Pattern of breast cancer among white-American, African-American, and nonimmigrant west-African women.

This study reviews the current understanding of the pattern of breast cancer among whites, African Americans, and West Africans who have never immigrated to the US to find better ways of improving the prevention, early detection, and care of breast cancer world-wide. In the United States, the behavior pattern of breast cancer in African-American women differs from that of white women. Among the three populations, breast cancer appears to be least common in nonimmigrant West-African women. The peak incidence in African Americans and West Africans occurs around the premenopausal period while it occurs postmenopausal period in whites. Also, unlike white women, West-African and African-American women present late for treatment with a greater cancer burden and consequently lower survival rates. The predominant histological type is infiltrating ductal carcinoma in the three groups but the highest percentage (33%) of infiltrating poorly differentiated anaplastic carcinoma occurs in West Africans. Menstrual and obstetric history, obesity, and high body mass index status appear to be greater specific risk factors among African Americans than among West Africans. African Americans and West Africans have three "Ls" in common: late stage in seeking treatment, lower age at peak incidence with severe tumor burden, and consequently lower survival rates. There is a need for more detailed population-based research at molecular levels to elucidate the basis for some of these features.     

Elastosis in the normal aging breast. A histopathologic study of 140 cases.

The incidence and pattern of elastosis of the breast was studied in tissue specimens taken at autopsy from 140 women with clinically normal breasts, ranging in age from 19 through 101 years. Elastosis, presence of excess elastic fibers, while less common in younger women, may be found in nearly half of all women over age 50 years with no breast disease. Elastosis occurs in three sites: diffusely in the stroma, around vessels, and around ducts. In the first two sites, it bears little relationship to age, while periductal elastic tissue appears to accumulate with age, probably reflecting parity, until about age 50 years. Thereafter, it is found at a more or less constant incidence and degree. While it may be associated with breast cancer, periductal elastosis by itself is not a cause for concern. Marked perivascular elastosis is, however, uncommon at any age, and its presence should suggest a special search for carcinoma, if not already evident.     

Increasing prevalence of breast cancer among Saudi patients attending a tertiary referral hospital: a retrospective epidemiologic study

Aim

To determine the pattern of breast diseases among Saudi patients who underwent breast biopsy, with special emphasis on breast carcinoma.

Methods

A retrospective review was made of all breast biopsy reports of a mass or lump from male and female patients seen between January 2001 and December 2010 at the King Khalid University Hospital, Riyadh, Saudi Arabia.

Results

Of 1035 breast tissues reviewed, 939 specimens (90.7%) were from female patients. There were 690 benign (65.8%) and 345 (34.2%) malignant cases. In women, 603 (64.2%) specimens were benign and 336 (35.8%) were malignant. In men, 87 specimens (90.6%) were benign and 9 (9.4%) were malignant. All malignant cases from male patients belonged to invasive ductal carcinoma and the majority of malignant cases from female patients belonged to invasive/infiltrating ductal carcinoma. The proportion of malignancy was 18% in patients younger than 40 years and 63.2% in patients older than 60 years. The mean age of onset for malignancy was 48.6 years. The annual percentage incidence of malignant breast cancer steadily increased by 4.8%, from an annual rate of 23.5% in 2000 to 47.2% in 2007.

Conclusion

Among Saudi patients, there is a significant increase in the incidence of breast cancer, which occurs at an earlier age than in western countries. Continued vigilance, mammographic screening, and patient education are needed to establish early diagnosis and perform optimal treatment.Increased awareness and efficient breast cancer information-dissemination campaign led to an increased number of diagnosed cases of breast cancer. According to the American Cancer Society, about 1.3 million American women annually are diagnosed with breast cancer and about 465 000 die from the disease (1). The number of deaths has decreased since 1990, probably due to an earlier detection and advances in treatment. According to 2000-2004 Saudi National Cancer Registry data, there were 127.8 per 100 000 women with breast cancer and mortality rate was 25.5 per 100 000 (2).Most palpable breast masses are benign; less than 30% of women with palpable masses have a diagnosis of cancer (3-5). Approximately 4% of breast cancers present with a palpable mass without mammographic or ultrasonographic evidence of the disease (6). Therefore, evaluation of a breast mass should be done by taking into consideration patient’s history, physical examination, imaging, and biopsy. Definitive diagnosis in nearly all cases is established by needle biopsy. Because of the low specificity of mammography, many women undergo unnecessary breast biopsy. As many as 65%-85% of breast biopsies are performed on benign lesions (7), which subjects the patients to avoidable emotional and physical burden.Similarly to other countries, breast cancer in Saudi Arabia is the most common cancer in women (7). The Saudi National Cancer Registry reported a rising proportion of breast cancer among women of all ages, from 10.2% in 2000 to 24.3% in 2005 (8). A significant majority of these breast cancers (almost 80%) were of the infiltrating ductal type. The average age at presentation of breast cancer in Arab countries is 48 years, which is a decade earlier than in western countries (9). The median age of onset of breast cancer among Saudi women is 46 years (8). Due to the increasing incidence, several articles have been published on screening for breast cancer and on public awareness programs initiated by the Saudi Arabian government and non-governmental sectors (10-13). This study aims to describe the epidemiological characteristics of breast mass lesions of patients examined at the King Khalid University Hospital, Riyadh, Saudi Arabia from 2001 to 2010.     

Breast carcinoma in women over the age of 85: distinct histological pattern and androgen,oestrogen, and progesterone receptor status

AIMS: The pathogenesis of breast carcinoma in very elderly women is of interest, because oestrogen levels are likely to be extremely low during the development of the disease. In an effort to understand the pathogenesis of breast carcinoma in these women, this study was undertaken to compare the histological patterns and hormone receptor status of breast carcinomas arising in very elderly and younger women. METHODS AND RESULTS: Thirty-seven breast carcinomas from women over the age of 85 years at the time of their operation were examined histologically and compared with those from a large group of premenopausal women. The proportions of mucinous carcinoma and apocrine carcinoma were significantly greater in older women. The expression of steroid hormone receptors was studied immunohistochemically. Androgen receptor-positive carcinomas were significantly more frequent among older women, whereas progesterone receptor-positive carcinomas were significantly less frequent. There was no statistically significant difference in oestrogen receptor-alpha or -beta expression between the tumours from both groups. CONCLUSION: Breast carcinomas in women over the age of 85 years have a different morphological spectrum from carcinomas in younger age groups and may have different pathogenesis mechanisms that may be more dependent on androgen and androgen receptor interaction. Differences from the results of the other studies are discussed.     

Characterization of ten novel and 13 recurring BRCA1 and BRCA2 germline mutations in Italian breast and/or ovarian carcinoma patients. Mutations in brief no. 178. Online

Germline mutations in the BRCA1 and BRCA2 genes are associated with approximately 80% of families with a high incidence of breast and/or ovarian cancers (OMIM database reference numbers: 113705, 600185). Furthermore, constitutional mutations in the these genes have been reported in women with early-onset breast carcinoma and without family history of cancer. We analyzed by protein truncation test (PTT) and single strand conformation polymorphism (SSCP) followed by sequence analysis, BRCA1 exons 11 and 20 and BRCA2 exons 10 and 11 in 142 Italian cancer patients. These included six male breast cancer cases, 61 women with breast carcinoma diagnosed before 36 years old and selected independently of family history of breast cancer and 75 familial breast and/or ovarian cancer patients. In a previous report, we described 11 different BRCA1 mutations in a subset of 70 cases. Here, we report the characterization of 23 additional mutations, 14 in BRCA1 and 9 in BRCA2, subsequently identified. Ten mutations were not previously described, while the other 13 were recurrent. Of the 61 women with early-onset breast cancer, 11 carried a germline mutation in BRCA1 (18.0%) and four in BRCA2 (6.6%). These frequencies indicate that BRCA1/BRCA2 genetic tests should be advised to women with breast cancer diagnosed at early age, independently of family history of cancer.     

Paget's disease of the breast: clinical, imaging and pathologic findings: a review of 16 patients

Objectives:

To determine the clinical, imaging and pathological findings of Paget’s disease of the breast.

Materials and methods:

Approval by Institutional Review Board was granted and informed consent was waived. Retrospective review of the pathological diagnosis of 2,361 women with breast carcinoma between January 2004 and April 2010 revealed 27 patients with Paget’s disease of the breast. The clinical, mammographic and ultrasonographic images were retrospectively reviewed.

Results:

The prevalence of Paget’s disease of the breast was 1.14% of all breast carcinoma at this institution. Of the 27 patients with Paget’s disease, only 16 had imaging studies and this group constituted the basis of this study. All 16 patients were women, with ages ranging from 36–68 years (mean age 50.31 years). Eleven patients presented with clinical findings suggestive of Paget’s disease of the breast. Seven of these 11 patients also had associated palpable mass(es). Four patients presented with a palpable mass alone and one presented with bloody nipple discharge alone. Mammography was performed in all 16 patients and ultrasonography (US) in 15 patients. Of the 16 mammographic studies, two were negative. Of the 15 US studies, three were negative. Of these three negative US studies, two also had negative mammography and one had pleomorphic microcalcifications on mammogram. US was helpful in detecting multifocality in two patients. Mammography was 100% positive in patients who presented with palpable breast mass(es) and bloody nipple discharge, but 50% positive in patients who had clinically suggestive Paget’s disease alone. Almost all patients (15/16) had underlying breast malignancies. Seven patients had multifocality or multicentricity. Modified radical mastectomy was performed in 13 patients, simple mastectomy in two, and wide local excision in one patient. Pathological findings were ductal carcinoma in situ (DCIS) (n = 3), invasive ductal carcinoma (IDC) (n = 10), metaplastic carcinoma (n = 1), invasive lobular carcinoma (ILC) (n = 1), and only Paget’s disease of the nipple without underlying breast carcinoma (n = 1).

Conclusion:

Patients with Paget’s disease of the breast have a high incidence of an underlying breast carcinoma. Most of the patients in this study presented late and were more likely to have positive mammograms. Mammography should be performed to identify the underlying breast carcinoma. Those who have only nipple areolar changes and no palpable mass have less positive mammography and less invasive carcinoma.     

Physiological COX-2 Expression in Breast Epithelium Associates with COX-2 Levels in Ductal Carcinoma in Situ and Invasive Breast Cancer in Young Women

Cyclooxygenase-2 (COX-2) overexpression is implicated in increased risk and poorer outcomes in breast cancer in young women. We investigated COX-2 regulation in normal premenopausal breast tissue and its relationship to malignancy in young women. Quantitative COX-2 immunohistochemistry was performed on adjacent normal and breast cancer tissues from 96 premenopausal women with known clinical reproductive histories, and on rat mammary glands with distinct ovarian hormone exposures. COX-2 expression in the normal breast epithelium varied more than 40-fold between women and was associated with COX-2 expression levels in ductal carcinoma in situ and invasive cancer. Normal breast COX-2 expression was independent of known breast cancer prognostic indicators, including tumor stage and clinical subtype, indicating that factors regulating physiological COX-2 expression may be the primary drivers of COX-2 expression in breast cancer. Ovarian hormones, particularly at pregnancy levels, were identified as modulators of COX-2 in normal mammary epithelium. However, serial breast biopsy analysis in nonpregnant premenopausal women suggested relatively stable baseline levels of COX-2 expression, which persisted independent of menstrual cycling. These data provide impetus to investigate how baseline COX-2 expression is regulated in premenopausal breast tissue because COX-2 levels in normal breast epithelium may prove to be an indicator of breast cancer risk in young women, and predict the chemopreventive and therapeutic efficacy of COX-2 inhibitors in this population.In 2010, approximately 13% of all breast cancers in the United States were diagnosed in women age 45 and younger, accounting for nearly 18,600 cases of invasive breast cancer and 6500 cases of ductal carcinoma in situ (DCIS).¹ Furthermore, the proportion of advanced breast cancers diagnosed in young American women is increasing at a rate of 2% per year, making young women''s breast cancer an emerging concern.² Compared with breast cancer in older women, young breast cancer patients have increased recurrence and lower survival rates.^3–8 Although a delayed diagnosis can contribute to poorer survival in some young patients,^6,9 the primary factor driving poor prognosis is tumor biology. Young women''s breast cancer has increased hormone-receptor negativity, tumor cell proliferation, and lymphovascular invasion compared with postmenopausal cases.^4,6,10 Moreover, young age at the time of breast cancer diagnosis is an independent poor prognostic factor.^4,6,7,11,12 These data provide compelling arguments to develop novel strategies to reduce breast cancer incidence and poor outcomes in young women.One potential target for young women''s breast cancer is cyclooxygenase-2 (COX-2),¹³ a key enzyme in the synthesis of homeostatic and proinflammatory prostanoids.¹⁴ In rodent breast cancer models, COX-2 overexpression induces mammary tumorigenesis and is associated with multiple tumor-promotional effects including increased angiogenesis, enhanced tumor cell migration and invasion, and reduced antitumor immunity.^15–20 Conversely, COX-2 inhibition or loss in rodent models reduces mammary tumorigenesis and metastasis.^17,21–23 Clinical data are consistent with similar roles for COX-2 in human breast cancer because COX-2 overexpression in breast cancer is associated with decreased disease-free and overall survival.^24,25 In addition, regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), which inhibit the COX family of enzymes, can reduce overall breast cancer risk.^26,27 To date, the function of COX-2 in young women''s breast cancer has not been addressed. In a single study, high COX-2 expression in combination with increased collagen I is reported as a poor prognostic indicator in young-onset breast cancer patients (age, <45 years).¹⁶ One mechanism by which COX-2 may contribute to young-onset breast cancers is through its role in normal breast tissue remodeling. Importantly, windows of active breast tissue remodeling specific to young women, such as those associated with puberty, menstrual cycling, pregnancy, and postpartum breast involution, correlate with an increased risk for incidence and progression of breast cancer.^28,29 Support for this has been shown in rodent models in which postpartum mammary gland involution promotes tissue remodeling, tumor progression, and metastasis, all of which are mitigated by anti–COX-2 treatment.^16,30 Furthermore, COX-2 up-regulation has been observed in rat mammary glands after treatment with the ovarian hormones estrogen and progesterone,³¹ which is consistent with a role for COX-2 in physiological breast tissue remodeling associated with pregnancy and the menstrual cycle.We hypothesized that if COX-2 is involved in breast tissue remodeling, then COX-2 inhibition may represent a particularly efficacious chemoprevention strategy for young women. One important step in addressing this hypothesis is to evaluate COX-2 expression in young women''s breast tissue. We used human and rodent mammary tissues to investigate the effect of pregnancy and ovarian hormones on COX-2 expression in normal tissue as well as to explore the link between COX-2 expression in histologically normal adjacent breast tissue, DCIS, and invasive ductal carcinoma (IDC) in young-onset cases. We found that COX-2 expression primarily was epithelial and varied greatly between individual women, with evidence of modulation by ovarian hormones. In addition, analysis of COX-2 expression in paired normal adjacent breast epithelium, DCIS, and IDC within breast tissue from the same woman showed that COX-2 expression in the normal epithelium was associated with COX-2 expression in DCIS and IDC. Altogether, these data suggest that factors regulating COX-2 expression in normal breast epithelium influence COX-2 levels in breast cancer, and indicate that further research is warranted into whether women with high COX-2 expression may benefit preferentially from COX-2 inhibition strategies.     

Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age

One hundred and twenty-six radial scars and complex sclerosing lesions from 91 women were examined to determine the incidence of and the clinical and pathological factors associated with the development of carcinoma and atypical hyperplasia within them. There was a clear relationship between the presence of carcinoma and atypical hyperplasia and the size of the lesion. This was not, however, a progressive relationship, there being a cut-off point about 6-7 mm. below which carcinoma was very uncommon and above which it was relatively frequent. A similar relationship was seen with patient age. Carcinoma was not seen in lesions removed from women under 40, was rare in the decade 41-50 and was relatively common above this age but with no further increase in the over 60s. A significantly higher incidence of carcinoma and atypical hyperplasia was encountered in scars detected by mammographic screening and could be explained by lesion size and the ages of the patients from which they were removed. No relationship was found between the presence of carcinoma within radial scars and complex sclerosing lesions and the existence of carcinoma in the residual breast tissue when direct extension was excluded. The carcinomas identified in the scars were of variable type and included small and large cell ductal carcinoma in situ, lobular carcinoma in situ and invasive carcinoma of tubular and ductal types. In situ carcinoma and atypical hyperplasia involved a very variable percentage of the epithelium of the lesions with mean values for ductal carcinoma in situ of 32%, lobular carcinoma in situ 25% and atypical hyperplasia 25%. It is concluded that all screen-detected radial scars and complex sclerosing lesions should be excised and subjected to thorough histological examination. Further studies on larger numbers of screened women are indicated to determine more precisely the incidence of carcinoma in these lesions and the risk of developing cancer in women in whom uncomplicated scars are detected.     

Reduced breast cancer incidence in women treated with subcutaneous testosterone,or testosterone with anastrozole: A prospective,observational study

Objectives

There is evidence that androgens are breast protective and that testosterone therapy treats many symptoms of hormone deficiency in both pre and postmenopausal patients. However, unlike estrogen and progestins, there is a paucity of data regarding the incidence of breast cancer in women treated with testosterone therapy. This study was designed to investigate the incidence of breast cancer in women treated with subcutaneous testosterone therapy in the absence of systemic estrogen therapy.

Study design

This is a 5-year interim analysis of a 10-year, prospective, observational, IRB approved study investigating the incidence of breast cancer in women presenting with symptoms of hormone deficiency treated with subcutaneous testosterone (T) implants or, T combined with the aromatase inhibitor anastrozole (A), i.e., T + A implants. Breast cancer incidence was compared with that of historical controls reported in the literature, age specific Surveillance Epidemiology and End Results (SEER) incidence rates, and a representative, similar age group of our patients used as a ‘control’ group. The effect of adherence to T therapy was also evaluated.

Results

Since March 2008, 1268 pre and post menopausal women have been enrolled in the study and eligible for analysis. As of March 2013, there have been 8 cases of invasive breast cancer diagnosed in 5642 person-years of follow up for an incidence of 142 cases per 100 000 person-years, substantially less than the age-specific SEER incidence rates (293/100 000), placebo arm of Women's Health Initiative Study (300/100 000), never users of hormone therapy from the Million Women Study (325/100 000) and our control group (390/100 000). Unlike adherence to estrogen therapy, adherence to T therapy further decreased the incidence of breast cancer (73/100 000).

Conclusion

T and/or T + A, delivered subcutaneously as a pellet implant, reduced the incidence of breast cancer in pre and postmenopausal women. Evidence supports that breast cancer is preventable by maintaining a T to estrogen ratio in favor of T and, in particular, by the use of continuous T or, when indicated, T + A. This hormone therapy should be further investigated for the prevention and treatment of breast cancer.     

乳腺癌病理学诊断研究

目的探讨乳腺癌的临床病理诊断的特点及其方法。方法对243例乳腺癌患者进行组织病理学检查以及针吸细胞学检查。结果乳腺癌的病理类型以浸润性导管癌为主;出现淋巴道转移概率最高的为浸润性小叶癌;40~60岁为乳腺癌高发年龄段。结论乳腺癌的诊断应注意术前针吸细胞学检查与术中和术后的组织病理学检查结合,保证患者在术后有良好的预后。     

Age‐specific incidence rates for breast cancer in carriers of BRCA1 mutations from Norway

Møller P, Mæhle L, Vabø A, Clark N, Sun P, Narod SA. Age‐specific incidence rates for breast cancer in carriers of BRCA1 mutations from Norway. Incidence rates of breast cancer among women with a BRCA1 mutation vary according to their reproductive histories and country of residence. To measure cancer incidence, it is best to follow‐up cohort of healthy women prospectively. We followed up a cohort of 675 women with a BRCA1 mutation who did not have breast or ovarian cancer before inclusion and who had a normal clinical examination and mammography at first visit. After a mean of 7.1 years, 98 incident cases of breast cancer were recorded in the cohort. Annual cancer incidence rates were calculated, and based on these, a penetrance curve was constructed. The average annual cancer risk for the Norwegian women from age 25 to 70 was 2.0%. Founder mutations had lower incidence rate (1.7%) than less frequent mutations (2.5%) (p = 0.03). The peak incidence (3.1% annual risk) was observed in women from age 50 to 59. The age‐specific annual incidence rates and penetrance estimate were compared with published figures for women from North America and from Poland. The risk of breast cancer to age 70 was estimated to be 61% for women from Norway, compared with 55% for women from Poland and 69% for women from North America.     

Solid-papillary carcinoma of the breast: clinicopathological study of 20 cases

The purpose of the present paper was to evaluate the clinicopathological and biological features of 20 Japanese patients with solid-papillary carcinoma of the breast (SPC) or SPC associated with invasive breast cancer. All the patients were Japanese women, including two sisters. The mean age was 66.0 years. The incidence of SPC among all the breast cancers treated at two institutions was 1.1% and 1.7%, respectively. The mean disease-free interval was 4 years 11 months. Axillary lymph node metastasis or tumor recurrence did not occur in any of the cases. Fifteen cases of SPC contained invasive cancers that ranged from <5% to 60% of the entire tumor area. Histological types of invasive cancers were mucinous carcinoma in five cases and neuroendocrine cell carcinoma in 10 cases. These results indicate that SPC is a potential precursor lesion for neuroendocrine carcinoma as well as mucinous carcinoma. When all the cases were classified and analyzed according to both the 2002 tumor node metastasis (TNM) classification system and the Nottingham histological grade, SPC patients, even those with invasive cancers, seemed to have longer disease-free survival compared to patients with the other invasive breast cancers of matching grade and stage. Clinicopathologically, SPC could be regarded as a separate type of ductal carcinoma in situ.     

Oral contraceptives and breast cancer among African-american women and white women

The higher incidence of breast cancer among African-American women younger than 50 as compared to white women points to the need to examine exposures that are common among younger women, including exposure to oral contraceptives (OC). We examined patterns of OC use and their associations with breast cancer in a population-based, case-control study conducted in North Carolina between 1993 and 1996. The study population was comprised of 858 cases and 789 controls, of whom 40% were African-American women. There was little evidence that breast cancer was associated with OC use among older women (age >50) of either race, most of whom discontinued use in the distant past. Among younger women, there was a modest, but nonsignificant, increase in risk associated with ever use of OCs for both African-American and white women. There was a trend of increasing risks with more recent use among African-American women, whereas no such trend was apparent for white women. Overall, we found more substantial age differences than race differences in patterns of OC use and the risk of breast cancer associated with their use. The similarity of the associations between African-American and white women suggest that racial differences in breast cancer incidence are not likely to be attributable to OC use.     

Breast cancer racial differences before age 40--implications for screening

BACKGROUND: Most authorities advocate mammogram screening for breast cancer beginning at age 40 based on the age-specific distribution and incidence of breast cancer in the general population. This policy has been bolstered by studies that demonstrate that, for the general population, mammography in the 40-49 age bracket reduces mortality. However, it also has been reported that African-American breast cancer patients are diagnosed more often than white patients below the age of 40. Young African-American women are also more likely to have advanced disease at the time of diagnosis with predictably higher mortality. The purpose of this investigation is to explore the question, whether a subset of African-American women, age 30-39, by virtue of increased vulnerability, would benefit from early mammogram screening. STUDY DESIGN: The age-specific distribution (age 30-84) of African-American and white breast cancer patients in five State cancer registries were compared. Prognostic indicators (tumor size and nodal status) in two of the five registries in African-American and white breast cancer cases below the age of 40 were compared. Age-specific incidence in the 30-39 age group and the relative populations of black and white women in the United States were noted in the Surveillance Epidemiology and End Report (SEER) (1994-1998) and The U.S. Census 2000. RESULTS: The differences of age-specific distribution and age-specific incidence of African-American and white breast cancer patients were found to be significant. More than 10% of African-American women with breast cancer were diagnosed before age 40 compared to 5% of white patients. The incidence of breast cancer (SEER Report 1994-1998) in the 30-39-age bracket for African-American and white women was 48.9 and 40.2 at the 95% confidence level, while the proportion of African-American and white women reported by the Census Bureau was not too dissimilar, 15.8% and 14.6% respectively. Prognostic indicators (tumor size and nodal status) support the notion that young African-American women are more likely to have advanced disease at diagnosis. CONCLUSIONS: African-American women in the 30-39 age group have twice the age-specific distribution, have a higher incidence compared to their white counterparts, and exhibit more ominous prognostic signs. This study provides evidence that African-American women in the 30-39 age category represent a high-risk group that may benefit from efforts at earlier detection. Although mammography remains the preferred screening modality, investigators have pointed out difficulties encountered when using mammography in young women, including low sensitivity, high breast density, cost/benefit concerns, and low positive predictive value. Nevertheless, the increasing mortality and persistent racial incidence gap in young African-American women, age 30-39, argue for considering early screening mammography in spite of recognized concerns.     

维吾尔族及汉族早发性乳腺癌 BRCA1基因突变分析

目的研究维吾尔族及汉族早发性乳腺癌患者BRCA1突变情况及突变位置。方法选取35例维吾尔族及汉族早发性乳腺癌根治标本（其中维吾尔族早发性乳腺癌22例,汉族乳腺癌13例）,对照组为32例维汉族乳腺良性病变（纤维腺病及纤维腺瘤）及乳腺癌旁非癌组织;运用PCR—SSCP和DNA序列测定的方法检测BRCA1基因突变。结果（1）35例新疆早发性乳腺癌（≤35岁）BRCA1突变率为22．86％（8／35）,22例维吾尔族早发性乳腺癌BRCA1突变率为31．82％（7／22）。（2）35例新疆早发性乳腺癌中发现8例BRCA1突变的12个新位点,其中2例突变位点IVS20-68insA均为维吾尔族早发性乳腺癌患者。（3）35例新疆早发性乳腺癌中发现7例BRCA1基因核苷酸多态性,对照组32例维吾尔族及汉族乳腺癌旁非癌组织及乳腺良性病变中仅发现1例BRCA1基因核苷酸的多态性。结论BRCA1突变可能与新疆早发性乳腺癌尤其是维吾尔族早发性乳腺癌密切相关,其突变位点IVS20—68insA可能是新疆维吾尔族早发性乳腺癌的遗传易感性位点,尚需扩大样本进一步研究证实。     

TRAIL protein expression in breast cancer cells correlates with nuclear grade

Introduction

TRAIL protein may serve as an escape mechanism for cancer cells from the immune response. The aim of the study was to assess whether the presence of TRAIL protein correlates with unfavourable prognostic factors in breast carcinoma.

Material and methods

The study group was composed of breast cancer patients treated surgically in the Department of Surgical Oncology, Medical University of Lodz, Poland, from January to December 2003. Inclusion criteria for the study were fulfilled by 117 women. The immunohistochemical study of TRAIL protein expression was performed in 118 breast carcinomas diagnosed in the study group. TRAIL protein expression was correlated with other variables: tumour size, lymph node status, grade, histological type of carcinoma, oestrogen and progesterone receptor status, HER2 expression, presence of lymphovascular invasion and age of the patient.

Results

Expression of TRAIL protein was present in 73% of breast carcinomas. The percentage of TRAIL-expressing breast carcinoma cells correlated with the nuclear grade (τ = 0.26, p < 0.05; Tau Kendall test). The intensity of TRAIL expression (intensity of staining) in breast carcinoma cells correlated with the nuclear grade (τ = 0.15, p < 0.05; Tau Kendall test). TRAIL expression in breast carcinoma did not correlate with other studied variables.

Conclusions

Our analysis revealed that expression of TRAIL protein in breast carcinoma cells correlates with nuclear grade of carcinoma.     

转移消失基因在乳腺癌中的表达及其临床意义

目的:探讨转移消失(missing in metastasis,MIM)基因在乳腺癌及癌旁组织中的表达及其与乳腺癌临床病理特征的关系.方法:采用SYBR Green实时定量PCR技术检测60例乳腺癌及癌旁组织MIM mRNA的表达,并分析其在不同临床参数间的表达差异.结果:MIM mRNA在乳腺癌中的表达高于癌旁组织(...     

Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy

OBJECTIVE: There is now convincing evidence that usual hormone therapy for ovarian failure increases the risk for breast cancer. We have previously shown that ovarian androgens normally protect mammary epithelial cells from excessive estrogenic stimulation, and therefore we hypothesized that the addition of testosterone to usual hormone therapy might protect women from breast cancer. DESIGN: This was a retrospective, observational study that followed 508 postmenopausal women receiving testosterone in addition to usual hormone therapy in South Australia. Breast cancer status was ascertained by mammography at the initiation of testosterone treatment and biannually thereafter. The average age at the start of follow-up was 56.4 years, and the mean duration of follow-up was 5.8 years. Breast cancer incidence in this group was compared with that of untreated women and women using usual hormone therapy reported in the medical literature and to age-specific local population rates. RESULTS: There were seven cases of invasive breast cancer in this population of testosterone users, for an incidence of 238 per 100,000 woman-years. The rate for estrogen/progestin and testosterone users was 293 per 100,000 woman-years--substantially less than women receiving estrogen/pro-gestin in the Women's Health Initiative study (380 per 100,000 woman-years) or in the "Million Women" Study (521 per 100,000 woman-years). The breast cancer rate in our testosterone users was closest to that reported for hormone therapy never-users in the latter study (283 per 100,000 woman-years), and their age-standardized rate was the same as for the general population in South Australia. CONCLUSIONS: These observations suggest that the addition of testosterone to conventional hormone therapy for postmenopausal women does not increase and may indeed reduce the hormone therapy-associated breast cancer risk-thereby returning the incidence to the normal rates observed in the general, untreated population.     

Simultaneous bilateral malignant breast neoplasms in Nigerian women.

This study reviews the clinicopathological features and survival of 18 Nigerian women with simultaneous bilateral breast cancer. Twelve (67%) of these patients had bilateral Burkitt''s lymphoma of the breast. The average age of these patients was 22 years, and all of the women were pregnant or lactating at the time of initial clinical presentation. The remaining six patients (33%) had bilateral malignant epithelial neoplasms, with lobular carcinoma being present in four cases. The average age of patients with bilateral malignant epithelial tumors was 37 years. None of the 18 patients with simultaneous bilateral breast cancer survived for up to 2 years after diagnosis, indicating that bilateral synchronous breast cancer in Nigerian women is a rapidly progressive and aggressive disease.