W. Tjalma MD, PhD

The ideal cervical cancer screening recommendation for Belgium, an industrialised country in Europe

Cervical cancer should be a historical disease, why are we not succeeding! The prophylactic vaccination will reduce cervical cancer by almost 80% in Belgium. Cervical cancer screening should therefore continue in order to prevent the remaining 20%. The currently used Pap cytology test misses 50% of all clinically significant precancers and cancers at the time of testing. The test should remain but the analysis should be altered. The screening should be modified based on our knowledge of human papillomavirus as a causal factor. Instead of looking for cell abnormality one should look for the presence of human papillomavirus. Then, depending on the test, only two to ten percent of all relevant lesions are missed. The introduction of the vaccination should lead to the reintroduction of the screening based on human papillomavirus. This will lead to a considerable reduction in morbidity and mortality, allow longer screening intervals and be more cost-effective. More for less should be the driving force in cervical cancer screening if we want to be successful.

(BELG J MED ONCOL 2014;8(2):44–51)

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Case report: squamous cell carcinoma of the breast, a rare cancer?

Summary

We present the case of a 56-year old patient with primary squamous cell carcinoma of the breast. She underwent a radical mastectomy with adjuvant chemotherapy, consisting of carboplatinum and gemcitabine, and consecutive radiotherapy. Twenty-seven months after her treatment she is still disease-free. Hormonal therapy was initiated for a small tubular carcinoma and is continuing. As yet, there is uncertainty about the correct management of this rare and aggressive type of cancer, but there is growing evidence that adjuvant platinum-based regimens, especially cisplatinum, might be effective in inducing long-term complete remission.

(BELG J MED ONCOL 2013;7(3):89–92)

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Practical issues in the approach of the axilla

Concerning the previously published article:
Smeets A, Carly B, Cocquyt V, et al. The changing role of axillary dissection in the treatment of breast cancer. Belg J Med Oncol 2012;6:78–95

(BELG J MED ONCOL 2013;7:8–9)

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Prognostic factors in ductal carcinoma in situ (DCIS)

Ductal carcinoma in situ of the breast (DCIS) is a clinical entity which is discovered as microcalcifications on screening mammography, it rarely represents a palpable disease. Asymptomatic women with DCIS receive treatments that are similar to women with invasive breast cancer and therefore experience substantial psychological distress despite the fact that they have an excellent prognosis and normal life-expectancy. It is also true that, in spite of aggressive treatment approaches, some patients do recur.

In analogue with invasive breast cancer, DCIS is a heterogeneous disease with different prognostic profiles. The high incidence of DCIS and variations in its treatment with different outcomes led to the introduction of the Van Nuys Prognostic index (VNPI) developed in 1996 by Silverstein. This index is a simple decision-making tool to improve or at least standardise DCIS care and had been incorporated in our daily practice since 1997. Data on that experience were analysed. We tried to obtain a better understanding of the molecular behaviour of DCIS laesions and looked for predictive and prognostic markers associated with disease-free survival (DFS). The next step was the use of micro-array analysis with the Genomic Grade Index (GGI), based on four proliferation genes, and the proliferation index Ki-67. These two indices, which are considered to be predictive for the behaviour of invasive breast cancer, were incorporated into the VNPI. Furthermore, we looked if the tumour microenvironment might play a crucial role in local relapse of DCIS and risk of subsequent invasive disease. (BELG J MED ONCOL 2012;6:164–168)

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