6): 1689-700. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10561205

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Locoregional failure 15 years after mastectomy in women with one to three positive axillary nodes with or without irradiation the significance of tumor size. Author(s): Fodor J, Polgar C, Major T, Nemeth G. Source: Strahlentherapie Und Onkologie : Organ Der Deutschen Rontgengesellschaft. [et Al]. 2003 March; 179(3): 197-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12627264

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Locoregional failure rates in patients with involved axillary nodes after mastectomy and systemic therapy. Author(s): Recht A. Source: Seminars in Radiation Oncology. 1999 July; 9(3): 223-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10378960

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Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy. Author(s): Haylock BJ, Coppin CM, Jackson J, Basco VE, Wilson KS. Source: International Journal of Radiation Oncology, Biology, Physics. 2000 January 15; 46(2): 355-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10661342

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Locoregional recurrence in patients with one to three positive axillary nodes after mastectomy without adjuvant radiotherapy. Author(s): Cheng JC, Chen CM, Liu MC, Tsou MH, Yang PS, Cheng SH. Source: J Formos Med Assoc. 2000 October; 99(10): 759-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11061070

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Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. Author(s): Katz A, Strom EA, Buchholz TA, Thames HD, Smith CD, Jhingran A, Hortobagyi G, Buzdar AU, Theriault R, Singletary SE, McNeese MD. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2000 August; 18(15): 2817-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10920129

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Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation. Author(s): Jager JJ, Volovics L, Schouten LJ, de Jong JM, Hupperets PS, von Meyenfeldt MF, Schutte B, Blijham GH. Source: Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology. 1999 March; 50(3): 267-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10392812

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Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. Author(s): van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, van der Schueren E, Helle PA, van Zijl K, Bartelink H. Source: Journal of the National Cancer Institute. 2000 July 19; 92(14): 1143-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10904087

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Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for T(is,1,2) breast cancer. Author(s): King TA, Bolton JS, Kuske RR, Fuhrman GM, Scroggins TG, Jiang XZ. Source: American Journal of Surgery. 2000 October; 180(4): 299-304. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11113440

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Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy. Author(s): Frost MH, Schaid DJ, Sellers TA, Slezak JM, Arnold PG, Woods JE, Petty PM, Johnson JL, Sitta DL, McDonnell SK, Rummans TA, Jenkins RB, Sloan JA, Hartmann LC. Source: Jama : the Journal of the American Medical Association. 2000 July 19; 284(3): 319-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10891963

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Low risk of locoregional recurrence of primary breast carcinoma after treatment with a modification of the Halsted radical mastectomy and selective use of radiotherapy. Author(s): Bijker N, Rutgers EJ, Peterse JL, van Dongen JA, Hart AA, Borger JH, Kroon BB. Source: Cancer. 1999 April 15; 85(8): 1773-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10223572

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Lumpectomy as good as mastectomy for tumors up to 5 cm across. Author(s): Gottlieb S. Source: The Western Journal of Medicine. 2000 October; 173(4): 227-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11017971

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Lung carcinoma after radiation therapy in women treated with lumpectomy or mastectomy for primary breast carcinoma. Author(s): Zablotska LB, Neugut AI. Source: Cancer. 2003 March 15; 97(6): 1404-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12627503

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Mastectomy and concomitant sentinel lymph node biopsy for invasive breast cancer. Author(s): Sabel MS, Degnim A, Wilkins EG, Diehl KM, Cimmino VM, Chang AE, Newman LA. Source: American Journal of Surgery. 2004 June; 187(6): 673-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15191855

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Mastectomy and oophorectomy by menstrual cycle phase in women with operable breast cancer. Author(s): Love RR, Duc NB, Dinh NV, Shen TZ, Havighurst TC, Allred DC, DeMets DL. Source: Journal of the National Cancer Institute. 2002 May 1; 94(9): 662-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11983754

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Mastectomy by inverted drip incision and immediate reconstruction: data from 510 cases. Author(s): Van Geel AN, Contant CM, Wai RT, Schmitz PI, Eggermont AM, MenkePluijmers MM. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 2003 May; 10(4): 389-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12734087

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Mastectomy is not always so bad. Author(s): Gould KF. Source: Bmj (Clinical Research Ed.). 2003 January 18; 326(7381): 166. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12531862

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Mastectomy or lumpectomy? Helping women make informed choices. Author(s): Whelan T, Levine M, Gafni A, Sanders K, Willan A, Mirsky D, Schnider D, McCready D, Reid S, Kobylecky A, Reed K. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1999 June; 17(6): 1727-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10561209

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Mastectomy patients' decision-making for or against immediate breast reconstruction. Author(s): Harcourt D, Rumsey N. Source: Psycho-Oncology. 2004 February; 13(2): 106-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14872529

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Mastectomy performed with scissors following tumescent solution injection. Author(s): Shoher A, Hekier R, Lucci A Jr. Source: Journal of Surgical Oncology. 2003 July; 83(3): 191-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12827691

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Mastectomy retaining nipple as well as areola. Author(s): Hughes LE. Source: Journal of the Royal Society of Medicine. 2001 June; 94(6): 317. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11387436

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Mastectomy using ultrasonic dissection: effect on seroma formation. Author(s): Galatius H, Okholm M, Hoffmann J. Source: Breast (Edinburgh, Scotland). 2003 October; 12(5): 338-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14659149

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Mastectomy without drain at pectoral area: a randomized controlled trial. Author(s): Puttawibul P, Sangthong B, Maipang T, Sampao S, Uttamakul P, Apakupakul N. Source: J Med Assoc Thai. 2003 April; 86(4): 325-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12757076

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Mastectomy. Author(s): Gunn SW. Source: World Journal of Surgery. 1998 May; 22(5): 425-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9584009

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Metastatic breast cancer to the gastroesophageal junction 14 years after radical mastectomy. Author(s): LeBlanc J, Youssef W, DeWitt J, Sherman S, Chappo J, McHenry L. Source: Gastrointestinal Endoscopy. 2004 May; 59(6): 733-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15114327

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Minimal injury mastectomy in the surgical treatment of stage I and II breast cancer patients. A 20-year experience. Author(s): Nomikos IN, Papatheophanis JD, Elemenoglou J, Papaioannou A. Source: Eur J Gynaecol Oncol. 1999; 20(4): 332-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10475138

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Modified radical mastectomy using harmonic scalpel. Author(s): Deo SV, Shukla NK. Source: Journal of Surgical Oncology. 2000 July; 74(3): 204-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10951418

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Modified radical mastectomy with knife technique. Author(s): Staradub VL, Morrow M. Source: Archives of Surgery (Chicago, Ill. : 1960). 2002 January; 137(1): 105-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11772228

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Modified V-Y advancement technique for mastectomy closure. Author(s): Gibbs ER, Kent RB 3rd. Source: Journal of the American College of Surgeons. 1998 December; 187(6): 632-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9849739

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Morbidity of immediate breast reconstruction (IBR) after mastectomy by a subpectorally placed silicone prosthesis: the adverse effect of radiotherapy. Author(s): Contant CM, van Geel AN, van der Holt B, Griep C, Tjong Joe Wai R, Wiggers T. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2000 June; 26(4): 344-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10873353

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Motivations, satisfaction, and information of immediate breast reconstruction following mastectomy. Author(s): Contant CM, van Wersch AM, Wiggers T, Wai RT, van Geel AN. Source: Patient Education and Counseling. 2000 June; 40(3): 201-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10837999

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Myocardial perfusion imaging in breast cancer patients treated with or without postmastectomy radiotherapy. Author(s): HLjris I, Sand NP, Andersen J, Rehling M, Overgaard M. Source: Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology. 2000 May; 55(2): 163-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10799728

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New bedside test to assess feasibility of primary closure after mastectomy for locally advanced breast cancer. Author(s): Vaidya JS. Source: Journal of Surgical Oncology. 1995 December; 60(4): 286. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8551741

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New operative technique for modified radical mastectomy with reconstruction using pectoralis minor flap transfer in situ. Author(s): Nagaie T, Koyanagi N. Source: The European Journal of Surgery = Acta Chirurgica. 1993 November-December; 159(11-12): 631-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8130306

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Nipple excised and areola retained after total mastectomy (NEAT). Author(s): Gordon AB, Nasiri N, Gui GP, Sacks NP. Source: Journal of the Royal Society of Medicine. 2001 April; 94(4): 185-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11317623

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Nipple placement in simple mastectomy with free nipple grafting for severe gynecomastia. Author(s): Murphy TP, Ehrlichman RJ, Seckel BR. Source: Plastic and Reconstructive Surgery. 1994 November; 94(6): 818-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7972427

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Nipple reconstruction and mastectomy scars. Author(s): Collis N, Lalloo MT, Sharpe DT. Source: Plastic and Reconstructive Surgery. 2000 May; 105(6): 2277. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10839443

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Nipple-areola complex autonomization and delayed nipple-sparing subcutaneous mastectomy. Author(s): Palmieri B, Benuzzi G, Grappolini S, Costa A, Baitchev G. Source: Plastic and Reconstructive Surgery. 2004 June; 113(7): 2226-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15253229

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Nipple-areola reconstruction after mastectomy. Author(s): Serafin D, Georgiade N. Source: Annals of Plastic Surgery. 1982 January; 8(1): 29-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7041775

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Nipple-sparing mastectomy in breast cancer: a viable option? Author(s): Cense HA, Rutgers EJ, Lopes Cardozo M, Van Lanschot JJ. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2001 September; 27(6): 521-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11520082

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Nipple-sparing mastectomy: technique and results of 54 procedures. Author(s): Crowe JP Jr, Kim JA, Yetman R, Banbury J, Patrick RJ, Baynes D. Source: Archives of Surgery (Chicago, Ill. : 1960). 2004 February; 139(2): 148-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14769571

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Nipple-sparing total mastectomy of large breasts: the role of tissue expansion. Author(s): Verheyden CN. Source: Plastic and Reconstructive Surgery. 1998 May; 101(6): 1494-500; Discussion 15012. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9583478

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No serious late cardiac effects after adjuvant radiotherapy following mastectomy in premenopausal women with early breast cancer. Author(s): Gustavsson A, Bendahl PO, Cwikiel M, Eskilsson J, Thapper KL, Pahlm O. Source: International Journal of Radiation Oncology, Biology, Physics. 1999 March 1; 43(4): 745-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10098429

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Nonobesity at the time of mastectomy is highly predictive of 10-year disease-free survival in women with breast cancer. Author(s): Zumoff B, Gorzynski JG, Katz JL, Weiner H, Levin J, Holland J, Fukushima DK. Source: Anticancer Res. 1982 January-April; 2(1-2): 59-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7114803

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Normal and abnormal US findings at the mastectomy site. Author(s): Kim SM, Park JM. Source: Radiographics : a Review Publication of the Radiological Society of North America, Inc. 2004 March-April; 24(2): 357-65. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15026586

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Nurses fight "drive-through mastectomy" trend. Author(s): Canavan K. Source: The American Nurse. 1997 January-February; 29(1): 3, 8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9069767

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Nursing care study - mastectomy: the operation that every woman dreads. Author(s): Clough J. Source: Nurs Mirror. 1982 January 6; 154(1): 48-50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6915547

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Oestrogen and progesterone receptor estimation by enzyme-immunoassay on tissues removed before and after a modified radical mastectomy. Author(s): Vyas JJ, Redkar AA, Kabre SS, Mittra I. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 1993 August; 19(4): 368-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8359284

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On call. Breast cancer seems to run in my wife's family. She is healthy, I'm glad to say, but her mother died of it, and her sister needed surgery and chemo. Worst of all, our 44-year-old daughter just had a mastectomy and is waiting to hear if she needs more treatment. We also have two sons, ages 46 and 40. My question is, do they have anything to worry about? Author(s): Simon HB. Source: Harvard Men's Health Watch. 2003 July; 7(12): 8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12888464

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Oncologic safety of skin-sparing mastectomy. Author(s): Singletary SE, Robb GL. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 2003 March; 10(2): 95-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12620899

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Oncological aspect of immediate breast reconstruction in mastectomy patients. Author(s): Noguchi M, Fukushima W, Ohta N, Koyasaki N, Thomas M, Miyazaki I, Yamada T, Nakagawa M. Source: Journal of Surgical Oncology. 1992 August; 50(4): 241-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1640708

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One-day hospitalization following modified radical mastectomy. Author(s): Clark JA, Kent RB 3rd. Source: The American Surgeon. 1992 April; 58(4): 239-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1586082

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One-day mastectomy. Author(s): Steging L. Source: Home Healthcare Nurse. 1997 August; 15(8): 529. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9281934

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Optimal cosmetic autogenous reconstruction with modified radical mastectomy. Author(s): Dinner MI, Sampliner J, Artz JS, Foglietti MA. Source: Surg Gynecol Obstet. 1993 January; 176(1): 82-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8427008

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Outcome of treatment for breast cancer patients with chest wall recurrence according to initial stage: implications for post-mastectomy radiation therapy. Author(s): Chagpar A, Kuerer HM, Hunt KK, Strom EA, Buchholz TA. Source: International Journal of Radiation Oncology, Biology, Physics. 2003 September 1; 57(1): 128-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12909225

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Outpatient mastectomy. Plan for breast cancer surgery to avoid 'drive-through' label. Author(s): Patterson P. Source: Or Manager. 1997 March; 13(3): 1, 9, 12-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10172948

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Outpatient mastectomy: clinical, payer, and geographic influences. Author(s): Case C, Johantgen M, Steiner C. Source: Health Services Research. 2001 October; 36(5): 869-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11666108

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Predictors of patients' choices for breast-conserving therapy or mastectomy: a prospective study. Author(s): Molenaar S, Oort F, Sprangers M, Rutgers E, Luiten E, Mulder J, de Haes H. Source: British Journal of Cancer. 2004 June 1; 90(11): 2123-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15150557

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Preincisional dextromethorphan decreases postoperative pain and opioid requirement after modified radical mastectomy. Author(s): Wong CS, Wu CT, Yu JC, Yeh CC, Lee MM, Tao PL. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1999 December; 46(12): 1122-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10608204

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Preoperative psychological reactions and quality of life among women with an increased risk of breast cancer who are considering a prophylactic mastectomy. Author(s): Brandberg Y, Arver B, Lindblom A, Sandelin K, Wickman M, Hall P. Source: European Journal of Cancer (Oxford, England : 1990). 2004 February; 40(3): 36574. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14746854

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Prognostic value of p53 for local failure in mastectomy-treated breast cancer patients. Author(s): Zellars RC, Hilsenbeck SG, Clark GM, Allred DC, Herman TS, Chamness GC, Elledge RM. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2000 May; 18(9): 1906-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10784631

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Prophylactic mastectomy and inherited predisposition to breast carcinoma. Author(s): Hughes KS, Papa MZ, Whitney T, McLellan R. Source: Cancer. 1999 December 1; 86(11 Suppl): 2502-16. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10630176

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Prophylactic mastectomy for BRCA1/2 carriers: progress and more questions. Author(s): Hartmann LC, Degnim A, Schaid DJ. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2004 March 15; 22(6): 981-3. Epub 2004 February 23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14981099

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Prophylactic mastectomy or screening in women suspected to have the BRCA1/2 mutation: a prospective pilot study of women's treatment choices and medical and decision-analytic recommendations. Author(s): Unic I, Verhoef LC, Stalmeier PF, van Daal WA. Source: Medical Decision Making : an International Journal of the Society for Medical Decision Making. 2000 July-September; 20(3): 251-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10929847

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Prophylactic mastectomy, oophorectomy, hysterectomy, and immediate transverse rectus abdominis muscle flap breast reconstruction in a BRCA-2-negative patient. Author(s): Morris RJ, Koshy CE, Zambacos GJ. Source: Plastic and Reconstructive Surgery. 2000 January; 105(1): 473. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10627025

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Prophylactic mastectomy: pathologic findings in high-risk patients. Author(s): Khurana KK, Loosmann A, Numann PJ, Khan SA. Source: Archives of Pathology & Laboratory Medicine. 2000 March; 124(3): 378-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10705389

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Prophylactic mastectomy; evolving perspectives. Author(s): Sakorafas GH, Tsiotou AG. Source: European Journal of Cancer (Oxford, England : 1990). 2000 March; 36(5): 567-78. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10738120

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Quality control in health care: an experiment in radiotherapy planning for breast cancer patients after mastectomy. Author(s): Holli K, Laippala P, Ojala A, Pitkanen M. Source: International Journal of Radiation Oncology, Biology, Physics. 1999 July 1; 44(4): 827-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10386639

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Quality control in prophylactic mastectomy for women at high risk of breast cancer. Author(s): Petit JY, Greco M; EUSOMA. Source: European Journal of Cancer (Oxford, England : 1990). 2002 January; 38(1): 23-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11750836

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Quality of life after breast conservation or mastectomy: a systematic review. Author(s): Irwig L, Bennetts A. Source: The Australian and New Zealand Journal of Surgery. 1997 November; 67(11): 750-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9396988

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Quality of life among mastectomy patients using external breast prostheses. Author(s): Hart S, Meyerowitz BE, Apolone G, Mosconi P, Liberati A. Source: Tumori. 1997 March-April; 83(2): 581-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9226025

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Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Cooperative Group (BCCG). Author(s): Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, Bartelink H. Source: European Journal of Cancer (Oxford, England : 1990). 1998 February; 34(3): 30714. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9640214

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Quality of survival of patients following mastectomy. Author(s): Wilson RG, Farnon JR, Hutchinson A. Source: European Journal of Cancer (Oxford, England : 1990). 1980; Suppl 1: 227-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7318864

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Quality of the capsule in reconstructions with textured or smooth silicone implants after mastectomy. Author(s): Hammerstad M, Dahl BH, Rindal R, Kveim MR, Roald HE. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 1996 March; 30(1): 33-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8711440

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Quantitative magnetic resonance for assessment of radiation fibrosis after postmastectomy radiotherapy. Author(s): Johansen J, Taagehoj F, Christensen T, Overgaard J, Overgaard M. Source: The British Journal of Radiology. 1994 December; 67(804): 1238-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7874424

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Randomized clinical trial comparing level II and level III axillary node dissection in addition to mastectomy for breast cancer. Author(s): Tominaga T, Takashima S, Danno M. Source: The British Journal of Surgery. 2004 January; 91(1): 38-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14716791

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Re: Dormancy of mammary carcinoma after mastectomy. Author(s): Spratt JS. Source: Journal of the National Cancer Institute. 2000 July 5; 92(13): 1101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10880558

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Re: Dormancy of mammary carcinoma after mastectomy. Author(s): Demicheli R, Miceli R, Valagussa P, Bonadonna G. Source: Journal of the National Cancer Institute. 2000 February 16; 92(4): 347-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10675389

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Re: Skin-sparing mastectomy with sun flap closure. Author(s): Cederna JP. Source: Annals of Plastic Surgery. 2000 April; 44(4): 461-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10783110

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Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis. Author(s): Edeiken BS, Fornage BD, Bedi DG, Sneige N, Parulekar SG, Pleasure J. Source: Radiology. 2003 May; 227(2): 542-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12732703

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Reduction or elimination of postoperative pain medication after mastectomy through use of a temporarily placed local anesthetic pump vs. control group. Author(s): Morrison JE Jr, Jacobs VR. Source: Zentralblatt Fur Gynakologie. 2003 January; 125(1): 17-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12877104

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Reoperations after prophylactic mastectomy with or without implant reconstruction. Author(s): Zion SM, Slezak JM, Sellers TA, Woods JE, Arnold PG, Petty PM, Donohue JH, Frost MH, Schaid DJ, Hartmann LC. Source: Cancer. 2003 November 15; 98(10): 2152-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14601084

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Residual breast tissue in the skin flaps after Patey mastectomy. Author(s): Tewari M, Kumar K, Kumar M, Shukla HS. Source: The Indian Journal of Medical Research. 2004 May; 119(5): 195-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15218982

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Retrospective study of the skin-sparing mastectomy in breast reconstruction. Author(s): Toth BA, Forley BG, Calabria R. Source: Plastic and Reconstructive Surgery. 1999 July; 104(1): 77-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10597677

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Routine histological examination of the mastectomy scar at the time of breast reconstruction: important oncological surveillance? Author(s): Soldin MG, Grob M, Dawson A, Cooper MA. Source: British Journal of Plastic Surgery. 2004 March; 57(2): 143-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15037169

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Second malignancies after treatment of early-stage breast cancer: lumpectomy and radiation therapy versus mastectomy. Author(s): Obedian E, Fischer DB, Haffty BG. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2000 June; 18(12): 2406-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10856100

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Skin sparing mastectomy using the Wise pattern: protecting the T-junction with a dermal pedicle. Author(s): Matteucci P, Fourie le R. Source: British Journal of Plastic Surgery. 2004 July; 57(5): 473-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15191836

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Skin-sparing and nipple-sparing mastectomy: preoperative, intraoperative, and postoperative considerations. Author(s): Chagpar AB. Source: The American Surgeon. 2004 May; 70(5): 425-32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15156951

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Skin-sparing mastectomy in the UK--a review of current practice. Author(s): Sotheran WJ, Rainsbury RM. Source: Annals of the Royal College of Surgeons of England. 2004 March; 86(2): 82-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15005923

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Skin-sparing mastectomy. Author(s): Cunnick GH, Mokbel K. Source: American Journal of Surgery. 2004 July; 188(1): 78-84. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15219490

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Skin-sparing mastectomy. specialty bias and worldwide lack of consensus. Author(s): Bleicher RJ, Hansen NM, Giuliano AE. Source: Cancer. 2003 December 1; 98(11): 2316-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14635064

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Some cases of severe post-mastectomy pain syndrome may be caused by an axillary haematoma. Author(s): Blunt C, Schmiedel A. Source: Pain. 2004 April; 108(3): 294-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15030949

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Stewart-Treves syndrome: lymphangiosarcoma following mastectomy. Author(s): Heitmann C, Ingianni G. Source: Annals of Plastic Surgery. 2000 January; 44(1): 72-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10651369

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Subcutaneous mastectomy with implant reconstruction: cosmetic outcome and patient satisfaction. Author(s): Al-Ghazal SK, Blamey RW. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2000 March; 26(2): 137-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10744930

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T3 disease at presentation or pathologic involvement of four or more lymph nodes predict for locoregional recurrence in stage II breast cancer treated with neoadjuvant chemotherapy and mastectomy without radiotherapy. Author(s): Garg AK, Strom EA, McNeese MD, Buzdar AU, Hortobagyi GN, Kuerer HM, Perkins GH, Singletary SE, Hunt KK, Sahin A, Schechter N, Valero V, Tucker SL, Buchholz TA. Source: International Journal of Radiation Oncology, Biology, Physics. 2004 May 1; 59(1): 138-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15093909

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The effectiveness of continuous epidural infusion of low-dose fentanyl and mepivacaine in perioperative analgesia and hemodynamic control in mastectomy patients. Author(s): Kotake Y, Matsumoto M, Morisaki H, Takeda J. Source: Journal of Clinical Anesthesia. 2004 March; 16(2): 88-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15110368

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The influence of radiotherapy on skin circulation of the breast after subcutaneous mastectomy and immediate reconstruction. Author(s): Benediktsson K, Perbeck L. Source: British Journal of Plastic Surgery. 1999 July; 52(5): 360-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10618978

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The role of bilateral prophylactic mastectomy (BPMX) in women at high risk of breast cancer. Author(s): Baildam AD. Source: Disease Markers. 1999 October; 15(1-3): 197-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10595278

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The use and outcomes of outpatient mastectomy in Florida. Author(s): Ferrante J, Gonzalez E, Pal N, Roetzheim R. Source: American Journal of Surgery. 2000 April; 179(4): 253-9; Discussion 259-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10875979

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The use of skin sparing mastectomy in the treatment of breast cancer: The Emory experience. Author(s): Carlson GW, Styblo TM, Lyles RH, Jones G, Murray DR, Staley CA, Wood WC. Source: Surgical Oncology. 2003 December; 12(4): 265-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14998566

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Thoracic epidural anesthesia for modified radical mastectomy in a patient with cryptogenic fibrosing alveolitis: a case report. Author(s): Trikha A, Sadhasivam S, Saxena A, Arora MK, Deo SV. Source: Journal of Clinical Anesthesia. 2000 February; 12(1): 75-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10773515

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Transpectoral anterior approach to the axilla for lymph node dissection in association with mastectomy preserving both pectoral muscles and their neurovascular bundles. Author(s): Dasgupta S, Sanyal S, Sengupta SP. Source: Tumori. 1999 November-December; 85(6): 498-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10774573

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Treatment and outcome of patients with chest wall recurrence after mastectomy and breast reconstruction. Author(s): Chagpar A, Langstein HN, Kronowitz SJ, Singletary SE, Ross MI, Buchholz TA, Hunt KK, Kuerer HM. Source: American Journal of Surgery. 2004 February; 187(2): 164-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14769300

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Two doses of oral sustained-release tramadol do not reduce pain or morphine consumption after modified radical mastectomy: a randomized, double blind, placebo-controlled trial. Author(s): Thienthong S, Krisanaprakornkit W, Taesiri W, Thaninsurat N, Utsahapanich S, Klaichanad C. Source: J Med Assoc Thai. 2004 January; 87(1): 24-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14971531

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Ultra-conservative skin-sparing 'keyhole' mastectomy and immediate breast and areola reconstruction. Author(s): Peyser PM, Abel JA, Straker VF, Hall VL, Rainsbury RM. Source: Annals of the Royal College of Surgeons of England. 2000 July; 82(4): 227-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10932655

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Ultrasound-guided fine needle aspiration biopsy in the diagnosis of breast cancer recurrence after mastectomy. Author(s): Rissanen TJ, Apaja-Sarkkinen MA, Makarainen HP, Heikkinen MI. Source: Acta Radiologica (Stockholm, Sweden : 1987). 1997 March; 38(2): 232-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9093157

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Uncertainty and anxiety after mastectomy for breast cancer. Author(s): Wong CA, Bramwell L. Source: Cancer Nursing. 1992 October; 15(5): 363-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1423255

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Understanding the experience of prophylactic bilateral mastectomy: a qualitative study of ten women. Author(s): Lloyd SM, Watson M, Oaker G, Sacks N, Querci della Rovere U, Gui G. Source: Psycho-Oncology. 2000 November-December; 9(6): 473-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11180582

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Unusual consequence of a fall: pressure sores of both breasts resulting in bilateral partial mastectomy. Author(s): Mannesse CK, van Riet GJ, van der Cammen TJ. Source: The Netherlands Journal of Medicine. 1994 July; 45(1): 30-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8065482

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Use of an electron beam for post-mastectomy radiotherapy: 5-year follow-up of 500 cases. Author(s): Magee B, Ribeiro GG, Williams P, Swindell R. Source: Clin Oncol (R Coll Radiol). 1991 November; 3(6): 310-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1742229

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Use of genetic testing and prophylactic mastectomy and oophorectomy in women with breast or ovarian cancer from families with a BRCA1 or BRCA2 mutation. Author(s): Meijers-Heijboer H, Brekelmans CT, Menke-Pluymers M, Seynaeve C, Baalbergen A, Burger C, Crepin E, van den Ouweland AW, van Geel B, Klijn JG. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2003 May 1; 21(9): 1675-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12721241

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Utilisation of prophylactic mastectomy in 10 European centres. Author(s): Evans DG, Anderson E, Lalloo F, Vasen H, Beckmann M, Eccles D, Hodgson S, Moller P, Chang-Claude J, Morrison P, Stoppa-Lyonnet D, Steel M, Haites N. Source: Disease Markers. 1999 October; 15(1-3): 148-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10595270

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Utility of four-quadrant random sections in mastectomy specimens. Author(s): Gupta D, Nath M, Layfield LJ. Source: The Breast Journal. 2003 July-August; 9(4): 307-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12846866

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Value of radiotherapy in preventing loco-regional recurrences after radical mastectomy for carcinoma of the breast. Author(s): Lopez-Mujica RJ, Marcial VA, Tome JM, Ubinas J. Source: Bol Asoc Med P R. 1982 October; 74(10): 289-94. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6963890

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Various methods of breast reconstruction after mastectomy: an economic comparison. Author(s): Elkowitz A, Colen S, Slavin S, Seibert J, Weinstein M, Shaw W. Source: Plastic and Reconstructive Surgery. 1993 July; 92(1): 77-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8516410

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Vascular considerations in the use of a latissimus dorsi myocutaneous flap after a mastectomy with an axillary dissection. Author(s): Maxwell GP, McGibbon BM, Hoopes JE. Source: Plastic and Reconstructive Surgery. 1979 December; 64(6): 771-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=117475

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Vascular density and the response of breast carcinomas to mastectomy and adjuvant chemotherapy. Author(s): Protopapa E, Delides GS, Revesz L. Source: European Journal of Cancer (Oxford, England : 1990). 1993; 29A(10): 1391-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8398265

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Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer. Author(s): Camoriano JK, Loprinzi CL, Ingle JN, Therneau TM, Krook JE, Veeder MH. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1990 August; 8(8): 1327-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2199619

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When can the nipple-areola complex safely be spared during mastectomy? Author(s): Jensen JA. Source: Plastic and Reconstructive Surgery. 2002 February; 109(2): 805-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11818873

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Why and how post-mastectomy edema should be quantified in patients with breast cancer. Author(s): Galland C, Auvert JF, Flahault A, Vayssairat M. Source: Breast Cancer Research and Treatment. 2002 September; 75(1): 87-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12500937

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Why most women with breast cancer still undergo mastectomy. Author(s): Masood S. Source: The Breast Journal. 2003 March-April; 9(2): 69-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12603376

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Willy Meyer's radical mastectomy. Author(s): Rutkow IM. Source: Archives of Surgery (Chicago, Ill. : 1960). 1997 December; 132(12): 1362. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9403544

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Women with localized breast cancer selecting mastectomy treatment, Iowa, 1991-1996. Author(s): Rushton G, West M. Source: Public Health Reports (Washington, D.C. : 1974). 1999 July-August; 114(4): 370-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10501140

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Women's regrets after bilateral prophylactic mastectomy. Author(s): Payne DK, Biggs C, Tran KN, Borgen PI, Massie MJ. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 2000 March; 7(2): 150-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10761795

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Work capacity of the upper limbs after mastectomy. Author(s): Capodaglio P, Strada MR, Lodola E, Grilli C, Panigazzi M, Bazzini G, Bernardo G. Source: G Ital Med Lav Ergon. 1997 October-December; 19(4): 172-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9775011

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Wound complications after modified radical mastectomy compared with tylectomy with axillary lymph node dissection. Author(s): Vinton AL, Traverso LW, Jolly PC. Source: American Journal of Surgery. 1991 May; 161(5): 584-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2031542

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Wound complications in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction for breast cancer. Author(s): Furey PC, Macgillivray DC, Castiglione CL, Allen L. Source: Journal of Surgical Oncology. 1994 March; 55(3): 194-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8176932

•

You don't have to be an expert to give sexual counseling to a mastectomy patient. Author(s): Frank DI. Source: Nursing. 1981 January; 11(1): 64-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6904885

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CHAPTER 2. NUTRITION AND MASTECTOMY Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and mastectomy.

Finding Nutrition Studies on Mastectomy The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “mastectomy” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “mastectomy” (or a synonym): •

Effect of mastectomy on milk fever, energy, and vitamins A, E, and beta-carotene status at parturition. Author(s): National Animal Disease Center, USDA-ARS, Ames, IA 50010, USA. [email protected] Source: Goff, J P Kimura, K Horst, R L J-Dairy-Sci. 2002 June; 85(6): 1427-36 0022-0302

•

Ethics in action: a preop mastectomy patient who knows a little about therapeutic touch. Source: Haddad, A RN. 1994 November; 57(11): 21-2, 24 0033-7021

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

•

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

•

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

•

Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

•

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

•

Google: http://directory.google.com/Top/Health/Nutrition/

•

Healthnotes: http://www.healthnotes.com/

Nutrition

•

Open Directory Project: http://dmoz.org/Health/Nutrition/

•

Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

•

WebMDHealth: http://my.webmd.com/nutrition

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND MASTECTOMY Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to mastectomy. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to mastectomy and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “mastectomy” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to mastectomy: •

A breast cancer support group: activities and value to mastectomy patients. Author(s): Stevenson BS, Coles PM. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1993 Fall; 8(3): 239-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8274372

•

A comparison of body image, self-esteem and social support in total mastectomy and breast-conserving therapy in Turkish women. Author(s): Yilmazer N, Aydiner A, Ozkan S, Aslay I, Bilge N. Source: Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer. 1994 July; 2(4): 238-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8087442

•

A holistic nursing response to mastectomy trauma syndrome. Author(s): Pasquali EA.

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Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 1993 September; 11(3): 258-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8409350 •

A randomized trial of postoperative five-versus three-drug chemotherapy after mastectomy: a Cancer and Leukemia Group B (CALGB) study. Author(s): Weiss RB, Tormey DC, Holland F, Weinberg VE, Lesnick G, Perloff M, Falkson G, Glidewell OJ. Source: Recent Results Cancer Res. 1982; 80: 170-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7036280

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An analysis of prognostic factors in response to conservative treatment of postmastectomy lymphedema. Author(s): Bertelli G, Venturini M, Forno G, Macchiavello F, Dini D. Source: Surg Gynecol Obstet. 1992 November; 175(5): 455-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1440176

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Cancer and Leukemia Group B adjuvant chemotherapy trials in postmastectomy breast cancer patients. Author(s): Wood WC. Source: Breast Cancer Research and Treatment. 1983; 3 Suppl: S39-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6367859

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Coping mechanisms of postmastectomy women. A group experience. Author(s): Baider L, Edelstein EL. Source: Isr J Med Sci. 1981 September-October; 17(9-10): 988-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7309490

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Effectiveness of combined methods of physiotherapy for post-mastectomy lymphoedema. Author(s): Swedborg I. Source: Scandinavian Journal of Rehabilitation Medicine. 1980; 12(2): 77-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7209441

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Ethics in action: a preop mastectomy patient who knows a little about therapeutic touch. Author(s): Haddad A. Source: Rn. 1994 November; 57(11): 21-2, 24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7984876

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Evaluation of the results of three different methods of postmastectomy lymphedema treatment. Author(s): Zanolla R, Monzeglio C, Balzarini A, Martino G.

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Source: Journal of Surgical Oncology. 1984 July; 26(3): 210-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6738072 •

Fear of mastectomy: the most common factor responsible for late presentation of carcinoma of the breast in Nigeria. Author(s): Ajekigbe AT. Source: Clin Oncol (R Coll Radiol). 1991 March; 3(2): 78-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2031886

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Lymphedema 30 years after radical mastectomy. Author(s): Brennan MJ, Weitz J. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1992 February; 71(1): 12-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1739437

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Malignant lymphoma of skin associated with postmastectomy lymphedema. Author(s): Waxman M, Fatteh S, Elias JM, Vuletin JC. Source: Archives of Pathology & Laboratory Medicine. 1984 March; 108(3): 206-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6546506

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Manual lymphatic drainage for chronic post-mastectomy lymphoedema treatment. Author(s): Fiaschi E, Francesconi G, Fiumicelli S, Nicolini A, Camici M. Source: Panminerva Medica. 1998 March; 40(1): 48-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9573754

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Mastectomy as an adjunct to combination chemotherapy. Author(s): Morris D, Aisner J, Elias EG, Wiernik PH. Source: Archives of Surgery (Chicago, Ill. : 1960). 1978 March; 113(3): 282-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=205189

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Mastectomy rehabilitation service. Author(s): Peters JM. Source: N Z Nurs J. 1980 November; 73(11): 14-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6936656

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Mastectomy, body image and therapeutic massage: a qualitative study of women's experience. Author(s): Bredin M. Source: Journal of Advanced Nursing. 1999 May; 29(5): 1113-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10320494

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Mastectomy: facts and figures. Author(s): Westgate B. Source: Nurs Mirror. 1981 January 1; 152(1): 30-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6906758

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Mastectomy: woman to woman. Author(s): Swaffield L. Source: Community Outlook. 1981 October 14; : 355. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6913463

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Physical treatment of postmastectomy lymphedema. Author(s): STILLWELL GK, REDFORD JW. Source: Mayo Clinic Proceedings. 1958 January 8; 33(1): 1-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13505880

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Postmastectomy couple counseling: an outcome study of a structured treatment protocol. Author(s): Christensen DN. Source: Journal of Sex & Marital Therapy. 1983 Winter; 9(4): 266-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6663643

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Postmastectomy educational needs and social support. Author(s): Feather BL, Wainstock JM, Remington A, Ringenberg QS. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1988; 3(2): 135-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3275230

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Postmastectomy lymphangiosarcoma-temporary response to cyclophosphamide chemotherapy in 2 cases. Author(s): Tong D, Winter J. Source: The British Journal of Surgery. 1974 January; 61(1): 76-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4811506

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Post-mastectomy lymphoedema treatment and measurement. Author(s): Bunce IH, Mirolo BR, Hennessy JM, Ward LC, Jones LC. Source: The Medical Journal of Australia. 1994 July 18; 161(2): 125-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8028536

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Psychic consequences of mastectomy. Author(s): Kornyey E.

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Source: Acta Chir Plast. 1985; 27(4): 217-23. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4096168 •

Psychological intervention with couples after mastectomy. Author(s): Baider L. Source: Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer. 1995 July; 3(4): 239-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7551626

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Psychosocial benefits of postmastectomy lymphedema therapy. Author(s): Mirolo BR, Bunce IH, Chapman M, Olsen T, Eliadis P, Hennessy JM, Ward LC, Jones LC. Source: Cancer Nursing. 1995 June; 18(3): 197-205. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7600551

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Regression of recurrence of carcinoma of the breast at mastectomy site associated with intensive meditation. Author(s): Meares A. Source: Aust Fam Physician. 1981 March; 10(3): 218-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6264906

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Rehabilitation after mastectomy. Author(s): Bostwick J. Source: J Med Assoc Ga. 1987 May; 76(5): 336-41. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3598406

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Rehabilitation of the mastectomy patient. Author(s): Marchant J. Source: Nurs Times. 1977 April 21; 73(16): 564-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=191794

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Rehabilitation of the postmastectomy patient with lymphedema. Author(s): Grabois M. Source: Ca: a Cancer Journal for Clinicians. 1976 March-April; 26(2): 75-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=816433

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Repeated adjuvant chemotherapy with phenylalanine mustard or 5-fluorouracil, cyclophosphamide, and prednisone with or without radiation, after mastectomy for breast cancer. Author(s): Ahmann DL, Scanlon PW, Bisel HF, Edmonson JH, Frytak S, Payne WS, O'Fallon JR, Hahn RG, Ingle JN, O'Connell MJ, Rubin J.

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Source: Lancet. 1978 April 29; 1(8070): 893-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=76842 •

Self-esteem and apparel satisfaction with appropriate clothing: value of product attributes and support groups for mastectomy survivors. Author(s): Chowdhary U, Ryan L. Source: Percept Mot Skills. 2003 August; 97(1): 35-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14604020

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Self-help groups: the Mastectomy Association. Author(s): Jones IH. Source: Nurs Times. 1979 October 25; 75(43): 1862. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=260026

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The effects of the Reach to Recovery Program on the quality of life and rehabilitation of mastectomy patients. Author(s): Stecchi JH. Source: Bioethics Q. 1980 Winter; 2(4): 237-46. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10251696

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Therapeutic touch and mastectomy: a case study. Author(s): Ledwith SP. Source: Rn. 1995 July; 58(7): 51-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7624727

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Time-limited thematic group with post-mastectomy patients. Author(s): Baider L, Amikam JC, De-Nour AK. Source: Journal of Psychosomatic Research. 1984; 28(4): 323-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6481665

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Treatment of inflammatory breast cancer with combination chemotherapy and mastectomy versus breast conservation. Author(s): Brun B, Otmezguine Y, Feuilhade F, Julien M, Lebourgeois JP, Calitchi E, Roucayrol AM, Ganem G, Huart J, Pierquin B. Source: Cancer. 1988 March 15; 61(6): 1096-103. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3342369

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Unnecessary mastectomy for gynecomastia in testicular cancer patient. Author(s): Moul JW, Moellman JR. Source: Military Medicine. 1992 August; 157(8): 433-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1382250

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

•

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

•

Healthnotes: http://www.healthnotes.com/

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

•

HealthGate: http://www.tnp.com/

•

WebMDHealth: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to mastectomy; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Breast Cancer Source: Healthnotes, Inc.; www.healthnotes.com Breast Cancer Source: Integrative Medicine Communications; www.drkoop.com Edema Source: Healthnotes, Inc.; www.healthnotes.com Skin Cancer Source: Integrative Medicine Communications; www.drkoop.com

•

Herbs and Supplements Cayenne Alternative names: Capsicum annuum, Capsicum frutescens Source: Healthnotes, Inc.; www.healthnotes.com

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Cayenne Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,765,00.html

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON MASTECTOMY Overview In this chapter, we will give you a bibliography on recent dissertations relating to mastectomy. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “mastectomy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on mastectomy, we have not necessarily excluded nonmedical dissertations in this bibliography.

Dissertations on Mastectomy ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to mastectomy. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

(Re)constructing the self: Autobiographical responses to breast cancer and mastectomy by Audre Lorde, Susan Miller, and Matuschka by Demaray, Elyse, PhD from INDIANA UNIVERSITY, 1996, 182 pages http://wwwlib.umi.com/dissertations/fullcit/9716428

•

Biofeedback-assisted, client-centered counseling in the treatment of anxiety and depression in mastectomy patients by Lazar, Janice Claire Morgan, PhD from MICHIGAN STATE UNIVERSITY, 1981, 121 pages http://wwwlib.umi.com/dissertations/fullcit/8212419

•

Emotional, physical, and sexual responses in women who experience prophylactic mastectomy and breast reconstruction for the prevention of breast cancer by Shea Welch, Kelly Jean, PhD from KANSAS STATE UNIVERSITY, 1999, 149 pages http://wwwlib.umi.com/dissertations/fullcit/9933108

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•

Female breast cancer patients' attitudes toward mastectomy and sleepwear design preferences by Paek, Jae Eun, PhD from TEXAS WOMAN'S UNIVERSITY, 2001, 200 pages http://wwwlib.umi.com/dissertations/fullcit/3012873

•

THE PSYCHOSOCIAL IMPACT OF CANCER: AN EVALUATION OF LARYNGECTOMY, MASTECTOMY AND OSTOMY REHABILITATION SERVICE PROGRAMS FOR CANCER PATIENTS by LEE, PETER CHING-YUNG, DSW from UNIVERSITY OF CALIFORNIA, BERKELEY, 1980, 290 pages http://wwwlib.umi.com/dissertations/fullcit/8029303

•

The role of the complexity of women's self-concepts in the prediction of the importance of body image in adjustment to mastectomy with and without reconstruction by Brower, Eleanor Irene, PhD from FIELDING GRADUATE INSTITUTE, 2003, 237 pages http://wwwlib.umi.com/dissertations/fullcit/3082489

•

TREATMENT CHOICES IN BREAST CANCER: A COMPARATIVE ANALYSIS OF MASTECTOMY PATIENTS AND RADIATION PATIENTS by WILLIAMS, JEAN, PhD from UNIVERSITY OF SOUTHERN CALIFORNIA, 1985 http://wwwlib.umi.com/dissertations/fullcit/f1811765

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON MASTECTOMY Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “mastectomy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on mastectomy, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Mastectomy By performing a patent search focusing on mastectomy, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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Mastectomy

example of the type of information that you can expect to obtain from a patent search on mastectomy: •

Artificial breast and nightgown incorporating same Inventor(s): Ettipio; Marion Carol (70 Alma Ave., Buffalo, NY 14215) Assignee(s): none reported Patent Number: 4,100,621 Date filed: October 7, 1976 Abstract: An artificial breast or mastectomy prosthesis is a light weight substantially breast-shaped pad having hook type fastening means at a plurality of locations about the periphery of the pad, which are fastenable to mating pile attachment means on the inside of the bosom area of a nightgown and are readily removable therefrom, when desired. More particularly, the artificial breast is of substantially triangular outline shape, when viewed from the front thereof, with hook tape fastening means at each corner and extending away from the triangle and with pile attachment means, ready for fastening to a nightgown, removably held to the hook tape fastening means. Specific pad structures are also described, as are nightgowns with pile attachment means and artificial breasts of this invention attached thereto, and a method of removably attaching the described artificial breast or mastectomy prosthesis to the inside of a nightgown. Excerpt(s): This invention relates to an artificial breast or mastectomy prosthesis. More particularly, it relates to such an article which is fastenable to the inside of a nightgown or other such sleepwear item so as to make such gown hang naturally and to conceal the absence of a breast of the wearer. The invention also relates to the nightgown incorporating such artificial breast and to a method for applying the artificial breast to the nightgown so that it is adequately held thereto but is readily removable therefrom when desired. Women who have undergone mastectomies will usually wear some type of prosthetic device, such as a special brassiere, so as to maintain a normal body shape. This is done to conceal the effect of the mastectomy, to make clothing fit better, to make the woman feel and appear more feminine and for psychological reasons. Similarly, women with undeveloped breasts may use padded brassieres. Special prosthetic brassieres are known in the prior art, as illustrated by U.S. Pat. No. 3,498,297, padded brassieres for flat-chested girls and women are well known. Especially with respect to the prosthetic brassieres, although such devices may be satisfactory for daytime wear, when worn in bed they tend to move upwardly and if tight enough not to move, they tend to be binding and thereby inhibit relaxation at night. As a result, to avoid the discomfort of the brassiere, especially when worn for a long time, and to prevent undesirable movement upward thereof when the wearer is lying down, the brassiere will often be removed. Of course, this results in a noticeable change in the woman's profile and the fitting of her nightgown and the resulting appearance is unsatisfactory and unacceptable to many women. Accordingly, it has been suggested to insert breastform prostheses into interior pockets of a certain type of lounge wear. However, such pockets may be conspicuous, are not readily removable from garments to which they are attached and usually will be sewn to the garment when it is manufactured, because the wearer will not be as readily able to position them for best appearance as will be a knowledgeable manufacturer. This may be due mostly to the way the artificial breast will lie rather loosely in the pocket or may be because the pocket is difficult to hold in proper position on the nightgown for sewing into place. In addition to employing pockets for positioning such prostheses one may also utilize ties, buttons, snaps and

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zippers for holding the prosthesis in place against the nightgown but, as mentioned in U.S. Pat. No. 3,348,241, such may result in uncomfortable protrusions that could irritate sensitive areas near the site of a breast amputation. It is an object of the present invention to produce an artificial breast especially suitable for attachment to sleepwear, such as a nightgown, on the inside thereof, to satisfactorily shape the sleepwear and give it the appearance of covering a natural breast. Another object is to have such a prosthetic device which is readily attachable to the sleepwear and removable from it to facilitate washing and to allow the user to employ the prosthetic device or not, as desired, with a particular nightgown. A further object is to manufacture such a product which may readily be used with any of a variety of nightgowns or similar sleepwear, with easy application of relatively inconspicuous attaching means onto the sleepwear interior. Still further objects of the invention will be apparent from this specification, including the drawing. Web site: http://www.delphion.com/details?pn=US04100621__ •

Body suit Inventor(s): Storie; Lyndola M. (1739 Cherokee, Caseyville, IL 62232) Assignee(s): none reported Patent Number: 4,627,111 Date filed: August 22, 1985 Abstract: A body suit constructed of thin, flexible, porous, resilient material such as latex rubber or the like constructed to fit an existing human female body in skintight relation with the external surface of the body suit closely simulating the color and skin texture of the wearer so that it is substantially indiscernible to an observer. The body suit includes breast areas, a navel and pubic hair simulative of a human female body and a crotch opening enabling normal body functions to be performed including coital intercourse without removing the body suit. The breast areas may include pockets receiving existing breasts or padding or prosthesis to augment small or flat breasts or replace breasts which may have been removed as a result of a mastectomy thereby enabling the wearer to eliminate psychological barriers to removal of clothing or garments and enabling the wearer to be more satisfied with their personal appearance and enabling greater satisfaction from sexual coitus. Excerpt(s): Many efforts have been made to shape the exterior of certain portions of the human anatomy and to replace removed components by providing prostheses. However, such efforts have generally been restricted to a localized area of the body. For example, if a breast is removed as a result of a mastectomy, brassieres can be worn having a simulated breast or breasts incorporated therein. Also, the chest area having the breast removed therefrom can be rebuilt by skin grafts, silicone inserts and the like. Also, various under garments have been provided to reshape the abdomen area, hip area and the like by compressing such areas or in some instances adding padding to increase the size of such areas. However, such devices have a limited degree of success since they involve only one local area of the human body and frequently are removable which sometimes results in psychological problems for the person when it becomes necessary or desirable to remove all articles of clothing. An object of the present invention is to provide a complete, skintight body suit, closely simulative of a naked, female human body constructed of porous, stretch film of latex rubber, plastic or the like constructed in such a manner that when worn, the body of the wearer will closely simulate the size, shape and appearance of a theoretically perfect human body. These

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together with other objects and advantages which will become subsequently apparent reside in the details of construction and operation as more fully hereinafter described and claimed, reference being had to the accompanying drawings forming a part hereof, wherein like numerals refer to like parts throughout. Web site: http://www.delphion.com/details?pn=US04627111__ •

Brassiere Inventor(s): Farino; Frank G. (Shaker Heights, OH) Assignee(s): Leading Lady Foundations, Inc. (Cleveland, OH) Patent Number: 3,957,057 Date filed: September 8, 1975 Abstract: There is provided an improved mastectomy brassiere of the type including two breast cups each adapted to receive either a natural breast or a mastectomy form pad. Each of the breast cups has two upwardly tapering, non-elastic margin strips, a lower curved margin strip connecting said tapering margin strips, an outer non-elastic fabric cover with a desired breast forming contour and a retaining means generally spaced from the fabric cover to form a pocket for a mastectomy form pad. The improvement comprises providing the retaining means as first and second separate stretchable flaps with the first flap secured along one of the marginal strips and along the lower strip, the second flap secured along the other of the margin strips and along the lower strip and wherein the flaps are overlapped at the lower strip to define an upper, generally triangular access opening for the mastectomy form pad. Excerpt(s): The present invention relates to the art of brassieres and more particularly to an improved mastectomy brassiere. The invention is particularly applicable for use by a mastectomy patient having a single breast surgically removed and it will be described with particular reference thereto. It is appreciated that the invention has broader applications and may be used for a mastectomy patient having a double mastectomy operation. In recent years, extensive effort has been directed toward improving the postoperative comfort of a mastectomy patient. In furtherance of this effort, substantial improvements are being made in mastectomy brassieres so that the mastectomy patient has a somewhat normal appearing bust line. This is essential for preventing, to the extent possible, some of the emotional strain surrounding this type of surgical procedure. It has now become somewhat common practice to use a mastectomy form pad, which is a unit having, as close as possible, the contour and physical reaction of a natural breast. The mastectomy form pad is inserted into the side of a brassiere corresponding to the mastectomy operation while a normal breast occupies the other breast cup of the brassiere. Web site: http://www.delphion.com/details?pn=US03957057__

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Brassiere construction Inventor(s): Lamborn; Sally (Stedman Rd., Lee Center, NY 13363) Assignee(s): none reported Patent Number: 4,261,366 Date filed: December 26, 1979

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Abstract: An improved brassiere for a person who has had a mastectomy operation. The brassiere may comprise a conventional garment in which at least one of the bust cups is adapted to receive and hold an artificial bust form. The cup in which the bust form is received is provided with an inside liner member that coacts with the cup to form a pocket enclosure for the form. The liner member is a unitary piece of bias cut soft material that extends continuously from a point adjacent the center of the brassiere, across the bust form receiving cup and out to the end of the adjacent side strap. The liner member is dimensioned so that its peripheral edges extend beyond the peripheral edges of the cup and strap thereby preventing the edges of the latter from contacting the wearer. Excerpt(s): This invention relates generally to female undergarments, and has particular reference to an improved brassiere for a woman who has had a mastectomy operation. Through the years a considerable amount of prior art has been developed in the field of undergarments, and particularly brassieres, for women who have had one or both breasts removed by surgery. In most instances, it has been the objective of the designers to provide a garment that offers comfort and peace of mind to the wearer and, at the same time, gives a natural appearance under all conditions of activity. Unfortunately, some of the prior art brassieres have been too uncomfortable to wear after surgery because of wires, relatively stiff seams or the like. Others, while more comfortable, have not felt natural to the wearer and sometimes have not presented a natural appearance. Another problem that has been encountered is that some mastectomy brassieres tend to slide or shift position unnaturally during activities such as sports or dancing. Finally, some mastectomy brassieres that have a number of very good features are so expensively constructed that the average woman cannot afford to buy them. Web site: http://www.delphion.com/details?pn=US04261366__ •

Breast prosthesis Inventor(s): Knoche; Bodo (Stockumer Str. 24, D-3204 Nordstemmen 4, DE) Assignee(s): none reported Patent Number: 4,317,241 Date filed: May 1, 1980 Abstract: A breast prosthesis for use as a replacement in the case of a mastectomy where the chest of the wearer presents problems in providing a satisfactory support surface for a standardized prosthesis. The prosthesis includes an internal filler part which seats in the cavity so that the prosthesis assumes its normal position. Excerpt(s): The present invention is directed to a breast prosthesis such as is used as a replacement in the case of a mastectomy and, more particularly, to a prosthesis where the chest of the wearer presents problems in providing a satisfactory support surface for a standarized prosthesis. In co-pending patent application Ser. No. 841,478, filed Oct. 12, 1977 by Bodo Knoche, now U.S. Pat. No. 4,199,825, a breast prosthesis and a method of molding the prosthesis have been disclosed. This breast prosthesis has met with considerable success, however, it has been noted in certain instances that the prosthesis does not fit properly because of the cicatrization formed following a mastectomy. Usually the chest of a person who has undergone a mastectomy follows the normal chest curvature, but without the amputated breast. When a standardized prosthesis formed in accordance with regular brassiere cup sizes, is placed on such a normal chest surface it fits properly. In certain instances, however, because of the nature of the

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operation performed and the amount of tissue and muscle removed, after the healing process, a cavity or depression is present inwardly from the normal chest surface. The breast prosthesis formed in accordance with the above mentioned patent is intended to be used where the chest surface of the wearer is smooth and follows the normal chest curvature without any cavity or depression. If there is a cavity or depression inwardly of the normal chest surface, when the prosthesis is placed on the wearer it tends to sink in and does not fit properly in the brassiere cup for which it is designed. Web site: http://www.delphion.com/details?pn=US04317241__ •

Breast prosthesis Inventor(s): Rice; Jean E. (1409 W. Yakima Ave., Yakima, WA 98902) Assignee(s): none reported Patent Number: 5,066,302 Date filed: April 25, 1990 Abstract: A one-piece prosthesis for use by a woman who has undergone a mastectomy, the prosthesis comprising the form of a complete breast, without voids therein, and with a supplement extending toward the axilla, and a supplement extending toward the clavicle, each supplement designed to fill a void left by surgery, and further having a band below the breast to underlie the lower band of brassiere, said supplements and band being tapered to a fine edge of avoid the appearance of demarcation lines. The prosthesis is molded of silicone which may contain dye to match skin coloration, and approximates the size, shape, density, resilience and pliability of the natural breast in various chest and cup sizes. Excerpt(s): A woman who has had a simple or a radical mastectomy can compensate to some extent by having reconstructive surgery, or by wearing a breast prosthesis. Many women, particularly those who are elderly, would not care to undergo reconstructive surgery, and must wear a breast prosthesis. Most prostheses seem to be designed by men who do not have an understanding of the requirements for a breast prosthesis that will fit the altered shape of the chest in a way that will be truly comfortable, will give the wearer confidence, and will simulate as closely as possible the graceful, flowing lines of the natural mature breast. For example, most mastectomy patients are past the childbearing age, and the upper part of the breast, above the nipple, is not full, as with younger women, but is more-or-less concave in that area. Various designs have been patented that feature a back wall made of material such as plastic or sheepskin that would not feel natural against the skin. Some prostheses have a large hollow at the back. Some prostheses simulate the weight of the breast by having an internal void in which a weight is placed. None of them tries to fill all the voids left by radical surgery with a prosthesis approximating the size, shape, weight, resiliency and pliability of an actual breast. Web site: http://www.delphion.com/details?pn=US05066302__

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Camisole for mastectomy patients Inventor(s): Sebring; Corene M. (Ortonville, MI) Assignee(s): Gentle Touch Medical Products, Inc. (Ortonville, MI) Patent Number: 6,048,252 Date filed: July 20, 1998 Abstract: A camisole-like garment for use by medical patients includes front and rear segments with the front segment divided into two panels which may be selectively, temporarily closed. The garment includes a yoke-like neck area and arm-receiving openings. Additional side openings are provided adjacent the line of joinder of the front and rear segments to provide for access for drainage tubes or the like and at least one pocket is formed on the outer surface of at least one of the front panels, also for the receipt of a drainage bulb associated with the drainage tube. Prosthesis-receiving pockets may also be provided on the inner surfaces of the front panels. Excerpt(s): None. This invention relates in general to articles of apparel and relates in particular to a camisole style garment intended for use by mastectomy patients. It is known that, during recovery, and before any permanent corrective surgery, such as implants, takes place, mastectomy patients have a psychological need for at least a temporary replacement of the breast or breasts. To that end, artificial breasts or prostheses have been provided and used in the past and various garments of wearing apparel have been provided to accommodate the wearing of these items. These garments are generally provided with pockets of some sort to receive the artificial breast or breasts so that the wearer, when wearing the garment, will appear to the casual observer to be unaffected by the surgical process. Such garments are important to the mental well being of the patient after undergoing such a traumatic operation. Web site: http://www.delphion.com/details?pn=US06048252__

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Double-closure clasp Inventor(s): Crew-Gee; Martin P. (Gatineau, CA) Assignee(s): Warnaco Inc. (New York, NY) Patent Number: 5,380,238 Date filed: September 30, 1993 Abstract: A double-closure clasp for maternity, mastectomy or like garments, the clasp comprising a housing member and a pair of clip members slidably insertable in the housing; the housing being unitarily molded from plastic material and comprising a substantially flat base wall, opposed side walls and an upper wall defining a pair of adjacent apertures therethrough, the side walls, base wall and upper wall defining a pair of guideways terminating in transverse open entry slots in the housing through which the clip members are inserted. The clip members each including a substantially flat body defining a fenestration therein, and a resilient tongue extension having one end thereof integral with the body and disposed at an angle relative thereto, the tongue extension being disposed to move into and out of the fenestration, the body further including means for attachment to a portion of the garment. The garment including an elongated band adapted to encircle the body, having a pair of frontal breast supporting and encircling portions; a pair of shoulder straps attached at one end thereof to the breast supporting and encircling portions and at the opposite end thereof to the band; and a

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pair of breast cups integral with the band, each having a free end to which the clip members are respectively attached. Excerpt(s): The present invention relates generally to a separable fastener, and more particularly, to a separable fastener adapted for any application where it is desirable to provide independent joinder of adjacent areas such as in maternity or mastectomy garments or the like, to facilitate independent exposure of either breast of the wearer without removal of the garment. Maternity or mastectomy garments are designed to provide the ability to independently expose a single breast at a time without having to remove the entire garment. To this end, there are several patents directed to garments having special fastener provisions which permit such operation. An example is provided in U.S. Pat. No. 3,002,515 of Oct. 3, 1961 to Glogover, which teaches a nursing brassiere for independently opening and securing either of two separable bra cups to a medial pillar with hook and eye fasteners. A similar type of nursing brassiere is disclosed in U.S. Pat. No. 2,613,355 of Oct. 14, 1952 to Coleman, in which a pair of releasable breast pockets are independently secured to a medial stay by a plurality of hook and eye fasteners. In spite of the independent closure feature in such designs, there is a drawback in that the wearer must expend time and effort to close and open a plurality of individual fastener components. This can be remedied by using a single fastener adapted to release either side of an attached portion of the garment. Web site: http://www.delphion.com/details?pn=US05380238__ •

Drain tube belt and shower pack kit Inventor(s): Watson; Paul L. (136 Lakeside Dr. East, Mossyrock, WA 98564), Watson; Viola M. (136 Lakeside Dr. East, Mossyrock, WA 98564) Assignee(s): none reported Patent Number: 6,152,915 Date filed: March 23, 1999 Abstract: After an operation, a drain tube or drain tubes may be placed in the patient's body. Sometimes the drain tube is sutured into the open end of the body and hangs from the body. After a mastectomy, the drain tube is often sutured into the body of the patient. The drain tube hangs downwardly and there is a collection bulb on the end of the drain tube to the discomfort of the patient. The applicant has devised a strap which fits around the abdomen and on the strap there is a pocket for receiving the drain tube and the collection bulb. The patient can walk and maneuver with less discomfort because the pocket and the strap are bearing some of the weight of the drain tube and collection bulb and provide proper drainage. Also, there is disclosed a receptacle for holding the collection bulb by itself. The patient may want to take a shower or dress or undress. The collection bulb can be placed in this second receptacle. This allows freedom of movement of the hands and of the patient. The patient can position the receptacle on some of the plumbing features and accessory features in the shower as the receptacle does have a handle. Or, the patient can position the receptacle and the collection bulb on the rod holding the shower curtain. In essence, the patient can be made more comfortable with this invention as the patient has assistance in supporting the drain tube and the collection bulb. Excerpt(s): There is no related application. This invention and patent application was financed with private funds and there was no federal assistance in developing the invention and in the filing of the patent application. The genesis of this invention is that

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one of the co-inventors had breast cancer. A mastectomy was performed. Two drain tubes were placed inside of her. These drain tubes extended from inside of her to outside of her. A drain tube is sutured into the body of the patient so that the drain tube cannot be accidentally removed. On the outer end of the drain tube there is positioned a collection bulb. The collection bulb may be at a lower internal pressure than the atmospheric pressure for the patient and the fluid from the patient's body flows into the collection bulb. Web site: http://www.delphion.com/details?pn=US06152915__ •

Mastectomy accessory for bra Inventor(s): Williams; Marguerite R. (500 Plattsville Road, Trumbull, CT 06611) Assignee(s): none reported Patent Number: 3,950,792 Date filed: February 7, 1975 Abstract: An accessory which can be incorporated into a conventional bra at the time of manufacture or added subsequent thereto for conversion thereof to a mastectomy bra. The accessory hides variable amounts of scar tissue or other type of chest disfigurement in the region where the breast has been removed, by means which may be adjusted by the wearer, the area hidden depending in amount and location upon the nature and extent of the mastectomy, i.e., removal of all or a part of one or both breasts with or without removal of adjacent muscle tissue and/or lymph nodes. The resultant mastectomy bra functions to contain in each cup one or more breast prostheses in cases where both natural breasts have been removed, or where only one breast has been removed to support a natural breast in conventional fashion in one cup and one or more prostheses in the other cup, while maintaining a harmonious and apparently similar appearance on both the left and right sides thereof, while covering both the mastectomy area and the normal breast in a visually similar manner. Excerpt(s): This invention relates to a mastectomy bra, and more particularly to an accessory for converting a conventional bra into a bra suitable for a mastectomy patient. Mastectomy operations vary from patient to patient. Such operations may involve removal of the left, right or both breasts, as well as removal of the surrounding muscle tissue and/or the lymph nodes situated under the arms. Some patients undergo removal of all of the foregoing, others less. Subsequent to recovery from surgery, the mastectomy patient is faced with the problem of reconstructing as close an approximation as possible to the original chest and/or underarm configuration. Such is important for physical, psychological and aesthetic reasons. To accomplish this, the patient selects one or more prosthetic devices depending on the nature and extent of the operation. For example, if a single breast and substantial surrounding muscle tissue and lymph nodes have been removed, multiple artificial breast forms, prostheses, and/or pads may be needed. In addition, the patient must select a mastectomy bra to contain and position the prosthetic device(s), as well as support in conventional fashion a natural breast if both breasts have not been removed. Web site: http://www.delphion.com/details?pn=US03950792__

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Mastectomy and shunt coverage assembly Inventor(s): Le Blanc; Donald A. (1208 Mercury Ave., Metairie, LA 70003), Le Blanc; Patricia M. (1208 Mercury Ave., Metairie, LA 70003) Assignee(s): none reported Patent Number: 6,226,798 Date filed: August 25, 2000 Abstract: A mastectomy and shunt coverage assembly for protecting the area of a mastectomy or shunt while showering. The mastectomy and shunt coverage assembly includes a main member with an opening for receiving an arm of the user and an interior edge, the interior edge has a front portion positionable to abut the chest of the user, a back portion positionable to abut the back of the user, and a top portion positionable to abut the shoulder of the user, an adhesive strip is coupled to the main member and adapted for removably affixing the main member to the user forming a moisture proof seal between the interior edge and the user. Excerpt(s): The present invention relates to wound protective devices and more particularly pertains to a new mastectomy and shunt coverage assembly for protecting the area of a mastectomy or shunt while showering. The use of wound protective devices is known in the prior art. More specifically, wound protective devices heretofore devised and utilized are known to consist basically of familiar, expected and obvious structural configurations, notwithstanding the myriad of designs encompassed by the crowded prior art which have been developed for the fulfillment of countless objectives and requirements. Known prior art includes U.S. Pat. No. 5,181,274; U.S. Pat. No. 4,911,151; U.S. Pat. No. 5,342,287; U.S. Pat. No. 3,616,464; U.S. Pat. No. Des. 59,555; and U.S. Pat. No. Des. 399,003. Web site: http://www.delphion.com/details?pn=US06226798__

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Mastectomy bandage Inventor(s): Chase; Beverly J. (14820 S.E. 111th Pl., Renton, WA 98059), Schellert; Barbara A. (3506 Park Ave., Renton, WA 98056), Yelland; Emeline E. (10703 - 148th Ave S.E., Renton, WA 98509-4232) Assignee(s): none reported Patent Number: 5,527,270 Date filed: March 1, 1994 Abstract: A bandage for use to apply pressure to the wound area of a patient who has undergone a mastectomy includes a main body panel formed from a fabric that is nonelastic and breathable. The bandage is secured adjacent the side of the body of the patient to avoid the formation of a seam adjacent the wound area, yet allow application and removal of the bandage by the patient without assistance and with minimal pain and discomfort. An elastic member enables adjustment of the bandage for proper fit around the torso of the patient and ensures the application of adequate pressure. The bandage is configured so that the material that contacts the person's skin is non-elastic and breathable for increased comfort. Excerpt(s): The present invention relates to a medical bandage, and more particularly, to a bandage for use to secure a dressing over the chest area of a person. Although the bandage of the present invention is described in relation to a patient who has undergone

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a mastectomy, it should be understood that the present invention is not limited to such use but may be employed to apply pressure over other types of wounds and to other areas of the body. After a mastectomy, it is necessary for the mastectomy patient to wear a dressing over the wound area. The patient is required to wear the dressing throughout the recovery period which typically is about four to six weeks. The dressing must be changed at least once every day. Initially the patient is assisted by hospital personnel or other persons in changing the dressing. However, in view of the relatively lengthy recovery period, it is desirable that the patient eventually be able to change the dressing by herself with minimal pain and discomfort, since oftentimes there may not be anyone available to assist the patient. Moreover, since a dressing is required continually throughout the recovery period, it is especially important that the means used to secure the dressing to the patient be comfortable. For example, it should not chafe the skin nor trap excessive moisture against the skin. Furthermore, the patient experiences significant swelling in the wound area. This swelling decreases over time. The bandage should be easily adjustable to achieve proper fit in conformance with the amount of swelling experienced at any given time. It is known to use nonadhesive bandages (i.e., bandages that do not use adhesive tape) that encircle the chest of a patient to secure a dressing to a mastectomy area. However, these bandages are characterized by the use of elastic material that contacts the skin and tends to entrap excessive moisture so as to create further discomfort for the person. Elastic material returns with force to substantially, if not completely, its original shape when released after stretching. As a result of this tendency to return to its original shape, elastic material when pulled over a surface exerts pronounced pressure on that surface. Thus, a bandage that uses elastic material to cover a wound applies a substantial amount of pressure to the area of the body contacting the elastic material. In contrast, a non-elastic material tends to resist stretching or to lose shape upon stretching (i.e., it does not have a tendency to rebound to its original shape). Web site: http://www.delphion.com/details?pn=US05527270__ •

Mastectomy bra Inventor(s): Evans; Annette (16 Lightsey La., Lutz, FL 33549) Assignee(s): none reported Patent Number: 4,269,191 Date filed: July 16, 1979 Abstract: The invention comprises an improved mastectomy bra specifically adapted for a female having a single mastectomy. The bra comprises a left and a right bra element, each being an independent and separate article. Each of the left and right bra elements comprises a bra cup and a chest band secured to the bra cup for encircling the chest of the female. A bra clasp is diposed in at least one of the chest bands enabling one of the bra elements to be completely removed to expose the breast of the female while simultaneously enabling the other of the bra elements to remain in place to cover the prosthesis of the female. Excerpt(s): This invention relates to wearing apparel and more particularly, to a bra specifically adapted for a female with only one breast. Statistics of the American Cancer Society reveal that an alarming number of mastectomy operations are performed in this country every year. Presently, there are several different types of mastectomy operations. In general, one of the female's breasts and possibly substantial adjacent tissue is removed in order to insure the complete removal of all malignant cells from the

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female. Accordingly, the woman is left with a single breast remaining after the mastectomy operation. Although various types of plastic surgery is now available to mastectomy patients, the overwhelming majority of mastectomy patients adopt the use of a prosthesis which is worn in place of the removed breast. A substantial amount of psychological and emotional discomfort is encountered by a woman subsequent to a mastectomy operation. This emotional discomfort is most severe when the female engages in sexual activity. In general, the female wears a conventional brassiere with the prosthesis in place of the removed breast. At the time of sexual encounter, the female has several alternatives, each of which is unsatisfactory for both the female and her partner. The first alternative is to leave the bra on during the sexual activity. This alternative is unsatisfactory for obvious reasons. The second alternative is to partially remove the bra to expose only the remaining breast. This is unsatisfactory since the female and her partner are encumbered by the presence of the brassiere. The third alternative is to remove the bra and the prosthesis, thereby exposing an unsightly scar and a flat chest. In all of the alternatives, the psychological and emotional discomfort is exaggerated and, in general, destroys the mood and attitude of both parties. Web site: http://www.delphion.com/details?pn=US04269191__ •

Mastectomy brace Inventor(s): Guttentag; Anne (39 N. Main St., New Hope, PA 18938) Assignee(s): none reported Patent Number: 4,257,412 Date filed: November 4, 1977 Abstract: An appliance for exerting pressure on a breast which has a surgically inserted implant including a semi-firm plate curved and contoured to form a concave section adapted to engage the upper and outer surfaces of the breast as well as the chest area surrounding these breast sides and relieved at the nipple area. A cushioning layer is secured to the concave surface of the plate which may be retained in downwardly and inwardly pressured contact with the breast either with a body strap that secures to the plate with separable fasteners and extends around the chest of the wearer or by retention of the plate within a cup of a brassiere. Excerpt(s): 1. Field of the Invention. This invention relates to an appliance for exerting forces on a breast which has undergone Mastectomy and/or contains a surgical implant to change the attitude of projection of the breast and its position. 2. Prior Art. Web site: http://www.delphion.com/details?pn=US04257412__

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Mastectomy compression surgical brassiere Inventor(s): McCurley; Arlene B. (2339 Foster La., Westlake, LA 70669) Assignee(s): none reported Patent Number: 5,158,541 Date filed: January 23, 1992 Abstract: The present disclosure is directed to a mastectomy compression surgical brassiere having as a component a mastectomy brassiere having a pair of camisole shoulder straps and lined brassiere cups, a rectangular compression pad sewn to the

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inside of the front of the brassiere at substantially its mid point, the rectangular compression pad is covered with a soft porous VELCRO pile looped structure on its external surface lined with a soft fabric, and has an elastic return force band having a portion of a VELCRO hook fabric fastener fabric secured on the side of said return force band away from the body of said compression pad adapted to engage the loops of the VELCRO pile structure cover on said compression pad to retain surgical gauze pads against the incision between the body and the compression pad, and wherein a loop fabric type hook and fastener fabric is secured to the elastic return force band positioned to attach the VELCRO hooks on the return force band to said brassiere to retain the compression pad of the brassiere and surgical dressing pads firmly in place against a mastectomy incision, and to maintain the brassiere firmy against the body of the wearer. Excerpt(s): The present invention is directed to the technical field of a brassiere for retaining surgical dressings post operatively over a mastectomy incision area under proper compression. The invention is directed to a brassiere structure which may be placed on the patient immediately following surgery while still in the operating room to retain the surgical compress pads against the incision and properly retain the pads against the incision line at the pressure necessary to promote healing and to eliminate a body wrap or bandage and to eliminate tape burns associated with the use of adhesive tape to retain the surgical gauze pads in place. This is attained by employing an elastic return force band in place with fabric VELCRO fasteners so that as healing progresses the pressure of the brassiere against the incision may be applied as physician desires. The invention is an integral part of a brassiere structure. It is composed of a mastectomy brassiere, a compression pad and an elastic band to supply the return force needed for compression over the incision. The invention eliminates the need for a body wrap bandage or other bandage associated with adhesive tape and the related tape burns. A consistent and even compression is applied to the incision for 24 hours a day. The compression is applied by an elastic return force band with hook fabric fastener on each end. Compression applied by bandage and tape is inconsistent and uneven because gauze stretches after the first day. Consistent even compression is advantageous to healing and relieving pain. Web site: http://www.delphion.com/details?pn=US05158541__ •

Mastectomy garments with built-in prosthetic device Inventor(s): Fanelli; Marie (3 Erhle Ct., Fort Salonga, NY 11768) Assignee(s): none reported Patent Number: 6,234,867 Date filed: January 13, 2000 Abstract: A mastectomy bra is constructed with a built-in prosthetic device and includes at least one bra outer portion within which a breast-shaped prosthetic device of varying weight and composition is permanently adjusted. The single bra cup includes an outer fabric layer fully enclosing and supporting the prosthetic device, and the outer fabric layer includes a breast contoured portion and a body facing portion. The prosthetic device is formed in a natural shape of a woman's breast. The device is also constructed of a non-permeable, soft flexible outer shell layer within which is disposed the fluid-like material. An optional valve may be included for adding or removing fluid material from the bra cup for aesthetic adjustment of its size.

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Excerpt(s): The invention relates generally to mastectomy bras. More particularly, the invention relates to fashionable garments, including bras, dresses, bathing suits, nightgowns, etc., which include one or more built-in and non-removable prosthetic devices forming a bra cup in various shapes and sizes, complementing the size and shapes of a mastectomy patient's surgical area, and/or remaining breast portions. Various breast prosthesis are known for use by mastectomy patients. For example, U.S. Pat. No. 4,195,639 discloses an external breast prosthesis comprising a thin plastic shell of elastomeric material. The external breast prosthesis is contoured to conform to the configuration of the breast of a mastectomy patient and includes a rear peripheral edge for attachment by adhesive to the chest wall of the patient. Adhesive attached mastectomy devices are known to cause irritation to the surgical area of the woman's body to which it is applied. Also known is an artificial breast form, disclosed in U.S. Pat. No. 5,458,635, including contoured, molded breast shape layers that can be sculptured by a user to create a cosmetically acceptable appearance, i.e., fit. Use of such form, however, limits the type of garment which may be worn therewith. Further known is U.S. Pat. No. 5,855,606, which discloses a breast prosthesis comprising an underwire adapted to retain the breast prosthesis, which prosthesis may be removably attached to an unmodified bra. There are particular problems known to those skilled in the art associated with the use of bra-removable mastectomy problems. Also known are garments constructed for use by mastectomy patients. For example, U.S. Pat. No. 4,100,621, discloses an artificial breast or mastectomy prosthesis and nightgown incorporating same. The prosthesis is constructed as a lightweight substantially breast shaped pad having hook-type fastening means at a plurality of locations about the pad which are fastenable to mating pile attachments means on the inside of a bosom area of a nightgown and readily removable therefrom. As does the '621 patented prosthesis, the '621 patented prosthetic device is constructed to be removed from the garment for storage and maintenance. Web site: http://www.delphion.com/details?pn=US06234867__ •

Mastectomy pad Inventor(s): Silverman; Abe (Chicago, IL) Assignee(s): Silveco Products, Inc. (Chicago, IL) Patent Number: 4,071,914 Date filed: January 26, 1977 Abstract: A mastectomy pad embodying an outer seamless molded fibrous material casing molded of high-loft non-woven bonded polyester fibrous material (such as Eastman KODEL) and including a generally conical preshaped body which is adapted to be worn in the conical-shaped cup of a brassiere or garment to simulate the breast of a woman who has had a mastectomy operation, and a laterally projecting tongue portion which is adapted to extend into the underarm area of the wearer to fill area from which tissue has been removed as an incident to the mastectomy operation. A generally conical preshaped molded closed foam rubber internal casing is arranged within the seamless molded polyester fibrous material outer casing and is molded of foam rubber and is weighted with a body of filler material which is preferably a mixture of particles of shredded foam rubber and sand. An outer protective fabric cover is arranged over and is stitched around its marginal edge portions to the outer marginal edge portions of the seamless molded polyester fibrous material outer casing outwardly of the outer marginal edge portion of the foam rubber internal casing so that the foam rubber

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internal casing is completely enclosed within the seamless molded outer fibrous material casing. A non-stretchable fabric attaching strap is attached to the weighted foam rubber internal casing and has attaching portions in the form of loops or tabs which are attached to a brassiere or garment worn by the user of the new mastectomy pad. Excerpt(s): The prior art of mastectomy pads is exemplified by two of the applicant's earlier patents, namely, U.S. Pat. No. 2,482,297 granted to applicant on Sept. 20, 1949 on "Surgical Breast Pad," and U.S. Pat. No. 3,278,947 granted to the applicant on Oct. 18, 1966 on "Surgical Breast Pad." The mastectomy pads disclosed in the applicant's two earlier patents, referred to above, have enjoyed substantial success in the market and have, in general, functioned satisfactorily within their structural and functional applications. However, there has developed a need for a mastectomy pad which would combine all of the desirable characteristics of the applicant's two earlier mastectomy pads and certain additional novel features, advantages and improvements thereon, which will be referred to hereinafter. Thus, there has been a need for a weighted mastectomy pad which embodies a seamless molded outer casing which would combine the desirable advantages and characteristics of the high-loft bonded polyester fibrous material of applicant's earlier U.S. Pat. No. 3,278,947, including softness; flexibility; ability to withstand repeated washings over a prolonged period of use; ability to adapt itself and the seamless molded outer casing thereof to brassiere cups of varying shapes; ability to impart to the wearer, as far as possible, a feeling of balance at both sides of the chest and resulting elimination of a tendency of the mastectomy patient to lean away from the body side at which the breast has been removed and toward the heavier body side at which the natural breast remains; a seamless molded front or outer side which eliminates the undesirable and unsightly appearance or indication of a seam at the front or outer side of the mastectomy pad to which some users of such mastectomy pads object for the reason that such a seam may be seen or otherwise observed from the front of the brassiere or other garment which may be worn by the user of such mastectomy pads; with the advantages of the foam rubber mastectomy pad of applicant's earlier U.S. Pat. No. 2,482,297 including its ability to retain its generally conical-shape while, at the same time, it has been desirable that such a mastectomy pad embody means for readily attaching it in position of use in a brassiere or garment and so that it will not shift from its desired position when in use; and so that it may readily be fastened to and removed from a brassiere or garment worn by the user of the new mastectomy pad. An object of the invention is to provide a new and improved weighted mastectomy pad which embodies a seamless molded outer casing and which is soft; flexible; comfortable in use; is washable in repeated washings over a pronlonged period of use; retains its molded form; readily adapts itself to brassiere cups of varying shapes; and in the preferred embodiment thereof has no visible or otherwise discernible seam or stitching at the front surface of the seamless molded outer casing thereof; will not shift from its desired position when in use; is readily attached to and removable from a brassiere or garment worn by the user; and has the other desirable advantages and characteristics referred to herein. Web site: http://www.delphion.com/details?pn=US04071914__

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Method for heating ductal and glandular carcinomas and other breast lesions to perform thermal downsizing and a thermal lumpectomy Inventor(s): Fenn; Alan J. (Wayland, MA), Mon; John (Silver Spring, MD) Assignee(s): Celsion Corporation (Columbia, MD) Patent Number: 6,470,217 Date filed: April 13, 2000 Abstract: A method for selectively heating cancerous conditions of the breast including invasive ductal carcinoma and invasive glandular lobular carcinoma, and pre-cancerous conditions of the breast including ductal carcinoma in-situ, lobular carcinoma in-situ, and intraductal hyperplasia, as well as benign lesions (any localized pathological change in the breast tissue) such as fibroadenomas and cysts by irradiation of the breast tissue with adaptive phased array focused microwave energy is introduced. Microwave energy provides preferential heating of high-water content breast tissues such as carcinomas, fibroadenomas, and cysts compared to the surrounding lower-water content normal breast tissues. To focus the microwave energy in the breast, the patient's breast can be compressed and a single electric-field probe, inserted in the central portion of the breast, or two noninvasive electric-field probes on opposite sides of the breast skin, can be used to measure a feedback signal to adjust the microwave phase delivered to waveguide applicators on opposite sides of the compressed breast tissue. The initial microwave power delivered to the microwave applicators is set to a desired value that is known to produce a desired increase in temperature in breast tumors. Temperature feedback sensors are used to measure skin temperatures during treatment to adjust the microwave power delivered to the waveguide applicators to avoid overheating the skin. The microwave energy delivered to the waveguide applicators is monitored in real time during treatment, and the treatment is completed when a desired total microwave energy dose has been administered. By heating and destroying the breast lesion sufficiently, lesions can be reduced in size and surrounding normal breast tissues are spared so that surgical mastectomy can be replaced with surgical lumpectomy or the lesions can be completely destroyed so that surgical mastectomy or lumpectomy is avoided. Excerpt(s): The present invention generally relates to a minimally invasive method for administering focused energy such as adaptive microwave phased array hyperthermia for treating ductal and glandular carcinomas and intraductal hyperplasia as well as benign lesions such as fibroadenomas and cysts in compressed breast tissue. In addition, the method according to the invention may be used to treat healthy tissue containing undetected microscopic pathologically altered cells of high-water content to prevent the occurrence of or the recurrence of cancerous, pre-cancerous or benign breast lesions. In order to treat primary breast cancer with hyperthermia, it is necessary to heat large volumes of tissue such as a quadrant or more of the breast. It is well known that approximately 90% of all breast cancers originate within the lactiferous ductal tissues (milk ducts) with much of the remaining cancers originating in the glandular tissue lobules (milk sacks) (Harris et al., The New England Journal of Medicine, Vol. 327, pp. 390-398, 1992). Breast carcinomas often involve large regions of the breast for which current conservative treatments have a significant risk of local failure. Schnitt et al., Cancer, Vol. 74 (6) pp. 1746-1751, 1994. With early-stage breast cancer, known as T1 (0-2 cm), T2 (2-5 cm) cancers, the entire breast is at risk and often is treated with breastconserving surgery combined with full-breast irradiation to destroy any possible microscopic (not visible to the human eye without the aid of a microscope or mammography) cancer cells in the breast tissue (Winchester et al., CA-A Cancer Journal

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for Clinicians, Vol. 42, No. 3, pp. 134-162, 1992). The successful treatment of invasive ductal carcinomas with an extensive intraductal component (EIC) where the carcinomas have spread throughout the ducts is particularly difficult, since large portions of the breast must be treated. Over 800,000 breast needle biopsies of suspicious lesions are performed annually in the United States with approximately 180,000 cases of cancer detected, the rest being nonmalignant such as fibroadenomas and cysts. The use of heat to treat breast carcinomas can be effective in a number of ways, and in most cases the heat treatment must be capable of reaching, simultaneously, widely separated areas within the breast. Heating large volumes of the breast can destroy many or all of the microscopic carcinoma cells in the breast, and reduce or prevent the recurrence of cancer--the same approach is used in radiation therapy where the entire breast is irradiated with x-rays to kill all the microscopic cancer cells. Heating the tumor and killing a large percentage or all of the tumor cells prior to lumpectomy may reduce the possibility of inadvertently seeding viable cancer cells during the lumpectomy procedure, thus reducing local recurrences of the breast. Sometimes, the affected breast contains two or more tumor masses distributed within the breast, known as multi-focal cancer, and again the heating field must reach widely separated regions of the breast. Locally advanced breast carcinomas (known as T3) (Smart et al., A Cancer Journal for Clinicians, Vol. 47, pp. 134-139, 1997) can be 5 cm or more in size and are often treated with mastectomy. Pre-operative hyperthermia treatment of locally advanced breast cancer may shrink the tumor sufficiently to allow a surgical lumpectomy procedure to be performed--similar to the way pre-operative chemotherapy is currently used. Preoperative hyperthermia treatment of locally advanced breast cancer may destroy the tumor completely, eliminating the need of any surgery. Web site: http://www.delphion.com/details?pn=US06470217__ •

Method for total, immediate, post-mastectomy breast reconstruction using a latissimus dorsi myocutaneous flap Inventor(s): Knowlton; Edward W. (25 Chestnut Pl., Danville, CA 94506) Assignee(s): none reported Patent Number: 5,301,692 Date filed: November 16, 1992 Abstract: A technique for immediate, total breast reconstruction is described that equally preserves the skin of both the mastectomy and remaining breast. The technique is most applicable to a mastectomy which is performed through a circumareolar incision. Replacement tissue for the excised nipple-areolar complex is provided by a latissimus dorsi flap having a cutaneous peg. The pectoralis major and latissimus dorsi flap serve to create a submuscular prosthetic compartment. The submuscular compartment, together with the volume of the latissimus dorsi flap, closely approximates the volume of the contralateral breast, and the normal contour of the breast skin envelope. Accordingly, insertion of a permanent implant instead of an expander is possible. The nipple-areolar reconstruction can also be completed at the initial operative stage. Excerpt(s): The invention relates to a medical procedure, and more specifically to a surgical method that can provide an aesthetically pleasing breast reconstruction from a single-stage procedure. Cancer of the female breast is a significant health matter worldwide. The current treatment of breast cancer includes surgery, chemotherapy and radiation therapy, as well as various combinations of these three modalities.

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Approximately one-half the women in the U.S. that are diagnosed with breast cancer will elect or will require a mastectomy. Thus, mastectomy procedures are commonly used for the treatment of breast cancers. Mastectomies have been performed since the late 1800s, by a procedure commonly known as the Halstead radical mastectomy. During this procedure, the breast tissue and the pectoralis major muscle along with a variable amount of skin including the nipple-areolar complex is removed. Typically, an axillary lymph node dissection is performed concurrently with the mastectomy. This procedure leaves the patient with a Halstead radical mastectomy deformity which is disfiguring and is often emotionally traumatic. The deformity is especially disfiguring when skin grafting is required to close the defect. Web site: http://www.delphion.com/details?pn=US05301692__ •

Method of making breast prosthesis Inventor(s): Volk; Stephan (Miesbach, DE), Weber-Unger; Georg (Kufstein, AT) Assignee(s): Dr. Helbig GmbH & Co. Orthopadische Produkte (Brannenburg, DE) Patent Number: 5,603,791 Date filed: May 16, 1995 Abstract: A breast prosthesis to be worn on the body of a person who has had a mastectomy includes a soft-elastic prosthetic body made of two plastic sheets which are connected to each other along a common edge, with a plastic mass being contained hollow-free between the plastic sheets. The prosthetic body has a front side resembling in its form the natural breast and a rear side which faces the wearer's body. A fabric member covers the rear side and is attached solely to the peripheral edge of the plastic sheets of the prosthetic body to thereby increase the comfort of wearing the breast prosthesis. The fabric member is suitably made of thermoplastic material, with the welding of the plastic sheets and the welding of the fabric member with the plastic sheets being carried out in a single working step. Excerpt(s): The present invention refers to a breast prosthesis to be worn on the body of a person who has had a mastectomy, and in particular to a breast prosthesis of a type having a soft elastic prosthetic body comprised of two plastic sheets connected to each other along a common edge and a plastic mass enclosed hollow-free between the plastic sheets, with the prosthetic body having a front side resembling in its form the natural breast and a rear side which faces a wearer's body, and a fabric member which spans the rear side and is attached to the prosthetic body. The present invention further relates to a method for making a breast prosthesis. German publication DE-OS 28 27 077 discloses a breast prosthesis of this type, with the plastic sheet that is arranged on the rear side of the prosthetic body being coated with a fabric member in form of a textile, knitted fabric or web. The fabric member is made of cotton material which is sweat-absorbing, with the fabric member and the plastic sheet being joined together coextensively over their entire area. Thus, no hollow is formed between the plastic sheet and the fabric member through which moisture absorbed by the fabric member could exit. At prolonged sweat absorption, the fabric member becomes increasingly moist so that the prosthesis will stick or cling to the wearer's skin and will cause uncomfort for the wearer of the prosthesis because of evaporative cooling which leaves an unpleasant cold feeling on the wearer's skin. These drawbacks which result from coating the one plastic sheet arranged on the rear side of the prosthetic body with a fabric member are not encountered when loosely disposing the prosthesis within a completely surrounding fabric pocket, as known for example from U.S. Pat. No. 4,795,464. This prosthesis has a

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rear side which forms a depression, and a cushion body which follows the contour of the rear side of the prosthetic body and is detachably held in the depression by the fabric pocket which surrounds the prosthetic body on the front side. The fabric pocket is made of elastic cotton material, with the section of the fabric pocket forming the rear side thereof bearing on the wearer's skin to enable absorbed sweat to be carried off into the depression and to eliminate the formation of a moisture accumulation in this fabric section. The transport of moisture from the fabric section is further enhanced by the pump effect created through the relative movement between the prosthetic body and the fabric section. Still, the provision of a fabric pocket of this type has drawbacks because the costs for manufacturing such a fabric pocket are comparably high and the prosthesis shifts and becomes displaced relative to the fabric pocket during wearing. Web site: http://www.delphion.com/details?pn=US05603791__ •

Natural fixation of breast prosthesis Inventor(s): Eaton; L. Daniel (Little Rock, AR) Assignee(s): Board of Trustees of the University of Arkansas (Little Rock, AR) Patent Number: 6,156,065 Date filed: August 2, 1999 Abstract: A mastectomy garment for retaining a breast prosthesis in place on the anterior chest wall of a mastectomy patient. A combination bandeau/bra includes a normal bra cup for the natural breast (unless the patient has undergone a double mastectomy, in which case no normal bra cup is required), and a fold down cup for the prosthesis. Beneath the fold down cup a bandeau conforms to the anatomy of the patient's chest and presents a surface of hook and loop fastening material for the attachment of the breast prosthesis which carries mating hook and loop material on the posterior side. In one embodiment, the bandeau over the mastectomy site is provided with fenestration to improve the breathability of the site. The hook and loop fastening material on the bandeau covers substantially the entire portion of the bandeau over the mastectomy site allowing flexibility in the placement of the breast prosthesis on the bandeau. The fold down cup over the breast prosthesis is desirably held in position by a plurality of snap fasteners and by one or more tabs with hook and loop fastening material. Excerpt(s): The present invention relates to a breast prosthesis garment for the secure fixation of a breast prosthesis, and particularly to a breast prosthesis garment in which the breast cup for the natural breast is replaced over the mastectomy site by a bandeau with hook and loop type fastening material for the fixation of the breast prosthesis and a folding cup for covering the breast prosthesis. In one embodiment the bandeau is fenestrated for improved air flow and thus greater comfort for the wearer. Breast prostheses are necessary for women who have undergone radical mastectomies. An acceptable breast prosthesis should replicate the appearance of the natural breast while being comfortable to wear. The prior art of breast prostheses shows a number of attempts to achieve one or the other of these objectives, although with limited success at achieving both. Among the problems not completely solved in the prior art include achieving a natural look and feel to the prosthesis. Related to this problem is the perceived need to maintain a balanced weight of the prosthesis vis-a-vis the remaining natural breast. This may in fact be less of a problem with actual wearers who are likely to feel that weight is less of a concern than maintaining a natural relationship between the prosthesis and the chest of the wearer. Many patients complain that the location of

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the prosthesis in relation to the chest wall shifts and there is nothing in the way of "feedback" to the wearer that the prosthesis is in the correct position. An additional problem not well addressed by the prior art is the method of attachment or wearing of the breast prosthesis by the patient. One common solution is to attach the prosthesis directly to the chest of the patient with adhesives. This is obviously an uncomfortable solution and not always effective. Furthermore, a tight adhesive fit to the chest traps heat and prevents ventilation of the skin surface. Another common answer is to place the prosthesis in a pocket of a bra. This is also not a complete answer as the prosthesis may shift out of position within the bra, and, even if securely placed in the bra, does not have a natural feel to the wearer since it does not maintain its position with respect to the chest as is true of a natural breast. Various attempts have been made to provides a breast prosthesis garment using two bras, and underbra to provide the prosthesis fixation and an outerbra for appearance. An example is U.S. Pat. No. 4,637.398 to Sherwood. Sherwood '398 discloses a mastectomy garment including an underbra, a breast prosthesis, and an outerbra. The underbra is of a form fitting material such as spandex. The underbra has attachment means, such as a ring of velcro material, for fixing the breast prosthesis to the underbra over the mastectomy site. An outerbra is described as a conventional off the shelf type of bra which is placed over the underbra and breast prosthesis and secured to the underbra to prevent relative movement. Sherwood '398 employs two layers of garments, including two layers of material over the site of the natural breast Sherwood '398 suggests attaching the breast prosthesis with a ring of velcro material which limits the ability of the user to position the prosthesis. Web site: http://www.delphion.com/details?pn=US06156065__ •

Nipple illuminator for photodynamic therapy Inventor(s): Petit; Michael G. (1309-A State St., Santa Barbara, CA 93101) Assignee(s): none reported Patent Number: 5,766,222 Date filed: July 7, 1997 Abstract: A device for delivering phototherapeutic light to the nipple and surrounding tissue of a breast. Many mastectomy procedures for patients with breast cancer require removal of the nipple. Thus, for the best aesthetic result, post-operative augmentation or reconstruction of the breast includes the implantation of an artificial nipple. The present device and method permits a more conservative mastectomy to be performed while reducing the risk of recurrence wherein cancerous and pre-cancerous tissue in the nipple and surrounding aureole tissue are treated by illuminating the tissue with phototherapeutic light. The tissue is first perfused with a photosensitizer which accumulates therewithin. An embodiment of the device, which includes a rigid or semirigid hemispherical shell for structural stability, is attached to the breast. The device includes a transparent flexible aperture which is designed to fit snugly against the outer surface of the nipple and surrounding tissue. Phototherapeutic light from a light source enters the shell by means of a fiber optic and is conducted to a light diffuser tip disposed within the shell in optical communication with the light output end of the fiber optic. The light emanating from the diffuser tip is reflected from the interior surface of the hemispherical shell to uniformly illuminate the nipple and surrounding photosensitizerladen tissue. In another embodiment a tissue expander is implanted within the breast following mastectomy. The tissue expander is adapted to receive light from a light

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source via a fiber optic and deliver diffuse phototherapeutic illumination to the tissue adjacent to and surrounding the tissue expander. Excerpt(s): The invention relates to a light delivery device for uniformly illuminating the nipple and surrounding tissue of a breast. Ductile carcinoma in situ (DCIS) is the most common form of breast cancer. The treatment of choice for DCIS depends upon the stage of growth of the tumor. For small tumors, that is, tumors less than 1 or 2 centimeters in diameter, a lumpectomy followed by radiation treatment to the affected breast is conventional. If there is more extensive involvement and/or there is an invasive component present it may be preferable to perform a mastectomy. A conventional mastectomy, when DCIS is present includes the removal of the nipple. The reason for this is that much of the pre-cancerous cell are contained within the milk ducts of the breast. Since the nipple area is rich in milk ducts, it is prudent to remove the entire nipple. The use of photodynamic therapy for treating breast cancer has been restricted due to the limited ability of light to penetrate tissue. Whole breast illumination is not practical at present because a dosage of phototherapeutic light having a wavelength suitable for administering photodynamic therapy only penetrates to an extent to about 1 centimeter in depth. Thus, the conventional mastectomy is the most commonly employed procedure for treating advanced stages of DCIS. In addition, even with nipple excision, some tissue remains behind following a mastectomy, adhering to the overlying skin, which tissue may include cancerous or precancerous cells. Web site: http://www.delphion.com/details?pn=US05766222__ •

Post-mastectomy garment Inventor(s): Luedy; Joyce A. (1917 Wedgewood Dr., Carolina Trace, Sanford, NC 27330) Assignee(s): none reported Patent Number: 4,854,915 Date filed: September 22, 1988 Abstract: The invention comprises post-mastectomy garments having one or two pockets in the breast area of a facing that is attached to a bodice of the garment. In one or both of the pocket areas may be placed a breast prosthesis, preferably constructed of a light-weight, flexible material. The invention is especially useful in construction of garments for casual or house wear. Excerpt(s): This invention relates to post-mastectomy garments that may be worn by women to conceal the absence of one or both breasts. In particular, the invention pertains to garment facings designed so that soft breast prostheses may be inserted in interior pocket structures formed in attached facings. Women who have had mastectomy operations often wear prosthetic garments to enable them to maintain a normal body shape without undergoing breast reconstruction. These garments are generally in the form of special brassieres that hold one or two prosthetic devices to simulate one or both breasts. These special brassieres are often uncomfortable and heavy or restrictive of movement. Women who have had mastectomy operations who wish to be relieved of the discomfort associated with the prosthetic brassieres or who otherwise are unwilling or unable to wear them at all times need comfortable garments that may be used with light-weight soft breast prostheses for wear at home and for less formal wear. Garments have been designed with various prosthesis attachments. Some garments are designed with pockets of various types to hold a prosthesis. Prosthesis pockets incorporated directly into a garment may be visible through the garment itself.

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For example, the prosthetic lounge wear of Dodds (U.S. Pat. No. 3,348,241) comprises garments with a bodice. A prosthesis is placed in a pocket that is attached to the bodice and that has vertical sides opening interiorly within the garment bodice. This patent, and all others cited herein, are incorporated herein by reference. Web site: http://www.delphion.com/details?pn=US04854915__ •

Post-mastectomy garment Inventor(s): Ewen; Carol J. (1104 S. McDougal Rd., Mahomet, IL 61853) Assignee(s): none reported Patent Number: 5,257,956 Date filed: April 14, 1992 Abstract: A garment for use by a patient after surgery for breast removal which alleviates post-operative pain and discomfort and facilitates normal activities during the recovery period. A padded vest-like garment is adapted for applying comforting pressure to the sites of removal of breast and other tissues and for holding pain relieving packages. A detachable arm support provides further comfort in a similar manner. Excerpt(s): The present invention relates to a garment for use by a patient after surgery for breast removal which alleviates post-operative pain and facilitates normal activities during the recovery period. Cancer of the breast is a significant health problem because of the usually fatal results if it is not treated in time to prevent metastasis or spread of the cancer to other parts of the body. Because of the severe consequences, the most prevalent treatment is a radical mastectomy entailing removal of the entire breast including lymphatic vessels and adjacent axillary lymph nodes under the arm, through which, if not removed, the cancerous cells can easily spread throughout the body, and sections of the arm and chest muscles beneath the breast. Less radical treatments may also be used such as a "lumpectomy", where only the tumor and immediately surrounding tissues are excised, or a modified mastectomy, where less surrounding tissues are removed than in a radical mastectomy. Such treatments may present greater risk of recurrence of the cancer. All of these treatments may be combined with postoperative radiation therapy, chemotherapy or hormone treatments to prevent recurrence. Breast cancer is also known to strike men. However, since the vast majority of victims are women and because the shape and size of a woman's breasts are considered important in many cultures, much of the creative activity designed to benefit post-mastectomy patients has focused on cosmetic aspects. Thus, silicone implants were developed to be used in surgically reconstructed breasts and have become a subject of current controversy as to their safety. Numerous prosthetic garments have been developed to conceal the absence of one or both breasts. One such, among many, is shown in U.S. Pat. No. 4,854,915. Web site: http://www.delphion.com/details?pn=US05257956__

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Prosthesis pad retainer means for a brassiere or other breast garment Inventor(s): Griffin; Ivon D. (2769 Brouse St., Indianapolis, IN 46218), Griffin; John A. (2769 Brouse St., Indianapolis, IN 46218) Assignee(s): none reported Patent Number: 4,166,471 Date filed: July 13, 1977 Abstract: A brassiere or other garment for a female's breast area, which is provided with a retaining means primarily for a prosthesis pad following a breast mastectomy; it provides a sureness and positiveness of retention without any irregular bulk or other unattractiveness or visible hints of its special function, yet it provides comfort in the wearing, and also convenience in the insertion or removal of the prosthesis pad. Its padretainer panel is easily attached to other brassieres with scarcely any indication of its special use or nature; and it can convert any brassiere or breast garment to this special use, without imposing any visible unattractiveness to the outside portion of the garment. Excerpt(s): This invention relates to brassieres and other garments for the covering of a female's breast region. Concepts of the invention, more particularly, provide either a new garment or a convenient retainer means for existing garments, particularly for the sure and positive retention of a pad known as a prosthesis pad to be worn as a false breast following a mastectomy surgery. The concepts of the invention are particularly significant and advantageous due to the common desire of the female that her bosom and her bosom garments look particularly attractive; and a common fear and dread of breast surgery, even if desperately needed as a life-saving surgical procedure, is that of a supposed ugliness or supposed deformity which the person might fear will be noticed, either due to irregular bulk or shape of a prosthesis garment, or due to some danger of slippage of a prosthesis pad, etc. Web site: http://www.delphion.com/details?pn=US04166471__

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Prosthetic device for mastectomy patients Inventor(s): Goad; Helen G. (9459 Mission Gorge Rd. #124, Santee, CA 92071) Assignee(s): none reported Patent Number: 4,363,144 Date filed: October 24, 1980 Abstract: A prosthetic device for mastectomy patients is provided wherein a brassiere is modified by the incorporation of temporary fasteners in at least one cup which will hold in place a prosthetic pad of unique manufacture. The brassiere itself is preferably releasably retained by fasteners mounted to the frontal top portions of a slip. Excerpt(s): Most brassieres are maintained in place at least partially by straps which pass posterially of the upper torso and cinch the brassiere cups firmly against the chest. This cinching action, in order to be effective, is of sufficient force that the strap passing along the bottom of the brassiere presses into the flesh, and in the instance of mastectomy patients who have sensitive scar tissue in many instances which pass across the lower band of the brassiere, the chafing of this band can become quite a problem. As the band chafes, the wearer is tempted to unhook the brassiere, which in itself present a difficulty inasmuch as much of the muscle tissue is removed during a radical

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mastectomy, making it difficult for the wearer to get both hands behind the back to the position where most bras are fastened. An additional difficulty is that the prosthetic insert pad is conventionally a silicone device designed to be approximately the same density as a natural breast, and loosening the bottom strap of the bra will sometimes cause the pad to fall out. Therefore, there is a deficiency in the art of prosthetic devices for mastectomy patients inasmuch as there is needed a pad which is easily and comfortably held in place by other than the cinching force of a hand or strap passing posterially of the patient. Web site: http://www.delphion.com/details?pn=US04363144__ •

Prosthetic garment for bilateral mastectomy Inventor(s): Budd; Isabelle A. (2832 Innis Road, Gloucester, Ontario, CA) Assignee(s): none reported Patent Number: 4,781,650 Date filed: November 9, 1987 Abstract: A light weight, fitted prosthetic garment comprising in combination a generally cylindrical body-encircling member on each side of the top front of the bodyencircling member is a rounded flap corresponding to the two breast positions of the wearer; on the inside of each rounded flap is a pocket member for holding artificial breast members; attached at the top of each rounded flap is a shoulder strap each looped back and each attached at the rear of the body-encircling member, said shoulder straps being spaced at the rear at approximately the same distance apart as at the front of the garment. Excerpt(s): This invention relates to an undergarment for women, and more particularly to a prosthetic garment that will give the bilateral mastectomy patient, that is, a woman who has had both breasts removed, a natural bust contour. The designers of prosthetic brassiers and other prosthetic undergarments have failed to appreciate that devices heretofore used have been objectionable in two respects. Firstly, prosthetic garments heretofore used have had an unnatural bulkiness, a variety of strapping devices, have been attendent with physical inconvenience and discomfort. Secondly, prosthetic garments heretofore used have a tendancy to rise up as the wearers of same engage in activity wherein the arms are raised above the shoulders. The various tightly fitting straps heretofore used on prosthetic devices do not allow those prosthetic devices heretofore available to return to an equilibrium position after physical activity, resulting in an unnatural bust contour as well as in physical discomfort to the wearer. The present invention seeks to overcome these physical inconveniences and discomforts by having lightweight removable foam bust members fitting into a lightweight, fitted, garment which returns to an equilibrium position after physical activity ceases. Web site: http://www.delphion.com/details?pn=US04781650__

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Reversible mastectomy brassiere Inventor(s): Williams; Marguerite R. (443 W. 44th St., New York, NY 10036) Assignee(s): none reported Patent Number: 5,180,326 Date filed: January 26, 1992 Abstract: A reversible mastectomy brassiere which may be worn soon after surgery is disclosed with the primary purpose of this brassiere concept being to provide a mastectomy brassiere which may position a prosthesis on the left breast, or when said brassiere is completely reversed, to position a prosthesis on the right breast of the mastectomy patient. This design further includes front fasteners which function equally well irrespective of the side on which the brassiere is worn. The brassiere will provide adequate coverage for the patient soon after surgery, without the necessity of an expensive and time consuming special fitting. The second important aspect of this design is its continuous unbroken and smooth appearance when worn becuase the brassiere configuration and all outer edges have no apparent sewing or standard finishing of any kind on the outer surface of the brassiere. This design blends smoothly with the body's contour and gives visual reassurance and psychological relief to the patient recovering from the trauma of surgery. Excerpt(s): This invention relates to a reversible mastectomy bra, and in particular to a new concept in the construction and adaptability for its use after surgery for Mastectomy, Reconstruction and/or cosmetic reasons. The sewing construction of this bra is done so as to result in almost invisible seams when worn on either side, including the straps and front closing, which are equipped with flat and smooth adjustments. The purpose of the bra is to provide both physical and psychological relief to the patient, who after surgery is faced with the altered appearance of her chest. Therefore a most important application of this concept is that the patient could conceivably be supplied with this bra even before surgery, and upon inserting a light-weight disposable prosthesis into the pocket have the garment ready to wear upon removal of postoperative bandages. Web site: http://www.delphion.com/details?pn=US05180326__

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Robe garment for mastectomy patient Inventor(s): Reichert; D. Jeanie (E. 1415 - 18th Ave., Spokane, WA 99203) Assignee(s): none reported Patent Number: 4,412,542 Date filed: July 19, 1982 Abstract: A robe garment is described for a mastectomy patient in which the garment extends from a neckline downward to a bottom hem below the patient's knees. The robe garment has a front opening to enable a patient to put on or take off the garment. The robe garment has an inner panel that extends across the patient's back, around the patient's side to a front panel section having a pair of breast cup members that are connectable at the front opening. Each breast cup member is formed with a pocket to receive a soft pillow-like breast prosthesis. The inner panel has a lower tension member along the bottom thereof that extends about the body below the breast line. An outer

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layer is connected to the inner layer along the shoulder straps and the back neckline, and is draped downward over the inner layer to the bottom hem. Excerpt(s): It is even more difficult to provide a robe type garment for mastectomy patients that enables the mastectomy patient to project a normal profile, yet enable the patient to quickly put on the robe and to utilize the robe in both the standing and resting posture, particularly when the patient desires to rest in the prone position on her stomach. The prosthesis device normally makes the stomach-prone position very uncomfortable and greatly restricts the ability of the patient to rest and sleep while wearing a robe-type garment. This invention provides a unique robe garment for mastectomy patients which greatly increases the confidence of the mastectomy patient to be able to quickly put on the robe garment to answer a door or meet a visitor without having to completely change into more formal attire such as a dress and the like. The following disclosure is submitted in compliance with the purpose of the United States Constitution "to promote the progress of science and useful arts" (Article I, Sec. 8). Web site: http://www.delphion.com/details?pn=US04412542__ •

Surgical recovery brassiere Inventor(s): Brooks; Debra A. (6073 Cherokee Valley Ter., Lithonia, GA 30058) Assignee(s): none reported Patent Number: 6,390,885 Date filed: April 10, 2001 Abstract: The present invention, in the preferred embodiment, is a surgery recovery brassiere which resolves many of the problems faced by women who have undergone breast surgery and particularly, mastectomy. The present invention comprises front panels, prosthesis panels, rear panels, torso band, straps, drain tube apertures and fluid collection storage pouch.More specifically, two front panels each comprise a cup portion and a conforming portion. The prosthesis panels are attached to the rear facing of the cup portion of the front panel to form enclosed pockets to hold one or two prosthesis. Each of the two rear panels are joined at one end to the front panels and extend to meet the opposing rear panel at a back closure. The free end of each of the front panels meet to form a front closure. Straps extend from the top of the front panel to the top of the adjacent rear panel. The torso band extends around the lower edge of the surgery recovery brassiere to form an almost continuous strip of material along the lower edge of the front and rear panels.The surgery recovery brassiere further accommodates postoperative surgical drainage systems composed of one or more drain tubes and associated fluid collection bulbs. The position of drainage tube apertures, generally located proximate to the joint between the front and rear panels, allow drainage tubes to protrude from the chest wall, through the apertures and into the collection storage pouch. Tab closures allow the wearer to secure the drainage tubes within the aperture to further reduce movement of the tubes and disturbance of the drainage system. The storage pouch provides pockets with elastic top entry so that collection bulbs are within easy, convenient reach for emptying lymphatic fluids and other waste materials. The upper edge of the storage pouch releasably attaches to the torso band with a hook-andloop fastener system. Excerpt(s): The present invention relates generally to surgical appliances and supplies and, more specifically, to a garment worn by women who have undergone breast surgeries. Each year, thousands of women undergo breast surgery. Of all the surgeries

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that a woman may experience, breast surgery, and particularly mastectomy or removal of a breast or breasts, is the most traumatic. A mastectomy is the most common surgical procedure performed when a malignant tumor is found. The type of surgery depends upon the staging of the tumor and the client's preferences. Although many women look for more conservative treatment and less destructive surgery than removal of the breast, mastectomy continues to be the preferred course of treatment to increase the likelihood of destroying the breast cancer. Mastectomy procedures include modified radical mastectomy (removal of the underlying muscle as well as the breast), simple mastectomy (removal of one breast), bilateral mastectomy (removal of both breasts) and lumpectomy (removal of a portion of the breast). When the cancer involves the muscle or interpectoral node, substantially more muscle and tissue must be removed. Removal of auxiliary nodes and lymphatic channels predisposes the client to infection and lymphatic obstruction. Edema, an abnormal excess accumulation of serious fluid in connective tissue, is a frequent occurrence in breast surgeries unless positive steps are taken to prevent it. The body develops a collateral lymphatic drainage system usually within 3 to 4 weeks postoperatively. In the interim, lymphatic fluid production must be drained to prevent infection and promote healing. Web site: http://www.delphion.com/details?pn=US06390885__ •

Surgical vest Inventor(s): Fletcher; Jo Ann (220 Carroll Dr., St. Clairsville, OH 43950) Assignee(s): none reported Patent Number: 4,630,610 Date filed: July 26, 1985 Abstract: A surgical vest designed for use after mastectomy or mammoplasty and also for casual- and sleep-wear, which promotes postoperative healing and provides support for the breasts or prostheses by covering at least the thorax of a wearer with a soft thoracic sheath. The thoracic sheath bears one or two support straps on its outer surface; one end of the strap is attached in the area of the sternum of the wearer, and the other end of the strap is affixed in the area beneath the arm. As a result, the support straps pass beneath and support the breasts or prostheses without contacting or binding the underlying skin in any way. In addition, the thoracic sheath provides an absorbent dressing for the postoperative site and can serve to hold additional absorbent materials in place, either between its layers or adjacent the skin, eliminating the need for painful adhesive dressings in the area of the wound. Excerpt(s): The invention relates to feminine apparel, generally, and specifically relates to surgical vests suitable for wearing after mastectomy or mammoplasty. Substance reflects title. Throughout the historic U.S. medical and patent literature, support garments for the female anatomy have traditionally been characterized as "compression bandages," reflecting the philosophy which led to the initial designs. True to the unfortunate title, modern brassierres and corset-like garments continue to compress the wearer to a degree unwarranted by the legitimate breast-support function for which such garments are worn. For healthy wearers, these tight garments create discomfort, impair circulation, and frequently actually damage underlying tissue and skin. For postoperative mastectomy or mammoplasty patients, who must wear support garments after surgery, these garments are excruciating and invariably retard or prevent healing of the postoperative site. A need remains, therefore, for a breast- or prosthesis-

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supporting garment which not only is comfortable to both pre- and postoperative wearers but which actually promotes healing and wellness in the area it covers. Web site: http://www.delphion.com/details?pn=US04630610__ •

Therapeutic body suit Inventor(s): Gollestani; Maria (P.O. Box 2388, Kailua-Kona, HI 96745) Assignee(s): none reported Patent Number: 4,802,469 Date filed: August 3, 1987 Abstract: The invention is a therapeutic body suit designed to produce therapeutic pressure on the abdominal and lower abdominal body areas as an aid to healing after certain types of surgery including: liposuction abdominal plasty; hysterectomy; cesarean section; mastectomy and breast surgery; and hernia. This invention may be utilized on women and men. The invention consists of three major components. The first component is a body suit designed to provide theraputic pressure. The second component is an elastic binding surrounding the body suit with detachable and adjustable ends designed to enhance the therapeutic pressure of the body suit. The third component is a breathing elastic crotch therapeutically supporting binding attached in a removable manner to the second component. Excerpt(s): This device pertains to field of medical equipment; to subclass of artificial abdominal supporting prosthesis designed to temporarily exert pressure as an aid to medical and post-surgical healing. Certain types of surgery including liposuction; abdominal plasty; hysterectomy; mastectomy; cesarean section & breast surgery; and hernia repairs result in the separation of certain soft body tissue and swelling. Postsurgical healing for this tissue is promoted with the use of devices designed to exert certain therapeutic pressure externally about the affected body area. Present day devices consist of elastic bands of one of the three following types: (1) all elastic bands attached in an adjustable manner about the circumference of the abdomen capable of stretching about the length and width of the band; (2) all adjustable elastic bands attached as in 1, but containing attached restrictions permitting stretching about the length only, not the width; (3) bands as cited in 1 and 2 further including separate elastic crotch supporting bands. Limitations of the prior art cited above include (1) inability of the devices to consistently remain in position with body movements occurring during daily living; (2) inability of the devices to comfortably transition from areas of the desired therapeutic pressure, to surrounding areas of non-pressure. Web site: http://www.delphion.com/details?pn=US04802469__

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Versatile post mastectomy device Inventor(s): Donnelly; Alice S. (24231 W. Trevino Dr., Valencia, CA 91355) Assignee(s): none reported Patent Number: 4,338,946 Date filed: December 29, 1980 Abstract: In surgical procedures of the mastectomy and partial mastectomy type, a serious aftermath problem exists because of the present cultural attitude of such

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surgery. Authorities recognize the emotional trauma that a woman goes through after having been subjected to a radical, or less than radical, mastectomy. The removal of a woman's breast can have traumatic consequences and during the post operative stage, a need for femininity and a need for some means of reducing trauma is necessary. With the herein disclosed invention, a cover pad or the like, of aesthetic and feminine design, is disclosed which aids the woman in the post operative stage in a most positive and productive manner, especially with regard to her dealings with herself and those of a personal nature with others close to the wearer of the inventive device. A conformable fabric material covering of a variety of shapes is provided wherein a singular retaining means is provided wherein a plurality of loops may be utilized to receive a securement member in selected manner so that the device may be utilized in right hand or left hand manner and securely positioned about the body of the wearer. Excerpt(s): Mastectomy and radical mastectomy procedures can be devastating to a woman from not only the physical standpoint, but from the emotional standpoint. Medical authorities are well aware of the psychological impact upon a woman who has undergone breast surgery. In order to reduce the impact of that surgery upon her and those around her, the device of the invention provides a cover, or the like, for the surgical situs which is of unique and selected configuration and design and of aesthetic quality so as to not only cover the surgical site of the mastectomy, or other surgery, but to impart psychological support to the wearer of the device, not only in her own mind, but also to present a pleasing appearance to those closely and personally associated with her. It is an object of the invention to provide a post surgical device for covering surgical sites on a human body. It is another important object of the invention to provide a versatile post mastectomy device which may be positioned on the right, left hand or both sides of a human body. Web site: http://www.delphion.com/details?pn=US04338946__

Patent Applications on Mastectomy As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to mastectomy: •

Isolation and use of solid tumor stem cells Inventor(s): Al-Hajj, Muhammad; (Ann Arbor, MI), Clarke, Michael F.; (Ann Arbor, MI), Morrison, Sean J.; (Ann Arbor, MI), Wicha, Max S.; (Ann Arbor, MI) Correspondence: John Prince; Mcdermott, Will & Emery; 28 State Street; Boston; MA; 02109-1775; US Patent Application Number: 20020119565 Date filed: August 1, 2001 Abstract: A small percentage of cells within an established solid tumor have the properties of stem cells. These solid tumor stem cells give rise both to more tumor stem cells and to the majority of cells in the tumor that have lost the capacity for extensive proliferation and the ability to give rise to new tumors. Thus, solid tumor heterogeneity

9 This

has been a common practice outside the United States prior to December 2000.

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reflects the presence of tumor cell progeny arising from a solid tumor stem cell. This discovery is the basis for solid tumor stem cell compositions, methods for distinguishing functionally different populations of tumor cells, methods for using these tumor cell populations for studying the effects of therapeutic agents on tumor growth, and methods for identifying and testing novel anti-cancer therapies directed to solid tumor stem cells.We have developed a xenograft model in which we have been able to establish tumors from primary tumors via injection of tumors in the mammary gland of severely immunodeficient mice. Xenograft tumors have been established from mastectomy specimens of breast cancer patients. Furthermore, in the three tumors that we have tested, we have been able to make single-cell suspensions and transfer the tumors serially through immunocompromised mice. These improvements in the xenograft assay have allowed us to do biological and molecular assays to characterize clonogenic solid tumor stem cells.We have also developed evidence that strongly implicates the Notch pathway, especially Notch 4, as playing a central pathway in carcinogenesis. Antibodies against Notch4 reduced tumor cell proliferation and survival. Excerpt(s): This application claims priority to U.S. provisional patent applications Serial No. 60/222,794, filed Aug. 3, 2000, and Serial No. 60/240,317, filed Oct. 13, 2000. This invention relates to the diagnosis and treatment of cancer. Cancer remains the number two cause of mortality in this country, resulting in over 500,000 deaths per year. Despite advances in detection and treatment, cancer mortality remains high. Despite the remarkable progress in understanding the molecular basis of cancer, this knowledge has not yet been translated into effective therapeutic strategies. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Mastectomy brassiere Inventor(s): Casey, Reeta G.; (Windermere, FL), Courtney, Kathryn A.; (West Balm Beach, FL) Correspondence: Gregory A. Nelson, ESQ.; Akerman, Senterfitt & Eidson, P.A.; 222 Lakeview Avenue, Suite 400; P.O. Box 3188; West Palm Beach; FL; 33402-3188; US Patent Application Number: 20020102913 Date filed: January 31, 2001 Abstract: A mastectomy brassiere, comprising: a member adapted to encircle a torso; a first cup on the member adapted to support a reconstructed breast having an unnaturally firm implant, the first cup being adjustable to comform in shape at least in part to the reconstructed breast; and, a second cup on the member adapted to support a natural breast, the second cup having padding for urging the natural breast to conform in appearance to the reconstructed breast with the unnaturally firm implant, whereby the brassiere can be custom tailored to support natrual and reconstructed breasts differing significantly from one another in firmness, yet impart to the natural and reconstructed breasts an appearance of similar firmness. The brassiere can further comprise: a deformable support wire for adjusting the partial perimeter of the first cup to conform to the partial perimeter of the reconstructed breast; and, padding in the second cup for urging the natural breast to conform in appearance to the reconstructed breast. A method for fitting a brassiere to mastectomy patients is also disclosed. Excerpt(s): This invention relates to clothing accessories. More particularly, this invention relates to a mastectomy brassiere specifically adapted to support breasts with

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and without implants, for example, used in surgical breast reconstruction. The traditional brassiere is made with the assumption that the person wearing the brassiere has breasts that are the same size and shape. However, the left and right breasts of a person may not be symmetrical for many reasons. For example, the person may have undergone a mastectomy operation in which all or part of one or both breasts is removed. In this situation, the person originally may have had symmetrical breasts, but the mastectomy operation changed the size and/or shape of one or both of the breasts. The wearer of a traditional brassiere by a person having asymmetrical breasts, particularly as resulting from a mastectomy, suffers discomfort and often embarrassment. A traditional brassiere usually simply does not properly fit a reconstructed breast, even if the size and cup are properly fitted according to conventional practice. More importantly, for many cancer victims, a natural breast and a reconstructed breast just don't look the same under clothing, or when partially exposed by certain dress and blouse designs, even though a traditional brassiere is thought to be properly fitted. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Surgical binder and methods of use Inventor(s): Lebovic, Gail S.; (Menlo Park, CA) Correspondence: Mueting, Raasch & Gebhardt, P.A.; P.O. Box 581415; Minneapolis; MN; 55401; US Patent Application Number: 20010029346 Date filed: June 13, 2001 Abstract: A binder for application of pressure to the wound area of a patient who has undergone a mastectomy or other type of chest surgery. The binder includes an elasticized main body portion formed from a fabric that is substantially nonelastic, yet breathable, with gathering, elastic stitching therein. Excerpt(s): The present invention relates to a binder for use after surgery, and more particularly, to a binder for securing a bandage or dressing over the torso, particularly the chest area, of a person. After a surgical breast procedure, such as a mastectomy, or other chest surgery, it is necessary for the patient to wear a bandage or dressing over the wound area, which is typically changed once per day. Because this dressing is typically required for several weeks, the patient may need to change the dressing without assistance. Thus, it is desirable that the means used to secure the dressing be easy to put on and take off. It is also desirable that the means used to secure the dressing be comfortable, without significantly chafing the skin or trapping moisture against the skin, and easily adjustable to achieve proper fit. One means of securing a dressing involves the use of nonadhesive bandages that encircle the chest of a patient. Such bandages typically are made of an elastic material for even distribution of pressure. Although some elastic materials breathe to a limited extent, they tend to entrap significantly more moisture against the skin as compared to a breathable material such as cotton, gauze, flannel, or other fabrics. What is needed is a surgical binder that is breathable and generally easy to apply and remove, and is preferably capable of evenly distributing pressure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with mastectomy, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “mastectomy” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on mastectomy. You can also use this procedure to view pending patent applications concerning mastectomy. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON MASTECTOMY Overview This chapter provides bibliographic book references relating to mastectomy. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on mastectomy include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “mastectomy” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “mastectomy” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “mastectomy” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

A colour atlas of mastectomy with immediate reconstruction (Single surgical procedures series) by David J. T Webster; ISBN: 0815191588; http://www.amazon.com/exec/obidos/ASIN/0815191588/icongroupinterna

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Breast reconstruction following mastectomy for carcinoma by William M Cocke; ISBN: 0316149209; http://www.amazon.com/exec/obidos/ASIN/0316149209/icongroupinterna

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Color atlas of modified radical mastectomy (Single surgical procedures series) by David Ralphs; ISBN: 0874895340; http://www.amazon.com/exec/obidos/ASIN/0874895340/icongroupinterna

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Journey Unknown: Focusing on the emotional aspects of cancer, mastectomy and chemotherapy by Margaret P. Barnhart; ISBN: 0962512117; http://www.amazon.com/exec/obidos/ASIN/0962512117/icongroupinterna

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My God Why a Mastectomy from a Husbands Point of View by Jim Pollnow; ISBN: 0960370803; http://www.amazon.com/exec/obidos/ASIN/0960370803/icongroupinterna

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Primary management of breast cancer: Alternatives to mastectomy (Management of malignant disease series); ISBN: 0713144653; http://www.amazon.com/exec/obidos/ASIN/0713144653/icongroupinterna

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Prophylactic Mastectomy Registry Bill: [HC]: [1998-99]: House of Commons Bills: [1998-99]; ISBN: 0103037993; http://www.amazon.com/exec/obidos/ASIN/0103037993/icongroupinterna

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Rehabilitation of mastectomy patients: A handbook by June Marchant; ISBN: 0433203153; http://www.amazon.com/exec/obidos/ASIN/0433203153/icongroupinterna

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Sweet breathes the breast: A mastectomy rehabilitation handbook : a practical, humane approach to the aftermath of breast surgery, a how to book with a sprinkling of how do you do by Nancy Robinson Flannery; ISBN: 0869461125; http://www.amazon.com/exec/obidos/ASIN/0869461125/icongroupinterna

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Your rights after a mastectomy : Women's Health and Cancer Rights Act of 1998 (SuDoc L 40.2:R 44) by U.S. Dept of Labor; ISBN: B000115VMA; http://www.amazon.com/exec/obidos/ASIN/B000115VMA/icongroupinterna

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CHAPTER 7. PERIODICALS AND NEWS ON MASTECTOMY Overview In this chapter, we suggest a number of news sources and present various periodicals that cover mastectomy.

News Services and Press Releases One of the simplest ways of tracking press releases on mastectomy is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “mastectomy” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to mastectomy. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “mastectomy” (or synonyms). The following was recently listed in this archive for mastectomy: •

Device may reduce mastectomy for breast cancer Source: Reuters Health eLine Date: June 14, 2004

•

Double mastectomy markedly reduces cancer risk in BRCA1/2 carriers Source: Reuters Medical News Date: February 23, 2004

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Long-term survival similar with mastectomy or breast-conserving therapy Source: Reuters Medical News Date: July 25, 2003

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Excision plus brachytherapy may obviate mastectomy for recurrent breast cancer Source: Reuters Industry Breifing Date: November 26, 2002

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Prophylactic mastectomy patients often overestimate breast cancer risk Source: Reuters Medical News Date: October 18, 2002

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Radiation reduces risk of recurrence in node-positive mastectomy patients Source: Reuters Medical News Date: October 08, 2002

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Long-term lumpectomy, mastectomy survival similar Source: Reuters Health eLine Date: October 07, 2002

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Breast cancer screening reduces mastectomy rates in Italy Source: Reuters Medical News Date: August 22, 2002

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Menstrual cycle phase seen to affect outcome of mastectomy plus oophorectomy Source: Reuters Medical News Date: April 30, 2002

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Prophylactic mastectomy reduces cancer risk in BRCA mutation carriers Source: Reuters Medical News Date: November 07, 2001

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Outpatient mastectomy on the rise in US Source: Reuters Medical News Date: October 02, 2001

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Prophylactic mastectomy reduces incidence of breast cancer in high-risk women Source: Reuters Medical News Date: July 18, 2001

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Five years of tamoxifen after mastectomy is enough Source: Reuters Health eLine Date: March 30, 2001

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Perceived cancer risk influences mastectomy decision Source: Reuters Health eLine Date: January 12, 2001

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Prophylactic mastectomy reduces anxiety in women at high risk of breast cancer Source: Reuters Medical News Date: January 11, 2001

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Many mastectomy patients report 'phantom' pain Source: Reuters Health eLine Date: October 17, 2000

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UK nurse wins damage over double mastectomy error Source: Reuters Health eLine Date: October 06, 2000

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “mastectomy” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “mastectomy” (or synonyms). If you know the name of a company that is relevant to mastectomy, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “mastectomy” (or synonyms).

Academic Periodicals covering Mastectomy Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to mastectomy. In addition to

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these sources, you can search for articles covering mastectomy that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “mastectomy” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 17403 214 893 65 13 18588

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “mastectomy” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on mastectomy can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to mastectomy. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to mastectomy. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “mastectomy”:

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Breast Cancer http://www.nlm.nih.gov/medlineplus/breastcancer.html Breast Diseases http://www.nlm.nih.gov/medlineplus/breastdiseases.html Breast Reconstruction http://www.nlm.nih.gov/medlineplus/breastreconstruction.html Male Breast Cancer http://www.nlm.nih.gov/medlineplus/malebreastcancer.html Plastic and Cosmetic Surgery http://www.nlm.nih.gov/medlineplus/plasticandcosmeticsurgery.html

Within the health topic page dedicated to mastectomy, the following was listed: •

Coping Lymphedema Source: Y-ME National Breast Cancer Organization http://www.y-me.org/diagnosed/lymphedema.php Post-Mastectomy Breast Reconstruction Complications Common Source: American Cancer Society http://www.cancer.org/docroot/NWS/content/NWS_1_1x_PostMastectomy_Breast_Reconstruction_Complications_Common.asp What Happens After Treatment for Breast Cancer? Source: American Cancer Society http://www.cancer.org/docroot/CRI/content/CRI_2_4_5X_What_happens_after_t reatment_5.asp?sitearea=

•

Latest News Breast Reconstruction Less Likely for Black Women Source: 08/24/2004, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_19696 .html

•

Law and Policy Your Rights After a Mastectomy Source: Dept. of Labor http://www.dol.gov/ebsa/publications/whcra.html

•

Organizations American Cancer Society http://www.cancer.org/ National Cancer Institute http://www.cancer.gov/ Y-Me National Breast Cancer Organization http://www.y-me.org/

Patient Resources

•

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Pictures/Diagrams Pictures of Treatment (Breast Cancer Surgery) Source: Breastcancer.org http://www.breastcancer.org/treatment_picture.html

•

Research Breast Cancer Survivors Can Save Breast After Large Tumor Removal Source: American Society of Plastic Surgeons http://www.plasticsurgery.org/news_room/press_releases/Breast-CancerSurvivors-Can-Save-Breast.cfm Immediate Breast Reconstruction After Mastectomy Is Safe Source: American Society of Plastic Surgeons http://www.plasticsurgery.org/news_room/press_releases/Immediate-BreastReconstruction-After-Mastectomy-is-Safe-ASPS-Study-Says.cfm Mastectomy to Prevent Cancer in the Second Breast Gets High Marks Source: American Cancer Society http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Mastectomy_to_Preve nt_Cancer_in_the_Second_Breast_Gets_High_Marks.asp Race, Age, Geography, Significantly Decrease Odds of Breast Reconstruction After Mastectomy Source: American Society of Plastic Surgeons http://www.plasticsurgery.org/news_room/press_releases/Race-Age-GeographySignificantly-Decrease-Odds-of-Breast-Reconstruction-After-Mastectomy.cfm Radiation Therapy After Lumpectomy May Save Lives Source: American Cancer Society http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Radiation_Therapy_af ter_Lumpectomy_May_Save_Lives.asp Survey Finds Room for Improvement in Prophylactic Mastectomy Source: American Cancer Society http://www.cancer.org/docroot/NWS/content/NWS_2_1x_Survey_Finds_Room_ For_Improvement_In_Prophylactic_Mastectomy.asp

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to mastectomy. The drawbacks of this approach are that the information is not

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organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to mastectomy. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with mastectomy. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about mastectomy. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/.

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Simply type in “mastectomy” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “mastectomy”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “mastectomy” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “mastectomy” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on mastectomy: •

Basic Guidelines for Mastectomy Mastectomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002919.htm

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Diagnostics and Tests for Mastectomy Mammography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003380.htm

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Surgery and Procedures for Mastectomy Lumpectomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002918.htm

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Background Topics for Mastectomy Radiation therapy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001918.htm

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Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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MASTECTOMY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Ablate: In surgery, is to remove. [NIH] ACE: Angiotensin-coverting enzyme. A drug used to decrease pressure inside blood vessels. [NIH]

Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adhesives: Substances that cause the adherence of two surfaces. They include glues (properly collagen-derived adhesives), mucilages, sticky pastes, gums, resins, or latex. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adjuvant Therapy: Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, or hormone therapy. [NIH]

Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of

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antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Aggressiveness: The quality of being aggressive (= characterized by aggression; militant; enterprising; spreading with vigour; chemically active; variable and adaptable). [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alopecia: Absence of hair from areas where it is normally present. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Alveolitis: Inflammation of an alveolus. Called also odontobothritis. [EU] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In

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addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angiosarcoma: A type of cancer that begins in the lining of blood vessels. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antidiuretic: Suppressing the rate of urine formation. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-presenting cell: APC. A cell that shows antigen on its surface to other cells of the immune system. This is an important part of an immune response. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Areola: The area of dark-colored skin on the breast that surrounds the nipple. [NIH] Aromatase: An enzyme which converts androgens to estrogens by desaturating ring A of the steroid. This enzyme complex is located in the endoplasmic reticulum of estrogenproducing cells including ovaries, placenta, testicular Sertoli and Leydig cells, adipose, and brain tissues. The enzyme complex has two components, one of which is the CYP19 gene product, the aromatase cytochrome P-450. The other component is NADPH-cytochrome P450 reductase which transfers reducing equivalents to P-450(arom). EC 1.14.13.-. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Aspartate: A synthetic amino acid. [NIH]

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Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Axilla: The underarm or armpit. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary dissection: Surgery to remove lymph nodes found in the armpit region. [NIH] Axillary lymph node dissection: Surgery to remove lymph nodes found in the armpit region. [NIH] Axillary lymph nodes: Lymph nodes found in the armpit that drain the lymph channels from the breast. [NIH] Axonal: Condition associated with metabolic derangement of the entire neuron and is manifest by degeneration of the distal portion of the nerve fiber. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bilateral: Affecting both the right and left side of body. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopsy specimen: Tissue removed from the body and examined under a microscope to determine whether disease is present. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in

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an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Brace: Any form of splint or appliance used to support the limbs or trunk. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Breast reconstruction: Surgery to rebuild a breast's shape after a mastectomy. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cadaver: A dead body, usually a human body. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH]

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Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Carcinoma in Situ: A malignant tumor that has not yet invaded the basement membrane of the epithelial cell of origin and has not spread to other tissues. [NIH] Cardiac: Having to do with the heart. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH]

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Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Cicatrix: The formation of new tissue in the process of wound healing. [NIH] Cicatrization: The formation of a cicatrix or scar. [EU] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clavicle: A long bone of the shoulder girdle. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Coitus: Sexual intercourse. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and

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leaves the body through the anus. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Combination chemotherapy: Treatment using more than one anticancer drug. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up

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secretions; an absorbent pad. [NIH] Compression bandage: A bandage designed to provide pressure to a particular area. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computer Simulation: Computer-based representation of physical systems and phenomena such as chemical processes. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Core biopsy: The removal of a tissue sample with a needle for examination under a microscope. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU]

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Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclophosphamide: Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the liver to form the active aldophosphamide. It is used in the treatment of lymphomas, leukemias, etc. Its side effect, alopecia, has been made use of in defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Daunorubicin: Very toxic anthracycline aminoglycoside antibiotic isolated from Streptomyces peucetius and others, used in treatment of leukemias and other neoplasms. [NIH]

Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH]

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Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Dendritic cell: A special type of antigen-presenting cell (APC) that activates T lymphocytes. [NIH]

Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dextromethorphan: The d-isomer of the codeine analog of levorphanol. Dextromethorphan shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is a NMDA receptor antagonist (receptors, N-methyl-D-aspartate) and acts as a non-competitive channel blocker. It is used widely as an antitussive agent, and is also used to study the involvement of glutamate receptors in neurotoxicity. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease-Free Survival: Period after successful treatment in which there is no appearance of the symptoms or effects of the disease. [NIH] Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Doxorubicin: Antineoplastic antibiotic obtained from Streptomyces peucetics. It is a hydroxy derivative of daunorubicin and is used in treatment of both leukemia and solid tumors. [NIH] Drip: The continuous slow introduction of a fluid containing nutrients or drugs. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present

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before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Ductal carcinoma in situ: DCIS. Abnormal cells that involve only the lining of a duct. The cells have not spread outside the duct to other tissues in the breast. Also called intraductal carcinoma. [NIH] Duodenum: The first part of the small intestine. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH]

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Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Varices: Stretched veins in the esophagus that occur when the liver is not working properly. If the veins burst, the bleeding can cause death. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Extender: Any of several colloidal substances of high molecular weight, used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling

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reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Feasibility Studies: Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project. [NIH] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filler: An inactive substance used to make a product bigger or easier to handle. For example, fillers are often used to make pills or capsules because the amount of active drug is too small to be handled conveniently. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Follicular Phase: The period of the menstrual cycle that begins with menstruation and ends with ovulation. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Gadolinium: An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups

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within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Germ-Line Mutation: Any detectable and heritable alteration in the lineage of germ cells. Mutations in these cells (i.e., "generative" cells ancestral to the gametes) are transmitted to progeny while those in somatic cells are not. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH]

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Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Hematologic malignancies: Cancers of the blood or bone marrow, including leukemia and lymphoma. Also called hematologic cancers. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening.

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[NIH]

Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hysterectomy: Excision of the uterus. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunocompromised: Having a weakened immune system caused by certain diseases or treatments. [NIH] Immunogen: A substance that is capable of causing antibody formation. [NIH]

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Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammatory breast cancer: A type of breast cancer in which the breast looks red and swollen and feels warm. The skin of the breast may also show the pitted appearance called peau d'orange (like the skin of an orange). The redness and warmth occur because the cancer cells block the lymph vessels in the skin. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of

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glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intraductal carcinoma: Abnormal cells that involve only the lining of a duct. The cells have not spread outside the duct to other tissues in the breast. Also called ductal carcinoma in situ. [NIH] Intraoperative Complications: Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ipsilateral: Having to do with the same side of the body. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keyhole: A carrier molecule. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called

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colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lesion: An area of abnormal tissue change. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Levorphanol: A narcotic analgesic that may be habit-forming. It is nearly as effective orally as by injection. [NIH] Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Lipid: Fat. [NIH] Liposomes: Artificial, single or multilaminar vesicles (made from lecithins or other lipids) that are used for the delivery of a variety of biological molecules or molecular complexes to cells, for example, drug delivery and gene transfer. They are also used to study membranes and membrane proteins. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locoregional: The characteristic of a disease-producing organism to transfer itself, but typically to the same region of the body (a leg, the lungs, .) [EU] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumpectomy: Surgery to remove the tumor and a small amount of normal tissue around it. [NIH]

Luteal Phase: The period of the menstrual cycle that begins with ovulation and ends with menstruation. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic Metastasis: Transfer of a neoplasm from its primary site to lymph nodes or to distant parts of the body by way of the lymphatic system. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells

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that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphedema: Edema due to obstruction of lymph vessels or disorders of the lymph nodes. [NIH]

Lymphocele: Cystic mass containing lymph from diseased lymphatic channels or following surgical trauma or other injury. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Magnetic Resonance Spectroscopy: Spectroscopic method of measuring the magnetic moment of elementary particles such as atomic nuclei, protons or electrons. It is employed in clinical applications such as NMR Tomography (magnetic resonance imaging). [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Mammaplasty: Surgical reconstruction of the breast including both augmentation and reduction. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Mammography: Radiographic examination of the breast. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Medical Oncology: A subspecialty of internal medicine concerned with the study of neoplasms. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanin: The substance that gives the skin its color. [NIH]

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Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Menarche: The establishment or beginning of the menstrual function. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modified radical mastectomy: Surgery for breast cancer in which the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles are removed. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH]

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Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuroma: A tumor that arises in nerve cells. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier

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nuclei during their decay. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Node-positive: Cancer that has spread to the lymph nodes. [NIH] Nonmalignant: Not cancerous. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oestradiol: Growth hormone. [NIH] Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. [NIH] Oophorectomy: Surgery to remove one or both ovaries. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic cup: The white, cup-like area in the center of the optic disc. [NIH] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Overall survival: The percentage of subjects in a study who have survived for a defined period of time. Usually reported as time since diagnosis or treatment. Often called the survival rate. [NIH]

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Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Advocacy: Promotion and protection of the rights of patients, frequently through a legal process. [NIH] Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Peau d'orange: A dimpled condition of the skin of the breast, resembling the skin of an orange, sometimes found in inflammatory breast cancer. [NIH] Pedicle: Embryonic link between the optic vesicle or optic cup and the forebrain or diencephalon, which becomes the optic nerve. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptic Ulcer Hemorrhage: Bleeding from a peptic ulcer. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of

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the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peroneal Nerve: The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Phantom: Used to absorb and/or scatter radiation equivalently to a patient, and hence to estimate radiation doses and test imaging systems without actually exposing a patient. It may be an anthropomorphic or a physical test object. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photodynamic therapy: Treatment with drugs that become active when exposed to light. These drugs kill cancer cells. [NIH] Photosensitizer: A drug used in photodynamic therapy. When absorbed by cancer cells and exposed to light, the drug becomes active and kills the cancer cells. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH]

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Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Ploidy: The number of sets of chromosomes in a cell or an organism. For example, haploid means one set and diploid means two sets. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precursor: Something that precedes. In biological processes, a substance from which

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another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Preoperative: Preceding an operation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary tumor: The original tumor. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progeny: The offspring produced in any generation. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylactic mastectomy: Surgery to remove one or both breasts in order to decrease the risk of developing breast cancer. Also called preventive mastectomy. [NIH] Prophylactic oophorectomy: Surgery intended to reduce the risk of ovarian cancer by removing the ovaries before disease develops. [NIH]

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Prophylaxis: An attempt to prevent disease. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Prosthesis Design: The plan and delineation of prostheses in general or a specific prosthesis. [NIH]

Protective Devices: Devices designed to provide personal protection against injury to individuals exposed to hazards in industry, sports, aviation, or daily activities. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Quality of Life: A generic concept reflecting concern with the modification and

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enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation fibrosis: The formation of scar tissue as a result of radiation therapy. [NIH] Radiation oncologist: A doctor who specializes in using radiation to treat cancer. [NIH] Radiation Oncology: A subspecialty of medical oncology and radiology concerned with the radiotherapy of cancer. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radionuclide Imaging: Process whereby a radionuclide is injected or measured (through tissue) from an external source, and a display is obtained from any one of several rectilinear scanner or gamma camera systems. The image obtained from a moving detector is called a scan, while the image obtained from a stationary camera device is called a scintiphotograph. [NIH]

Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH]

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Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recovery Room: Hospital unit providing continuous monitoring of the patient following anesthesia. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH]

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Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Scalpel: A small pointed knife with a convex edge. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Scatter: The extent to which relative success and failure are divergently manifested in qualitatively different tests. [NIH] Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. [NIH] Sclerotherapy: Treatment of varicose veins, hemorrhoids, gastric and esophageal varices, and peptic ulcer hemorrhage by injection or infusion of chemical agents which cause localized thrombosis and eventual fibrosis and obliteration of the vessels. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and cause the growth of a new tumor. When this happens, the disease is called metastatic breast cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmental mastectomy: The removal of the cancer as well as some of the breast tissue

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around the tumor and the lining over the chest muscles below the tumor. Usually some of the lymph nodes under the arm are also taken out. Sometimes called partial mastectomy. [NIH]

Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sentinel lymph node: The first lymph node that cancer is likely to spread to from the primary tumor. Cancer cells may appear first in the sentinel node before spreading to other lymph nodes. [NIH] Sentinel Lymph Node Biopsy: A diagnostic procedure used to determine whether lymphatic metastasis has occurred. The sentinel lymph node is the first lymph node to receive drainage from a neoplasm. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skin graft: Skin that is moved from one part of the body to another. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the

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brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatic cells: All the body cells except the reproductive (germ) cells. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Standard therapy: A currently accepted and widely used treatment for a certain type of cancer, based on the results of past research. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent

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carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sternum: Breast bone. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland

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consists of a single tube, a coiled body, and a superficial duct. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Systemic therapy: Treatment that uses substances that travel through the bloodstream, reaching and affecting cells all over the body. [NIH] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thoracic: Having to do with the chest. [NIH] Thoracotomy: Surgical incision into the chest wall. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH]

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Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tibial Nerve: The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Banks: Centers for acquiring, characterizing, and storing organs or tissue for future use. [NIH] Tissue Expansion: Process whereby tissue adjacent to a soft tissue defect is expanded by means of a subcutaneously implanted reservoir. The procedure is used in reconstructive surgery for injuries caused by trauma, burns, or ablative surgery. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Topical: On the surface of the body. [NIH] Total hysterectomy: Surgery to remove the entire uterus. [NIH] Total mastectomy: Removal of the breast. Also called simple mastectomy. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Tramadol: A narcotic analgesic proposed for severe pain. It may be habituating. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH]

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Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tumor Stem Cells: Colony-forming cells which give rise to neoplasms. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Vertebrae: A bony unit of the segmented spinal column. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and

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treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Void: To urinate, empty the bladder. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH]

187

INDEX A Abdomen, 89, 94, 114, 147, 151, 153, 163, 165, 166, 171, 180, 181, 182 Abdominal, 114, 147, 152, 171 Ablate, 16, 147 ACE, 135, 147 Acoustic, 12, 147 Acrylonitrile, 147, 178 Adaptability, 111, 147 Adhesives, 106, 147 Adipose Tissue, 46, 147 Adjustment, 17, 21, 86, 96, 99, 147 Adjuvant, 7, 8, 15, 22, 27, 48, 51, 52, 53, 59, 70, 71, 78, 81, 147 Adjuvant Therapy, 7, 15, 22, 70, 147 Adrenal Cortex, 147, 174 Adverse Effect, 57, 147, 179 Aerosol, 147, 181 Afferent, 23, 147 Affinity, 147, 148, 157, 180 Aggressiveness, 9, 148 Agonist, 148, 157, 182 Algorithms, 19, 148, 150 Alkaline, 148, 151 Alkaloid, 148, 168 Allergen, 148, 179 Alopecia, 148, 156 Alpha Particles, 148, 176 Alternative medicine, 123, 148 Alveoli, 148, 184 Alveolitis, 67, 148 Amino acid, 148, 149, 171, 172, 175, 178, 181, 183, 184 Ammonia, 148, 181, 184 Amputation, 23, 89, 148 Anaesthesia, 28, 41, 61, 148, 164 Anal, 9, 62, 148, 159, 160 Analgesic, 148, 153, 166, 168, 170, 183 Analog, 148, 157, 160 Anatomical, 48, 50, 148, 153 Androgens, 147, 148, 149 Anesthesia, 18, 34, 41, 67, 149, 177 Angiosarcoma, 46, 149 Annealing, 149, 173 Antibiotic, 149, 156, 157, 182 Antibody, 148, 149, 154, 163, 164, 165, 168, 176, 179, 185 Antidiuretic, 30, 149

Antigen, 4, 147, 149, 154, 157, 163, 164, 179 Antigen-presenting cell, 4, 149, 157 Anti-inflammatory, 149, 161, 174 Antimetabolite, 149, 160 Antineoplastic, 149, 156, 157, 160 Antitussive, 149, 157, 170 Anus, 148, 149, 154, 177 Anxiety, 68, 122, 149 Aponeurosis, 149, 161 Areola, 28, 55, 57, 58, 68, 70, 149 Aromatase, 19, 32, 149 Arteries, 149, 151, 155, 168, 169 Artery, 24, 149, 151, 156, 175 Aspartate, 149, 157 Aspiration, 43, 68, 150 Assay, 116, 150, 163 Asymptomatic, 11, 150 Atmospheric Pressure, 95, 150 Autologous, 4, 29, 150 Axilla, 67, 92, 150, 151 Axillary, 6, 15, 25, 29, 31, 37, 40, 42, 49, 52, 53, 64, 66, 69, 71, 104, 108, 150 Axillary dissection, 6, 40, 69, 150 Axillary lymph node dissection, 71, 104, 150 Axillary lymph nodes, 108, 150 Axonal, 24, 150 Axons, 24, 150, 169, 170 B Bacteria, 149, 150, 168, 184 Basal Ganglia, 150, 161 Basement Membrane, 150, 152, 159 Benign, 18, 22, 31, 102, 150, 161, 169, 176 Bilateral, 18, 20, 21, 22, 26, 28, 29, 30, 33, 39, 50, 51, 54, 67, 68, 71, 110, 113, 150 Biochemical, 10, 149, 150 Biopsy, 22, 37, 43, 68, 150, 171 Biopsy specimen, 22, 150 Biotechnology, 25, 26, 123, 129, 150 Bladder, 150, 154, 175, 184, 185 Blood Coagulation, 150, 151 Blood pressure, 151, 168, 180 Blood transfusion, 28, 151 Blood vessel, 147, 149, 151, 153, 162, 166, 167, 172, 180, 182, 184 Body Fluids, 151, 158, 180 Body Image, 18, 33, 77, 79, 86, 151 Bone Marrow, 151, 162, 163, 166, 167, 180

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Bone scan, 151, 178 Bowel, 8, 148, 151, 165, 181 Brace, 98, 151 Brachial, 29, 151 Brachial Plexus, 29, 151 Brachytherapy, 53, 122, 151, 165, 176, 185 Burns, 99, 151, 183 Burns, Electric, 151 Bypass, 24, 151 C Cadaver, 12, 151 Calcium, 24, 46, 151, 154 Capsules, 151, 160 Carbohydrates, 152 Carbon Dioxide, 152, 160, 161, 172, 177 Carcinogenesis, 116, 152 Carcinogenic, 152, 164, 174, 181 Carcinoma, 26, 27, 34, 38, 39, 40, 44, 49, 54, 61, 64, 69, 79, 81, 102, 103, 107, 119, 152 Carcinoma in Situ, 107, 152 Cardiac, 13, 24, 59, 152, 159, 169, 181 Carotene, 74, 152 Case report, 67, 152 Caudal, 152, 157, 173 Causal, 152, 159, 177 Cell Division, 150, 152, 167, 172, 174 Cell membrane, 23, 152, 161, 172 Cell proliferation, 116, 152 Central Nervous System, 152, 160, 168, 170 Cerebrospinal, 152, 179 Cerebrospinal fluid, 152, 179 Cervical, 151, 152 Cesarean Section, 114, 152 Character, 152, 156 Chemoprevention, 10, 21, 152 Chest wall, 13, 21, 32, 38, 60, 68, 100, 105, 106, 112, 153, 168, 182 Chin, 41, 153, 168 Cholesterol, 153, 181, 182 Chromatin, 153 Chromosomal, 22, 153 Chronic, 23, 79, 153, 164, 181 Cicatrix, 153 Cicatrization, 91, 153 Clamp, 24, 153 Clavicle, 92, 153 Clinical trial, 3, 5, 7, 15, 16, 19, 129, 153, 155, 169, 175, 176 Cloning, 150, 153 Codeine, 153, 157, 170 Cohort Studies, 53, 153, 159

Coitus, 89, 153 Colectomy, 25, 153 Collagen, 147, 148, 150, 153 Colloidal, 153, 159, 181 Colon, 15, 153, 154, 165, 166 Colonoscopy, 15, 154 Colorectal, 15, 25, 154 Colorectal Cancer, 16, 25, 154 Combination chemotherapy, 79, 82, 154 Comorbidity, 24, 154 Complement, 154, 179 Complementary and alternative medicine, 77, 84, 154 Complementary medicine, 77, 154 Compliance, 15, 112, 154 Compress, 99, 113, 154 Compression bandage, 113, 155 Computational Biology, 129, 155 Computed tomography, 12, 155, 178 Computer Simulation, 12, 155 Computerized axial tomography, 155, 178 Computerized tomography, 155 Conception, 155, 160, 181 Concomitant, 54, 155 Confounding, 17, 155 Connective Tissue, 113, 151, 153, 155, 160, 166, 178, 182 Connective Tissue Cells, 155 Consultation, 20, 155 Contraceptive, 6, 155 Contraindications, ii, 155 Contralateral, 17, 21, 22, 34, 40, 44, 103, 155 Control group, 64, 155 Core biopsy, 19, 155 Coronary, 24, 155, 156, 168, 169 Coronary Thrombosis, 156, 168, 169 Corpus, 156, 174 Corpus Luteum, 156, 174 Cortisone, 156, 174 Cross-Sectional Studies, 156, 159 Curative, 18, 156, 182 Cutaneous, 103, 156 Cyclophosphamide, 80, 81, 156 Cytochrome, 149, 156 Cytoplasm, 152, 156, 178 Cytotoxic, 156, 176 D Data Collection, 9, 156, 160 Daunorubicin, 156, 157 Degenerative, 23, 156 Delivery of Health Care, 156, 162

189

Denaturation, 156, 173 Dendrites, 156, 157, 169 Dendritic, 4, 157 Dendritic cell, 4, 157 Density, 70, 92, 110, 157, 170 Dermal, 65, 157 Dextromethorphan, 61, 157 Diagnostic Imaging, 17, 157 Diagnostic procedure, 87, 123, 157, 179 Dialyzer, 157, 162 Diencephalon, 157, 171 Digestion, 151, 157, 165, 166, 171, 181 Diploid, 157, 172, 173 Direct, iii, 19, 23, 157, 177, 182 Disease-Free Survival, 5, 15, 59, 157 Dissection, 49, 55, 64, 67, 157 Distal, 49, 150, 157 Dopamine, 157, 169, 172 Dorsal, 24, 157, 173 Dorsum, 157, 161 Doxorubicin, 5, 46, 53, 157 Drip, 55, 157 Drive, ii, vi, 13, 38, 59, 61, 73, 157 Drug Interactions, 158 Duct, 107, 158, 165, 182 Ductal carcinoma in situ, 4, 7, 9, 19, 23, 38, 158, 165 Duodenum, 158, 171, 181 E Edema, 70, 83, 113, 158, 167 Efficacy, 6, 9, 18, 21, 36, 39, 40, 158 Elastic, 90, 96, 97, 99, 104, 112, 114, 117, 158 Electrolyte, 158, 180 Electrons, 158, 165, 167, 176 Elementary Particles, 158, 167, 169, 175 Embryo, 158, 164 Emulsion, 158, 160 Endemic, 158, 180 Endogenous, 10, 157, 158 Endoscope, 38, 158 Environmental Health, 128, 130, 158 Enzymatic, 148, 151, 152, 154, 158, 173 Enzyme, 59, 147, 149, 158, 173, 177, 185 Epidemic, 159, 180 Epidemiologic Studies, 25, 159 Epidemiological, 11, 159 Epidural, 34, 41, 67, 159 Epithelial, 10, 16, 41, 152, 159 Epithelial Cells, 10, 16, 159 Epithelium, 21, 150, 159 Equipment and Supplies, 13, 159

Erythrocytes, 151, 159, 179 Esophageal, 159, 178 Esophageal Varices, 159, 178 Esophagus, 159, 171, 181 Estrogen, 11, 59, 149, 159, 179, 182 Excitability, 23, 159 Exogenous, 10, 158, 159 Expander, 103, 106, 159 Extender, 159 External-beam radiation, 159, 165, 176, 185 Extracellular, 155, 159, 180 Extracellular Matrix, 155, 159 Extremity, 151, 159, 178 F Family Planning, 129, 159 Fat, 8, 147, 151, 152, 160, 166, 180 Feasibility Studies, 13, 160 Fentanyl, 34, 67, 160 Fetus, 152, 160, 172, 184 Fibrosis, 160, 178 Filler, 91, 100, 160 Fixation, 105, 160, 179 Fluorouracil, 81, 160 Focus Groups, 18, 160 Fold, 105, 160 Follicular Phase, 15, 160 Fovea, 160 G Gadolinium, 5, 160 Gallbladder, 147, 160 Gamma Rays, 160, 176 Ganglion, 24, 160, 170 Gap Junctions, 161, 182 Gas, 148, 152, 161, 170, 181, 184 Gas exchange, 161, 184 Gastric, 161, 171, 178 Gastrin, 161, 163 Gene, 10, 14, 22, 23, 39, 149, 150, 161, 166 Gene Expression, 22, 23, 161 Genetic Counseling, 14, 161 Genetic testing, 14, 20, 69, 161, 173 Genetics, 8, 33, 50, 161 Germ Cells, 161, 167, 182 Germ-Line Mutation, 33, 161 Gland, 116, 147, 156, 161, 166, 171, 175, 178, 181, 183 Glucocorticoid, 161, 174 Glucose, 11, 161, 164, 165 Glucuronic Acid, 161, 162 Glutamate, 157, 161 Glycoprotein, 16, 161

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Gonadotropin, 16, 162 Governing Board, 162, 173 Grade, 4, 10, 162 Graft, 162, 164 Graft Rejection, 162, 164 Grafting, 58, 162, 164 Gravidity, 162, 171 H Haematoma, 66, 162 Haploid, 162, 172, 173 Health Care Costs, 24, 162 Health Education, 25, 162 Health Expenditures, 162 Hematologic malignancies, 8, 162 Hemodialysis, 36, 157, 162 Hemorrhoids, 162, 178 Heparin, 46, 162 Hereditary, 20, 21, 33, 50, 162 Heredity, 161, 162 Hernia, 114, 162 Heterogeneity, 9, 115, 147, 163 Homologous, 28, 163, 179, 182 Hormonal, 7, 15, 19, 22, 163 Hormonal therapy, 7, 19, 22, 163 Hormone, 10, 15, 30, 108, 147, 156, 161, 163, 164, 168, 170, 174, 182, 183 Hormone therapy, 147, 163 Hyperalgesia, 24, 163 Hyperplasia, 102, 163 Hypersensitivity, 148, 163, 179 Hyperthermia, 102, 163 Hypertrophy, 163 Hysterectomy, 62, 114, 163 Hysterotomy, 152, 163 I Immune response, 147, 149, 156, 162, 163, 164, 179, 181, 184 Immune Sera, 163 Immune system, 149, 163, 164, 167 Immunization, 4, 163, 164, 179 Immunoassay, 59, 163 Immunocompromised, 116, 163 Immunogen, 4, 163 Immunologic, 163, 164, 176 Immunology, 147, 164 Immunosuppressant, 160, 164 Immunosuppressive, 4, 156, 161, 164 Immunosuppressive therapy, 164 Immunotherapy, 4, 164 Implant radiation, 164, 165, 176, 185 Implantation, 106, 155, 164 In situ, 7, 57, 164

In vivo, 162, 164 Incision, 55, 99, 103, 153, 163, 164, 165, 182 Induction, 25, 42, 148, 164 Infarction, 164 Infection, 36, 113, 163, 164, 166, 167, 181 Inflammatory breast cancer, 41, 82, 164, 171 Infusion, 67, 164, 178, 183 Initiation, 19, 164 Innervation, 151, 164, 172, 178, 183 Insulin, 11, 164, 165 Insulin-dependent diabetes mellitus, 165 Internal radiation, 165, 176, 185 Interstitial, 151, 165, 185 Intestinal, 152, 165 Intestine, 151, 154, 165 Intracellular, 23, 164, 165, 168 Intraductal carcinoma, 158, 165 Intraoperative Complications, 18, 165 Intravenous, 41, 164, 165 Invasive, 4, 7, 9, 11, 19, 22, 23, 35, 42, 54, 102, 107, 165, 167 Ion Channels, 165, 182 Ionizing, 148, 165, 176 Ipsilateral, 22, 165 Irradiation, 6, 35, 52, 53, 102, 165, 185 K Kb, 128, 165 Keyhole, 68, 165 Kidney stone, 165, 184 L Large Intestine, 154, 165, 177, 180 Latent, 166, 174 Lavage, 29, 38, 166 Length of Stay, 43, 166 Lesion, 11, 45, 102, 166 Leukemia, 78, 157, 162, 166 Levorphanol, 157, 166 Life Expectancy, 9, 24, 35, 166 Ligament, 166, 175 Lipid, 165, 166 Liposomes, 5, 166 Liver, 147, 156, 158, 159, 160, 161, 162, 166, 174, 178, 184 Liver scan, 166, 178 Localized, 4, 16, 70, 89, 102, 160, 162, 164, 166, 172, 178 Locoregional, 26, 29, 33, 43, 46, 52, 53, 54, 66, 166 Loop, 99, 105, 112, 162, 166 Lumbar, 166, 178, 183 Luteal Phase, 15, 166

191

Lymph, 29, 37, 66, 67, 95, 150, 152, 164, 166, 167, 168, 170, 179 Lymph node, 29, 37, 66, 67, 95, 150, 152, 166, 167, 168, 170, 179 Lymphatic, 39, 79, 108, 112, 113, 164, 166, 167, 173, 179, 180, 183 Lymphatic Metastasis, 166, 179 Lymphatic system, 166, 180, 183 Lymphedema, 8, 78, 79, 80, 81, 134, 167 Lymphocele, 36, 167 Lymphocyte, 149, 167 Lymphoid, 167 Lymphoma, 79, 162, 167 M Magnetic Resonance Imaging, 167, 178 Magnetic Resonance Spectroscopy, 10, 167 Malignancy, 4, 9, 167 Malignant, 22, 31, 79, 97, 113, 120, 149, 152, 167, 169, 176, 178 Malignant tumor, 113, 152, 167 Mammaplasty, 28, 167 Mammary, 38, 40, 64, 116, 167, 182 Mammography, 9, 11, 15, 17, 19, 102, 145, 167 Manifest, 150, 167 Medial, 94, 167, 183 Mediate, 24, 157, 167 Medical Oncology, 51, 167, 176 Medical Records, 167, 177 MEDLINE, 129, 167 Medullary, 157, 167 Meiosis, 167, 182 Melanin, 167, 172 Membrane, 23, 152, 154, 157, 159, 165, 166, 168, 171, 172, 173, 177, 184 Membrane Proteins, 166, 168 Menarche, 10, 168 Menopause, 168, 173, 174 Menstruation, 160, 166, 168 Mental, iv, 3, 21, 25, 33, 93, 128, 130, 153, 168, 175 Mental Health, iv, 3, 21, 25, 33, 128, 130, 168 Metabolite, 10, 168 Metastasis, 16, 108, 168 Metastatic, 4, 19, 56, 168, 178 MI, 32, 52, 60, 68, 93, 115, 146, 168 Microbe, 168, 183 Mobility, 41, 168 Modeling, 4, 13, 168 Modification, 12, 54, 148, 168, 175

Molecular, 8, 10, 16, 22, 116, 129, 131, 150, 155, 159, 162, 166, 168, 178 Molecule, 149, 154, 165, 168, 176, 177 Monitor, 5, 168, 170 Monoclonal, 165, 168, 176, 185 Morphine, 27, 41, 68, 153, 168, 169, 170 Morphological, 9, 158, 168 Motion Sickness, 168, 169 Mucinous, 161, 169 Multicenter study, 43, 169 Myocardial infarction, 24, 156, 168, 169 Myocardium, 168, 169 N Narcotic, 160, 166, 168, 169, 183 Nausea, 18, 169 Necrosis, 164, 168, 169 Neoplasia, 22, 169 Neoplasm, 166, 169, 178, 179, 184 Neoplastic, 11, 167, 169 Nerve, 23, 149, 150, 151, 153, 156, 160, 164, 169, 170, 172, 173, 178, 181, 183 Nerve Fibers, 151, 169, 183 Nervous System, 147, 152, 169, 172, 182 Neural, 23, 147, 169 Neuroma, 45, 169 Neuronal, 23, 169 Neurons, 23, 156, 169, 182 Neurotoxicity, 157, 169 Neurotransmitter, 148, 157, 161, 165, 169, 181, 182 Neutrons, 148, 165, 169, 176 Nitrogen, 148, 149, 156, 160, 170 Node-positive, 15, 70, 122, 170 Nonmalignant, 103, 170 Nuclear, 150, 158, 160, 169, 170 Nuclei, 148, 158, 167, 169, 170, 175 Nucleus, 153, 156, 158, 160, 167, 169, 170, 174, 175, 181 O Odds Ratio, 12, 170, 177 Oestradiol, 32, 170 Oncologist, 19, 34, 170 Oophorectomy, 15, 21, 28, 35, 50, 54, 62, 69, 122, 170 Opacity, 157, 170 Ophthalmology, 12, 160, 170 Opiate, 168, 170 Opium, 168, 170 Optic cup, 170, 171 Optic Nerve, 170, 171, 177 Outpatient, 61, 67, 122, 170 Ovaries, 149, 170, 174, 179

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Overall survival, 15, 29, 170 Ovulation, 160, 166, 171 Ovum, 156, 171, 174 P Palliative, 171, 182 Palsy, 29, 171 Pancreas, 147, 164, 171 Parity, 10, 171 Parturition, 74, 171 Patch, 24, 171 Pathologic, 5, 7, 62, 66, 150, 155, 163, 171 Pathologies, 10, 171 Pathologist, 7, 171 Pathophysiology, 23, 171 Patient Advocacy, 23, 171 Patient Satisfaction, 23, 25, 66, 171 Peau d'orange, 164, 171 Pedicle, 65, 171 Pelvic, 171, 175 Pelvis, 147, 165, 166, 170, 171, 184 Peptic, 171, 178 Peptic Ulcer, 171, 178 Peptic Ulcer Hemorrhage, 171, 178 Peptide, 4, 148, 171, 175 Perception, 18, 30, 171 Percutaneous, 24, 171 Perfusion, 57, 171 Perioperative, 34, 67, 172 Peripheral Nervous System, 169, 171, 172, 181 Peroneal Nerve, 172, 178 Phallic, 160, 172 Phantom, 122, 172 Pharmacologic, 18, 149, 172, 183 Phenylalanine, 81, 172 Phospholipids, 160, 172 Phosphorus, 151, 172 Photodynamic therapy, 106, 107, 172 Photosensitizer, 106, 172 Physiologic, 148, 157, 168, 172, 177 Pigments, 152, 172 Pilot study, 62, 172 Placenta, 149, 172, 174 Plants, 148, 152, 161, 172, 183, 184 Plasma, 152, 159, 172, 179 Platinum, 166, 173 Plexus, 151, 173, 178 Ploidy, 37, 173 Pneumonia, 155, 173 Poisoning, 169, 173 Polymerase, 10, 173 Polymerase Chain Reaction, 10, 173

Polyposis, 154, 173 Polysaccharide, 149, 173 Posterior, 105, 148, 157, 171, 173 Postmenopausal, 19, 173 Postnatal, 173, 181 Postoperative, 18, 27, 41, 53, 61, 64, 65, 78, 90, 113, 173 Postsynaptic, 173, 182 Practicability, 160, 173 Practice Guidelines, 25, 33, 130, 173 Precancerous, 107, 173, 174 Precursor, 156, 157, 158, 172, 173 Predisposition, 61, 174 Prednisolone, 174 Prednisone, 81, 174 Premalignant, 173, 174 Premenopausal, 6, 15, 59, 174 Preoperative, 5, 19, 61, 65, 174 Presynaptic, 169, 174, 182 Prevalence, 37, 170, 174 Primary tumor, 5, 6, 116, 174, 179 Probe, 102, 174 Progeny, 116, 161, 174 Progesterone, 11, 59, 174, 181 Prognostic factor, 7, 11, 53, 78, 174 Progression, 10, 20, 174 Progressive, 169, 174, 184 Projection, 12, 98, 170, 174 Promoter, 8, 174 Prone, 27, 112, 174 Prone Position, 112, 174 Prophase, 174, 182 Prophylactic oophorectomy, 20, 174 Prophylaxis, 46, 175, 184 Prospective Studies, 11, 21, 175 Prospective study, 35, 61, 175 Prostate, 8, 15, 25, 175 Prosthesis Design, 114, 175 Protective Devices, 96, 175 Protein S, 150, 175, 178, 182 Proteins, 10, 148, 149, 152, 153, 154, 161, 168, 170, 171, 172, 175, 179, 183, 184 Protocol, 15, 25, 80, 175 Protons, 148, 165, 167, 175, 176 Psychiatry, 160, 175, 184 Psychic, 80, 168, 175 Psychotherapy, 175, 176 Puberty, 6, 175 Public Policy, 17, 129, 175 Publishing, 15, 25, 175 Pulmonary, 13, 151, 175, 184 Pulse, 168, 175

193

Q Quality of Life, 4, 9, 16, 21, 23, 25, 29, 61, 82, 175 R Radiation fibrosis, 63, 176 Radiation oncologist, 170, 176 Radiation Oncology, 13, 26, 35, 46, 48, 52, 53, 59, 60, 62, 66, 176 Radiation therapy, 6, 15, 27, 37, 51, 53, 54, 60, 65, 103, 108, 145, 147, 159, 165, 176, 185 Radioactive, 151, 164, 165, 166, 170, 176, 178, 185 Radioimmunotherapy, 176 Radiolabeled, 165, 176, 185 Radiological, 59, 171, 176 Radiology, 5, 11, 17, 27, 32, 53, 57, 63, 64, 176 Radionuclide Imaging, 16, 176 Randomized, 9, 13, 14, 15, 19, 27, 34, 36, 39, 40, 44, 50, 53, 56, 64, 68, 78, 158, 176 Randomized clinical trial, 9, 15, 19, 44, 64, 176 Reassurance, 111, 176 Receptor, 11, 15, 59, 149, 157, 177 Recovery Room, 18, 177 Rectal, 15, 177 Rectum, 149, 153, 154, 161, 165, 175, 177 Reductase, 149, 177 Refer, 1, 90, 154, 160, 169, 176, 177 Regimen, 41, 158, 177 Registries, 21, 177 Relapse, 42, 177 Relative risk, 21, 177 Remission, 177 Resection, 11, 39, 177 Respiration, 152, 168, 177 Respiratory Physiology, 177, 184 Retina, 170, 177, 178 Retrospective, 21, 29, 31, 50, 65, 177 Retrospective Studies, 21, 177 Retrospective study, 50, 65, 177 Ribosome, 178, 184 Risk factor, 10, 36, 159, 175, 177, 178 Risk patient, 12, 13, 62, 178 Rod, 94, 153, 178 Rubber, 89, 100, 101, 147, 178 S Sarcoma, 51, 178 Scalpel, 26, 56, 178 Scans, 12, 178 Scatter, 172, 178

Sciatic Nerve, 24, 172, 178, 183 Sclerotherapy, 50, 178 Screening, 10, 12, 16, 17, 21, 22, 28, 62, 122, 153, 178 Secondary tumor, 168, 178 Secretion, 30, 165, 178, 179 Secretory, 178, 182 Segmental, 37, 53, 178 Segmental mastectomy, 37, 53, 178 Segmentation, 178, 179 Selective estrogen receptor modulator, 179, 182 Semen, 175, 179 Sensibility, 148, 163, 179 Sensitization, 4, 179 Sentinel lymph node, 49, 54, 179 Sentinel Lymph Node Biopsy, 54, 179 Sequencing, 173, 179 Serologic, 163, 179 Serum, 11, 32, 154, 162, 163, 179 Sex Characteristics, 148, 175, 179, 182 Shock, 179, 184 Shunt, 96, 179 Side effect, 18, 147, 156, 179, 183 Signs and Symptoms, 177, 179 Skeletal, 149, 153, 179 Skin graft, 89, 104, 179 Skull, 179, 182 Small intestine, 158, 163, 165, 180 Smooth muscle, 155, 168, 180, 181 Social Environment, 176, 180 Social Support, 77, 80, 180 Sodium, 46, 180, 181 Soft tissue, 12, 151, 180, 183 Solid tumor, 115, 157, 180 Somatic, 161, 167, 172, 180 Somatic cells, 161, 167, 180 Specialist, 136, 180 Species, 167, 168, 180, 184, 185 Spectroscopic, 9, 167, 180 Spinal cord, 13, 151, 152, 153, 159, 161, 169, 172, 178, 180 Spleen, 166, 167, 180 Splint, 151, 180 Sporadic, 22, 180 Staging, 113, 178, 180 Standard therapy, 6, 180 Steel, 69, 153, 180 Stem Cells, 115, 181 Sterility, 156, 181 Sternum, 113, 181 Steroid, 149, 156, 181

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Mastectomy

Stimulus, 157, 164, 165, 181, 182 Stomach, 112, 147, 159, 161, 163, 166, 169, 171, 180, 181 Stool, 153, 165, 181 Strand, 173, 181 Stress, 18, 169, 174, 178, 181 Styrene, 178, 181 Subacute, 164, 181 Subclinical, 164, 181 Subcutaneous, 30, 31, 38, 40, 44, 46, 49, 58, 66, 67, 158, 181 Substance P, 168, 178, 181 Support group, 77, 82, 181 Survival Rate, 170, 181 Suspensions, 116, 181, 184 Sweat, 104, 181 Sweat Glands, 181 Symphysis, 153, 175, 182 Symptomatic, 15, 182 Synapse, 174, 182 Synaptic, 23, 169, 182 Synaptic Transmission, 23, 182 Systemic, 7, 43, 52, 151, 164, 165, 174, 176, 182, 183, 185 Systemic therapy, 52, 182 T Tamoxifen, 8, 9, 15, 21, 32, 52, 122, 179, 182 Temporal, 24, 182 Tendon, 161, 182 Testicular, 82, 149, 182 Testis, 182 Testosterone, 32, 177, 182 Tetracycline, 50, 182 Therapeutics, 182 Thermal, 102, 169, 173, 182 Thoracic, 34, 67, 113, 151, 182, 185 Thoracotomy, 23, 182 Thorax, 113, 147, 166, 182 Threshold, 159, 182 Thrombosis, 175, 178, 182 Thymus, 163, 166, 167, 183 Thyroid, 16, 183 Thyroxine, 172, 183 Tibial Nerve, 178, 183 Tissue Banks, 21, 183 Tissue Expansion, 31, 58, 183 Tolerance, 147, 183 Tomography, 13, 167, 183 Topical, 50, 183

Total hysterectomy, 34, 183 Total mastectomy, 51, 57, 58, 77, 183 Toxic, iv, 156, 181, 183 Toxicity, 13, 15, 158, 183 Toxicology, 130, 183 Toxins, 149, 161, 164, 176, 183 Trachea, 183 Traction, 153, 183 Tramadol, 68, 183 Transfection, 150, 183 Transfer Factor, 163, 183 Transfusion, 159, 183 Translation, 18, 148, 184 Translational, 19, 24, 184 Transplantation, 163, 184 Trauma, 4, 23, 77, 111, 115, 167, 169, 183, 184 Trees, 178, 184 Tumor Stem Cells, 115, 184 Tumour, 37, 161, 184 U Urea, 181, 184 Urethra, 175, 184 Uric, 11, 184 Urinate, 184, 185 Urine, 149, 150, 165, 184 Uterus, 152, 156, 163, 168, 170, 174, 183, 184 V Vaccination, 5, 184 Vaccines, 184 Varicose, 178, 184 Varicose vein, 178, 184 Vascular, 69, 70, 164, 172, 184 Vein, 165, 170, 184 Ventilation, 106, 184 Vertebrae, 180, 184 Veterinary Medicine, 129, 184 Virulence, 183, 185 Vitro, 162, 164, 173, 185 Vivo, 9, 185 Void, 92, 185 W Windpipe, 183, 185 X Xenograft, 116, 185 X-ray, 12, 103, 155, 160, 165, 170, 176, 178, 185 X-ray therapy, 165, 185

195

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