Patterns of utilization of mammography comparison by physician specialties in 6,000 consecutive mammograms.

Mammography is regarded as the most important screening test for breast cancer. The combination of physical examination of the breast by a physician and mammography can result in reduced breast cancer mortality. Evidence is mounting that mammography alone can produce similar results. Despite these facts, mammography is underutilized in the United States. In an attempt to define the utilization of mammography in the Ochsner Medical Institutions, New Orleans, Louisiana, the records of 6,000 consecutive patients who underwent mammography were reviewed with respect to the specialty of the physician ordering the test. The ratio of the number of mammograms ordered by each service to the number of eligible patients (women over age 50) visiting that service provided insight into the patterns of utilization of mammography in the Ochsner Clinic. This information will allow for efficient utilization of time and resources in planning continuing education programs geared toward mammographic screening.     

Hexaminolevulinate-mediated photodynamic purging of marrow grafts with murine breast carcinoma

Photodynamic therapy (PDT) with porphyrin precursors is an established therapy for certain tumors. This study aimed to explore the use of hexaminolevulinate (HAL), a porphyrin precursor, for photodynamic purging of BM grafts contaminated with cells of the 4T1 breast carcinoma cell line. The optimal PDT dose was not effective in eradicating 4T1 cells when the tumor cells were mixed with murine marrow cells in vitro. However, the number of pulmonary metastases was reduced, and the survival of experimental animals was prolonged substantially when they were subjected to TBI followed by transplantation of syngeneic BM containing metastasized 4T1 cells that had been treated ex vivo by HAL-PDT. Despite the failure of in vitro experiments, HAL-based photodynamic purging could be a useful modality for treating animals bearing an experimental breast carcinoma.     

Estrogen Promotes Breast Cancer Cell Survival in an Inhibitor of Apoptosis (IAP)-dependent Manner

The estrogen receptor (ER) is a major prognostic and therapeutic marker that is expressed in nearly 75% of breast tumors. We have previously shown that the presence of inflammatory mediators can alter the genomic function of the estrogen receptor (ER) in a gene specific manner. In particular, 17β-estradiol (E2) works in combination with the pro-inflammatory cytokines to enhance the expression of a number of pro-survival factors, including the Inhibitor of Apoptosis (IAP) family member, cIAP2. Here we confirm that mRNA and protein levels for cIAP2, but not the related family members cIAP1 and XIAP, are highly up-regulated in MCF-7 breast cancer cells by E2 and cytokines. Similar regulation of cIAP2 is evident in other ER positive but not ER negative cell lines. In agreement with its role as a pro-survival factor, cIAP2 is highly expressed in a subset of invasive breast carcinomas but not in normal breast tissue or ductal carcinoma in situ. Antagonizing IAPs with mimetics of SMAC, which is a known endogenous IAP antagonist, or knockdown of IAPs by siRNA led to greater cell death by TNFα and prevented E2 from promoting cell survival. In addition, a SMAC mimetic reversed TNFα resistance in ER positive breast cancer cells that express high levels of endogenous IAPs. In summary, our findings indicate a new mechanism by which E2 allows breast cancer cells to evade cell death and suggest that an antagonist of IAPs may be a potential therapeutic option for a subset of ER positive breast tumors.     

Mammography of Breast Cancer in Women Under 30

Abstract: The purpose of this study was to assess the efficacy of mammography of breast cancer in women less than 30 years old. A retrospective record review revealed 47 breast cancers in 45 women age 29 and younger who had preoperative mammography. Patients ranged in age from 22 to 29 years (mean = 27 years). All presented with clinically evident disease. Mammography revealed focal abnormality in 26 (55.3%) of 47 cases. Specific positive mammographic findings (n = 22) included uncalcified mass in ten (45.5%), calcification without mass in nine (40.9%), mass and calcifications in two (9.1%), and skin ulceration in one. Mammographic parenchymal density ( n = 21) was P2 in 9 (42.9%) and DY in 12 (57.1%). The mean time interval from symptom onset to biopsy was 4.5 months, but was shorter if the mammogram was positive. High parenchymal density contributes to the diminished sensitivity of mammography in women under age 30. A positive mammogram may hasten the diagnosis of carcinoma in a young woman with palpable malignant breast disease.     

Absence of p16 gene (CDKN2) deletions in microdissected primary breast carcinoma specimens

Background: The p16 gene (CDKN2), a tumor suppressor gene located on chromosome 9p21, has been demonstrated to be mutated or deleted with high frequency in a variety of tumor cell lines, including breast. While previous studies have not demonstratedCDKN2 mutations in primary breast carcinomas, it is possible that gene deletion in neoplastic DNA was masked by the presence of contaminating normal stromal DNA in breast carcinoma specimens. Methods: We investigated the incidence of homozygous deletion ofCDKN2 by analyzing 20 microdissected pure populations of primary breast carcinoma cells. Using polymerase chain reaction (PCR) techniques, the entire coding region and intervening introns ofCDKN2 were amplified. The PCR products were resolved by agarose gel electrophoresis and single-strand conformation polymorphism (SSCP) analysis. Results: We detected no deletions or mutations of the p16 gene. Conclusions: CDKN2 is not deleted with high frequency in primary breast carcinomas, and the p16 gene does not play a role in breast carcinogenesis via this mechanism. Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

Male breast cancer.

Breast cancer in the male is an uncommon disease, occurring less than 1% as often as in females. Because of its rarity, this disease has not been as extensively studied as its female counterpart. Male breast cancer is evaluated and managed in a fashion very similar to that for female breast cancer. Primary management in early stage disease is usually a modified radical mastectomy. First line hormonal therapy for metastatic disease, in our institution, is tamoxifen for patients with positive estrogen receptors. Second line therapy consists of progestins or antiandrogens/LHRH analogs. No firm recommendations can be made concerning adjuvant systemic therapy. However, it is likely that studies from female patients are adaptable. Unfortunately, carcinoma of the male breast is such an infrequently encountered tumor that unfamiliarity with the disease can lead to delays in diagnosis and treatment. An increased awareness of the disease may be expected to result in earlier detection and institution of therapy at a stage when cure may be possible.