妊娠与乳腺癌

乳腺癌在年轻女性中罕见发生，到四五十岁时其发病率开始上升。现在妇女的分娩年龄有一种延迟到老年的趋势。关于妊娠和乳腺癌的关系这一主题的重要性在于，有一些妇女在怀孕时发现患有乳腺癌，还有一些妇女在治疗时可能尚未结婚。我们以一例妊娠期乳腺癌为例，回顾她在诊断时和治疗后所面临的选择     

Adipocytokines and breast cancer risk

Background Many researches suggested that obesity increased the risk of breast cancer, but the mechanism was currently unknown. Adipocytokines might mediate the relationship. Our study was aimed to investigate the relationship between serum levels of resistin, adiponectin and leptin and the onset, invasion and metastasis of breast cancer. Methods Blood samples were collected from 80 newly diagnosed, histologically confirmed breast cancer patients and 50 age-matched healthy controls. Serum levels of resistin, adiponectin and leptin were determined by enzyme-linked immunosorbent assays (ELISA); fasting blood glucose (FBG), lipids, body mass index (BMI), and waist circumference (WC) were assayed simultaneously.Results Serum levels of adiponectin ((8.60±2.92) mg/L vs (10.37±2.81) mg/L, P=0.001) and HDL-c were significantly decreased in breast cancer patients in comparison to controls. Serum levels of resistin ((26.35±5.36) μg/L vs (23.32±4.75) μg/L, P=0.000), leptin ((1.35±0.42) μg/L vs (1.06±0.39) μg/L, P=0.003), FBG and triglyceride (TG) in breast cancer patients were increased in contrast to controls, respectively. However, we did not find the significant difference of the serum levels of resistin, adiponectin and leptin between premenopausal breast cancer patients and healthy controls (P＝0.091, 0.109 and 0.084, respectively). The serum levels of resistin, adiponectin and leptin were significantly different between patients with lymph node metastasis (LNM) and those without LNM (P=0.001, 0.000 and 0.006, respectively). The stepwise regression analysis indicated that the tumor size had the close correlation with leptin (R(2)=0.414, P=0.000) and FBG (R(2)=0.602, P=0.000). Logistic regression analysis showed that reduced serum levels of adiponectin (OR: 0.805; 95%CI: 0.704–0.921; P＝0.001), HDL (OR: 0.087; 95%CI: 0.011–0.691, P＝0.021), elevated leptin (OR: 2.235; 95%CI:1.898–4.526; P＝0.004) and resistin (OR: 1.335; 95%CI: 1.114–2.354; P＝0.012) increased the risk for breast cancer; Reduced serum levels of adiponectin (OR: 0.742; 95%CI: 0.504–0.921; P=0.003) and elevated leptin (OR: 2.134; 95%CI:1.725–3.921; P= 0.001) were associated with lymph node metastasis of breast cancer. Conclusions The decreased serum adiponectin levels and increased serum resistin and leptin levels are risk factors of breast cancer. The low serum adiponectin levels and high serum leptin levels are independent risk factors for metastasis of cancer. The association between obesity and breast cancer risk might be explained by adipocytokines.     

Prolactin and breast cancer risk

A study of 424 women was undertaken to determine whether there was an association between serum prolactin levels and breast cancer; whether prolactin levels would reflect degrees of risk of developing breast cancer; and whether associations between known risk factors for breast cancer and serum prolactin concentrations could be demonstrated. Prolactin levels higher than the median value in control subjects were found to be associated with a more than two-fold increase in the risk of breast cancer (relative risk, 2.1; confidence interval [CI], 1.0-4.5). Moreover, a relative risk of 1.7 (CI, 0.9-3.3) for a group of women with benign epithelial hyperplasia (high risk of developing breast cancer), and a relative risk of 1.0 (CI, 0.6-1.8) for a group with benign fibrocystic disease (low risk of developing breast cancer), provided supportive evidence that prolactin plays a role in the development of breast cancer. A considerable fall in the concentration of prolactin at menopause was noted, so those women who have an early menopause have a reduced period of exposure to high concentrations of prolactin. Similarly, there was a considerable reduction in prolactin concentration after the first pregnancy. Finally, our results showed that, in premenopausal women, a high intake of saturated fats was associated with a high prolactin concentration. Our study supports the concept that parity, menstrual status, and saturated fat consumption influence a woman's exposure to prolactin and therefore the risk of developing breast cancer.     

乳腺癌后妊娠：人群为基础的研究

目的 识别乳腺癌存活的妇女及其后的妊娠，以确定妊娠率（比例）、处理、乳腺癌预后、以及初次妊娠的结局。 设计 人群为基础的描述性研究，病例来源于西澳大利亚数据连锁系统，并通过对医疗表格进行回顾分析进一步确认。补充资料来自于医院及门诊记录。 地点 西澳大利亚，1982--2003年。 对象 年龄〈45岁，确诊乳腺癌后妊娠的妇女。 主要结局评估指标 妊娠结局及妊娠率，生存情况，从诊断到妊娠的时间。 结果 62名（54％）妇女在诊断为乳腺癌后2年内妊娠。其中，29例人工流产，27例活产，6例自然流产。采用比例风险回归模型分析继发妊娠与总生存时间改善的相关性（风险比0．59，95％可信区间0．37—0．95）。将该模型按从诊断乳腺癌至继发妊娠的时间进行分层，发现诊断至少24个月后的继发妊娠与总生存率的改善相关（0．48，0．27—0．83），而在确诊6个月后妊娠的妇女中这种保护作用并不显著。 结论 我们的研究不支持目前推荐绝经前诊断乳腺癌的妇女在试图妊娠前应等待两年的医疗建议。这一建议可能适用于那些正在接受治疗、或在诊断时患有全身性疾病的妇女。但对于那些病灶局限的妇女，在完成治疗6个月后的早期妊娠不一定降低生存。     

Oral contraceptives and risk of breast cancer

Use of oral contraceptives (OCs) by women before age 25 or first full-term pregnancy has been theorized to increase the risk of breast cancer. While multiple studies have reported a positive relationship between early use and subsequent breast cancer development, numerous researchers have concluded there is no effect. One reason for the varied results may be the case control methodology utilized by the majority of studies and its associated biases including selection, information, and recall bias. Other theories include an undetected latent effect, changing dosages and formulations, earlier breast cancer diagnosis and follow-up among OC users, and chance. While more research is needed, the weight of evidence supports no increased risk of breast cancer among OC users, including women less than 25 years of age and before first full-term pregnancy. Hence, it seems unnecessary to change the current approach toward OC use.     

35例非肿块型乳腺癌的超声分析

目的 分析非肿块型乳腺癌的超声表现,提高彩色多普勒超声对非肿块型乳腺癌的诊断水平. 方法对35例经手术或穿刺活检病理确诊的非肿块型乳腺癌资料进行回顾性分析. 结果 35例非肿块型乳腺癌中,片状低回声型12例、导管型7例、微钙化型6例、腺体结构紊乱型8例、隐匿型2例. 结论对于非肿块型乳腺癌的诊断,应密切结合临床查体,仔细观察病灶的灰阶超声表现和彩色血流分布情况,对比双侧乳腺结构,以防止误诊、漏诊.