Breast Carcinoma in Childhood and Adolescence: Case Report and Review of the Literature

Secretory breast carcinoma is a rare tumor originally described in children and adolescent women with a characteristic morphology and a controversial choice of treatment. We report an additional case of a 4-year-old girl with a breast tumor diagnosed as a secretory carcinoma without involvement of the axillary lymph nodes. The therapy consisted of simple mastectomy and low axillary dissection. She presented with a local recurrence near the surgical scar 8 months later, and a wide elliptical excision of the scar and underlying tissue was performed with subsequent radiotherapy of the surgical bed. This tumor has a relatively benign behavior and rarely metastasizes. A literature review revealed only 22 cases of breast carcinoma in childhood and adolescence. ▪     

Smoking in pregnancy: A survey from Northern Italy

Summary The prevalence of smoking in pregnancy was analyzed in a survey of women delivering between January and March 1989 in a large maternity clinic in Milan, Northern Italy. Out of the 528 women interviewed, 183 (35%) were current smokers before pregnancy and 99 stopped smoking during pregnancy. The probability of stopping smoking decreased with increasing age and was lower in less educated women, but these findings were not statistically significant. Considering persistent smokers only, the mean number of cigarettes per day fell from 13 before to 8 during pregnancy; this reduction was generally consistent in various subgroups of age and education. The reductions, however, are probably overestimated, since they are based on the women's reports only. Thus, there still appears to be ample scope for intervention on smoking in pregnancy, particularly in older and less educated women.

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Zusammenfassung Die Rauchprävalenz während der Schwangerschaft wurde in einer Querschnittstudie bei Frauen untersucht, welche zwischen Januar und März 1989 in einer grossen Frauenklinik in Mailand ein Kind zur Welt brachten. Von 528 befragten Frauen hatten 183 (35%) vor der Schwangerschaft geraucht, und 99 Frauen war es gelungen, während der Schwangerschaft mit Rauchen aufzuhören. Die Wahrscheinlichkeit für letzteres nahm mit zunehmendem Alter ab und war kleiner für Frauen mit geringer Ausbildung (statistisch nicht signifikant). Bei den Raucherinnen wurde eine Reduktion der mittleren Anzahl Zigaretten von 13 Stück vor der Schwangerschaft auf 8 während der Schwangerschaft festgestellt. Diese Reduktion fand sich in allen Alters- und Ausbildungsgruppen. Wahrscheinlich wurde die Reduktion aber überbewertet, weil sich ihre Berechnung nur auf die Aussagen der Frauen abstützte. Für Gesundheitsaktionen, die ein Rauchstopp während der Schwangerschaft zum Ziele haben, besteht immer noch ein grosser Bedarf, besonders bei älteren und weniger ausgebildeten Frauen.

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Résumé La prévalence du tabagisme durant la grossese a été étudiée lors d'une enquête des parturientes entre janvier et mars 1989 dans une grande maternité de Milan. Parmi les 528 femmes interrogées, 183 (35%) étaient tabagiques avant la grossesse et 99 avaient arrêté de fumer durant la grossesse. La probalité de cesser l'habitude diminue lorsque l'âge augmente, et est basse chez les femmes dont le niveau d'éducation est bas, sans significantion statistique. En considérant uniquement les parturientes tabagiques, le nombre quotidien de cigarettes fumées passe de 13 avant la grossesse à 8 durant la grossesse; cette diminution se retrouve dans tous les groupes d'âge et tous les niveaux d'éducation. Ces diminutions sont probablement surestimées, puisqu'elles sont basées sur les seules déclarations des parturientes. Cette enquête montre qu'il existe encore une large place por la prévention.

     

Health-related quality of life parameters as prognostic factors in a nonmetastatic breast cancer population: an international multicenter study.

PURPOSE: The purpose of this research was to evaluate whether baseline health-related quality of life (HRQOL) parameters are prognostic factors for survival in locally advanced breast cancer patients. Although the literature highlights the important role of HRQOL parameters in predicting survival in advanced metastatic disease, little evidence exists for earlier stages. PATIENTS AND METHODS: The overall sample consisted of 448 patients randomly assigned to receive cyclophosphamide, epirubicin, and fluorouracil versus epirubicin, cyclophosphamide, and granulocyte colony-stimulating factor. Patients were enrolled in 12 countries. HRQOL baseline scores were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. In addition, a bootstrap resampling technique was used to assess the stability of the outcomes. Bootstrap results were then applied for model averaging purposes as a means to account for the observed model selection uncertainty. RESULTS: The final multivariate model retained inflammatory breast cancer (T4d) as the only factor predicting overall survival (OS) with a hazard ratio of 1.375 (95% CI, 1.027 to 1.840; P =.03). The presence of inflammatory breast cancer lowers the median survival time from 6.6 to 4.2 years (36% reduction). None of the preselected HRQOL variables were prognostic for OS or disease-free survival, in either the univariate or multivariate analysis. CONCLUSION: Our findings suggest that baseline HRQOL parameters have no prognostic value in a nonmetastatic breast cancer population.     

Alpha1 acid glycoprotein binds to imatinib (STI571) and substantially alters its pharmacokinetics in chronic myeloid leukemia patients.

PURPOSE: Imatinib (Glivec) is a potent inhibitor of bcr/abl, an oncogenic fusion protein that causes chronic myelogenous leukemia (CML). alpha1 acid glycoprotein (AGP) binds to imatinib with high affinity and inhibits imatinib activity in vitro and in vivo in an animal model. A pharmacokinetics analysis of imatinib was undertaken in CML patients. EXPERIMENTAL DESIGN: Imatinib plasma concentrations were measured in 19 CML patients treated with imatinib (400 or 600 mg/day). Five patients received a concomitant short-term course of clindamycin (CLI). RESULTS: A positive correlation between AGP and imatinib plasma levels was observed. CLI administration decreased imatinib plasma concentrations, evaluated as area under the curve (AUC) and peak concentrations (C(max)). The effects of a bolus of CLI was studied in three patients on imatinib 23 h after the last imatinib dose. Within 5-10 min in three of three cases, CLI caused a decrease in imatinib plasma concentrations of 2.6-, 2.7-, and 4.7-fold, respectively. In vitro experiments using fresh blasts from CML patients showed that AGP, at concentrations observed in the patients, decreased imatinib intracellular concentrations up to 10 times and blocked imatinib activity. The incubation with CLI restored imatinib intracellular concentrations and biological activity. CONCLUSION: AGP exerts significant effects of the pharmacokinetics, plasma concentrations, and intracellular distribution of imatinib in CML patients; these data indicate that plasma imatinib levels represent unreliable indicators of the cellular concentrations of this molecule.     

An Analysis of Approaches to the Management of Endometrial Cancer in North America: A CTF Study

Objective.The aim of this study was to define the clinical–therapeutical approach to endometrial cancer now being followed in some of the most important centers of reference for gynecological cancer in North America by means of a questionnaire.Study design.The questionnaire focused on four principal areas: (1) surgical staging and therapy; (2) adjuvant treatment; (3) treatment modifications; and (4) management of advanced stages (FIGO III–IV).Results.There were 48 evaluable responses (77%) received by the end of December 1994 which were considered for this analysis. Lymphadenectomy is utilized routinely in 26/48 centers (54.2%) and in selective clinical–pathological conditions in another 21/48 centers (43.5%). In the majority of centers (31/48; 64.6%) radical surgery is utilized for selected indications such as cervical involvement. Only 3/48 (6.2%) centers consider the vaginal approach totally inappropriate. The great majority (40/48; 83.3%) of the centers considered postsurgical adjuvant therapy to be necessary in FIGO Stage Ic. Brachytherapy is routinely performed in 3 centers (6.2%) in postsurgical management of Stage I endometrial cancer, while the majority of the centers (31/48; 64.6%) perform brachytherapy of the vaginal vault in certain clinical–pathological conditions. A wide variety of treatments are used for advanced stages (FIGO III–IV).Conclusions.It emerges that some controversial aspects exist on endometrial cancer treatment, and these conflicting data need a large-scale multicenter randomized clinical trial.