Breast Cancer

A High Number of Tumor Free Axillary Lymph Nodes from Patients with Lymph Node Negative Breast Carcinoma is Associated with Poor Outcome Reviewers: Li Liu, MD Source: Cancer, Volume 88:108-113, (January) 2000Précis: Total number of lymph nodes predicts outcome of node-negative breast cancerIntroductionThe histologic status of axillary lymph nodes is one of the most important...
Accuracy of Sentinel Lymph Node Biopsy in Patients with Large Primary Breast Tumors Reviewers: Li Liu, MD Source: Cancer, Volume 88:2540-2545, (June) 2000Précis: Sentinel lymph nodes biopsy in patients with 2-5 cm. breast cancers appears accurateIntroductionThe sentinel lymph node (SLN) is the first lymph node to drain the...
Adjuvant Radiotherapy in Pre-Menopausal Women with Breast Cancer Reviewers: John Han-Chih Chang, MD and Ken Blank, MD Source: N Engl J Med. 1997 Oct 2;337(14):956-62.Possibly more than any other cancer, the treatment of breast cancer has evolved over the past twenty years. Surgery to remove the entire breast...
Age-Related Variation in the Treatment and Outcomes of patients with Breast Carcinoma Reviewers: Li Liu, MD Source: Cancer, Volume 88:369-374, (January) 2000Précis: Breast cancer diagnosed between ages 60 and 69 appeared to have more favorable outcomeIntroductionThe relationship between young age at diagnosis and the...
Alcohol and Breast Cancer in Women Reviewers: John Han-Chih Chang, MD and Kenneth Blank, MD Source: Journal of the American Medical Association 1998; 279: 535 - 540BackgroundMany studies have shown an increased risk of breast cancer with alcohol consumption. The mechanism is not...
Analysis of Interfraction and Intrafraction Variation During Tangential Breast Irradiation with an Electronic Portal Imaging Device Source: Int J Radiat Oncol Biol Phys. 2005 Jun 1;62(2):373-8. Authors: Smith RP, Bloch P, Harris EE, McDonough J, Sarkar A, Kassaee A, Avery S, Solin LJ. Background During radiotherapy, a major goal is to deliver radiation to the target tissue...
BRCA1/BRCA2 Germline Mutations in Locally Recurrent Breast Cancer Patients After Lumpectomy and Radiation Therapy: Implications for Breast-Conserving Management in Patients With BRCA1/BRCA2 Mutation Reviewers: Li Liu, MD Source: Journal of Clinical Oncology, Volume 17, No 10:3017-3024, October 1999.BackgroundFor women with early stage breast cancer, lumpectomy followed by radiation therapy (LRT) has been an acceptable standard of care. Much...
Canadian National Breast Screening Study-2: 13-Year Results of a Randomized Trial in Women Aged 50-59 Years Reviewers: Li Liu, MD Source: Journal of the National Cancer Institute, Volume 92:1490-1499, (September) 2000Précis: Mammography may not offer survival advantage over annual breast examinationIntroductionThere is universal agreement that...
Combination chemotherapy versus single-agent therapy as first and second-line treatments in metastatic breast cancer: A prospective randomized trial Reviewers: Kenneth Blank, MD Source: Journal of Clinical Oncology Vol. 16, No. 12, p. 3720 1998BackgroundThe treatment of patients with metastatic breast cancer is challenging, with the roles of chemotherapy, endocrine therapy and radiation...
Combined Modality Treatment of Locally Advanced Breast Carcinoma in Elderly Patients or Patients with Severe Comorbid Conditions Using Tamoxifen as the Primary Therapy Reviewers: Li Liu, MD Source: Cancer Volume 88, 2054-2060 (May) 2000IntroductionLocally advanced breast cancers (LABC) are defined as tumors that measure more than 5 cm, tumors that extend to the chest wall or skin, and tumors with fixed ipsilateral...
Consensus Statement on Postmastectomy Radiation Therapy Reviewers: Li Liu, MD Source: International Journal of Radiation Oncology, Biology, and Physics, Volume 44, No 5 (July):989-990, 1999Based on the emerging data from many institutional reports as well as prospective randomized clinical trials, the...
Detection of Epstein-Barr Virus in Invasive Breast Cancers Reviewers: Li Liu, MD Source: Journal of the National Cancer Institute, Volume 91, No 16 (August):1376-1381, 1999BackgroundThe Epstein-Barr virus (EBV) has been known to play a role in the development of human malignancies, especially tumors of...
Dietary Factors and the Survival of Women with Breast Carcinoma Reviewers: Li Liu, MD Source: Cancer, 86(5): 826-835, September 1999BackgroundStage for stage, Japanese women with breast cancer have a better survival compared with Western women. Diet has been thought to be one of the contributing factors. This...
Dietary Fat, Fat Subtypes, and Breast Cancer in Postmenopausal Women: a Prospective Cohort Study Reviewers: Li Liu, MD Source: Journal of the National Cancer Institute, volume 92, 833-839 (May) 2000IntroductionHigh intake of total dietary fat has been postulated to increase breast cancer risk on the basis of animal studies, international...
Dual Effects of Weight and Weight Gain on Breast Cancer Risk Reviewers: John Han-Chih Chang, MD and Kenneth Blank, MD Source: Journal of the American Medical Association Nov 5, 1997; Volume 278 (Number 17): pp 1407 - 11.BackgroundIn most previous reports of the association of breast cancer and weight, an...
Effect of Nancy Reagan's Mastectomy on Choice of Surgery for Breast Cancer by US Women Reviewers: John Han-Chih Chang, MD and Kenneth Blank, MD Source: Journal of the American Medical Association 1998; Volume 279: pages 762 - 766.BackgroundCancer treatment can take on various forms. It can include surgery, radiation therapy or...
Effect of postmastectomy radiotherapy in patients <35 years old with stage II-III breast cancer treated with doxorubicin-based neoadjuvant chemotherapy and mastectomy Authors: Garg AK, et al. Source: Int J Radiat Oncol Biol Phys. 2007 Sep 12, epub. Introduction Young age is considered an independent poor prognostic factor in patients with breast cancer. In the past decade, several randomized trials and...
Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials Authors: Early Breast Cancer Trialists' Collaborative Group (EBCTCG) Source: Lancet. 2005 366:2087-2106 Affiliation: University of Oxford, Oxford, UK Background Numerous randomized, controlled trials have studied therapies directed at improving...
Efficacy of Bilateral Prophylactic Mastectomy in Women with a Family History of Breast Cancer Reviewers: Kenneth Blank, MD Source: The New England Journal of Medicine, January 14, 1999, Volume 340, Number 2BackgroundThe treatment of breast cancer has changed dramatically over the past two decades. Advances have included the recognition that...
Estrogen Replacement Therapy After Localized Breast Cancer: Clinical Outcome Of 319 Women Followed Prospectively Reviewers: Kenneth Blank, MD Source: Journal of Clinical Oncology, Vol. 17, Issue 5 (May), 1999: 1482IntroductionWith breast cancer screening programs detecting more young women with early stage breast cancer, the number of breast cancer survivors...
Gene Expression Profiles in Paraffin-Embedded Core Biopsy Tissue Predict Response to Chemotherapy in Women with Locally Advanced Cancer Author: Gianni L, Zambetti, K., et al. Source: Journal of Clinical Oncology 23;29, 2005. Introduction Gene array and RT-PCR technology allows for the rapid evaluation of hundreds of individual genes that may play a role in predicting response to...
HER-2/neu Amplification in Benign Breast Disease and the Risk of Subsequent Breast Cancer Reviewers: Li Liu, MD Source: Journal of Clinical Oncology, Volume 18, No. 2 (January): 267-274, 2000BackgroundThe HER-2/neu oncogene (also called c-erbB-2) codes a surface membrane protein that interacts with the epithelial growth factor receptor....
Impact of Concurrent Versus Sequential Tamoxifen With Radiation Therapy in Early-Stage Breast Cancer Patients Undergoing Breast Conservation Treatment Source: J Clin Oncol. 2005 Jan 1;23(1):11-6. Authors: Harris EE, Christensen VJ, Hwang WT, Fox K, Solin LJ. Affiliation: University of Pennsylvania, Philadelphia, PA. Background The optimal sequencing of breast irradiation and adjuvant...
Increased Risk of Acute Leukemia After Adjuvant Chemotherapy for Breast Cancer: A Population-Based Study Reviewers: Li Liu, MD Source: Journal of Clinical Oncology, Volume 18:2836-2842, (August) 2000Précis: Adjuvant treatment for breast cancer increased leukemia riskIntroductionSince the mid-1970s, adjuvant chemotherapy has been widely used to...
Late Cardiac Mortality and Morbidity in Early-Stage Breast Cancer Patients After Breast-Conservation Treatment Authors: Harris EER, Correa C, Hwang W-T, Liao J, Litt HI, Ferrari VA, and Solin LJ. Source: JCO Vol. 24, Sept. 1, 2006. Background The Early Breast Cancer Trialists' Collaborative Group meta-analysis demonstrated increased cardiac mortality...
Life Expectancy Gains from Cancer Prevention Strategies for Women with Breast Cancer and BRCA1 or BRCA2 Mutations Reviewers: Li Liu, MD Source: JAMA, volume 283, No. 5: 617-624, (February) 2000.Précis: Theoretical benefit of various cancer prevention strategies for breast cancer patients with BRCA mutationsIntroductionWomen who carry BRCA1 and BRCA2...
Lobular carcinoma in situ as a component of breast cancer: The long-term outcome in-patients treated with breast-conservation therapy Reviewers: Kenneth Blank, MD and Leonard Farber, MD Source: International Journal of Radiation Oncology, Biology and Physics. 15 January 1998, Volume 40 number 2, pg. 353Lobular carcinoma in situ (LCIS) was first described in 1941 as a noninvasive...
Long-Term Outcome after Breast-Conservation Treatment with Radiation for Mammographically Detected Ductal Carcinoma in Situ of the Breast Source: Cancer. Vol. 103, p. 1137-1146 (2005). Authors: Solin LJ, Fourquet A, Vicini FA, Taylor M, Olivotto IA, Haffty B, Strom EA, Pierce LJ, Marks LB, Bartelink H, McNeese MD, Jhingran A, Wai E, Bijker N, Campana F, Hwang WT. Affiliations:...
Long-term outcome after postmastectomy radiation therapy for breast cancer patients at high risk for local-regional recurrence Reviewers: Kenneth Blank, MD Source: Cancer J Sci Am 1999 Mar-Apr;5(2):77-83IntroductionTwo recently published randomized trials documented the benefit of administering radiotherapy after mastectomy for breast cancer. In both these papers, the...
Long-Term Results of a Randomized Trial Comparing Breast-Conserving Therapy With Mastectomy: European Organization for Research and Treatment of Cancer 10801 Trial Reviewers: Li Liu, MD Source: Journal of the National Cancer Institute, Volume 92(14):1143-1150, (July) 2000Précis: Survival is similar after mastectomy, breast-conserving therapy for stage II tumorsIntroductionIt has been well established...
Long-term Satisfaction and Psychological and Social Function Following Bilateral Prophylactic Mastectomy Reviewers: Li Liu, MD Source: JAMA Volume 284(3): 319-324, (July) 2000Précis: High satisfaction following prophylactic bilateral mastectomyIntroductionThe improved availability to identify women at high risk for breast cancer, such as...
Lumpectomy and Radiation Therapy for the Treatment of Intraductal Breast Cancer: Findings from National Surgical Adjuvant Breast and Bowel Project B-17 Reviewers: John Han-Chih Chang, MD and Kenneth Blank, MD Source: Journal of Clinical Oncology 1998; volume 16 (number 2): pages 441 - 452BackgroundWith the use of screening studies such as mammograms and ultrasounds along with self breast exams,...
Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17 Authors: Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, Fisher ER, Wickerham DL, Deutsch M, Margolese R, Dimitrov N, Kavanah M. Source: J Clin Oncol. 1998 Feb; 16(2): 441-52 Background Intraductal carcinoma-in-situ of the...
Mammography may not offer survival advantage over annual breast examination Reviewers: Li Liu, MD Source: Journal of the National Cancer Institute, Volume 92:1490-1499, (September) 2000Précis: Mammography may not offer survival advantage over annual breast examinationIntroductionThere is universal agreement that...
Menopausal Estrogen and Estrogen-Progestin Replacement Therapy and Breast Cancer Risk Reviewers: Li Liu, MD Source: JAMA, volume 283, No. 4: 485-491, (January) 2000IntroductionPostmenopausal estrogen therapy has been used widely to reduce menopausal symptoms, risk of osteoporotic fractures, and probably coronary heart disease. Side...
Morbidity following Sentinel Lymph Node Biopsy versus Axillary Lymph Node Dissection for Patients with Breast Carcinoma Reviewers: Li Liu, MD Source: Cancer, Volume 88:608-614, (February) 2000Précis: Sentinel lymph nodes biopsy is associated with negligible morbidityIntroductionThe histologic status of axillary lymph nodes, one of the most important...
MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study Authors: Kuhl CK, Schrading S, Bieling HB, Wardelmann E, Leutner CC, Koenig R, Kuhn W, Schild HH Source: Lancet 2007; 370:485-92 Affiliation: University of Bonn, Bonn, Germany No conflicts of interest to report Background While ductal carcinoma...
Occult Metastases in the Sentinel Lymph Nodes of Patients with Early Stage Breast Carcinoma Reviewers: Li Liu, MD Source: Cancer, 86:990-996, October 1999.BackgroundThe presence of nodal metastases and the number of lymph nodes with metastases are among the most important predictors of the outcome for patients with breast cancer....
Occupational and Residential Magnetic Field Exposure and Breast Cancer in Females Reviewers: Li Liu, MD Source: Epidemiology, Volume 11:24-29, (January) 2000Précis: Exposure to magnetic fields was not associated with increased risk of breast cancer in womenIntroductionAnalyses of exposure to magnetic fields and female...
Outcome after Invasive Local Recurrence in Patients with Ductal Carcinoma in Situ of the Breast Reviewers: Kenneth Blank, MD and John Han-Chih Chang, MD Source: Journal of Clinical Oncology, Volume 16 (Number 4): pages 1367-1373. The Van Nuys Breast Center, CaliforniaBackgroundDuctal carcinoma in situ (DCIS) is a non-invasive cancer of the...
Outcomes Among African-Americans and Caucasians in Colon Cancer Adjuvant therapy Trials: Findings From the National Surgical Adjuvant Breast and Bowel Project Reviewers: Li Liu, MD Source: Journal of the National Cancer Institute, 91(22): 1933-1940, November 1999IntroductionSome retrospective studies have reported poorer outcomes from colon cancer among African-Americans compared to Caucasian Americans....
Patterns of Breast Carcinoma Treatment in Older Women Reviewers: Li Liu, MD Source: Cancer, Volume 89:561-573, (August) 2000Précis: Very elderly women in US were often not offered full range of breast cancer treatments.IntroductionThe choices of treatment for breast cancer are influenced by...
Physical Activity and the Risk of Breast Cancer Reviewers: Kenneth Blank, M.D. and John Chang, M.D. Source: The New England Journal of Medicine -- May 1, 1997 -- Volume 336, Number 18Strong evidence exists tying estrogen exposure to breast cancer. For example, women who have early menopause,...
Plasma Organochlorine Levels and the Risk of Breast Cancer Reviewers: John Han-Chih Chang, MD and Ken Blank, MD Source: TheNew England Journal of Medicine -- October 30, 1997 -- Volume337, Number 18Several correlative pieces of data indicate that environment playsan important role in the etiology...
Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial Reviewers: John Han-Chih Chang, MD Source: Lancet 1999 May 15; Volume 353(Number 9165): 1641-8Background/Discussion/CritiqueThe New England Journal publications in 1997 from Denmark and Canada demonstrated a survival benefit for postmastectomy...
Prediction of Axillary Lymph Node Involvement of Women with Invasive Breast Carcinoma Reviewers: John Han-Chih Chang, MD Source: Cancer 1998; Volume 83 (Number 5): pages 948 - 955BackgroundAxillary lymph nodes (ALN) are the most commonly involved siteof disease in breast cancer that has spread outside the primary lesion. Clinical...
Preoperative Chemotherapy for Breast Cancer Reviewers: John Han-Chih Chang, MD Source: Journal of Clinical Oncology Jul 1997; Volume 15: pages 2483 - 93This article details the preliminary data from the National Surgical Adjuvant Breast and Bowel Project trial B-18. This study was designed to...
Prevention Of Breast Cancer With Tamoxifen: Preliminary Findings From The Italian Randomised Trial Among Hysterectomised Women Reviewers: John Han-Chih Chang, MD Source: Lancet 1998; volume 352: pages 93 - 97IntroductionIt is projected that 178,700 new cases of breast cancer will be diagnosed this year. For noninvasive and early stage invasive disease, the cure rate is...
Prognostic Value of p53 for Local Failure in Mastectomy-Treated Breast Cancer Patients Reviewers: Li Liu, MD Source: Journal of Clinical Oncology, Vol. 18, No 9, 1906-1913, (May) 2000IntroductionRandomized clinical trials have established that radiation therapy improves the local regional control and survival in selected breast cancer...
Prophylactic Surgery Decisions and Surveillance Practices One Year Following BRCA1/2 Testing Reviewers: Li Liu, MD Source: Preventive Medicine, Volume 31:75-80, (August) 2000Précis: BRCA testing has low impact on screening complianceIntroductionGermline BRCA1/2 mutations are associated with greatly increased risk of developing...
Prospective Randomized Trial of Docetaxel Versus Doxorubicin in Patients With Metastatic Breast Cancer Reviewers: Li Liu, MD Source: Journal of Clinical Oncology, Vol 17, Issue 8 (August), 1999: 2341-2354IntroductionDocetaxel is an effective chemotherapeutic agent for advanced breast cancer, with significant activity as both first-line therapy (J Clin...
Prospective Randomized Trial of Docetaxel Versus Mitomycin Plus Vinblastine in Patients With Metastatic Breast Cancer Progressing Despite Previous Anthracycline-Containing Chemotherapy Reviewers: Li Liu, MD Source: Journal of Clinical Oncology, Vol 17, Issue 5 (May), 1999: 1413-1424IntroductionIt is clear that chemotherapy provides clinical benefit to many women with metastatic breast cancer (J Clin Oncol. 1996 Aug;14(8):2197-205)....
Racial Differences in Breast Carcinoma Survival Reviewers: Li Liu, MD Source: Cancer, Volume 88:114-123, (January) 2000Précis: African-American women were at increased risk of death from breast cancerIntroductionPrevious studies have documented a worse prognosis from breast cancer for...
Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomized controlled trial Authors: Joan Houghton, et al. Affiliation: UKCCCR DCIS Working Party / DCIS trialists in the UK, Australia, and New Zealand Source: Lancet. 2003 Jul 12;362(9378):95-102 Introduction The establishment of breast screening programs in the UK,...
Randomized Trial of High-dose Chemotherapy and Blood Cell Autografts for High-Risk Primary Breast Carcinoma Reviewers: Li Liu, MD Source: Journal of the National Cancer Institute, Volume 92, No.3 (February):225-233, 2000BackgroundIn patients with high-risk breast carcinoma some studies have suggested that high-dose chemotherapy (HDC) and autologous...
Reduction in New Metastases in Breast Cancer with Adjuvant Clodronate Treatment Reviewers: John Han-Chih Chang, MD and Kenneth Blank, MD Source: New England Journal of Medicine, 339 (6):357IntroductionBisphosphonates are a class of drugs that are increasingly being used totreat osteoporosis. These medications inhibit the...
Risk of Breast Cancer with Oral Contraceptive Use in Women with a Family History of Breast Cancer Reviewers: Li Liu, MD Source: JAMA, Volume 284:1791-1798, (October) 2000Précis: Some oral contraceptives may link to higher risk of developing breast cancerIntroductionBreast cancer is common and on the increase. Use of hormonal...
Risk of Menopause During the First Year After Breast Cancer Diagnosis Reviewers: John Han-Chih Chang, MD Source: Journal of Clinical Oncology 1999; Volume 17: pages 2365 - 2370BackgroundBreast cancer is being "caught" earlier and earlier due to better screening practices. Premenopausal women comprise 1/4th of the...
Second Malignancies after Treatment of Early-Stage Breast Cancer: Lumpectomy and Radiation Therapy Versus Mastectomy Reviewers: Li Liu, M.D Source: Journal of Clinical Oncology, Volume 18 (12), 2406-2412 (June) 2000Précis: Radiation for breast cancer is not associated with greater risk of second malignancy.IntroductionAlmost all types of cancer can be...
Sentinel Lymph Node Biopsy with Metastasis: Can Axillary Dissection Be Avoided in Some Patients with Breast Cancer? Reviewers: John Han-Chih Chang, MD Source: Journal of Clinical Oncology; 1999, Volume 17: Pages 1720 26Background/Discussion/CritiqueThe sentinel lymph node (SLN) is the "first lymph node in a nodal basin to drain the primary tumor." In...
Significance of Axillary Lymph Node Extranodal Soft Tissue Extension and Indications for Postmastectomy Irradiation Reviewers: Li Liu, MD Source: Cancer, 86(7): 1258-1262, October 1999.BackgroundExtranodal soft tissue extension (ETE) is associated with decreased survival and increased recurrence rates in patients with breast cancer. However, whether axillary...
Similar Long-Term Results of Breast-Conservation Treatment for Stage I and II Invasive Lobular Carcinoma Compared with Invasive Ductal Carcinoma of the Breast Source: Cancer. 2005 Jun 15;103(12):2447-54. Authors: Santiago RJ, Harris EE, Qin L, Hwang WT, Solin LJ. Affiliation: University of Pennsylvania, Philadelphia, PA. Background In breast cancer, invasive lobular cancers (ILC) are rarer than...
Skin-sparing mastectomy and immediate reconstruction is an acceptable treatment option for patients with high-risk breast carcinoma Authors: Downes KJ, Glatt BS, Kanchwala SK, Mick R, Fraker DL, Fox KR, Solin LJ, Bucky LP, Czerniecki BJ. Source: Cancer. 2005 Mar 1;103(5):906-13. Background Skin-sparing mastectomy (SSM) has been a commonly performed procedure for greater than...
Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomized controlled trial Reviewers: John Han-Chih Chang, MD Source: Lancet 1999 Jun 12; Volume 353: pages 1993 - 2000BackgroundWe have shown previously that lumpectomy with radiation therapy was more effective than lumpectomy alone for the treatment of ductal carcinoma in...
Tamoxifen Therapy for Breast Cancer and Endometrial Cancer Risk Reviewers: Li Liu, MD Source: Journal of the National Cancer Institute, Volume 91, No 19:1654-1662, October 1999.BackgroundTamoxifen is now widely used among women of all ages for the treatment of all stages of breast cancer. Tamoxifen reduces the...
The effect of raloxifene on risk of breast cancer in postmenopausal women Reviewers: Kenneth Blank, MD Source: JAMA 1999 Jun 16; 281(23): 2189-97IntroductionThe best treatment of cancer is prevention: simply put, if cancer does not occur it cannot cause morbidity or mortality. Towards this end investigators at several...
The Influence of Margin Width on Local Control of Ductal Carcinoma In Situ of the Breast Reviewers: John Han-Chih Chang, MD Source: New England Journal of Medicine 1999; Volume 340: pages 1455 - 1461BackgroundNoninvasive breast cancer or ductal carcinoma in-situ (DCIS) has been increasing in prevalence over the past couple decades....
The Sentinel Node in Breast Cancer -- A Multicenter Validation Study Reviewers: Kenneth Blank, MD and John Han-Chih Chang, MD Source: The New England Journal of Medicine -- October 1, 1998 -- Volume 339, Number 14BackgroundThe treatment of invasive breast cancer always includes dissection of the axilla (the area of...
Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy Plus Irradiation for the Treatment of Invasive Breast Cancer Authors: Bernard Fisher, M.D., Stewart Anderson, Ph.D., John Bryant, Ph.D., et al. Source: N Engl J Med 2002, 347:1233-1241 Background The National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol B-04 showed that over 25 years of...