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The idea of conducting a geographical analysis of cancer incidence in Vercelli, a city with about 46,000 population in the Province of Vercelli (Piedmont, northern Italy), originated from the need to respond to concerns of the population and local administrators regarding the presence of a solid waste incinerator just a few kilometers from the city, and the ongoing intense agricultural activity in the area. The study also aimed to verify the excess risk identified in a similar study on mortality. We obtained census data and mortality data for the years 2002 to 2009, from the Italian Institute of Statistics (ISTAT) and analysed these from both an epidemiological point of view, through standardised mortality rates, and spatial analysis through the use of Bayesian models. Both approaches highlighted an overall increased risk for cancers and increased risks for colorectal and lung cancer, in persons residing south of the capital. They also identified an increased cancer risk in the young adult population of both sexes, which deserves further investigation.

Breast cancer is the most frequent neoplasm among women. The Outcomes Research could be a useful tool in managing this kind of tumour. A recent review of the literature evaluates the interest for this kind of research and the possible future evolution.

Aim: Several randomized trials on conservative surgery compared with mastectomy in early-stage breast cancer have validated this technique in terms of local and distant relapse and survival of patients. Standard conservative approach includes surgical removal of the cancer with adequate cancer-free margins, axillary dissection, postoperative breast irradiation and adjuvant treatments when required., Methods: From 1987 to 2003, 500 early stage breast carcinoma were treated on 494 patients with conservative surgery and postoperative radiotherapy. Surgery consisted in a wide tumorectomy, with intraoperative control of R0 margins. The total postoperative radiation dosage was 50 Gy on the whole breast, associated with a boost of 10 Gy on tumor bed (20 Gy in T2 neoplasms). Before 1997 node-positive patients were treated with axillary irradiation with 50 Gy. Postoperative chemotherapy and/or hormonal therapy were administered to patients according with node-involvement, age and menopausal status. AJCC-stage was T1N0 in 44%, T2N0 in 15%, T1N1 in 19% and T2N1 in 22% of the patients., Results: In a postoperative setting, we observed 9% of axillary seromas or hematomas and 7% of oedema of the arm. At a median follow-up of 150 months (range 48-248 months), actuarial local recurrence rates were 7% at 5 years and 14% at 10 years. The actuarial rates of distant metastases were 18% at 5 years and 33% at 10 years. Ten-year overall and disease-free survival rates were 81% and 60%, respectively. Cosmetic results were good/excellent in 80%, satisfactory in 10% and poor in 10% of patients., Conclusion: Recurrence and survival rates in breast-conserving surgery are consistent with indexed literature on conservative treatment of early breast cancer. Women eligible for conservative treatment should be offered the choice of either wide tumorectomy or quadrantectomy with axillary lymph nodes removal and postoperative radiotherapy, or modified radical mastectomy.

Phylloides tumours are unusual neoplasms, accounting for less than 0.5% of breast tumours and approximately 2.5% of fibro-epithelial tumours. They usually present as fast-growing, painless masses, with a high local recurrence rate. Grading and an adequate surgical resection with tumour-free margins are the most important factors predictive of recurrence. The treatment is based on surgery, with poor results reported for chemo- and radiotherapy, but controversy still exists as to whether the best surgical approach consists in radical or conservative procedures, depending upon tumour size at diagnosis. The authors report the case of a patient affected by a metachronous bilateral malignant phylloid tumour of the breast, involving regional nodes and with a single pulmonary metastasis. The patient was treated with radical surgery including a bilateral mastectomy, an axillary dissection and a right inferior pulmonary lobectomy. Unfortunately, even this substantially aggressive management was unable to change the final outcome of the disease. The review of the literature on the subject is consistent with a preferably conservative surgical treatment also in advanced stages of the disease.

Conservative surgery represents the standard care for patients with early breast cancer. The aim of this review was to discuss the extension of conservative surgery in controversial fields such as after primary chemotherapy for large tumours or the possibility to repeat conservative surgery for a local reappearance. The project of a conservative approach to breast cancers continues with sentinel node biopsy which is worldwide performed more and more frequently. In our institute sentinel node biopsy is the standard procedure in the axillary staging of breast cancer even in those clinical scenarios which were previously considered either controversial or a contraindication such as in multicentric breast cancer, during pregnancy, in intra-ductal neoplasias, after primary chemotherapy, and male breast cancer. This conservative approach is completed by the possibility to deliver a partial breast irradiation and to provide patients with more personalized adjuvant treatments tailored on the biological features of the tumour.

Breast cancer in elderly patients occurs frequently and is often inadequately managed. Furthermore, for organizational and social reasons, the incidence of locally advanced neoplasms is higher in this age group than in the younger population. The aim of the study was to assess our experience in this specific pathology and review the international literature on this topic. From 2001 to 2005 116 cases of breast cancer in elderly women (70-95 years old) were observed by our surgical units. Of these, 38 were at a locally advanced stage (10--26.3%--stage IIIA, 28--73.7%--stage IIIB). Comorbidity (two or more diseases) existed in 32 patients. A Madden modified radical mastectomy was carried out in all cases. Resection was extended to the chest-wall tissues in cases of local infiltration. Surgical mortality was 10% (4 cases). Eight of the 34 patients discharged died within 24 months (2 of disease progression). Adjuvant chemotherapy was never offered. On the other hand, all patients received hormone therapy (tamoxifen). 10 of the 26 patients (38.4%) surviving over 2 years underwent redo surgery for local relapse of disease. Our conclusions are: 1) breast cancer in elderly patients is often underestimated and undertreated; 2) disease management cannot be standardized, but must be tailored to the single patient; 3) short- and medium-term results are satisfactory; 4) comorbidity must be carefully assessed.

In cohort studies the event occurrence is usually described by the incidence rate and the survivor function. In comparison with these estimators the plot of the hazard function has the advantage to show the variations of the occurrence of the event along the period of observation, which often are important to be highlighted. Furthermore, when comparing individuals with different characteristics, the hazard function is a valuable support to check the assumption and to interpret the results of a Cox regression model. This paper illustrates the method for estimating the hazard function and an example is given from a real case by using the survival data of the breast cancers collected in the IMPACT study, aimed to detect the efficacy of the mammographic screening program. The relationship between the usual estimators and the hazard function is shown and its role in the survival regression modelling is emphasized. In the example the estimate of the hazard function allows to point out that the mortality rate of breast cancer in the first year after the diagnosis is lower than later and that the difference between the hazards of the invited cases and those of the not invited cases is approximately constant along the whole l0 years follow up, two important remarks both demonstrating the usefulness of the application of this function in the analysis of cohort studies.

Primary (neoadjuvant) systemic chemotherapy is the standard treatment for locally advanced breast cancer and a standard option for primary operable disease. Although survival results are similar, primary chemotherapy has the following advantages in comparison to adjuvant chemotherapy: it represents a chemosensitivity test in vivo and can be of value in determining the prognosis of the patient since pathologic complete responses are related to improved survival. Among a variety of primary chemotherapy regimens currently available, the most effective seem to be those containing both anthracyclines and taxanes, expecially when these agents are administered sequentially. There are also several ongoing studies evaluating primary hormonal therapy and the combination of cytotoxic chemotherapy and targeted agents. It is conceivable that in the future primary chemotherapy of breast cancer will be increasingly used. In fact, besides its clinical effectiveness, primary chemotherapy is extremely important to evaluate new agents and to find useful prognostic and predictive factors.

Breast cancer presents important differences in distribution of histopathologic factors between younger and older patients but it's less clear if reduction of survival which often occurs in cancer of the youth depends on the concomitant presence of negative prognostic factor or if age alone acts as a factor indicating more aggressiveness. Many studies seem to indicate that young age at diagnosis is an independent predictive factor mostly in patients with early stage of disease and negative nodes. Other studies assert that age can be considered as the most important predictive factor after nodes involvement.

Patients with breast cancer are frequently treated with anthracyclines and/or taxanes, which are among the most useful agents in this disease. Therefore, it is increasingly difficult to find active regimens in heavily pretreated patients. Gemcitabine is a cytosine arabinoside prodrug analog which shows significant activity, as single agent, in metastatic breast cancer. The combination of gemcitabine and taxanes is particularly valuable because of the different mechanisms of action of each drug and their non-everlapping toxicities. During the last years, we have carried out several trials with gemcitabine in combination with either docetaxel or paclitaxel. The combination of gemcitabine and docetaxel in 53 previously treated patients resulted in 53% response rate (RR) with a median time to progression of 7.5 months, and an overall survival of 16.5 months. When gemcitabine was combined with paclitaxel in a biweekly schedule in 34 evaluable patients with prior exposure to several chemotherapy regimens, RR was 53%. It was 50% in patients previously treated with docetaxel. Toxicity was generally mild to moderate. Paclitaxel plus gemcitabine given as an every 2-weeks schedule is a practical, well tolerated and active regimen in advanced breast carcinoma, which deserves further evaluation in less heavily pretreated patients.

Recently, preliminary results of several randomized studies using trastuzumab in the adjuvant or neoadjuvant treatment of HER2-positive breast cancer have been reported. In the neoadjuvant setting, patients have been randomized to receive either chemotherapy alone (Group I), 4 cycles of paclitaxel followed by FEC (fluorouracil, epirubicin, cyclophosphamide) fo 4 cycles, or the same chemotherapy with concomitant weekly trastuzumab for 24 weeks (Group II). Pathologic complete responses were 25% in Group I and 66.7% in Group II, showing a significant superiority of treatment including trastuzumab. Among several ongoing studies of adjuvant therapy with trastuzumab, NSABP B-31 trial and NCCTG N9831 trial compared a standard treatment of sequential AC (doxorubicin, cyclophosphamide) followed by paclitaxel to the same chemotherapy regimen in combination with weekly trastuzumab for 1 year. In a third study (HERA trial), patients were randomized to 3 arms following adjuvant chemotherapy: observation, triweekly trastuzumab for 1 year or for 2 years. Joint analysis of B-31 and N9831 trials and interim analysis of patients randomized to receive 1 year trastuzumab in the HERA trial, show a significant improvement in disease-free survival with chemotherapy combined with trastuzumab. Treatment has been generally well tolerated with acceptable cardiotoxic effects (< 4%). However, the short follow-up precludes any information about long-term side-effects. Overall, although the risk/benefit ratio is in favor of trastuzumab including regimens, the use of this monoclonal antibody in the neoadjuvant or adjuvant treatment of HER2-positive breast cancer, should be carefully discussed with the patient.

Aim: The aim of this study is to evaluate the prognosis and survival of patients aged over 70 years and affected by breast cancer., Methods: From January 1994 through December 2000, 56 patients with breast cancer aged 70 years or older were submitted to surgical treatment. Associated diseases were present in 24 patients, while no patient showed distant metastases at the time of hospital admission. All patients underwent breast preserving surgery regardless the tumour size and in 31 subjects out of 56, the surgical procedure was performed under local anesthesia. An axillary lymphectomy was associated in 46 patients. According to the TNM staging system, tumours were classified as follows: 10 T1Nx, 18 T1N0, 9 T1N1, 7 T2N0, 10 T2N1 and 2 T3N1., Results: There was no postoperative mortality and in 6 cases an axillary seroma was observed. Radiotherapy and tamoxifen treatment followed surgery in all cases. The median follow-up was 44 months. Nineteen patients (34%) died during the follow-up: 6 patients of cancer progression with a specific cancer-death of 10.7% while 13 patients (23.2%) died because of concurrent diseases. A local relapse (1.8%) was observed in a single patient 2 years after the primary surgical treatment and, at 3 years, 37 patients (66%) are alive and disease-free. Long-term survival was significantly related to the stage of disease at the time of surgery, while our data do not allow any conclusions concerning the impact of axillary dissection on long-term outcome., Conclusions: In conclusion, results for breast cancer therapy are comparable in old and young patients and therefore strategies and treatment protocols should be similar, breast preserving surgery followed by radiotherapy and ormonal treatment being ''the gold standard''.

Breast cancer (BC) is the most common malignancy and the second most common cause of cancer-related death in Western European and North American women. Neoadjuvant chemotherapy may be used in the management of both BC patients with locally advanced disease, and those with earlier stage and operable tumors. Data from recently phase III trials and worldwide consensus conference document the benefit of adjuvant chemotherapy in improving disease free survival and overall survival for patients diagnosed with invasive BC > 1 cm. When BC cells metastasize to distant organs, the disease is incurable, but chemotherapy may offer these patients a significant palliation.

Introduction: Breast cancer is the most frequent cancer among female sex, above all in rich countries where it occurs ten times more than the others. The most incidence of breast cancer is in female over 45 yrs and over 70 yrs with a plateau during menopause. So it is really very uncommon before 30 yrs. It is well known that breast cancer is related to several risk factors: these have always to be well evaluated before any treatment, especially in surgery. In the last years we can see an improvement of techniques to make diagnosis of breast cancer. Also surgery has improved in that way, so it can ensure better results to patients than before, also from the esthetical point of view. There are lot of discussions on which is the best surgical treatment to do, if lymphoadenectomy of the armpit is always required and if it has to be considered only as a prognostic element or also a therapeutical one. It is also important to plan radio, chemio and hormonal therapy, well chosen on the base of histological exams, and of the grading made either before either during surgery. Last studies moreover evaluate the specificity, the importance and the prognostic value of searching the so called "sentinel lymph node" who is always the first one to be interested in a metastatic process., Study and Discussion: Through a random and retrospective study among all our female patients (Department of Surgical Science in Rome University "La Sapienza") who had surgery for breast cancer in the last ten years (approving all the hystological exams) we have related the kind of surgical treatments to overall survival, to the therapies, and to any possible local recurrence of disease. We analyzed 270 female patients (age between 19 and 83). We considered all surgical treatments used in breast cancer: from the "simple" quadrantectomy up to radical mastectomy with the association of lymphoadenectomy of the armpit (both armpits in case of recurrence to disease). All these patients had then their own therapy (radio, chemo or hormonal one, it depended on each case) and follow up of the length of at least five years. The overall survival was of 82.2%. From these study we made important considerations about all the factors involved in breast cancer. The first step is to consider always all of these to have a well surgical approach, and to get the best compliance and performance from patients in order to have at distance the best results.

Breast cancer represents 40% of all carcinomas and is responsible for the 20% of deads due to a cancer in female population. Patients in more of 50% age over 65 years. 150 patients with breast cancer older then 65 years underwent surgery. T1 and T2 < 2 cm patients were treated with quadrantectomy and radiotherapy. T2 > 2 cm and T3 patients underwent radical mastectomy. T4 patients were treated with neoadjuvant chemotherapy before surgery. Mean follow up was 48 (range 12-78) months. 43 patients (28.6%) had a progression of the neoplasia. Five years mortality rate was 18.6%. Surgery nowadays represents the treatment of choice for breast cancer even in elderly woman. Associated diseases in these patients shouldn't always considered an absolute contraindication for surgery.

In spite of major advances in early detection and adjuvant therapy, metastatic breast cancer remains a major clinical problem affecting a significant number of patients. Metastatic disease is generally considered incurable and conventional therapy is used mainly with palliative intent. Therefore, the choice of appropriate therapeutic approach requires a reasoned evaluation of the likelihood of benefit from therapy balanced with the impact of therapy on the patient's quality of life. The estimated aggressiveness of the tumour and indicators of response to therapy (e.g. the status of hormonal receptors) are useful parameters to take into account before selecting a given treatment. Endocrine therapy is an important option in the management of stage IV disease, with tamoxifen the most widely used first-line drug in postmenopausal women. For progressing patients, the third generation of aromatase inhibitors (letrozole, anastrazole) are considered good second-line endocrine agents. The LH-RH agonists represent the initial choice in premenopausal patients candidate to receive hormonal therapy, with the use of tamoxifen as a valuable alternative. Combination chemotherapy regimens (e.g. CMF or CAF) are usually used for first-line treatment of patients with aggressive, steroid receptor-negative disease. Recently, several relatively new agents have shown significant activity in metastatic breast cancer. In particular, the taxanes (paclitaxel and docetaxel) are particularly promising as single agents but also in combination with other drugs, especially anthracyclines. Finally, another class of agents, the d mention because they represent an important new treatment modality in the management of metastatic.

Combined modality treatments are indicated for most patients with breast cancer. The definition of a proper treatment schedule and of the timing of each modality is a relevant issue that affects the feasibility and the clinical outcome of the treatment. A review of the literature was done on the timing of radiation therapy (RT) in the post-operative treatment of breast cancer. Retrospective studies and randomized clinical trials addressing the issue were considered and grouped according to the combined modality treatments performed. With regard to breast conserving surgery and adjuvant RT, it was verified that a delay up to 8 weeks between breast surgery and start of RT is not associated with an increased risk of local failure if compared with RT started within 4 weeks. Concerning breast conserving surgery followed by adjuvant RT and chemotherapy, the choice of the best schedule is still a complex unresolved issue. More results on sequential schedule of adjuvant RT and chemotherapy from recently published randomized studies are available. The reconstruction of the breast after conservative surgery is rarely necessary and is usually performed immediately after surgical treatment. With regard to mastectomy followed by adjuvant RT and breast reconstruction, it appears from some retrospective studies that autologous tissue transfer offers better results over implants. Concerning the transverse rectus abdominis muscle (TRAM) procedure, either immediate reconstruction before RT or delayed reconstruction after RT was feasible without significative differences in complication rates. Further randomized clinical studies are required to address the unresolved issues linked to the timing of RT. At present the treatment plan should be based on the patient's individual circumstances with regard to risk of metastasis and local failure.

We have reviewed the current status of primary chemotherapy for resectable breast cancer. Available findings indicate that the most immediate benefit of this treatment approach consists in an important tumor shrinkage, enabling to significantly increase the rates of breast conserving approaches. In spite of the logical and scientific rationale, available data from prospective randomized studies do not provide evidence of a clear superiority of primary chemotherapy over adjuvant chemotherapy. Nevertheless, the observed kinetic acceleration of micrometastases following noncurative surgical excision in animal studies represents a strong biologic evidence supporting primary chemotherapy. From a clinical perspective, primary chemotherapy with conventional regimens can induce a low to moderate rate of pathological complete remissions that appear to be an important marker of favorable treatment outcome. For this reason, well designed, prospectively randomized, large trials with drug regimens more effective than those used so far are mandatory to demonstrate the real worthiness of this newer treatment approach and to define the optimal timing of surgery and other locoregional modalities in respect to the long-term treatment outcome. Should there be no benefit to the use of primary drug treatment, then the biologic consequences of primary tumor removal, as observed in experimental models, are not likely to be of clinical significance. Nonetheless, since primary chemotherapy can achieve long-term results similar to those obtained with postoperative drug treatment while increasing the frequency of breast-sparing approaches, women can be offered a choice to maintain their body integrity. Should improved pathological complete remission rates from more effective regimens of primary chemotherapy translate into improved survival compared with the classical postoperative modality, then, regardless of the tumor diameter at diagnosis, our overall strategy for the management of operable breast cancer will require a radical departure from the traditional dogma.

Background: The prognostic parameters most universally accepted as indicative for the assessment of 5 and 10 year survival in breast cancer are considered., Methods: The aims of this study were to elucidate the relationships among these parameters and to determine the specific interrelations of these prognostic factors. These parameters (age, grading, tumour size, lymphatic and vascular invasion, necrosis, lymph node status and number of nodes positive) are analysed by univariate and multivariate analysis on a series of 75 patients., Results: The analysis performed confirms prognostic accuracy of age, tumor size, number of nodes positive (p < 0.05, p < 0.001, p < 0.003, respectively) when considered singularly but the impossibility of deriving any benefit from the study of their reciprocal interrelations., Conclusions: This is due to the importance of each parameter assumes independently from the other and to the reciprocal compensation that occurs when all possible interactions are considered.

The role of radiotherapy in breast cancer is examined, based on a review of literature. Its impact on survival is discussed in the framework of a multidisciplinary treatment of the disease.

The true significance of achieving local control has been a matter for debate among clinical oncologists for many years and still is for those tumors where distant metastases are the major cause of failure and mortality. The assessment of local control appears elusive as it may be conceived as the local eradication of neoplastic cells while this should be confirmed by no risk for recurrence. Tools and procedures are available to assess separately the local response after treatment and at long term. Direct methods are quite different according to the different clinical and pathologic conditions. Complete local responses may be followed by recurrence leading to a different approach: to wait for the appearance of recurrence rather than to pursue a complete response. The diagnostic clinical and instrumental methods while easy in superficial tumors, are complex, expensive and poorly reliable in deep-seated tumors. Thus, in general, any assessment of local control in terms of diagnostic work-up can frequently be difficult and misleading.

Purpose: To evaluate efficacy and toxicity of high-dose chemotherapy (HDCT) in metastatic breast cancer (MBC) MATERIALS AND METHODS: A literature search from January 1988 until July 1998 about the treatment of metastatic breast cancer with high dose chemotherapy was conducted., Results: After HDCT the overall response rate was about 80%, with 50% of complete remissions. The median survival was > 18 months. Approximately 20% of the patients experienced long-term progression-free survival., Conclusions: Although current results appear promising, randomised trials are required to determine the role of HDCT in the treatment of patients with MBC.

From 1981 to 1990, 1003 stage I-II breast cancers underwent surgery at the Division of Surgical Oncology of National Institute for Cancer Research of Genoa. This study described the clinical and pathologic features of these breast cancers. Radical mastectomy was performed in 73.8% of cases and conservative surgery in 26.2% of cases. In the last years the number of conservative treatment has increased. Related to size of tumour, in 1991 80.4% of pT1 performed a conservative surgery. The choice of type of surgery for pT2 tumours depended on the choice of patient and the ratio breast size and tumour size. The five-year overall survival was 85.8% in the group of conservative surgery and 65.3% in the group of radical surgery. The overall survival and relapse free survival have been calculated by Kaplan-Meyer method. Actuarial survival curves were computed according to type of surgery, tumor size, nodal status, hormonal receptors. In our experience the size of tumour was an important prognostic factor. The five years, overall survival was 80.7% in pT1 tumours and 67% in pT2-pT3 tumours (p = 10(-6)). The five-year overall survival in negative nodes patients was 80.5%. Conversely in patients with more than ten nodal metastases was 29.5%. The data reported in the present study were no different as in previous studies.

Four periods are recognizable in breast carcinoma treatment: the first period can be called as "era of the incurable disease". It begins at the arising of the mankind and lasts up to the end of the 19th century. During this period the disease was usually diagnosed in far advanced stage and any therapeutical attempt was unable to cure a significant percentage of patients. The second period begins with Halsted and ends in the late 60's. It should be considered as the "eve of the surgical treatment of the breast cancer". In these years an increasing number of patients was diagnosed in earlier, curable stage and about half of them was definitively cured. In the early 70's several multimodality treatments of breast cancer were proposed by different Cancer Centers worldwide. Usually a local treatment (surgery+radiotherapy) was adopted combined with a systemic treatment (chemotherapy or monotherapy), commonly in N+ patients. Such approach cured a further 25% of patients that the local treatment alone could not cure. Moreover conservative surgical procedures were extensively carried up. In the last ten years the increasing amount of clinical data leads us to adopt a tailored therapeutical plan for nearly every patient. Numerous subgroups of patients with different level of risk were identified (patients with inflammatory carcinoma, young women at high risk, elderly patients etc.). The early data show that some further advantages in survival rates, in cost saving policy and in cosmetic outcome can be achieved.

Authors report their experience concerning surgical treatment of thoracic recurrence from previously operated breast cancer. 96 patients were treated: 9 with loco-regional chest wall recurrence, 84 with malignant pleural effusion, 3 with solitary lung metastasis. Eight of 9 cases with chest wall recurrence underwent skin and soft tissue "en bloc" resection while in one case a thoracectomy was performed. Malignant pleural effusions were treated by thoracentesis in 21 cases (25%), tube thoracostomy in 8 (4.76%), tube thoracostomy plus chemical pleurodesis in 54 (64.2%) and pleurectomy in one case (1.19%). In all the cases with solitary lung metastasis a wedge resection was performed. Two out of 9 patients with chest wall recurrence are not evaluable as they did not enter the minimum follow-up period (15 months), 6 died after a mean period of 18.6 months (range 15-25) following surgery and one is alive at the end of the follow-up (39 months). Among the 3 patients with solitary lung metastasis 2 died respectively 26 and 31 months after procedure and 1 is alive at 28 months. Above 54 patients treated by tube thoracostomy plus pleurodesis for malignant pleural effusion, 35 showed a complete response, 13 a partial response and 6 were non-responders. No postoperative complications were observed in the patient who underwent pleurectomy while an almost complete resolution of the pain was achieved.

From 1990 to 1996, a total of 223 patients, with breast cancer, were treated. Out of these patients, 7 (3.04%) developed a second primary carcinoma in the controlateral breast. Two (28.5%) had a synchronous manifestation while the remaining 5 (71.5%) had a metachronous manifestation. The seven patients were followed up for periods between 4-8 years: 80% of the metachronous tumours occur within 5 years of follow-up. The 7-year actuarial survival was 100% in the two synchronous tumours and 60% in the five metachronous tumours (two patients died on account of intervening diseases). The prognosis does not depend on the length of the interval between the development of the two carcinomas but it is in relation with the anatomo-clinical state, to the adequate treatment of each primary tumour and to the rigorous clinical-instrumental follow-up, in which the mammography plays a fundamental role.

The influence of timing of surgery in relation to menstrual period on survival of breast cancer patients has been both advanced advocated and disputed. A meta-analysis on published series showed a statistically significant overall odds reduction when surgery is performed in the luteal phase. The records of 165 premenopausal M- breast cancer women, not on hormonal therapies, consecutively operated on from 1977 to 1991 were reviewed. All patients underwent modified radical mastectomies or quadrantectomies plus operative radiotherapy, Node-positive patients received standard adjuvant chemotherapy. Cox regression analysis was used to estimate the relative risk (RR) of death in three models including timing of surgery, age, histology, pathological T and N. In each model, patients were divided into two groups according to the criteria proposed by Badwe, Hrushesky, and Senie. Multivariate analysis showed a significant association between pT and pN and survival, whereas no association with survival was observed for timing of surgery according to Badwe or Hrushesky or Senie criteria (RR = 1.26, RR = 0.91, and RR = 0.88 respectively). Up-to-date agreement on the menstrual phase and relative expected better prognosis is still lacking.