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Educational programme of Early Breast Cancer Detection in 40-year-old female inhabitants from Cracow, as an element of a preventive treatment of complications requiring oncological rehabilitation

100%

Łabuzek M., Kołodziejski L. S.

Medical Rehabilitation

2014

vol. 18(1)

5-14

Introduction: Breast cancer is the most common malignant tumour among women in Poland, with a dynamically increasing incidence rate. At present, one-half of breast cancer cases are diagnosed at the stage of high locoregional advancement, which leads to common radical mastectomies. These procedures are the cause of the most serious complications, i.e. restricted mobility of the glenohumeral joint and lymphoedema of the upper limb, which usually require rehabilitation.Objective: An evaluation of the attendance and effectiveness of detecting suspicious breast lesions in 40-year-old female inhabitants of Kraków who were personally invited to take part in the Educational Programme of Early Breast Cancer Detection (EPEBCD). This study assumes that increasing the level of oncological education amongst women should result in high attendance in screening, which would lead to detection of breast cancer at earlier stages. In these cases, effective methods of breast-conserving therapy are used, which carry a minimal risk of complications that require rehabilitation.Material and methods: The subject of the analysis was a group of 19,773 female inhabitants of Kraków who took part in the EPEBCD between 2003 and 2008. The group consisted of 4723 women aged 40 years who were personally invited to take part in the Programme, and 15,010 other women who volunteered for the research. The percentage of suspicious lesions discovered in physical and mammographic examinations in both groups was analysed. In the statistical analysis, the stratum weight was examined, using a two-tailed test and the STATISTICA 6.0 program. The significance level α < 0.05 was assumed.Results: The attendance rate of 40-year old women who were sent personal invitations was similar in each year (2003 to 2008) and, on average, accounted for 24.4%, which was half of the assumed attendance. It demonstrates that the level of oncological education among young women is low. Breast cancer awareness increased with age and resulted in voluntary participation of older women in screening programmes. The percentage of suspicious changes detected by a physical examination among the 40-year-old women invited personally (Group 1; 0.49%) did not differ significantly from the “before screening” group (Group 2, aged 41 to 49; 0.47%) and even from the “screening” group (Group 3, aged 50 to 69; 0.45%). Only in the “after screening” group of the oldest women (Group 4, over 69), the percentage (1.57%) was significantly higher (p < 0.001). The percentage of suspicious changes detected by mammography did not differ significantly in the group of 40-year-old women (Group 1; 3.58%) and in the “before screening” group (Group 2; 4.11%; Groups 1 and 2, p > 0.05). Significant differences were only found in the “before screening” Group 2 and “after screening” Group 4 (p < 0.001). The percentage of suspicious changes identified by mammography did indeed increase with age, though this was only a marginal increase, at the level of tenths of a percent. Only in the oldest group (Group 4), this percentage (5.16%) was significantly higher than in the other research groups.Conclusions: The much higher percentage of suspicious breast lesions discovered by mammography in comparison with those discovered in a physical examination demonstrates a low level of breast cancer advancement in most cases, which can be treated by means of breast-conserving therapy. Dissemination of educational and screening programmes will help to increase the percentage of early detected breast cancer cases which, after breast-conserving therapy, will not constitute a risk of serious complications requiring rehabilitation.

Lymphedema of upper limb after radical treatment of breast cancer patients: current management principles

81%

Kołodziejski L. S., Łobaziewicz W., Ochałek K., Niedbała E.

Medical Rehabilitation

2009

vol. 13(2)

23-31

Upper limb lymphedema (ULL) is the most severe late complication following radical treatment of breast cancer (BC). It can be caused by both cancer recurrence and previous therapy (lymphadenectomy, axillary radiotherapy). In BC survivors, ULL- inducing factors include: previous irradiation treatment, infections within the upper limb or the scar, high BMI. Diagnosis of ULL makes use of measurements of the circumference and volume of the limb, imaging, measuring electrical impedance of tissues and lymphoscintigraphy which determines the type and severity of lymph flow disturbances. ULL has a chronic and progressive nature leading to physical, psychic and social disability and, on rare occasions, to secondary neoplasms of the lymphatic system. Therapeutic management involves: patients’ education, complex physical therapy (manual lymphatic drainage, compression therapy), reduction and drainage surgery (microsurgery) as well as liposuction. The most effective conservative procedures include complex physical therapy and particularly manual lymphatic drainage with compression therapy. Failure of conservative therapy indicates the need for surgery. Liposuction is a currently preferred surgical procedure because of its simplicity and a low percentage of complications. Surgery should be complemented by constant compression therapy. Due to low efficiency of all the methods applied, ULL prevention is of paramount importance. It should consist in rationalising indications for oncological treatment (lymphadenectomy, radiation therapy).

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Search results

Educational programme of Early Breast Cancer Detection in 40-year-old female inhabitants from Cracow, as an element of a preventive treatment of complications requiring oncological rehabilitation

Lymphedema of upper limb after radical treatment of breast cancer patients: current management principles