La Rumba Supermarket

Thomas Cole presents in JAMA the artwork of the Cuban American painter Emilio Sánchez (1921-1999) who is known for his sharply defined patterns of light and shadow on the houses, storefronts, and skyscrapers. Untitled, Bronx Storefront, “La Rumba Supermarket” is a painting of a New York grocery store with Cuban characteristics that is exhibited at the Smithsonian American Art Museum in Washington, DC. One can find on many street corners in the city of New York, bodegas with colorful awnings and window ads that sell convenience items to regular customers from local neighborhoods. The grocery in Sánchez’ painting is larger than most bodegas—large enough to host a party in the late afternoon. Seen dimly in the doorway of the grocery is a crowd of people standing close together, possibly dancing. The name of the store, La Rumba, refers to a style of music and dance that originated in Cuba in the 19th century. The most popular rumba dance, the guaguancó, is a flirtation: the woman’s role is to wave her skirt in time with the music to entice her man, but when he moves in closer she dances away.

Regional Nodal Irradiation in Early-Stage Breast Cancer

Whelan et al in a NEJM publication report the findings of a study on the effects regional nodal irradiation has on overall survival, disease-free survival, isolated locoregional disease-free survival, and distant disease-free survival.

 

They randomly assigned women with node-positive or high-risk node-negative breast cancer who were treated with breast-conserving surgery and adjuvant systemic therapy to undergo either whole-breast irradiation plus regional nodal irradiation (including internal mammary, supraclavicular, and axillary lymph nodes) (nodal-irradiation group) or whole-breast irradiation alone (control group).

A total of 1832 women were assigned to the nodal-irradiation group or the control group (916 women in each group).  At the 10-year follow-up, there was no significant between-group difference in survival, with a rate of 82.8% in the nodal-irradiation group and 81.8% in the control group. The rates of disease-free survival were 82.0% in the nodal-irradiation group and 77.0% in the control group. Patients in the nodal-irradiation group had higher rates of grade 2 or greater acute pneumonitis and lymphedema.

They concluded that women with node-positive or high-risk node-negative breast cancer, the addition of regional nodal irradiation to whole-breast irradiation did not improve overall survival but reduced the rate of breast-cancer recurrence.

N Engl J Med 2015; 373:307-316

More men with breast cancer opt for double mastectomies

Jemal et al reported in JAMA Surg that the percentage of men with breast cancer had both the affected and the unaffected breast removed in a double mastectomy had increased.

The data were from a nationwide population-based cancer database, the North American Association of Central Cancer Registries.  The data indicated that the percentage of contralateral prophylactic mastectomy (CPM) in 6,332 men nearly doubled to 5.6 percent in 2010-2011 from 3 percent in period 2004-2005 in the United States.

Previous studies have reported marked increases in the rates of contralateral prophylactic mastectomy (CPM) among US women who received a diagnosis of unilateral invasive breast cancer, and that this increase was particularly pronounced among younger women.

Rates of CPM among women vary depending on the population studied.  National statistics show that the percentage of women with unilateral invasive breast cancer undergoing a CPM increased from approximately 2.2% in 1998 to 11% in 2011.  This increase has occurred despite the lack of evidence for a survival benefit from bilateral surgery, in addition to the complications and costs associated with CPM. 

The researchers found that the number of males who received a diagnosis of unilateral invasive breast cancer patients and underwent CPM nearly doubled from 3 to 5.6 percent.

JAMA Surg. Sept 02, 2015.2657

Advantages of Hypo-fractionated versus Conventional Whole-Breast Irradiation

Shaitelman et al on a paper published by JAMA Oncol report the 6-month toxic effects and quality of life (QOL) with conventionally fractionated (CF-WBI) whole-breast irradiation (WBI) vs. hypo-fractionated WBI (HF-WBI). 

Their study included 287 women 40 years or older with stage 0 to II breast cancer for whom WBI without addition of a third field was recommended.  It was conducted between February 2011 through February 2014 and the patients were observed for a minimum of 6 months. 

The study was un-blinded randomized trial of CF-WBI (n = 149; 50.00 Gy/25 fractions + boost [10.00-14.00 Gy/5-7 fractions]) vs HF-WBI (n = 138; 42.56 Gy/16 fractions + boost [10.00-12.50 Gy/4-5 fractions]) following breast-conserving surgery.

Of 287 participants, 149 were randomized to CF-WBI and 138 to HF-WBI. Treatment arms were well matched for baseline characteristics, including FACT-B total score (HF-WBI, 120.1 vs CF-WBI, 118.8; P = .46) and individual QOL items such as somewhat or more lack of energy (HF-WBI, 38% vs CF-WBI, 39%; P = .86) and somewhat or more trouble meeting family needs (HF-WBI, 10% vs CF-WBI, 14%; P = .54). Maximum physician-reported acute dermatitis (36% vs 69%; P < .001), pruritus (54% vs 81%; P < .001), breast pain (55% vs 74%; P = .001), hyperpigmentation (9% vs 20%; P = .002), and fatigue (9% vs 17%; P = .02) during irradiation were lower in patients randomized to HF-WBI. The rate of overall grade 2 or higher acute toxic effects was less with HF-WBI than with CF-WBI (47% vs 78%; P < .001). Six months after irradiation, physicians reported less fatigue in patients randomized to HF-WBI (0% vs 6%; P = .01), and patients randomized to HF-WBI reported less lack of energy (23% vs 39%; P < .001) and less trouble meeting family needs (3% vs 9%; P = .01). Multivariable regression confirmed the superiority of HF-WBI in terms of patient-reported lack of energy and trouble meeting family needs.

 The authors concluded that treatment with HF-WBI appears to yield lower rates of acute toxic effects than CF-WBI as well as less fatigue 6 months after completing radiation therapy.

JAMA Oncol. Published online August 06, 2015.