小叶原位癌不影响乳腺癌保守性手术后疗效

美国密歇根大学一项研究显示，小叶原位癌（LCIS）不影响保守性手术治疗的乳腺癌患者的预后。[Cancer2006，106（1）：28]     

乳腺癌的相关因素

我院１９８０～１９９３年收治的１４２４例乳腺癌患者中女性１４１３例，与其相关因素进行分析。其中停经年龄＞４５岁１１９３例（８４．４％），行经时间≥３０年８４０例（５９．４％），初产年龄＞２５岁９８０例（８０．５％），无哺乳史９１２例（７４．９％）。结果提示：乳腺癌的发生与遗传、其它乳腺疾病、精神因素及头发中微量元素有一定关系。通过对乳腺癌及其相关因素的研究，可望为乳腺癌的治疗及预防开辟新途径。     

年龄与三阴性乳腺癌患者预后的关系

背景与目的:发病年龄与多种肿瘤的预后存在一定的关系,但不同肿瘤间,甚至在同类肿瘤不同亚型间有明显差异。三阴性乳腺癌(TNBC)作为预后较差的乳腺癌亚型一直备受关注,本研究旨在分析年龄因素与TNBC患者预后的关系。方法:根据入组及排除标准,收集北京协和医院2011年1月—2014年12月收治并手术的317例I～III期TNBC患者的病历资料进行回顾性研究。根据诊断乳腺癌时的年龄,将整个队列分为≤40岁组和40岁组,比较两组患者的临床病理特征、无局部-区域复发转移生存(LRRFS)、无远处转移生存(DMFS)、无疾病生存(DFS)和总生存(OS)的差异,分析包括年龄在内的影响TNBC患者DFS和OS的相关因素,并进一步比较早期发生远处转移(DM)(≤2年)与晚期发生DM(2年)患者之间年龄与其他临床病理因素的差异。结果:临床病理特征方面,≤40岁组较40岁组的组织学分级更差、脉管癌栓发生率更高、肿瘤分期更晚、接受化疗与放疗的比例更高(均P0.05)。生存分析显示,≤40岁组的DMFS(64.3% vs.83.2%)、DFS(55.7% vs.79.2%)和OS(71.8% vs.86.2%)均明显差于40岁组(均P0.05),但两组LRRFS差异无统计学意义(87.5% vs.94.9%,P0.05)。年龄≤40岁与淋巴结转移≥4枚为TNBC患者DFS与OS的独立危险因素(DFS:HR=1.983,95% CI=1.280～3.071,P=0.002;HR=2.064,95% CI=1.091～3.904,P=0.026;OS:HR=1.799,95% CI=1.052～3.076,P=0.032;HR=4.062,95% CI=1.841～8.963,P=0.001)。年龄对于患者DM发生的早晚无明显影响(P0.05)。结论:年龄是TNBC患者不良预后的独立危险因素,对于诊断时年龄≤40岁患者会有比40岁患者更差的预后。因此,对于年轻的TNBC患者,应给予更多的关注,并制定更为严谨的治疗随访计划,实现量体裁衣式的精准诊疗。     

AJCC第8版乳腺癌分期系统对乳腺浸润性小叶癌分期评价及临床病理分析

目的 研究AJCC第8版乳腺癌分期系统对乳腺浸润性小叶癌分期评价的临床意义及其临床病理特征分析.方法 参照AJCC第8版乳腺癌分期标准,重新对2011-2016年北京大学深圳医院乳腺外科治疗的浸润性小叶癌患者进行解剖学分期及预后分期评价,并与其他类型浸润性癌的临床病理资料进行分析.结果 共收治乳腺浸润性小叶癌21例,占全部浸润性乳腺癌的2.7％,研究发现浸润性小叶癌与其他类型浸润性乳腺癌相比,年龄分布、月经状况、分子分型特征及解剖学分期与预后分期差异均无统计学意义(P＞0.05);而组织学分级差异有统计学意义(P＜0.05).浸润性小叶癌解剖学分期与预后分期评价存在差异.结论 AJCC第8版乳腺癌分期系统中的预后分期为乳腺癌的临床治疗方案的制订提供了新的参考依据,但需参考解剖学分期共同评价.浸润性小叶癌与其他类型浸润性癌相比,组织学分级低,预后分期佳,但要对浸润性小叶癌进行精准的个体化治疗还需要更大样本更完善的研究.     

乳腺浸润性小叶癌与浸润性导管癌生物学特性比较

乳腺浸润性小叶癌(invasive lobular carcinoma ILC)与浸润性导管癌(invasive ductal carcinoma IDC)为乳腺癌中两种常见的病理类型,病理形态学有各自的特点。本文对ILC和IDC生物学特性进行比较。1资料和方法ILC及IDC共523例,均为女性。其中ILC有173例,IDC为350例,年龄20~80岁,     

超声征象对非肿块型乳腺癌与肉芽肿性小叶性乳腺炎的鉴别诊断价值

目的：研究超声征象在非肿块型乳腺癌（NMBC）与肉芽肿性小叶性乳腺炎（GLM）鉴别诊断中的价值。方法：回顾性分析2021年1月—2021年12月于北京中医药大学厦门医院胸外乳腺科就诊、经穿刺或术后病理证实的29个NMBC和37个GLM病灶的超声征象,包括生长方式、边缘情况、是否有微小钙化、周围组织情况、血流情况、腋窝淋巴结是否肿大等。结果：NMBC和GLM病灶的非平行、成角、毛刺、微小钙化、周围组织回声增强、窦道、腋窝淋巴结肿大、丰富血流、穿支血流及阻力指数大于0.7的比例差异有统计学意义（P<0.05）。结论：超声征象可为NMBC和GLM的鉴别诊断及治疗提供有价值的信息。     

应用远红外线(FIR)治疗乳腺癌相关的淋巴水肿的肿瘤安全性研究

目的 探讨应用远红外线(FIR)治疗乳腺癌相关的淋巴水肿的肿瘤安全性.方法 选取乳腺癌切除术后5年以上,且伴有1年以上上肢淋巴水肿的患者,分为FIR组和对照组,分别采用FIR治疗和绷带加压保守治疗.观察指标包括肿瘤标志物(CA153、CA125)、相关结构的超声检查,并对治疗后1年的不良反应进行监测.通过体外试验观察F...     

乳腺结构不良与乳腺癌

乳腺结构不良与乳腺癌白求恩医科大学三院基本外科（１３００２１）郑泽霖，张德恒白求恩医科大学一院普外科曹路宁乳腺结构不良与乳癌的确切关系一直是个争论不休但无定论的问题。乳腺组织增生具有自限性，通常是不会癌变的，一般在ｌ～３年内可以不治而愈，特别是未婚病...     

乳腺癌相关基因的研究进展

随着细胞生物学和分子生物学理论和技术的发展 ,已认识到乳腺癌是一种多基因变异引起的疾病。对乳腺癌发生发展中相关基因异常的认识 ,是乳腺癌防治的关键。本文就近年来乳腺癌相关基因异常的研究进展进行综述。1　致癌基因1.1　Ｂｃｌ 2癌基因族　Ｂｃｌ 2癌基因族是凋亡相关基因 ,是编码性细胞死亡 (ＰＣＤ)的关键调节因子 ,其成员包括Ｂｃｌ 2、Ｂａｘ、ｂｃｌ ｘ、ｂａｋ、ｂａｄ、Ｍｃ1 1等。其中研究较多的是Ｂｃｌ- 1及Ｂａｘ。Ｂｃｌ 2是凋亡抑制基因 ,位于 18ｑ2 1位点上 ,有 3个外显子构成 ,长度为 2 30ｋｂ ,编码一个分子量为 2 …     

Age-related differences in breast cancer treatment

Background: More than half of the cases of breast cancer treated in the United States occur in women over age 65. This study investigates age-related differences in breast cancer therapy. Methods: A retrospective review of all women with primary operable invasive breast cancer treated at the University of Michigan Breast Care Center over a 30-month period showed a total of 77 older patients aged 65 years (median, 71; oldest patient, 92) for whom full information was available regarding comorbidity, tumor stage and histology, and details of surgery, radiation, and chemohormonal therapy and complications. Fifty-one similar younger patients aged 55–64 years (median, 59) were identified for comparison. Patients were classified as either having received standard treatment or nonstandard treatment. Standard therapy was prospectively defined as follows: local/regional—lumpectomy and axillary lymph node dissection plus radiation therapy or modified radical mastectomy; systemic—chemotherapy and/or tamoxifen for stage II disease. A comorbidity score calculated for each patient assigned one point each for nursing home residence, nonambulatory status, recent surgery, and each medical problem requiring drug therapy. Results: When overall treatment (local/regional plus systemic) was assessed, proportionately fewer older patients (55 of 77 versus 47 of 51;p<0.01) received standard treatment. Fewer older than younger patients (62 of 77 versus 50 of 51;p<0.01) received surgical therapy that included an axillary dissection. A smaller proportion of older patients received radiation therapy following lumpectomy and axillary lymph node dissection (26 of 29 versus 19 of 19; N.S.). Overall, only 59 of 77 older patients versus 50 of 51 younger patients (p<0.001) received standard local/regional care. Similar proportions of younger and older patients (19 of 22 and 24 of 30, respectively) received standard systemic therapy for stage II breast cancer, but older patients were less likely to receive chemotherapy than younger patients (7% versus 50%;p<0.001). Treatment-related complications were not age-related but were more frequent in patients receiving standard treatment than in patients receiving nonstandard treatment (45 of 102 versus two of 26;p<0.001). Comorbidity score correlated with the use of nonstandard therapy but not with age. The scores for both older and younger patients receiving overall standard treatment were 0.8 versus 1.5 and 1.4, respectively, in patients receiving nonstandard treatment. Interestingly, explanations for decisions to deviate from standard treatment guidelines were often not identified. Comorbidity was explicitly noted in only one of four younger patients who received nonstandard treatment therapy. In 22 older patients who received nonstandard treatment, comorbidity was cited in eight cases, patient age was cited in six cases, and patient choice was cited in four cases. Follow-up (median, 34 months) did not show that disease-free or overall survival differences were related to age or to treatment (standard versus nonstandard). Conclusions: These data demonstrate age-related variations in breast cancer treatment in a multidisciplinary breast care unit. Lower complication rates and equivalent short-term outcomes in women who received nonstandard therapy suggest good clinical judgment may have played a role in these differences. Although age-related patient preferences and comorbidity are relevant, the age-related attitudes of caregivers must also be taken into account to fully explain these variations.Presented at the 46th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, March 18–21, 1993.     

Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis

ObjectivesMammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature.MethodsMedline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I² statistic, stratified and sensitivity analyses.ResultsNine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84–2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52–2.21) increased. Both results were statistically significant and homogenous.ConclusionsMammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.     

Family history of breast cancer,mammographic breast density and breast cancer risk: Findings from a cohort study of Korean women

BackgroundThis study investigated whether the association between family history of breast cancer in first-degree relatives and breast cancer risk varies by breast density.MethodsWomen aged 40 years and older who underwent screening between 2009 and 2010 were followed up until 2020. Family history was assessed using a self-reported questionnaire. Using Breast Imaging Reporting and Data System (BI-RADS), breast density was categorized into dense breast (heterogeneously or extremely dense) and non-dense breast (almost entirely fatty or scattered areas of fibro-glandular). Cox regression model was used to assess the association between family history and breast cancer risk.ResultsOf the 4,835,507 women, 79,153 (1.6%) reported having a family history of breast cancer and 77,238 women developed breast cancer. Family history led to an increase in the 5-year cumulative incidence in women with dense- and non-dense breasts. Results from the regression model with and without adjustment for breast density yielded similar HRs in all age groups, suggesting that breast density did not modify the association between family history and breast cancer. After adjusting for breast density and other factors, family history of breast cancer was associated with an increased risk of breast cancer in all three age groups (age 40–49 years: aHR 1.96, 95% confidence interval [CI] 1.85–2.08; age 50–64 years: aHR 1.70, 95% CI 1.58–1.82, and age ≥65 years: aHR 1.95, 95% CI 1.78–2.14).ConclusionFamily history of breast cancer and breast density are independently associated with breast cancer. Both factors should be carefully considered in future risk prediction models of breast cancer.     

Mammographic density and prognosis in primary breast cancer patients

PurposeMammographic density (MD) is one of the strongest risk factors for breast cancer (BC). However, the influence of MD on the BC prognosis is unclear. The objective of this study was therefore to investigate whether percentage MD (PMD) is associated with a difference in disease-free or overall survival in primary BC patients.MethodsA total of 2525 patients with primary, metastasis-free BC were followed up retrospectively for this analysis. For all patients, PMD was evaluated by two readers using a semi-automated method. The association between PMD and prognosis was evaluated using Cox regression models with disease-free survival (DFS) and overall survival (OS) as the outcome, and the following adjustments: age at diagnosis, year of diagnosis, body mass index, tumor stage, grading, lymph node status, hormone receptor and HER2 status.ResultsAfter median observation periods of 9.5 and 10.0 years, no influence of PMD on DFS (p = 0.46, likelihood ratio test (LRT)) or OS (p = 0.22, LRT), respectively, was found. In the initial unadjusted analysis higher PMD was associated with longer DFS and OS. The effect of PMD on DFS and OS disappeared after adjustment for age and was caused by the underlying age effect.ConclusionsAlthough MD is one of the strongest independent risk factors for BC, in our collective PMD is not associated with disease-free and overall survival in patients with BC.     

Role of conservation therapy for invasive lobular carcinoma of the breast

Background: Invasive lobular carcinoma (ILC) accounts for 5% to 10% of all invasive breast cancers. Although breast conservation therapy using local excision and postoperative irradiation is a standard therapy for early invasive ductal breast cancer, the result of this strategy in ILC is not well documented. We sought to determine the rate of locoregional recurrence after breast conservation therapy in patients with ILC. Methods: A retrospective review of 74 patients with ILC treated with breast conservation therapy at The University of Texas M. D. Anderson Cancer Center (n=43) or The John Wayne Cancer Institute (n=31) between 1977 and 1993 was performed. Results: The median age of patients was 60 years, and median follow-up was 56 months (range 1 to 207 months). Thirty-nine patients had American Joint Committee on Cancer stage I disease, 30 had stage IIa disease, and five had stage IIb disease. All patients underwent surgical resection and postoperative radiation therapy. Twelve patients received postoperative adjuvant chemotherapy, and 27 patients were treated with adjuvant hormonal therapy. The 5-year actuarial locoregional recurrence rate was 9.8%, and the median time to recurrence was 77 months (range 41 to 113 months). Patients with positive or close (⩽1 mm) surgical margins were at increased risk for local recurrence on univariate analysis (p=0.034). Of the nine patients with breast recurrence, six underwent salvage therapy with total mastectomy and are disease free at the time of this writing, two patients died of distant disease, and one is alive with local disease at the time of this report. The 5-year disease-specific survival rate was 93.7%. Conclusions: Breast conservation therapy for ILC achieves locoregional control in the majority of patients. However, long-term follow-up of patients is important because many local recurrences following breast conservation therapy are late events. Presented at the 50th Annual Cancer Symposium of the Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

Rectal metastasis from Breast cancer: A rare entity

IntroductionBreast cancer metastases occurs in around 50% of all presentation. It is the second most common type of cancer to metastasise to the GI tract but this only occurs in less than 1% of cases.Presentation of caseWe report a case that underwent treatment for invasive lobular cancer (ILC) of the breast and 5 years later was found to have rectal and peritoneal metastasis. She is currently receiving palliative management including chemotherapy in the form of weekly Paclitaxel (Taxol^®) and stenting to relieve obstruction.ConclusionThere should be high clinical suspicion of bowel metastasis in patients presenting with positive faecal occult blood with or without bowel symptoms even if the incidence is less <1% of metastases, particularly in cases where the initial breast tumour was large, with positive axillary nodes.     

Radial bone density and breast cancer risk in white and African-American women

A number of different models for assessing individual risk of breast cancer use known risk factors such as age, age at menarche, age at first live birth, previous breast biopsies, and family history. High bone mass in white women is also associated with an increased breast cancer risk; however, bone mass as a risk factor has not been studied in African-American women. We conducted a case-control study to evaluate bone mineral density as a risk factor for breast cancer in white and African-American women. We recruited 221 women with newly diagnosed breast cancer from a comprehensive breast cancer center at a large university hospital, and 197 control women who were frequency matched for ethnicity and age. Odds ratios were based on proximal and distal radial bone density measured by peripheral bone densitometry (Norland pDEXA) and expressed as a standardized Z-score (age and ethnicity specific). Logistic regression models were fitted controlling for body mass index, menopausal status, age, and HRT use (ever/never and duration). With proximal bone density Z-score included in the model as a continuous variable, a one-unit increase in radial shaft bone density increased the risk of breast cancer by 25% (p=0.02). When proximal bone density Z-score was analyzed as a dichotomous variable (0, >0) the odds ratio was 1.98 (95% CI, 1.32 to 2.97); that is, having an above average proximal bone density (age-specific) doubles the risk of breast cancer. There were no significant interactions with, and no appreciable confounding effects by, other covariates. An above-average radial shaft Z-score is a significant risk factor for breast cancer in both white and African-American women. The present study extends the association between bone mass and breast cancer risk to African-Americans, and suggests another potential application for bone density testing.     

Age-related differences in breast cancer stage at diagnosis between black and white patients in an urban community hospital

Background: Breast cancer mortality is significantly higher among black patients compared to white patients. Black women are reportedly at increased risk for early-onset breast cancer. Our goal was to evaluate stage distribution relative to age among black and white breast cancer patients in an institution with a relatively high minority patient population. Methods: We evaluated 425 patients diagnosed with breast cancer between 1990 and 1994: 56% white, 34% black, the remainder were other ethnicities. Patients were stratified by age: under 50 years versus 50 and older. Socioeconomic status was estimated by utilization of medical care in the private-practice setting versus the public clinic. Results: Significantly more black patients were younger at diagnosis compared to white patients (32% vs. 20%; p=0.008). There was a significantly more advanced stage distribution among the younger black patients, but not among the older black patients. Most of the black and white patients received private-practice care. Conclusions: These age-related differences in breast cancer stage distribution between black and white patients (which appeared independent of socioeconomic status) indicate that more aggressive screening and public education progams directed toward younger black women is warranted, and they lend support to the possibility of ethnicity-related variation in primary tumor biology.     

辅助化疗对乳腺癌患者骨密度的影响

目的观察辅助化疗对乳腺癌患者骨密度的影响。方法选取2015年3月至2016年3月就诊宣武医院普外科并行辅助化疗的乳腺癌患者71名,绝经前32人,绝经后39人,根据疾病采用不同化疗方案(EC、FEC、TC、EC-T),患者化疗前均进行骨密度的检查,同时在化疗结束后再进行骨密度的检查。结果在绝经前患者,化疗导致患者腰椎骨密度下降,且患者基础BMI越高,骨密度下降越快;在绝经后患者,化疗导致患者股骨骨密度的下降,与患者的基础BMI关系不大。结论化疗使乳腺癌患者骨密度下降,骨健康受损,且与绝经前患者的BMI相关。