Maria João Cardoso

Abstract
Background and objective: Cosmetic outcome of breast cancer conservative treatment (BCCT) remains without a standard evaluation method. Subjective methods, in spite of their low reproducibility, continue to be the most frequently used. Objective methods, although more reproducible, seem unable to translate all the subtleties involved in cosmetic outcome. The breast cancer conservative treatment cosmetic results (BCCT. core) software was developed in 2007 to try to overcome these pitfalls. The software is a semi-automatic objective tool that evaluates asymmetry, color differences and scar visibility using patient's digital pictures. The purpose of this work is to review the use of the BCCT. core software since its availability in 2007 and to put forward future developments. Methods: All the online requests for BCCT. core use were registered from June 2007 to December 2014. For each request the department, city and country as well as user intention (clinical use/research or both) were questioned. A literature search was performed in Medline, Google Scholar and ISI Web of Knowledge for all publications using and citing "BCCT.core". Results: During this period 102 centers have requested the software essentially for clinical use. The BCCT. core software was used in 19 full published papers and in 29 conference abstracts. Conclusions: The BCCT. core is a user friendly semi-automatic method for the objective evaluation of BCCT. The number of online requests and publications have been steadily increasing turning this computer program into the most frequently used tool for the objective cosmetic evaluation of BCCT.

Abstract

Abstract

Abstract
Locally advanced breast cancer (LABC) constitutes a heterogeneous entity that includes advanced-stage primary tumours, cancers with extensive nodal involvement and inflammatory breast carcinomas. Although the definition of LABC can be broadened to include some large operable breast tumours, we use this term to strictly refer to inoperable cancers that are included in the above-mentioned categories. The prognosis of such tumours is often unfavourable; despite aggressive treatment, many patients eventually develop distant metastases and die from the disease. Advances in systemic therapy, including radiation treatment, surgical techniques and the development of new targeted agents have significantly improved clinical outcomes for patients with this disease. Notwithstanding these advances, LABC remains an important clinical problem, particularly in developing countries and those without widely adapted breast cancer awareness programmes. The optimal management of LABC requires a multidisciplinary approach, a well-coordinated treatment schedule and close cooperation between medical, surgical and radiation oncologists. In this Review, we discuss the current state of the art and possible future treatment strategies for patients with LABC.

Abstract
"Taking less treating better" has been one of the major improvements of breast cancer surgery in the last four decades. The application of this principle translates into equivalent survival of breast cancer conserving treatment (BCT) when compared to mastectomy, with a better cosmetic outcome. While it is relatively easy to evaluate the oncological results of BCT, the cosmetic outcome is more difficult to measure due to the lack of an effective and consensual procedure. The assessment of cosmetic outcome has been mainly subjective, undertaken by a panel of expert observers or/and by patient self-assessment. Unfortunately, the reproducibility of these methods is low. Objective methods have higher values of reproducibility but still lack the inclusion of several features considered by specialists in BCT to be fundamental for cosmetic outcome. The recent addition of volume information obtained with 3D images seems promising. Until now, unfortunately, no method is considered to be the standard of care. This paper revises the history of cosmetic evaluation and guides us into the future aiming at a method that can easily be used and accepted by all, caregivers and caretakers, allowing not only the comparison of results but the improvement of performance. (C) 2014 Wiley Periodicals, Inc.