Study: Implants affect the diagnosis of Breast Cancer but not survival (HealthDay)

 A small study of women with cancer suggests that those who have already undergone surgery to receive breast implants not with no prognosis poorer than those without implants, despite the fact that mammograms were less precise pick up anomalies in this group of women.

Women who had breast implants were more likely to have tumors that can be detected by touch alone and were also more likely to have cancer that has spread in lymph nodes, but the rate of survival between the two groups in the study was similarresearchers have discovered.

"We found that women in the Group augmented had palpable tumors and were more likely to have nodes lymph positive disease," said study author Dr. Jessica a. Rayhanabad, a member of the division of surgery of the breast at Keck School of Medicine the USC in Los Angeles. "However, these conclusions are not translated into a significant difference in survival rates between the two groups."

But researchers have recognized that small sample size can biased that the rate of survival. Women whose cancer has invaded the lymph nodes generally have a poorer prognosis for survival, they noted, given that the tumor cells are then able to move by the bloodstream to other tissues and sites through the body.

The study, by researchers at the University of Southern California, is scheduled to be presented Friday at the annual meeting of the American Society of Breast Surgeons in Washington, D.C. Because of its size and because it has not yet been published in a peer review, the findings should be considered preliminary.

"It is commonly accepted that [a breast implant] impairs our ability to diagnose breast cancer and women increased have therefore a worse prognosis should they develop breast cancer," wrote the authors.

For the study, researchers reviewed records of 5,005 women, who had been treated for cancer of the breast in 15 years to determine whether patients with breast implants have been diagnosed more advanced disease and had thus a poorer prognosis. (In the medical language, the term breast implant is "augmentation mammoplasty.")

In the study, a total of 195 women had previously undergone breast augmentation and 121 had a mammogram before their diagnosis. The test showed no abnormal existing in 36 per cent of these cases, compared to a rate of false negatives from 15% in the general population.

However, researchers have found no difference in the size of the tumor, recurrence rates or rates of survival between the two groups.

Another surgeon of breast not involved in the research said that within 15 years of the study is an important limitation, because it suggests that the majority of patients probably did not undergo digital mammograms, which became much more widely used in since three or four years.

"Digital x-rays really made a big difference in terms of accuracy, because they can enter right through,", said Dr. Alexander j. Swistel, Chief of breast surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York.

Researchers have also noted that MRI can be an important tool for patients with implants, but Rayhanabad warned: "I'd make general recommendations for MRI screening on all women who have had breast augmentation.". It really depends on our ability to evaluate the chest on mammography. Get an MRI screening in an augmented woman should be at the discretion of the imaging of the chest and the surgeon.

According to the American Society of plastic surgeons, about winegrapes women undergo breast augmentation surgery last year, which is an increase of 39% from the year 2000.

"There is a level of comfort around implants I've ever seen, and it is for women of all ages," notes Swistel. "We now see young women who get implants in high school graduation gifts."

That comfort level may be unfounded, since the researchers noted that the study did not exclude the possibility of results in women with breast implants who develop breast cancer.

"One of the limitations of our study is the size of the small sample of women increased," said Rayhanabad. "We know that patients ganglion lymphatic-positive, on the whole, are more likely to have the poorest survival." "And it can therefore that the sample size may contribute to the lack of difference between the two groups, survival rates."

Diagnosis of Alzheimer's disease redefined

Alzheimer's disease begins long before family and friends notice differences in the patient's memory and behavior, doctors who treat the condition said Monday. By the time an official diagnosis is made, the person's function is usually significantly impaired and treatment rarely helps.

Doctors are suggesting a redefinition of Alzheimer's that would include even mild memory and behavioral symptoms. Disease experts expect an increase in the number of patients receiving the Alzheimer's diagnosis as a result of the change.

The idea, proposed by the Alzheimer's Association and the National Institutes of Health, would define Alzheimer's as a "spectrum" disease, creating three internships ranging from lesser to greater severity in hopes that the devastating neurological condition could be detected earlier.

In the U.S., 5.4 million people have an Alzheimer's diagnosis. By 2050, that number is expected to more than triple.

The aim of identifying the disease is to get patients earlier in the pipeline for research for future treatment. When the disease isn't identified until later in its progression, patients are more effective and treatments are even less impaired, doctors said. Current therapies usually don't make much difference, doctors acknowledged in a media briefing Monday.

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"It's critically important when we have effective drugs to intervene as quickly as possible," said Marilyn Albert, professor of neurology at Johns Hopkins University School of Medicine, who helped formulate the new guidelines. "there could be drugs available now, but we re using them too late in the disease course."

"the goal in the field is to find people earlier, so when new treatments are developed, we can use them."

The new guidelines appear Tuesday in the journal Alzheimer's & Dementia.

The original criteria for Alzheimer s disease, written in 1984, defined the disease in a single stage and assumed people who didn't have symptoms did not have the disease. This original definition addressed only later stages of the disease, when it ravages the patient's ability to function.

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The newly expanded stages of Alzheimer's are meant to cover the full spectrum of the disease as it first over the years.

"For people working with Alzheimer's patients day-to-day, it doesn't make a huge difference in practice right now," said Dr. Neil Kremen, unit chief at the Geriatric Psychiatry Inpatient Unit at Zucker Hillside Hospital in New York.

Most doctors working with Alzheimer's have already accepted that the disease is a progression.

"people who work in the field have known this," he said about various stages of Alzheimer's. "it has been accepted." It was never codified into a standard guideline. "In some sense, it's the formalization of things that people already know."

The courses have been divided into preclinical Alzheimer's, mild cognitive impairment and dementia.

First stage: Preclinical Alzheimer's disease

This internship is for research purposes only and will have no effect in your doctor's office.

The idea is that patients could be developing Alzheimer's, even when they are free of cognitive or memory problems.

This course is to help researchers determine whether there is a biological change caused by Alzheimer's that can be detected through blood, spinal fluid test or neuroimaging. Right now, there is no test that accurately predict whether a person will develop Alzheimer's disease.

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While studies show that Alzheimer's patients experience changes in the brain - the buildup of amyloid protein tangles and nerve cell changes - it is unknown whether this means an inevitable progression to Alzheimer's dementia.

"Changes in their brain can be measured, but we can't predict for sure whether they're going to have the clinical disease," said Dr. Creighton Phelps, director of the Alzheimer's Disease Centers Program of the National Institutes of Health.

These tests are used only in research settings.

Scientists are working to develop a more definitive test or a scan to determine Alzheimer's risk.

Second stage: Mild cognitive impairment (MCI)

Long before a person gets an Alzheimer's diagnosis, he or she may show small changes in memory, behavior and thinking. This is called mild cognitive impairment.

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While it does not cripple a person's ability to function throughout the day, these differences are often noticed by friends and family members.

Some patients in this stage are already observed by their doctors as "probable Alzheimer's."

This is a gray area because not all memory problems are Alzheimer's - related. Cognitive difficulties could stem from other factors such as a drug's side effects or vascular disease.

This stage could be used in specialized Alzheimer's clinics. A specialist might determine that the cognitive problems are caused by underlying Alzheimer's disease after a comprehensive exam, based on the disease process and symptoms, said Dr. John c. Morris, director and principal investigator of the Alzheimer's Disease Research Center at the Washington University School of Medicine.

But there are no blood or medical tests available in doctors' offices to confirm whether the mild cognitive impairment is because of Alzheimer's.

Third stage: because of Alzheimer's Dementia

This is the stage when memory, thinking and behavioral symptoms have become so damaging that the patient's ability to function is hindered.

The disease is not solely restricted to memory problems. The new guidelines include other symptoms such as difficulty finding words, visual and spatial problems, impaired reasoning and judgment.

This is the stage that people are most familiar with. The patient eventually becomes unable to carry out basic daily tasks - eating, bathroom-related functions and is fully dependent on others for basic care.

The purpose of setting out these updated stages of Alzheimer's is aimed at the future, Creighton said, to "define a research strategy for people who may be at risk for Alzheimer's."