Intraoperative frozen section examination of axillary sentinel lymph nodes in breast cancer

The study presents the results from intraoperative frozen section assessment of axillary sentinel lymph nodes (SLNs) in breast cancer. Routine histological frozen sections from one level were used, two sections stained with haematoxylin and eosin. Immunohistochemistry for cytokeratins was applied to the permanent SLN paraffin sections only. Axillary dissection was performed on all SLN-positive cases regardless of the size of the metastatic deposits. With a detection rate of 83%, 272 patients entered the study over a period of 46 months. A total of 61 cases were SLN positive by frozen section analysis. The paraffin sections gave an additional 23 SLN-positive cases. The false-negative rate for frozen sections was then 27% (23/84). Micrometastases were found in 28 of 84 cases, and macrometastases in 56. The false-negative rate of frozen sections for micrometastases was 71% (20/28), and for macrometastases 5% (3/56). A total of 73% (61/84) of the patients underwent axillary surgery as a one-step procedure.     

Cytogenetic differences in breast cancer samples between German and Japanese patients

BACKGROUND: Japanese and German breast cancer cases differ substantially in the frequency of egfr amplification. AIMS: To unravel further the cytogenetic differences between Japanese and German breast cancer cases. METHODS: Forty one Japanese breast cancer cases were evaluated by means of comparative genomic hybridisation (CGH). The results were compared with the CGH results from 161 German breast cancer cases. RESULTS: The mean number of genetic alterations/case was significantly higher in German premenopausal patients with breast cancer than in their Japanese counterparts. Japanese breast cancer cases revealed a higher number of chromosome 17p losses. Losses of 8p were associated with oestrogen receptor (ER) negativity in Japanese patients with breast cancer, whereas in the German patients gains of 3q and 6q were associated with the lack of ER expression. CONCLUSIONS: The interethnic differences of invasive breast cancer are reflected by cytogenetic aberrations, which are also associated with the differential expression of the ER.     

High prevalence of human papillomaviruses in fresh frozen breast cancer samples

While the etiology of breast cancer remains enigmatic, some recent reports have examined the role of human papillomavirus (HPV) in breast carcinogenesis. The purpose of this study was to determine the prevalence of HPV in breast cancer tissue using PCR analysis and sequencing. Fifty-four (54) fresh frozen breast cancers samples that were removed from a cohort of breast cancer patients were analyzed. Samples were tested for HPV using comprehensive PCR primers, and in situ hybridization was performed on paraffin embedded tissue sections. Findings were correlated with clinical and pathological characteristics. The HPV DNA prevalence in the breast cancer samples was 50% (27/54) with sequence analysis indicating all cases to be positive for HPV-18 type. While HPV patients were slightly younger, no correlation was noted for menopausal status or family history. HPV positive tumors were smaller with earlier T staging and demonstrated lesser nodal involvement compared to HPV negative cancers. In situ hybridization analyses proved negative. The high proportion of HPV positive breast cancers detected in this series using fresh frozen tissues cannot be dismissed, however the role of HPV in breast carcinogenesis remains unclear and may ultimately be ascertained by monitoring future breast cancer incidence amongst women vaccinated against high risk HPV types.     

Immunological and psychosocial predictors of disease recurrence in patients with early-stage breast cancer

Ninety women with recently diagnosed stage I or stage II breast cancer who had been admitted to the NIH Clinical Center and were participating in a randomized trial were entered onto this behavioral immunology protocol. Patients were immunologically and psychosocially assessed at baseline (approximately 5 days after surgery) and again at 3 and 15 months post surgery. All of the patients were followed up for a minimum of 5 years, and 60% of the patients were followed for 7 years or longer. Twenty-nine women in the study group reported disease recurrences over the entire follow-up period. Causal path modeling statistical techniques showed that natural killer (NK) cell activity was a strong predictor of disease outcome when the outcome variable was defined as recurrence v nonrecurrence of disease (chi 2 = 6.9, p less than .001). Higher NK cell activity at follow-up predicted disease-free survival over the follow-up period. When the disease outcome variable was operationally defined as time to recurrent disease, the psychosocial factors were more strongly predictive of the rate of disease progression for those who had a recurrence (chi 2 = -4.1, p less than .01), but NK cell activity was seemingly less relevant in this latter case. Overall, these findings suggest that including mood and potentially relevant immunological variables, along with important biological prognostic variables, in multivariate and prospective models such as those examined in this study, potentially contributes more to the explanation of greater outcome variance of early-stage breast cancer than has been believed in the past.     

乳腺癌患者腋下淋巴结来源的DC诱导自体特异性CTL的实验研究

目的:研究乳腺癌患者腋下淋巴结单个核细胞来源的树突状细胞(DC)诱导抗原特异性细胞毒T淋巴细胞(CTL)的能力。方法:以多种细胞因子联合诱导腋下淋巴结单个核细胞中的贴壁细胞为DC,非贴壁细胞与IL-2共培养后诱导成为肿瘤区域引流淋巴结细胞(TDLNC),用自体乳腺癌细胞冻融抗原刺激DC,并和TDLNC共培养,以诱导肿瘤抗原特异性CTL。结果:淋巴结细胞经体外培养后,贴壁细胞在DC诱导前,其特异性表面标志物CD1a、CD83、CD86的百分比(%)分别为11.0±2.4、26.6±5.2和33.0±6.1,经与rhGM-CSF、rhIL-4共同培养,并经自体肿瘤冻融抗原加TNF-α诱导后3种标志物的水平升高,其百分比(%)分别为50.2±5.7、60.5±16.5和56.2±16.4(P<0.01)。TDLNC中CD3 和CD8 细胞含量(%)分别为73.9±2.2和32.8±3.2;经DC和肿瘤抗原诱导后,DC-Ag-TDLNC中的CD3 和CD8 细胞含量升高,其百分比(%)分别为82.7±2.8和62.5±2.5(P<0.01)。结论:乳腺癌患者腋下引流淋巴结中的单个核细胞在rhGM-CSF和rhIL-4刺激活化和自体肿瘤抗原及TNF-α的诱导下,可以分化为典型的DC。成熟的DC具有较强的抗原提呈功能,可以促进TDLNC增殖、分化为抗原特异性CTL。     

乳腺癌患者妊娠次数与腋窝淋巴结转移的关系研究

目的探讨乳腺癌患者妊娠次数与腋窝淋巴结转移之间的关系。方法171例乳腺癌患者按妊娠次数分为妊娠1次，2次及2次以上共3组。统计该3组患者各自发生腋窝淋巴结转移的患者比例及发生转移的腋窝淋巴结在所检测的淋巴结中的比例，应用X2检验分析不同组别间腋窝淋巴结转移阳性患者比例的差异，阳性转移淋巴结比例之间的差异，从而探讨乳腺癌患者的妊娠次数与其腋窝淋巴结转移例数及转移个数之间的关系。结果妊娠1次、妊娠2次及妊娠2次以上组发生腋窝淋巴结转移的比例分别为34．78％、50％、64．10％。随妊娠次数增加，发生腋窝淋巴结转移的比例逐渐增高。其中妊娠2次以上患者组发生腋窝淋巴结转移的比例明显高于妊娠1次患者组发生腋窝淋巴结转移的比例（64．10％掷34．78％），2者相比差异有显著性（P：0．012）。妊娠1次、妊娠2次及妊娠2次以上组腋窝淋巴结发生转移的比例分别为44．58％、44．18％、52．97％。妊娠2次以上患者组腋窝淋巴结发生转移的比例明显高于妊娠2次患者组腋窝淋巴结发生转移的比例（52．97％协44．18％），2者相比差异有显著性（P=0．025）。但妊娠1次组腋窝淋巴结发生转移的比例与妊娠2次组及妊娠2次以上组相比，差异均无显著性（P=0．948，P=0．167）。结论妊娠次数较少的患者组发生腋窝淋巴结转移的比例相对较小，发生转移的腋窝淋巴结数目也相对较少。乳腺癌患者的妊娠次数与乳腺癌的腋窝淋巴结转移有关。乳腺癌患者的妊娠次数对判断乳腺癌患者的腋窝淋巴结转移有一定的意义。     

血浆D-二聚体水平与乳腺癌腋窝淋巴结转移的相关性研究

目的：探讨血浆D–二聚体水平与乳腺癌腋窝淋巴结转移的关系,为预测乳腺癌腋窝淋巴结转移状态提供依据。方法：选取乳腺癌患者73例(乳腺癌组),乳腺良性疾病患者36例(良性疾病组)及健康体检女性50例(正常对照组),均检测D–二聚体水平,并结合患者临床及病理资料(肿瘤大小、病理分型、是否淋巴结转移、淋巴结转移个数、激素受体、癌基因等)进行综合分析。结果：乳腺癌组血浆D–二聚体水平明显高于其他两组,差异有统计学意义(P<0.01);乳腺良性疾病组与正常对照组D–二聚体水平比较,差异无统计学意义(P>0.05);腋窝淋巴结转移阳性患者D–二聚体水平高于腋窝淋巴结转移阴性患者,差异有统计学意义(P<0.01);肿瘤大小、病理类型、血浆D–二聚体水平与腋窝淋巴结转移个数显著相关(P<0.01);原发肿瘤的病理类型、血浆D–二聚体水平是腋窝淋巴结转移的危险因素(OR =7.464、6.470);血浆D–二聚体水平诊断乳腺癌腋窝淋巴结转移时的ROC曲线下面积(area under concentration-time,AUC)为0.689,以0.455μg/mL为最佳诊断分界点,灵敏度为52.3%,特异度为86.2%。结论：血浆D–二聚体水平与乳腺癌腋窝淋巴结转移状态及转移个数有关,其对判断乳腺癌腋窝淋巴结转移状态有一定临床价值。     

冰冻和石蜡切片对TUNEL染色结果的影响

目的与方法：为比较不同组织切片方法对细胞凋亡TUNEL反应结果的影响，用雏鸭胸腺分别制成冰冻(8 μｍ)和石蜡(6 μｍ)切片，然后进行TUNEL染色。 结果： 冰冻切片组细胞凋亡阳性率高，背景清晰，特异性好。石蜡切片组则阳性率相对较低，反差较小，容易出现假阳性。 结论： 不同制片法对TUNEL结果有影响，即冰冻切片可能较石蜡切片具有更高的反应敏感性。     

Detection of Slit2 promoter hypermethylation in tissue and serum samples from breast cancer patients

Promoter hypermethylation has been shown to be a common mechanism for inactivation of tumor suppressor genes in breast cancer. The aim of this study was to investigate the prevalence of Slit2 promoter hypermethylation in both the tumor and serum samples of breast cancer patients with ductal carcinoma in situ (DCIS) or invasive breast carcinoma (IBC). The methylation status of Slit2 was investigated in 210 tissue samples (15 breast with no pathological findings, 26 DCIS, and 169 IBC samples) and 123 corresponding serum samples (15 breast with no pathological findings, 26 DCIS, and 82 IBC samples) using methylation-specific polymerase chain reaction. Immunohistochemical staining for Slit2 was also performed using tissue microarray blocks to determine whether Slit2 promoter hypermethylation correlated with loss of Slit2 expression. Slit2 promoter hypermethylation was not detected in breast tissue and serum samples from patients with no pathological findings. DCIS or IBC showed a statistically higher frequency of Slit2 promoter hypermethylation compared to breast with no pathological findings in both the tissue and serum samples; however, there were no statistically significant differences between DCIS and IBC samples. Similar Slit2 promoter hypermethylation patterns were seen in the tissue samples and corresponding serum specimens (p < 0.001). Slit2 promoter hypermethylation was associated with loss of Slit2 expression. These results suggest that Slit2 promoter hypermethylation appears to be responsible for functionally silencing Slit2 expression. Slit2 promoter hypermethylation may be considered as a possible serum marker for early detection of breast cancer.     

Immunohistochemical detection of estrogen receptors in paraffin sections from primary and metastatic breast cancer

With the availability of monoclonal antibodies against the estrogen receptor (ER) it is possible to demonstrate the presence of ER immunohistochemically. Some of the antibodies are claimed to be reactive in formalin fixed, paraffin embedded tissue. We have evaluated the reactivity of one of these antibodies, D75 and found an acceptable reaction in routinely formalin fixed, paraffin embedded tissue. The antibody was applied to both primary and secondary tumors from a group of patients with recurrent breast cancer. The metastatic lesions consisted of lymph node metastases, bone marrow metastases, and liver metastases. While 41% of the primary tumors were ER-positive, this was only the case with 35%, 20%, and 17% of the lymph node, bone marrow, and liver metastases, respectively. The discordance between the ER-status of the primary tumor and the distant metastasis was 41% in cases of bone marrow metastases, and 44% in liver metastases. In most cases the shift was from an ER-positive primary tumor to an ER-negative metastasis. The results support the hypothesis that ER-negative tumor cells are probably more aggressive with a larger metastatic potential than the higher differentiated, ER-positive tumor cells.     

Factors related to the expression of emotions by early-stage breast cancer patients

Objective(1) To report the number and type of emotional expressions (cues/concerns) raised by breast cancer patients; (2) to identify the influence of setting, patient characteristics, and doctor-patient interaction on emotional expression.Methods308 Italian-speaking female patients were recruited at their first breast cancer consultation. The visits were audio-recorded and analysed for number and type of emotional expressions (VR-CoDES). Oncologists’ interaction skills were rated by the VR-COPE. Socio-demographic, clinical and personality variables were gathered before the consultation. Clinical variables and oncologists’ evaluations of the patient were collected after.ResultsBreast cancer patients raised emotional issues mainly as cues. The setting (centre where the consultations took place), the oncologist’s attribution of anxiety, regardless of anxiety test screening (STAI-X1) score before the consultation, and the oncologist’s ability to pick up on patient’s worries, handle emotional needs or understand psychosocial condition were all positively related with the number of emotional expressions. More tightly structured consultations had fewer emotional expressions.ConclusionBoth contextual and interactional aspects have an impact on patient emotional expressions.Practice implicationsOncologists need to be trained to manage both the content and the process of medical consultation. Work organization of the consultation setting needs to be taken into account.     

New approaches for genotyping paraffin wax embedded breast tissue from patients with cancer: the Iowa women's health study

BACKGROUND: The use of paraffin wax embedded tissue samples as a source of DNA for genotype analysis has been limited because of difficulties in DNA extraction and single nucleotide polymorphism (SNP) analysis.AIMS: To test the feasibility of applying the combination of a commonly used DNA isolation procedure, PureGene, and a high throughput SNP analysis method, the polymerase chain reaction (PCR)-INVADER assay, to genotype several types of paraffin wax embedded breast tissues. METHODS: Twenty formalin fixed, paraffin wax blocks were obtained from five participants in the Iowa women's health study. Each participant provided several types of tissue including normal lymph node, normal nipple/areola tissue, inflammatory/fibrotic breast tissue, or normal breast tissue, and tumour tissue. RESULTS: Good quality DNA (260/280 ratio >1.6) was obtained from all tissues. Normal lymph nodes yielded the largest amount of DNA (97.1 mug). DNA obtained from the samples was tested for a germline C1183T polymorphism in the MnSOD gene by three methods-PCR-RFLP (restriction fragment length polymorphism), INVADER assay, and PCR-INVADER assay. Of the 20 samples, PCR-RFLP genotyped 16, the PCR-INVADER assay 18, and the INVADER assay two. This methodology was then used to analyse five additional genotypes and confirmed the general applicability of the method. CONCLUSIONS: This study demonstrated the feasibility of (1) using several paraffin wax embedded breast tissues as a source of DNA for germline genetic analysis, with lymph nodes providing the highest yield, and (2) using the combination of a common extraction method with a high throughput SNP analysis method, the PCR-INVADER assay.     

肩胛上神经和腋神经联合阻滞治疗肩周炎的应用解剖

目的：为神经阻滞治疗肩周炎提供解剖学基础。方法：在３４侧经常规防腐处理的成人尸体标本上解剖出肩胛上神经和腋神经,观察其走行位置及分支分布,拟定穿刺点及体表定位。结果：①肩胛上神经主要分支有冈上肌支和冈下肌支。肩胛上神经在肩胛横韧带处距皮肤的距离和冈上肌支起始段距皮肤的距离均为４．０～４．５ｃｍ,冈下肌支起始段距皮肤的距离为４．０ｃｍ。②腋神经主要分支有前支和后支。腋神经穿四边孔处距皮肤的距离为５．     

Use of alternative medicine by women with early-stage breast cancer.

BACKGROUND: We analyzed the use of alternative medicine by women who had received standard therapy for early-stage breast cancer diagnosed between September 1993 and September 1995. METHODS: A cohort of 480 patients with newly diagnosed early-stage breast cancer was recruited from a Massachusetts statewide cohort of women participating in a study of how women choose treatment for cancer. Alternative medical treatments, conventional therapies, and health-related quality of life were examined. RESULTS: New use of alternative medicine after surgery for breast cancer was common (reported by 28.1 percent of the women); such use was not associated with choices about standard medical therapies after we controlled for clinical and sociodemographic variables. A total of 10.6 percent of the women had used alternative medicine before they were given a diagnosis of breast cancer. Women who initiated the use of alternative medicine after surgery reported a worse quality of life than women who never used alternative medicine. Mental health scores were similar at base line among women who decided to use alternative medicine and those who did not, but three months after surgery the use of alternative medicine was independently associated with depression, fear of recurrence of cancer, lower scores for mental health and sexual satisfaction, and more physical symptoms as well as symptoms of greater intensity. All groups of women reported improving quality of life one year after surgery. CONCLUSIONS: Among women with newly diagnosed early-stage breast cancer who had been treated with standard therapies, new use of alternative medicine was a marker of greater psychosocial distress and worse quality of life.     

Intraoperative cytology in breast cancer diagnosis: Comparison between cytologic and frozen section techniques

The diagnostic accuracy of frozen section (FS) examination and intraoperative cytology (IOC) has been compared in two different series of breast biopsies in which only one of the two methods has been used. The intraoperative results have been compared with the final histological diagnoses. Five-hundred-ten cases have been investigated by using FS only, and 407 by means of IOC. The two series were comparable because they included the same pathologies; moreover we have subdivided each series into four groups of pathologies to better evaluate the diagnostic accuracy of two methods. The total diagnostic accuracy of FS has been 93.13% vs. 95.-33% of IOC The value of diagnostic accuracy of FS and IOC in the four sub-groups substantially overlapped; there was only a little difference in the group of “various lesions” in which the diagnostic accuracy of IOC was higher. No false positive has been observed in IOC. FS have produced one false positive (0.19%), whereas false negatives have amounted to 1.77% for IOC and to 1.72% for FS. Deferred diagnoses have been 2.95% in IOC and 4.90% in FS examination. For both methods according to Galen and Gambino the following values have been calculated: sensitivity, specificity, efficiency, and predictive value. By comparing the data, the value of the cytological examination in the intraoperative diagnoses results is evident mainly when the latter is coupled with the gross observation. Causes of diagnostic errors clearly overlap both in IOC and in FS: (1) lesions with a fibroadenomatous appearance can involve an overdiagnosis or an underdiagnosis; (2) low-grade lesions like tubular carcinomas or in situ lobular carcinomas can be interpreted as benign; (3) the differential diagnosis of intraductal lesions may be very difficult, and a conservative approach is the best choice; and (4) infiltrating lobular carcinoma may be neglected both in FS and IOC. The few disadvantages of the cytologic method are offset by its low cost, the wider sampling, the possibility of sparing tissue for further investigations (such as steroid receptors, cellular kinetic, electron microscopy, and other biological studies) proved more useful in prognostic evaluation of breast cancer.     

Paranodal vascular spread in breast cancer with axillary node involvement.

The presence of tumour cells in the efferent paranodal vessels of tumour-bearing axillary lymph nodes from patients with operable breast carcinoma was associated with a significant reduction in survival time at 5 yr compared to cases with node involvement in which these vessels did not contain tumour cells.     

Memory impairments with adjuvant anastrozole versus tamoxifen in women with early-stage breast cancer

OBJECTIVE: Hormones have been implicated as modulators of cognitive functioning. For instance, results of our previous work in women with breast cancer showed that cognitive impairment was more severe and involved more memory domains in those who received adjuvant tamoxifen therapy compared with women who received chemotherapy alone or no adjuvant therapy. Recently aromatase inhibitors such as anastrozole have been used in lieu of tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor-positive, early-stage breast cancer. Plasma estrogen levels are significantly lower in women who receive anastrozole compared with those who receive tamoxifen. We hypothesized, therefore, that anastrozole would have a more profound effect on cognitive function than tamoxifen, a mixed estrogen agonist/antagonist. DESIGN: To test this hypothesis we compared cognitive function in women with early-stage breast cancer who received tamoxifen with those who received anastrozole therapy in a cross-sectional study. We evaluated cognitive function, depression, anxiety, and fatigue in 31 postmenopausal women with early-stage breast cancer who were between the ages of 21 and 65 years and treated with tamoxifen or anastrozole for a minimum of 3 months. RESULTS: The results showed that women who received anastrozole had poorer verbal and visual learning and memory than women who received tamoxifen. CONCLUSIONS: Additional, prospective studies are needed to validate and confirm the changes in cognitive function associated with hormone therapy for breast cancer.     

The extent of retraction clefts correlates with lymphatic vessel density and VEGF-C expression and predicts nodal metastasis and poor prognosis in early-stage breast carcinoma

Although the earliest feature of disseminated disease in breast cancer is regional lymph node involvement, little is known about the mechanisms whereby cancer cells interact with lymphatic endothelial cells and enter the lymphatic system. We have previously reported that the extensive presence of retraction clefts in breast carcinomas highly significantly correlates with lymphatic tumor spread and predicts poor outcome, suggesting that retraction clefts are not just fixation artifacts, but real potential spaces that are exaggerated by tissue processing and may reflect an early stage of lymphatic invasion. In this study, we examined the correlation between the extent of retraction clefts and lymphangiogenesis, as assessed by lymphatic vessel density and vascular endothelial growth factor-C (VEGF-C) expression in a series of 256 early-stage breast carcinomas. The presence and extent of retraction clefts around tumor cell nests was determined by review of all hematoxylin- and eosin-stained tumor sections. Lymphatic vessels were detected by podoplanin immunohistochemistry and lymphatic vessel density was measured using the hot-spot method. The expression of VEGF-C in the tumor cells was determined by immunohistochemistry and analyzed semiquantitatively on a four-tiered scale. High levels of retraction clefts, peritumor lymphatic vessel density and VEGF-C expression at the invasive edge in breast carcinomas significantly correlated with tumor size, histological grade, lymphatic invasion and nodal metastasis. Breast carcinomas showing extensive retraction clefts (>20% of tumor volume) were found to have significantly higher lymphatic vessel density and VEGF-C expression levels compared to tumors without this feature. High retraction clefts, peritumor lymphatic vessel density and VEGF-C expression predicted poor outcome in breast carcinomas. Our results support the hypothesis that retraction clefts are real potential spaces that may represent 'pre-lymphatic spaces' facilitating initial lymphatic invasion and that growth factors secreted by the tumor cells may stimulate tumor-associated lymphangiogenesis by promoting the endothelialization of these 'pre-lymphatic channels'.     

乳腺X线检查在早期乳腺癌诊断中的价值

目的:探讨早期乳腺癌的X线诊断价值。方法:回顾性分析经手术病理证实的122个乳腺癌(114例)的乳腺X线表现,依据美国放射学会乳腺影像报告和数据系统(Breast imaging reporting and data system,BI-RADS)分类标准,进行乳腺X线判读。结果:122个乳腺癌中导管内原位癌23例(18.9%),浸润性导管癌77例(63.1%),小叶原位癌1例,浸润性小叶癌4例,乳头状癌12例,粘液癌5例。导管内原位癌乳腺X线影像学多不具备典型恶性征象,21例(91%)伴钙化,诊断BI-RADS-4a以上正确率为91%。浸润性导管癌1级多数不具备典型恶性征象,诊断BI-RADS-4a以上正确率为75%。浸润性导管癌2级(33例)和3级(40例)乳腺X线影像有相同的征象,二者较导管原位癌具有较明显的恶性征象,浸润性导管癌2级和3级诊断BI-RADS-4b以上正确率为77%。结论:按照BI-RADS分类标准判读乳腺X线影像在诊断早期乳腺癌中有重要临床意义。     

Effects of stress management on testosterone levels in women with early-stage breast cancer

We examined the effects of a10-week, group-based cognitive-behavioral stressman-agement (CBSM) intervention on serum testosterone levels in women with Stage 1or 2 breast cancer. At 4 to 8 weeks postsurgery, participants were randomized to CBSM (n = 24) or to a wait-list control group (n = 10). Free and total testosterone was assessed via radioimmunoassay before and after the study period. The participants also completed a questionnaire assessing the degree to which living with breast cancer had led to social and emotional benefits in their life. We observed significant decreases in testosterone levels in the CBSM group and no change in the controls. Decreasesintes-tosterone were related to increases in positive contributions. These findings suggest that a short-term psychological intervention can help modulate androgen functioning, and these changes are related to enhanced benefit finding observed among women with breast cancer participating in CBSM.