Male Breast Carcinoma: II. A study of the total material reported to the Swedish Cancer Registry 1958--1967 with respect to treatment, prognostic factors and survival

The complete material of male breast cancer, 166 cases, reported to the Swedish Cancer Registry in 1958--1967 is described and analyzed concerning different prognostic parameters, treatment methods and survival. Age at diagnosis, axillary lymph node status and tumour size all had significant prognostic importance in a multivariate analysis with axillary lymph node status as the strongest factor. Histologic malignancy grade was strongly correlated to axillary lymph node status and tumour size and thus to prognosis, but did not seem to be an independent prognostic factor. The primary treatment methods were quite heterogeneous and were obviously influenced by both age of the patient and clinical tumour status. No significant correlation was found between type of primary treatment and survival, but due to the retrospective nature of the study no definite conclusion could be drawn. Radical mastectomy seemed, however, to give fewer loco-regional recurrences than both modified radical mastectomy and simple mastectomy. Very few patients in the present series had received radiation therapy in adequate doses. The material gave some indications that orchiectomy might prolong survival in patients with recurrent or generalized disease.     

Inflammatory metastatic carcinoma. A clinical and histopathologic study of three cases.

The inflammatory metastatic carcinoma is a rare clinical entity, histologically characterized by lymphatic dermal invasion by neoplastic cells. We report three cases of inflammatory metastatic carcinoma, two of them secondary to a breast carcinoma, and the third secondary to a colon adenocarcinoma.     

Validity of breast cancer registration from one hospital into the Swedish National Cancer Registry 1961-1970

The validity of the Swedish Cancer Registry data on invasive female breast cancer in Malm? 1961-1970 was investigated. A total of 1311 entries in the register were examined, each entry representing an individual tumour, and compared to data from medical records and local registries. In 137 cases (10.5%) registered in the Swedish Cancer Registry, divergencies were found, of which at least 121 were overregistrations (9.2%). Forty-three tumours were identified meriting inclusion but not registered, giving an underregistration of 3.5%. The age distribution among the excluded cases differed somewhat from that of the verified cases.     

Undifferentiated carcinoma of the endometrium. A histopathologic and clinical study of 31 cases

A histopathologic review of 1985 cases of endometrial carcinoma yielded 31 undifferentiated carcinomas (1.6%). Forty-eight percent were large cell type and 52%, intermediate/small cell type. Twenty-one tumors were examined immunohistochemically. All stained for keratin. Eleven tumors reacted with vimentin antibodies, two with carcinoembryonic antigen antibodies, and ten with neuron-specific enolase (NSE) antibodies (four of which stained for bombesin, two for beta-endorphin, one for prealbumin, five for Leu7, and four for synaptophysin). The mean age at diagnosis was 63.9 years (range, 45 to 86). The crude 5-year and 10-year survival was 58% and 48%, respectively. Seventy-nine percent of the patients in surgicopathologic Stage I and 33% in Stage II survived 5 years. The intermediate/small cell types had a somewhat better prognosis than the large cell type, but the difference was not statistically significant. The presence or absence of NSE and vimentin immunoreactivity had no influence on survival. All patients with tumors infiltrating less than one half of the myometrium survived 5 years in contrast with 46% of the patients with deep infiltrating tumors. Fifty-four percent of the patients with demonstrable vessel invasion survived 5 years in contrast with 89% not so affected.     

A clinical and histopathologic analysis of the results of conservation surgery and radiation therapy in stage I and II breast carcinoma

One hundred eighty women with clinical Stage I or II operable breast carcinoma were treated by radiotherapy following local tumor excision at Yale-New Haven Hospital through 1980. With a median follow-up time of 6.9 years, the actuarial 5-year overall and disease-free survival rates were 82% and 78%, respectively. The 5-year actuarial breast-recurrence-free survival rate was 92%. Several clinical-histopathologic features and treatment parameters were assessed for their significance as predictors of local breast failure or distant relapse. Cox lifetable regression analysis showed that patients with clinical Stage II carcinomas had significantly worse overall and relapse-free survival rates, but clinical stage alone had no effect on the rate of breast recurrence. Furthermore, a decrease in overall and disease-free survival was evident when necrosis was present in the tumor or when patients had an infiltrating lobular carcinoma. Breast recurrence-free survival was also influenced adversely by the presence of these two tumor features, especially when either tumor necrosis or infiltrating lobular carcinoma was found in conjunction with clinical Stage II lesions. Other histologic features such as grade, vascular invasion, perineural invasion, or the presence of an intraductal component of carcinoma did not affect outcome, nor did the treatment techniques employed appear to have a differential effect.     

Validity of breast cancer in the Danish Cancer Registry. A study based on clinical records from one county in Denmark.

Cancer registries are essential in order to monitor the incidence of cancer and, with proper follow-up, survival in a population. However, the usefulness of the registry depends upon the data quality. To validate the Danish Cancer Registry concerning breast cancer in female residents of Aarhus county 1983-1989, registry records were compared with clinical records. Completeness was validated in 2062 patients and correctness was determined for pathologically proven primary invasive breast cancer in 1949 patients. Incidence data were complete with no tumours missing. Data were coded according to ICD-7 and correctness of registry data in terms of basis of diagnosis and tumour malignancy was 99%. Information on extent of disease (stage) was not complete and there was a high disconcordance, in particular for bilateral breast tumours and cases with distant metastasis. Even crude staging into local and regional disease was inconsistent for 13% of cases, which probably hampered survival analysis by stage. The quality of registry data should be addressed when using variables, such as stage, not routinely reported by registries.     

A clinical study of lobular carcinoma of the breast

In a review of 549 cases of breast cancer in the last 16 years, 7 cases with lobular carcinoma have been studied. All of the patients appeared well and were without recurrence. Two cases had been lobular carcinomas in situ, one of which had arisen in a small fibroadenoma associated with malignant phyllodes tumor in the opposite breast, and the other had shown multicentric foci of a lobular neoplasm. The remaining 5 cases had been invasive lobular carcinomas. The incidence of lobular carcinoma represented 1.3% (7/549) of all primary breast carcinomas, and had been increasing chronologically. Estrogen and progesterone receptors were positive in 5 eligible cases.     

Health among long-term survivors of breast cancer-an analysis of 5-year survivors based on the Swedish surveys of living conditions 1979-1995 and the Swedish Cancer Registry 2000

In this paper we examine health among breast cancer 5-year survivors. We raise two questions: (1) how do the health level of this survival group compare to the health level of the general population; and (2) how have the health levels among these survivors changed over time. We found that 5-year breast cancer survivors assess their health lower than the general population, and that having being diagnosed in a later year increases health compared to having received the diagnosis at an earlier point in time. This implies that screening and treatment of breast cancer have been successful. Further, we did not find any statistically significant effect of the length of the time spell since diagnosis on health. One reason for this may be that those additional individuals surviving over time as a result of improved treatment therapies have on average lower health levels than those who survived before more efficient medical technologies were introduced.     

Non-Hodgkin's Lymphoma in Northern Sweden: A retrospective analysis of morphologic diagnosis and stage in a material from the Swedish Cancer Registry

Morphologic diagnosis and clinical stage were studied in a retrospective material of non-Hodgkin's lymphomas comprising 352 patients diagnosed 1978 until 1982 and reported to a regional cancer registry. Classification was made according to the original Kiel classification. Patients who could be classified as belonging to low- (46%) or high-grade (47%) malignancy groups (n = 337) were further studied. The median age was high, 65 years, which probably reflects the low degree of selection in a regional register material compared to most hospital register-based materials. The proportion of stage I cases was rather high, in low-grade lymphomas 24%, and in high-grade 39%, which can be attributed to incomplete staging procedures in old patients. The aim of the study was to illustrate the distribution according to morphologic subclasses and clinical features in a material with a low degree of patient selection.     

Bilateral and multifocal breast carcinoma. A clinical and autopsy study with special emphasis on carcinoma in situ.

Bilateral clinical breast carcinoma has been reported to appear in up to approximately 10% of patients with breast carcinoma. Increasing diagnostic activity has raised figures of bilaterality, mainly due to detection of lesions of the in situ type. Knowledge of the natural history of carcinoma in situ is incomplete and clinical implications are uncertain. In the present study bilateral lesions were analysed by extensive histological examination in the following groups of patients: (1) Forty-six women (median age 44 years) with clinical and mammographical unilateral invasive breast carcinoma, where the contralateral breast was removed at subcutaneous mastectomy (SCM) during the course of breast reconstruction, 24/46 (52%) had bilateral malignant lesions, four invasive carcinomas and 20 in situ carcinomas (two ductal carcinomas in situ /DCIS/, 15 lobular carcinomas in situ (LCIS), three both DCIS and LCIS). (2) Fifty-two women (median age 50 years) with a unilateral diagnosis of in situ carcinoma (32 DCIS, 16 LCIS, four both DCIS and LCIS), in whom both breasts were removed at SCM. 25/52 (48%) had bilateral malignant lesions, one invasive carcinoma, 24 in situ carcinomas (three DCIS, 18 LCIS, three both DCIS and LCIS). Twelve of 20 cases with LCIS (60%) were bilateral. Of 36 cases with DCIS, seven (19%) were bilateral. (3) The contralateral breast was removed at autopsy in 64 women previously unilaterally mastectomized (at median age 65) for invasive breast carcinoma. Fifteen of 64 (23%) had contralateral primary carcinoma at autopsy, four invasive carcinomas, 11 in situ carcinomas (six DCIS, five LCIS) and 8/64 (13%) had metastases in the breast. Multifocal malignant findings were also analysed in 47 SCM specimens after excisional biopsy for in situ carcinoma. In 35/47 (75%) further malignant lesions were present in spite of normal mammographic and clinical findings. Four were invasive and 31 had in situ lesions (16 DCIS, 10 LCIS, five both DCIS and LCIS): These findings may favour the hypothesis that some carcinomas in situ may remain silent or even regress. It is thus important to embark upon randomized trials to clarify the natural history of breast carcinoma in situ. Such a trial has been started in the southern region of Sweden.     

Primary Carcinoma of the Fallopian Tube: A retrospective study of patients reported to the Danish Cancer Registry in a five-year period

Fifty-two patients with carcinoma of the fallopian tube diagnosed and treated during a 5-year period in Denmark were reviewed. The median age of the patients was 60 years. No patients had a preoperative diagnosis. History and clinical findings were similar to previously reported series. Treatment consisted of hysterectomy and bilateral salpingo-oophorectomy, often succeeded by postoperative whole pelvic irradiation. Five-year survival was 37.4%, depending on stage. In stage I+II the survival rates were similar regardless of whether postoperative radiation therapy had been given or not. Little is known about the patterns of spread. The relatively bad prognosis for stages I and II after radical surgery indicates early undetected metastases and the need for more aggressive adjunctive therapy.     

Is breast cancer a curable disease? A study of 14,731 women with breast cancer from the Cancer Registry of Norway

The question whether breast cancer is curable remains controversial. Late recurrences and death from the disease are not infrequent. Long term follow-up of a large patient population is necessary to study this issue. The authors report a study of 14,731 cases of breast cancer reported to the Cancer Registry of Norway with follow-up times ranging from 5 to 18 years. A model in which the logarithms of the survival times were assumed to be normally distributed, the lognormal model, fitted the data well for individual stages, age groups, and periods of treatment. The cured fraction, i.e., consisting of those only subject to normal mortality risks, was estimated from the model to 35 +/- 1% standard error. In Stages 1, 2, 3, and 4 it was 54 +/- 3%, 27 +/- 1%, 19 +/- 2%, and 2 +/- 1%, respectively. It is concluded, however, that the estimated cure rate in Stages 3 and 4 should be regarded with caution in view of the methodological problems involved in the analysis and the small number of patients with long follow-up. The estimated cured fraction in both the individual stages and in the entire material was significantly higher in patients younger than 55 years of age than in older patients. The median survival of non-cured patients was estimated to be 3.6 years for the entire material. In Stage 1, 2, 3, and 4 it was 7.6 years, 3.4 years, 2.1 years, and 0.7 years, respectively. The lognormal model seems to be a good approximation of breast cancer survival. The model is consistent both with late excess mortality and with the presence of a cured fraction. It is noteworthy that an excess mortality was observed during the whole follow-up period. Extrapolations from the model should therefore be cautiously judged until supported by observed data.     

Primary epidermoid carcinoma of the breast. Clinical, histopathologic and prognostic study of 14 patients]

We reviewed the charts of 14 patients with epidermoid breast carcinoma, whether pure or associated with a minor glandular component. These patients were treated between 1970 and 1989 at the Institut Curie and represented 0.06% of all breast cancer patients treated during the same period. No clinical or radiological criteria could help to discriminate these forms from other types of breast cancer. Four out of 13 patients with initial axillary node dissection had nodal involvement. Various combinations of surgery and radiotherapy were used to treat these patients. One out of 14 hormone receptor levels was positive. Median survival was 54 months (9 months-144 months). Two patients had a local recurrence and 7 had metastasis. No event occurred beyond 5 years of follow-up. This suggest that the outcome of epidermoid breast tumors is closer to that of other epidermoid tumors, rather than to other types of breast cancer.     

乳腺癌改良根治术患者生物学指标的临床研究

目的：探讨乳腺癌改良根治术患者乳腺癌组织中ＥＲ、ＰＲ、Ｃ-ｅｒｂＢ-２、Ｃｌｕｓｔｅｒｉｎ、ｐ-ｇｐ表达之间的相关性。方法：免疫组化法检测４８例乳腺癌改良根治术患者乳腺癌组织中ＥＲ、ＰＲ、Ｃ-ｅｒｂＢ-２、Ｃｌｕｓｔｅｒｉｎ、ｐ-ｇｐ的表达,应用数据挖掘技术对乳腺癌５种生物学指标进行分析。结果：４８例乳腺癌改良根治术患者乳腺癌组织中,ＥＲ阳性率为４３.８％,ＰＲ３５.４％,Ｃ-ｅｒｂＢ-２６０.４％,Ｃｌｕｓｔｅｒｉｎ６２.５％,ｐ-ｇｐ４１.７％,Ⅱ期ｐ-ｇｐ、Ｃｌｕｓｔｅｒｉｎ表达的阳性率低于ⅢＡ期（Ｐ＜０.０５）。指标聚类分析提示,ＥＲ、ＰＲ和Ｃ-ｅｒｂＢ-２之间具有较强的正相关性,它们与ｐ-ｇｐ、Ｃｌｕｓｔｅｒｉｎ分别呈较弱的负相关性,而ｐ-ｇｐ与Ｃｌｕｓｔｅｒｉｎ之间呈较强的正相关性。二阶段聚类分析结果提示,４８例乳腺癌患者的５个分子标记物情况可分为３类：第１类：Ｃｌｕｓｔｅｒｉｎ（－）、ｐ-ｇｐ（－）、Ｃ-ｅｒｂＢ-２（＋）和ＥＲ（＋）;第２类：Ｃｌｕｓｔｅｒｉｎ（＋）、ｐ-ｇｐ（＋）和Ｃ-ｅｒｂＢ-２（＋）;第３类：Ｃ-ｅｒｂＢ-２（－）、ＥＲ（－）和ＰＲ（－）。结论：Ｃｌｕｓｔｅｒｉｎ和ｐ-ｇｐ在乳腺癌中的表达与ＥＲ、ＰＲ和Ｃ-ｅｒｂＢ-２的表达存在明显的差异且相关性弱,有可能是乳腺癌治疗的新靶点。     

Controlled clinical study on the use of dichloromethylene diphosphonate in patients with breast carcinoma metastasizing to the skeleton.

Thirty-eight normocalcemic patients with bone metastases from breast carcinoma were randomized to receive dichloromethylene diphosphonate (CL2MDP) in addition to their specific antitumor treatment (chemotherapy and/or hormone therapy), at a dose of 300 mg/day/i.v. or placebo for the first 7 dys. The CL2MDP treatment then continued at a dose of 100 mg day/i.m. for 3 weeks and finally at 100 mg i.m. on alternate days for at least another 2 months. In both groups of patients there was a reduction in the intensity of pain (Scott-Huskisson analog), but there was a more frequent reduction in the daily consumption of analgesics in patients treated with CL2MDP (p = 0.02). Unlike the controls, the patients who received CL2MDP presented a significant reduction in urinary calcium (p = 0.003) and in hydroxyproline (p = 0.05) on the 7th day. As regards the clinical evolution, negative events such as the appearance of hypercalcemia, pathological fractures, new bone lesions or a substantial increase in the preexisting ones, were observed in 9 of the 12 evaluable patients treated with placebo and in 3 out of 9 treated with CL2MDP. Thickening of the preexisting osteolytic lesions was reported in 2 patients treated with CL2MDP. Tolerance was excellent: only a few patients complained of pain at the intramuscular drug injection site.     

Malignant melanoma of the vulva in a nationwide, 25-year study of 219 Swedish females: clinical observations and histopathologic features.

BACKGROUND: Because the clinical and histopathologic features of vulvar melanoma had not been characterized completely in a large, homogeneous population, the authors retrospectively analyzed all such patients recorded in Sweden during a 25-year period. METHODS: The Swedish National Cancer Registry opened its records to the authors for review of all 219 females with primary vulvar melanoma reported from 1960 to 1984. Histopathologic specimens and clinical histories of the 198 patients who qualified for this study were reanalyzed and the tumors rigorously subtyped. RESULTS: Macroscopically amelanotic tumors were observed in 27% of patients, predominantly in glabrous skin; the clitoral area and labia majora were the most common primary sites. Of all melanomas, 46% emerged in glabrous skin, 12% emerged in hairy skin, and 35% extended to both areas. On average, approximately 2.5 times more melanomas appeared in the vulva than on the whole body surface. Overall, 57% were of the mucosal lentiginous (MLM) type, 22% were nodular melanomas (NMs), 12% were unclassified, and only 4% were superficial spreading melanomas (SSMs); this was the reverse of the order observed for cutaneous melanoma. Almost all vulvar melanomas underwent a vertical growth phase; other common features were marked thickness and ulceration, particularly in the glabrous skin. Preexisting nevi occurred in 11 cases, all in hairy skin, and 71% in conjunction with SSM but only 4% with MLM. CONCLUSIONS: Several clinical and histopathologic features indicated that the natural history of vulvar melanomas is at variance with that of cutaneous melanomas. Because preexisting nevi, which are often considered a precursor to melanoma, were significantly linked to SSM and only in the vulvar hairy skin, melanomas in the glabrous skin apparently emerged de novo.     

Interdependence of radial scar and proliferative disease with respect to invasive breast carcinoma risk in patients with benign breast biopsies

BACKGROUND: Radial scars (RS) are benign breast lesions that have been implicated as independent risk factors for invasive breast carcinoma (IBC). METHODS: A retrospective cohort study of 9556 women who underwent biopsy between 1950-1986 and enrolled in the Nashville Breast Cohort was performed to investigate the association between RS in a benign breast biopsy and the risk of IBC. The risk associated with RS and coexistent proliferative disease (PD) was assessed adjusting for age at biopsy using a Cox hazards regression analysis with time-dependent covariates. RESULTS: RS were identified in 880 women (9.2%). The average follow-up time was 20.4 years. Sixty-two women (7.0%) with RS developed IBC compared with 5.5% of controls. The relative risk of IBC associated with RS was 1.82 (95% confidence interval [95% CI], 1.2-2.7) at 10 years. Restricting the analysis to women age > 49 years increased the risk to 2.14 (95% CI, 0.6-2.8). These risks decreased with increasing years of follow-up. Approximately 92% of women with RS also had PD, but RS were present in only 1.3% of biopsies without PD. Analyses stratifying relative risk with regard to PD found RS to minimally elevate the relative risk of subsequent IBC. CONCLUSIONS: RS in the absence of PD is uncommon. Although the presence of RS in a benign breast biopsy mildly elevates the risk of IBC risk, the current analysis indicated that this risk can be largely attributed to the category of coexistent PD. In women with both RS and atypical hyperplasia, recommendations for interventions beyond biopsy should be based on the extent of atypical hyperplasia.     

Invasive carcinoma of the uterine cervix following diagnosis and treatment of in situ carcinoma. Record linkage study within a National Cancer Registry

56117 women registered in the Swedish National Cancer Registry with the diagnosis carcinoma in situ of the uterine cervix were followed up and the risk for developing an invasive carcinoma of the uterine cervix was studied. The studied cohort provided 453 362 women years at risk. The primary treatment for carcinoma in situ in Sweden is generally conization. Hysterectomy is carried out in relatively few cases and intracavitary radium treatment was given to a limited number during the period studied. Cryosurgery and laser conization were of less quantitative importance during this period. The incidence rates of invasive carcinoma of the uterine cervix were compared with expected rates calculated from the National Cancer Registry. The ratio between observed and expected number of cases of invasive carcinomas of the uterine cervix is roughly 2.5 from the first year of observation after treatment of the in situ carcinoma until 20 years. There seems to be a distinct difference in risk for development of an invasive carcinoma of the uterine cervix for different age groups. In age group 50 years and older at time for treatment of the in situ lesion, 66 cases of invasive cancer were observed against 10.7 expected - O/E = 6.2. In ages 49 years or less, 145 cases were observed compared with 77.4 expected - O/E = 1.9. The conclusion from this study is that women treated for an in situ lesion are at a higher risk for an invasive carcinoma than the common female population and should be carefully followed up for a long time after treatment of the in situ lesion.