双侧原发性乳腺癌267例临床分析

目的探讨双侧原发性乳腺癌（bilateral primary breast cancer, BPBC）的临床病理特征及治疗和预后。方法回顾性分析267例双侧原发性乳腺癌患者的临床资料。结果第一侧为浸润性小叶癌为双侧乳腺癌发病的危险因素。双侧原发性乳腺癌占同期手术治疗乳腺癌的约4％,同时性双侧乳腺癌占18％,异时性双侧乳腺癌占82％。双侧原发性乳腺癌的治疗均应遵循普通乳腺癌的治疗原则。异时性双乳癌的总生存率（OS）高于同时性双乳癌。结论单侧乳腺癌患者,对侧乳腺癌发生的危险度逐年增加,应建立完善的随访制度,做到早期发现,早期诊断及早期治疗第二癌,提高双侧乳腺癌患者的治愈率及生存率。     

江西省宜春市3672例乳腺癌普查流行病学报告

目的调查江西省宜春市妇女乳腺疾病状况及乳腺癌发生的危险因素。方法采用调查表、体检、乳腺。,超声、钼靶X线检查对宜春市3672名妇女进行乳腺普查。结果乳腺增生检出率为51．6％。乳腺纤维腺瘤检出率为0．95％。乳腺癌5例,检出率为136．2／10万,40～59岁为乳腺发病高峰年龄段。乳腺癌的发生与患者年龄、乳腺癌家族史、月经初潮年龄〈12岁、未哺乳、高脂饮食、乳腺增生病史等因素有关（P均〈0．05）。结论乳腺普查是发现乳腺疾病的有效手段。早期发现、早期治疗乳腺增生和乳腺纤维腺,并倡导健康生活方式,可能减少乳腺癌的发生。     

Knowledge of Breast Density and Awareness of Related Breast Cancer Risk

Little is known about women’s knowledge of breast density or between-race differences in this knowledge. In the current study, we examined knowledge of breast density and awareness of its role as a breast cancer risk factor among women who had previously taken part in a breast imaging study. Seventy-seven women (54.5 % Black) returned a survey assessing perceptions and accuracy of breast density knowledge, knowledge of one’s own breast density, and breast cancer risk awareness. White women had greater perceived knowledge of breast density compared to Black women; however, differences in the accuracy of definitions of breast density were due to education. Black women were less likely to know how dense their own breasts were. Black and White women both lacked awareness that having dense breast increased breast cancer risk. The results highlight the need to disseminate information regarding breast density to women, while ensuring that the information is equally accessible to both Black and White women.     

特殊类型乳腺癌动态增强MRI诊断价值

 目的　评价乳腺动态增强MRI诊断特殊类型乳腺癌的价值。方法　回顾性分析 13例经手术病理证实的几种特殊类型乳腺癌的动态增强MRI表现特征。结果　 6例多中心性乳腺癌、4例多灶性乳腺癌及 2例隐匿型乳腺癌具有特征性MRI表现 ,1例炎性乳腺癌病变广泛且形态多样 ,缺乏特征性。结论　乳腺动态增强MRI对多中心性、多灶性乳腺癌及隐匿型乳腺癌有重要诊断价值 ,对炎性乳腺癌的诊断需结合临床资料与急性乳腺炎鉴别     

Effect of organ-specific fibroblasts on proliferation and differentiation of breast cancer cells

Summary Breast carcinomas contain both tumor cells and stromal cells, including fibroblasts, endothelial cells, and lymphocytes. Proliferation of breast cancer cells may be controlled partly by mesenchymal cells, especially fibroblasts. We studied effects of fibroblasts on tumorigenicity and histologic features of breast cancer cells vivo, and analyzed fibroblast-produced growth-promoting factors in vitro. Breast carcinoma cells from four lines, and fibroblasts from lines obtained from skin and breast tissue of four patients with breast cancer were used. A suitable number of breast tumor cells and fibroblasts were inoculated subcutaneously into nude mice; resulting tumors were examined. Then conditioned medium from fibroblasts was added to cultures of breast cancer cells to study growth effects, and growth-promoting factors from breast fibroblasts were analyzed. Co-inoculation of breast cancer cells with breast fibroblasts into mice significantly increased tumorigenicity and tumor size beyond those obtained with breast cancer cells alone. Histologically, tumors resulting from co-inoculation with breast fibroblasts showed a scirrhous pattern with extensive fibrosis, while those formed by breast cancer cells injected alone or co-inoculation with skin fibroblasts showed a solid pattern. Medium from breast fibroblasts significantly increased breast cancer cell growth in vitro, while the various skin fibroblasts did not all show this effect. Structural and functional interactions between organ-specific fibroblasts and breast cancer cells may importantly regulate breast cancer growth and progression.     

乳腺良性病变和乳腺癌临床病理特征及相关性分析

目的：探讨乳腺良性病变和乳腺癌的临床病理特征及相互关系.方法：对2 222例乳腺良性病变和乳腺癌的临床病理资料进行回顾性分析,免疫组化检测ER在癌旁组织中的表达.结果：乳腺增生性病变占乳腺良性病变的94.8%,乳腺浸润性癌在恶性肿瘤中占95.8%;乳腺癌平均发病年龄为47.1岁,显著高于乳腺增生性病变的34.98岁（Wilcoxon秩和检验,P＜0.000 1）;有恶性肿瘤家族史的乳腺疾病患者,发生乳腺癌的概率（6.5%）大于发生乳腺良性病变的概率（1.9%）,P＜0.001;72%的乳腺增生性病变存在＞3种病理成分;乳腺癌旁组织中不典型增生的发生率（23.5%）显著高于良性乳腺增生性病变中不典型增生的发生率（2.49%）,P＜0.01;乳腺癌旁不同良性病变与癌一样,对ER均有高表达.结论：乳腺增生性病变是女性最常见的病变成分复杂的良性疾病,其演变过程与乳腺癌有关.     

环氧化酶-2在乳腺癌演变过程的表达变化及其临床意义

目的：探讨环氧化酶-2（COX-2）在乳腺癌演变过程中的表达变化规律和意义。方法：采用免疫组织化学方法检测30例正常乳腺组织、50例乳腺良性肿瘤、45例非典型增生组织、49例乳腺癌组织中COX-2的表达程度。结果：COX-2在乳腺癌组织、非典型增生组织、乳腺良性肿瘤组织的表达与正常组织相比显著升高（P〈0．0001、P〈0．001、P〈0.01），COX-2在癌组织的表达比良性肿瘤组织高，P〈O．05。COX-2在正常组织、乳腺良性肿瘤组织、非典型增生组织及癌组织中逐渐增高，并呈现一定的线性增高的表达趋势，r=0．332，P〈0.001。COX-2在ER、PR、HER-2阴性组和阳性组的表达差异无统计学意义，P〉0．05。结论：COX-2在乳腺癌的演变过程中起重要作用；COX-2可能为乳腺癌的发病风险的预测和乳腺癌的预防与治疗提供一条新的途径。     

乳腺癌演变过程中胰岛素样生长因子-1的表达和临床意义

目的：探讨胰岛素样生长因子-1（IGF-1）在乳腺癌演变过程中的表达变化规律和意义。方法：采用ELESIA方法检测28名健康女性，51例乳腺良性肿瘤患者，8例非典型增生患者，60例乳腺癌患者血清中IGF-1的表达水平；采用免疫组织化学方法检测30例正常乳腺组织，52例乳腺良性肿瘤组织、35例非典型增生组织、49例乳腺癌组织中IGF-1的表迭程度。结果：IGF-1在非典型增生组织中表达程度与在乳腺癌组织、乳腺良性肿瘤组织和正常组织相比呈高表迭，P值分别为0.0208、0.048和〈0.001。乳腺癌组织和良性肿瘤组织的IGF-1表达程度与正常乳腺组织相比呈高表达，P=0.0008，P=0.0004。非典型增生患者和乳腺癌患者血清中IGF-1表达水平与乳腺良性肿瘤患者血清和正常女性血清相比差异均有统计学意义，P=0.019；绝经前乳腺癌患者血清的IGF-1表达水平比绝经后乳腺癌患者的高，P=0.039。结论：IGF-1在乳腺癌的发生和演变过程中起重要作用。IGF-1可能在非典型增生组织向癌的转变过程中发挥关键作用。血清高水平的IGF-1可能与绝经前女性乳腺癌的发病风险增加有关。IGF-1可能为乳腺癌的发病风险预测和靶向治疗提供新的途径。     

Expression of human mammary epithelial (HME) antigens in primary cultures of normal and abnormal breast tissue.

The expression of human mammary epithelial (HME) antigens was studied in primary cell cultures of normal and abnormal breast tissue and of tissues from other organs. By indirect immunofluorescence it was shown that heterologous anti-HME bound to the cell surface of both suspension and monolayer cultures of human breast epithelial cells from normal breast tissue, normal breast fluid, non-malignant atypical lesions of the female breast, gynecomastia in the male breast, breast carcinomas, and peritoneal and pleural effusions of patients with breast carcinomas. The fibroblast-like cells cultured from either normal, non-malignant atypical, or malignant breast tissue never bound anti-HME, nor did histiobyte-like cells from breast fluid or a sarcoid granuloma of the breast. From a Paget tumor of the breast, two distinguishable epithelial-like colonies appeared in the cultures, only one of which expressed HME-antigens. Anti-HME did not bind to cells cultured from tissues of other organs, whether epithelial-like or fibroblast-like; these organs included thyroid, ovary, endometrium, and skin.     

不同组织模式下乳腺癌筛查结果分析

背景与目的：近年来我国政府对乳腺癌筛查非常重视。本研究分析北京市顺义区乳腺专科和非乳腺专科医疗机构完成的3轮乳腺癌筛查结果,为公共卫生行政部门调整乳腺癌筛查组织模式提供科学依据。方法：乳腺癌普通筛查包括乳腺临床检查和乳腺超声检查,对于高危人群和普通筛查发现的可疑人员转诊至诊断单位行乳腺X线检查及后续诊断和治疗。顺义区乳腺癌筛查的组织模式分为2种,即顺义区妇幼保健院乳腺中心的专科组织模式和其他单位的非专科组织模式。采用非条件Logistic回归模型,对不同组织模式的乳腺癌检出率和间期癌发生率进行分析。结果：3轮筛查分别完成58 151、57 810和69 849例,检出乳腺癌25、10和30例,粗检出率为42.99/10万、17.30/10万和42.95/10万。第2轮和第3轮筛查中,专科模式的乳腺癌检出率是非专科模式的1.66和1.88倍(P均>0.05)。第2轮和第3轮筛查非专科模式乳腺间期癌的发生率均高于专科模式(65.94/10万 vs 31.20/10万,66.17/10万 vs 0),其中第2轮非专科模式间期癌的发生率是专科模式的2.47倍(P>0.05)。结论：不同筛查组织模式之间无论是乳腺癌的检出率还是间期癌的发生率均差异较大,差异无统计学意义可能与专科组织模式样本量尚不够大有关。本研究结果提示,大规模乳腺癌筛查以乳腺专科为主导的组织模式可能更有意义。     

女性散发性基底细胞型乳腺癌临床病理特征的研究

目的：筛选女性散发性基底细胞型乳腺癌,探讨其临床病理特征。方法：用免疫组化结合荧光原位杂交的方法从500例女性散发性乳腺癌中筛选出基底细胞型乳腺癌,结合形态学及临床病理参数分析散发性基底细胞型乳腺癌的临床病理特征。结果：在500例乳腺癌中共筛出三阴性乳腺癌77例（15.4%）,基底细胞型乳腺癌60例（12.0%）。基底细胞型乳腺癌的病理组织学形态学与非基底细胞型乳腺癌并无明显差异。基底细胞型乳腺癌与非基底细胞型乳腺癌相比,其在发病年龄、发病时月经状态及肿瘤TNM分期并无明显统计学差异,二者在肿瘤大小及淋巴结转移上有统计学差异。结论：散发型基底细胞型乳腺癌倾向于原发灶较大,淋巴结转移多。     

淋巴管生成因子对乳腺癌淋巴结转移的影响

目的 探讨淋巴管生成因子(VEGF-C)对乳腺癌淋巴结转移的影响.方法 采用免疫组织化学PV9000法对人乳腺浸润性导管癌和乳腺纤维瘤、乳腺病组织的石蜡切片分别进行检测,观察其VEGF-C的表达状态.结果 20例乳腺纤维瘤及乳腺病VEGF-C均为阴性,80例乳腺癌组织VEGF-C阳性率为72.5%(58/80);VEGF-C主要存在于癌细胞中,正常的乳腺纤维瘤及乳腺病的胞质中不表达VEGF-C.结论 乳腺癌细胞中存在VEGF-C,其表达状态与乳腺癌淋巴结转移关系密切.检测VEGF-C蛋白表达可能对人乳腺癌淋巴结转移具有预测和治疗价值.     

COX-2和bFGF在乳腺癌组织中的表达及相关性探讨

目的 研究环氧化酶-2(COX-2)和碱性成纤维细胞生长因子(bFGF)在正常乳腺组织、乳腺良性疾病和乳腺癌组织中的表达及其相关性.方法 用免疫组化方法检测10例正常乳腺组织、45例乳腺良性疾病和90例乳腺癌中COX-2和bFGF的表达,并分析其与乳腺癌的临床病理特征的相关性.结果 Cox-2和bFGF在良性乳腺疾病及...     

尿激酶型纤溶酶原uPA和P27蛋白在乳腺癌中的表达及其意义

目的　探讨正常乳腺组织、良性病变乳腺组织、乳腺癌中uPA和P2 7蛋白的表达水平及其意义。方法　应用免疫组织化学方法对 8例正常乳腺组织、2 4例良性病变乳腺组织及 66例乳腺癌中uPA、P2 7蛋白的表达进行测定。结果　uPA和P2 7蛋白在 66例乳腺癌中的高表达率分别为 5 7.6%、5 3 .0 % ,uPA在乳腺癌中的表达水平明显高于正常和良性病变乳腺组织 (P <0 .0 5 ) ;而P2 7蛋白在乳腺癌的表达水平明显低于正常和良性病变乳腺组织 (P <0 .0 5 )。uPA和P2 7蛋白在乳腺癌中的表达有显著相关性 ,它们与乳腺癌的病理学特征显著相关。结论　P2 7蛋白和uPA的表达水平可能与乳腺癌的发生、发展和预后有关 ,而且对于指导乳腺癌的治疗有一定的临床意义。     

YAP、p73在乳腺癌组织中的表达及意义

目的探讨YAP、p73在乳腺癌组织中的表达与乳腺癌临床病理特征的关系及其临床意义。方法应用免疫组织化学方法检测60例乳腺癌组织、26例癌旁正常乳腺组织YAP和p73的表达情况,分析两者表达与乳腺癌临床病理特征的关系。结果YAP在癌旁正常乳腺组织中呈现较高的表达率,而在乳腺癌组织中不表达或弱表达,YAP基因蛋白缺失可能参与乳腺癌的形成;p73在癌旁正常乳腺组织中呈现弱表达或不表达,而在乳腺癌中的表达升高,提示乳腺癌组织p73蛋白的过表达与乳腺癌的发生、发展关系密切。结论YAP和p73可作为乳腺癌早期诊断、预后判断及肿瘤分期监测的有价值的指标,联合检测YAP和p73对预测乳腺癌的发生、发展及评估乳腺癌病人的预后有重要意义。YAP和p73可能作为乳腺癌检测的肿瘤标志物和治疗的分子靶点。     

A review of prevention against cancer of the breast

Establishment of preventive countermeasures against cancer of the breast is earnestly desired because death from breast cancer has been rapidly increasing. In this paper preventive countermeasures against it was discussed from a point of view of system analysis. Primary prevention (prevention against occurrence of breast cancer) was discussed by multiple regression method and pass analysis. The result showed the today's most effective primary prevention was restriction of fat in food, however there might be more strong unknown risk factors. Secondary prevention (prevention against death from breast cancer) was also discussed with data of breast examination and breast self-examination in Kanagawa Prefecture. The result showed ratios of women who attended breast examination or practiced breast self-examination were not high, the effort to heighten these ratios was important and the most effective preventive countermeasures against breast cancer.     

The Increasing Use of Prophylactic Mastectomy in the Prevention of Breast Cancer

Selected high-risk women without breast cancer choose to undergo bilateral prophylactic mastectomy (BPM) to reduce their risk of developing the disease. Several studies have reported that BPM significantly reduces, but does not eliminate, breast cancer risk. Few studies have reported rates or trends of BPM use. Patients with unilateral breast cancer are at increased risk for developing cancer in the normal contralateral breast. Some breast cancer patients choose contralateral prophylactic mastectomy (CPM) to prevent cancer in the contralateral breast. The risk of contralateral breast cancer is significantly reduced after CPM. Recent studies reported that CPM rates have markedly increased in recent years in the United States. Alternatives to CPM include surveillance with clinical breast examination, mammography, and, potentially, breast MRI. Endocrine therapy with tamoxifen or aromatase inhibitors significantly reduces the risk of contralateral breast cancer and may be more acceptable than CPM for some patients.     

Measurement of prostate-specific antigen in detection of benign or malignant breast disease in women

Using a highly sensitive chemiluminescent enzyme immunoassay, we have evaluated the measurement of serum prostate-specific antigen (PSA) as a potential diagnostic test for differentiation between women with breast cancer and those with benign breast disease. In a controlled study consisting of 284 women with well-documented patient files and matched for age and long-term place of residence, serum samples collected from 90 women with histologically confirmed breast cancer, 94 women with benign breast disease and 100 controls were analysed. Serum total PSA levels in benign breast disease and cancer patients are not statistically different from those of healthy controls. Total PSA levels decrease with age in normal controls and breast cancer patients but not in those with benign breast disease. The total PSA concentration decreases after menopause in healthy women, though not in patients with breast cancer or benign breast disease. Total PSA bore no relation to the histological type or grade of the tumour or the disease stage of the breast cancer patients. In benign breast disease, all mastopathy patients had normal total PSA, whereas elevation of the values was observed in 7% of fibroadenoma patients. Our results show that serum total PSA cannot be used to distinguish between healthy women and/or women with breast cancer or benign breast disease.     

A population-based assessment of the clustering of breast cancer in families eligible for testing of BRCA1 and BRCA2 mutations.

BACKGROUND: The prevalence of families eligible for BRCA1/2 mutation testing in the population burden of breast cancer was analysed and the aggregation of breast cancer in these families was explored. PATIENTS AND METHODS: The families of the Swedish Family-Cancer Database with at least three generations (N=944 723) were classified according to the criteria proposed by the German Consortium for Hereditary Breast and Ovarian Cancer for BRCA1/2 mutation testing. We calculated the proportion of women with breast cancer in the classified families and used standardised incidence ratios (SIRs) to estimate the risk of histology specific breast cancers in families with suspected BRCA1/2 mutations. RESULTS: Families with two breast cancers before the age of 50 years included 1.8% of the breast cancer patients; 1% of the women with breast cancer belonged to families with breast and ovarian cancers. The SIR of female breast cancer was lowest in families with male breast cancer and highest in families with two women affected by breast cancer under the age of 50 years. The SIRs of medullary breast cancer agreed with the BRCA1 mutation prevalences detected by the German Consortium for Hereditary Breast and Ovarian Cancer. CONCLUSIONS: Most of the breast malignancies in families with male breast cancer are likely to be related to BRCA2 mutations. Non-BRCA1/2 related effects are probably involved in the strong clustering of breast cancer in families with early onset breast and ovarian cancers.