Prospective analysis of the long-term effect of teaching breast self-examination and breast awareness

Breast cancer is the most common cancer in women in the industrialized world and a leading cause of death. Breast self-examination (BSE) is one of the methods for an early detection of breast cancer. In the present study the effectiveness of a campaign promoting BSE and breast awareness was analysed. Seminars were conducted in 2003 in Lower Saxony, Germany by a female gynaecologist and a social pedagogue and included a lecture, an individual training in BSE in a separate room and a talk about the importance of regular BSEs. Questionnaires were handed out immediately after the seminar and were sent by post 1 year later. Attendance of the seminar resulted in a significantly higher percentage of monthly BSEs (21.4% before vs. 61.9% after the teaching). Furthermore, 92.1% of the women who did not perform a monthly BSE stated that at least they examined their breasts more frequently after attending the seminar. The data demonstrate that the seminars in BSE had profound effects on the compliance of women in carrying out BSE regularly and correctly, without influence of age or education.     

The anatomy of the arteries and veins of the breast

Textbook accounts of this subject are inadequate. This review considers the work of Cooper and Salmon and reproduces some of their figures. Applications in the diagnosis and treatment of cancer are discussed. The largest mammary arteries are the lateral (from the axillary) and the anterior medial and posterior medial (from the internal thoracic). The branches of these arteries do not follow the duct system, but instead form a plexus in the anterior fat layer. Normally there are no hypervascular or hypovascular areas. The contribution of the mammary branches of the posterior (aortic) intercostal arteries is minor. There are superficial and deep sets of veins, the latter associated with arteries. Mammary vessels of living women are demonstrated by infrared photography, thermography, and mammography. In the diagnostic use of these methods there is a tendency to rely upon the concept of normal vascular symmetry, but this is a fallacy.     

Breast reduction and cancer in the gland remnant: a review

Aims The main aims of this paper are: (1) to evaluate the impact of partial breast gland removal, for cosmetic or functional reasons on cancer incidence in the long-term post-surgical follow-up; (2) to define the incidental cancer finding during breast reduction; (3) to examine the oncological perspective of contralateral breast reduction in women with post-mastectomy breast reconstruction, (4) to consider the impact of breast reduction techniques as first choice procedure in the treatment of cancers in megalomastia. Methods. We reviewed the clinical articles published in the last 20 years addressed to the relationship between the amount of tissue removed and cancerogenesis of the remnant gland. The review has been also extended to published papers outlining the future trends of breast reduction procedures from an oncological perspective, potentially as specific choice of selected cancer treatment in megalomastia. Results. Assessment of the literature data reveals that breast reduction does decrease the risk of breast and other types of cancers. The actual risk lowering for patients older than 40 is related to the amount of tissue removed. Conclusion. This study illustrates that breast reduction surgery should be encouraged, besides the known aims, as a preventive operation in those patients presenting degrees of breast hypertrophy and a family history of breast cancer.     

Chemotherapy and pattern of metastases in breast cancer patients

A retrospective analysis of all breast cancer patients who died of their disease at Harper Grace Hospital during 1962 to 1976, was conducted to determine the pattern of metastases and its relation to chemotherapy. The autopsy incidence of distant metastases, to all organ sites, was noted to be higher among patients who previously received cytotoxic therapy, compared with those who did not. Such incidence was unrelated to differences in patients' age, menopausal status, and disease-free interval. It is postulated that chemotherapy contributes to the wider metastases, especially to the central nervous system and meninges, in a breast cancer patient. This is possibly due to a longer survival of patients treated.     

Clinical Presentation and Frequency of Risk Factors in Patients with Breast Carcinoma in Pakistan

Background: Breast cancer is known to be one of the most prevalent cancers among women in both developing nd developed countries .The incidence of breast cancer in Pakistan has increased dramatically within the last ew years and is the second country after Israel in Asia to have highest proportional cases of breast cancer. owever, there are limited data for breast cancer available in the literature from Pakistan. Objectives: The tudy was conducted to bring to light the common clinical presentation of breast cancer and to evaluate the requency of established risk factors in breast carcinoma patients and furthermore to compare the findings etween premenopausal and postmenopausal women in Pakistan. Materials and Methods: A 6 months (from uly 2012 to Dec 2012) cross sectional survey was conducted in Surgical and Oncology Units of Civil Hospital, arachi. Data were collected though a well developed questionnaire from 105 female patients diagnosed with arcinoma of breast and analyzed using SPSS version 17. Institutional ethical approval was obtained prior to ata collection. Results: Out of 105 patients, 43 were premenopausal and 62 were postmenopausal, 99 being arried. Mean age at diagnosis was 47.8±12.4 years. A painless lump was the most frequent symptom, notived y 77.1%(n=81). Some 55.2% (n=58) patients had a lump in the right breast and 44.8%(n=47) in the left breast. n the majority of cases, the lump was present in upper outer quadrant 41.9% (n=44). Mean period of delay om appearance of symptoms to consulting a doctor was 5.13±4.8 months, from the shortest 1 month to the longest 36 months. Long delay (> 3 months) was the most frequent figure 41.9%. Considering overall risk factors most frequent were first pregnancy after 20 years of age (41%), physical breast trauma (28.6%), lack of breast feeding(21.9%), and early menarche <11 years (19%), followed by null parity (16.2%), consumption of high fat diet (15.2%), family history of breast cancer or any other cancer in first degree relatives (9.5% and 13.3%, respectively). Some of the less common factors were late menopause >54 years (8.6%), use of oral contraceptive pills (10.5%), use of hormone replacement therapy (4.7%),smoking (4.7%) and radiation (0.96%). Significant differences (p<0.005) were observed between pre and post menopausal women regarding history of physical breast trauma, practice of breast feeding and parity. Conclusions: A painless lump was the most frequent clinical presentation noted. Overall age at first child > 20 years, physical breast trauma, lack of breast feeding ,early menarche <11 were the most frequent risk factors. Physical breast trauma, lower parity, a trend for less breast feeding had more significant associations with pre-menopausal than post-menopausal onset. Increase opportunity of disease prevention can be obtained through better understanding of clinical presentation and risk factors important in the etiology of breast cancer.     

广泛导管内成分与保乳术后局部复发风险评估

保乳手术已成为早期乳腺癌的主要治疗手段,评估其局部复发的首选指标为广泛导管内成分(EIC).许多研究证实,EIC阳性者局部复发率较高,但远期生存率并不明显低于阴性者.除了病理检查之外,钼靶X线对检出EIC也有较高的参考作用.从分子生物学角度看,EIC与染色体1q21-23区域的等位基因缺失、cerbB-2过表达等因素正相关,而与p53的过度表达、细胞凋亡没有明显关系.EIC的检测对于早期乳腺癌的综合治疗方案选择具有重要指导意义.     

survivin在乳腺癌中的表达及临床意义

目的探讨survivin在乳腺癌中的表达及其临床意义。方法应用免疫组织化学方法检测66例乳腺癌及22例乳腺腺瘤中survivin的表达。结果@survivin在乳腺腺瘤组织中表达的阳性率明显高于乳腺癌组织（P〈0．05）;②survivin与患者的年龄和乳腺癌的位置无关（P〉0．05）,而与淋巴结是否转移有关（P〈0．05）。结论①survivin蛋白可以通过抑制细胞凋亡对乳腺癌的发生、发展起重要作用;②检测乳腺癌中survivin的表达对制定化疗方案具有重要意义。     

Roles of the matrix metalloproteinases in mammary gland development and cancer

Tissue remodeling is a key process involved in normal development, wound healing, bone remodeling, and embryonic implantation, as well as pathological conditions such as tumor invasion and metastasis, and angiogenesis. The degradation of the extracellular matrix that is associated with those processes is mediated by a number of families of extracellular proteinases. These families include the serine proteinases, such as the plasminogen-urokinase plasminogen activator system and leukocyte elastases, the cysteine proteinases, like cathepsin D and L, and the zinc-dependent matrix metalloproteinases (MMPs) [1]. Accumulating evidence has highlighted the central role of MMP-driven extracellular matrix remodeling in mammary gland development and breast cancer.     

Ultrasound elastography as an objective diagnostic measurement tool for lymphoedema of the treated breast in breast cancer patients following breast conserving surgery and radiotherapy

Background.

Lymphoedema of the operated and irradiated breast is a common complication following early breast cancer treatment. There is no consensus on objective diagnostic criteria and standard measurement tools. This study investigates the use of ultrasound elastography as an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema.

Patients and methods.

The elasticity ratio of the subcutis, measured with ultrasound elastography, was compared with high-frequency ultrasound parameters and subjective symptoms in twenty patients, bilaterally, prior to and following breast conserving surgery and breast irradiation.

Results.

Elasticity ratio of the subcutis of the operated breast following radiation therapy increased in 88.9% of patients, was significantly higher than prior to surgery, unlike the non operated breast and significantly higher than the non operated breast, unlike preoperative results. These results were significantly correlated with visibility of the echogenic line, measured with high-frequency ultrasound. Big preoperative bra cup size was a significant risk factor for the development of breast oedema.

Conclusions.

Ultrasound elastography is an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema, in combination with other objective diagnostic criteria. Further research with longer follow-up and more patients is necessary to confirm our findings.     

乳腺密度与乳腺癌保乳术后局部复发的关系探讨

目的:探讨乳腺密度与乳腺癌保乳术后局部复发的关系。方法:收集2005年6月至2010年6月于我院肿瘤外科治疗的女性乳腺癌患者210例。所有患者均进行乳腺密度检测,对乳腺癌保乳手术后局部复发的危险因素进行单因素和多因素分析。结果:单因素分析结果显示局部复发与年龄、肿瘤直径、有腋窝淋巴结、术后放疗、乳腺百分比密度有关。多因素分析结果显示,术后放疗、乳腺密度是乳腺癌保乳手术术后局部复发的独立危险因素。结论:乳腺癌保乳术后局部复发与术后放疗、乳腺密度密切相关,但其复发的生物学机制尚需进一步研究。     

Immunohistochemical detection of ornithine-decarboxylase in primary and metastatic human breast cancer specimens

Increased ornithine decarboxylase (ODC) activity in human breast cancer specimens has recently been shown to be an independent adverse prognostic factor for recurrence and death. Biochemical measurement of ODC, however, is not practical for routine clinical use. Furthermore, it does not take into account the heterogeneous composition of human breast cancers which contain variable proportions of epithelial and stromal elements. Therefore, we developed an immunohistochemical method for ODC determination which can be applied to formalin-fixed, paraffin-embedded tissue sections. We report here our results in a series of 30 human breast cancer samples. ODC expression was detected most consistently in the malignant epithelial component of the tumors. Twenty-seven of 30 samples stained positive with intensities ranging from 1+ to 3+. The fraction of malignant epithelial cells expressing ODC varied among specimens between 10% and >90%. When quantitated by H-SCORE, ODC expression was significantly higher in the malignant epithelial component than in normal appearing epithelial cells and stroma admixed within the tumor. Normal mammary tissue adjacent to the cancer was available for analysis in six cases. ODC expression was absent in two (while both cancers were positive) but present in four to a degree which was overall comparable to that observed in the corresponding tumors. We believe that this technique will be useful for future studies aimed at expanding our knowledge of the role of ODC and polyamines (PA) in breast cancer biology.     

Almost Complete Lack of Human Cytomegalovirus and Human papillomaviruses Genome in Benign and Malignant Breast Lesions in Shiraz,Southwest of Iran

Breast cancer ranks as the most common cancer among women worldwide. There have been controversial reports regarding contributions of human papillomaviruses (HPVs) and human cytomegalovirus (HCMV) to its development. The aim of this study was to determine the frequency of HPV and HCMV positivity in benign and malignant breast tumors. Materials and Methods: Formalin fixed paraffin-embedded tissue specimens of 150 breast cancers (invasive ductal and lobular carcinomas) and 150 non-malignant breast lesions (fibroadenomas, fibrocystic disease and adenosis) were examined. All samples were first deparafinized then subjected to commercial DNA extraction. The β-globin gene fragment was amplified using polymerase chain reaction (PCR) to confirm the quality of extracted DNA. The presence of HPV and HCMV genomic DNA was determined using PCR and Real time PCR techniques, respectively. Results: The mean ages of the test and control groups were 35.2 and 45 years, respectively. For HCMV, none of the malignant lesions were positive and only 2 of the 150 benign samples demonstrated presence of the virus. No HPV genomic DNA was found in either malignant or benign cases. Conclusion: The results of this study indicated no relationship between HCMV or HPV infection with breast cancer development. Whether investigations in larger populations with longer follow-up might demonstrate any role remains unclear.     

Women's Breast Cancer Risk Perception and Attitudes Toward Screening Tests

This study's objective is to identify women's breast cancer risk perceptions and their attitudes and knowledge on screening tests. The cross-sectional research. Gulhane Military Medical Academy, Ankara, Turkey. The population of 188 females who applied for gynecological examination. The study employed a semistructured questionnaire form. Questions such as female's demographic data, attitudes based on screening tests of breast cancer, family history, perceived risk breast cancer, and questions with regard to patients’ fear of breast cancer were included in the survey. In this study, it is determined that the rates of the women, who conduct breast self-examination (BSE), clinical breast examination (CBE) and mammography at least once, are very low. The reason for not performing the BSE was declared with a rate of 50.8% as “Do not know how to perform.” Of the women 20.2% were fully acknowledged about BSE. Nearly half of the women perceived 50% or more risk of developing breast cancer, and this rate increases as they get older. The risk perception and educational status increased CBE and mammography rates and BSE knowledge positively, but because of insufficient BSE application abilities BSE rate cannot increase as expected. It is recommended that nurses put forward the initiatives in training programs to increase women's BSE abilities. In planning such an education program risk perception and information of women about breast cancer should be considered.     

What is a large breast? Measuring and categorizing breast size for tangential breast radiation therapy

Despite consensus in published studies that larger‐breasted patients who undergo radiation therapy tend to suffer from more severe acute skin reactions and a more adverse cosmetic outcome, there appears to be no consensus on the definition of a ‘large breast’. This paper describes an analysis of breast size that was undertaken on 50 patients and compares this data with other published studies. The desired outcome for the study was to formulate a definition of ‘large breast size’ that would be appropriate for Australian patients and that could be determined simply and quickly in busy radiation oncology clinics. Analysis suggests that cup and brassiere size may be used to separate breast size into two categories. On the basis of published data and results from this study, it is recommended that patients with a cup size ≥D or a bra size ≥18 could be categorized as having large breasts, with all other patients considered average in size.     

全乳腺照射与加速部分乳腺照射治疗早期乳腺癌术后患者的效果和安全性的Meta分析

目的系统评价全乳腺照射(WBI)与加速部分乳腺照射(APBI)治疗早期乳腺癌术后患者的效果和安全性,为早期乳腺癌保乳手术术后放疗措施提供循证参考。方法计算机检索PubMed、The Cochrane Library、CNKI、维普和万方数据库中的相关文献,依据纳入和排除标准筛选关于WBI与APBI治疗早期乳腺癌保乳手术术后效果和安全性的随机对照实验,并进行资料提取,采用Cochrane Reviewers’Handbook 5.1.0进行质量评价,RevMan 5.4统计软件进行Meta分析。结果共纳入9项研究,合计11238例患者。Meta分析结果显示,术后接受WBI与APBI治疗的早期乳腺癌患者的总生存率和淋巴结转移率比较,差异均无统计学意义(P﹥0.05);与术后接受WBI治疗的早期乳腺癌患者相比,术后接受APBI患者的特异性生存率更高、远处转移率更低、急性皮肤毒性更低、不良美容评分更低,但差异均无统计学意义(P﹥0.05)。术后接受APBI治疗的早期乳腺癌患者的复发率明显高于WBI,差异有统计学意义(OR=0.74,95%CI:0.62~0.89,P=0.001)。术后接受WBI治疗的早期乳腺癌患者的迟发性皮肤毒性发生率明显低于APBI,差异有统计学意义(OR=0.76,95%CI:0.67~0.87,P﹤0.01)。结论APBI与WBI对早期乳腺癌保乳手术术后疗效相当,因纳入研究的治疗方法差异和样本量的限制,该结论有待更多高质量的大样本、双盲、随机对照试验加以验证。