Malignant neoplastic emboli to the coronary arteries: report of two cases and review of the literature

Two patients were seen with malignant neoplastic emboli to the coronary arteries. One, a 61-year-old woman with a malignant fibrous histiocytoma of the thigh and a solitary pulmonary metastatic lesion, died of an acute myocardial infarction due to a neoplastic coronary embolus after lobectomy. The other, a 51-year-old woman with bronchogenic adenocarcinoma, died of extensive cerebral metastases. At autopsy, she also was found to have had an acute myocardial infarction associated with a neoplastic coronary embolus.     

Important increase of invasive lobular breast cancer incidence in Geneva,Switzerland

A recent paper from the United States reported a sharp and unexplained increase in invasive lobular breast cancer incidence since 1977 (Li et al., Cancer 2000;88:2561-9). We investigated if this trend was also present in Geneva, Switzerland, where breast cancer incidence is one of the highest in Europe. We analyzed trends in breast cancer incidence according to histologic subtype, age and stage, to clarify the pattern. Our population-based study includes all histologically confirmed invasive breast carcinomas (n = 6,247) recorded between 1976 and 1999 at the Geneva Cancer Registry. Breast histology was classified as ductal carcinoma, lobular carcinoma and other. Incidence trends were studied by log-linear regression analyses. Models including effects of age, period and birth cohorts were used to describe rising incidence trends. The incidence of ductal carcinoma increased 1.2% per year (p(trend) < 0.001) from 85.2 to 110.1/100,000. This increase concerned women aged 50-69 years and early-stage tumors. Lobular cancer incidence increased disproportionately (14.4% per year, p(trend) < 0.01) and rose from 2.9 to 20.5/100,000. This increase affected all age categories and both localized and advanced stages. In addition, a strong age-cohort effect was present (p < 0.05), and women aged 50-59 years born after 1944 experienced the most marked increase. Our study shows a disproportionate increase of lobular breast cancer incidence compared to ductal cancer incidence. Contrary to ductal cancer, trends for lobular cancer are unlikely to be explained by increased use of screening mammography. Other explanations must be researched, in particular the role played by hormone replacement therapy.     

The "post-Chernobyl" childhood leukemia study (ECLIS Study).

Summary Numerous European cancer registries are working together to evaluate the current trends in the incidence of childhood leukemias after the Chernobyl accident. The study is coordinated by the International Agency for Research on Cancer. The primary objective is to establish whether the accident has resulted in an increase in the number of cases. The results will also allow an evaluation of the clusters which could be reported. According to the provisional estimations, the accident could lead to an increase of an average of 0.8% of the frequency of new cases in the European regions covered by the study. For the whole of Switzerland, this increase would correspond to 0.5 supplementary cases per year.

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Die Inzidenz der Kinderleukämien in Europa: Eine gemeinsame Krebsregisterstudie im Gefolge von Tschernobyl

Zusammenfassung Im Gefolge des Kernkraftunfalls von Tschernobyl hat sich die Grosszahl der Europäischen Krebsregister dahin geeinigt, die Inzidenz der Kinderleukämien in Europa in einer gemeinsamen, von der Internationalen Krebsforschungsagentur (IARC) koordinierten Studie genauer zu verfolgen. Als erstes gilt es zu eruieren, ob im Gefolge des Unfalls mehr Kinderleukämien aufgetreten sind; es wird auch möglich sein, vermutliche Häufungen (Clusters) von Kindheitsleukämien zu überprüfen. Aus der Zusatzstrahlung nach Tschernobyl ergibt sich die Schätzung, dass die Anzahl Neuerkrankungen in den von der Studie erfassten Gebieten um 0,8% zunehmen könnte. Für die Schweiz würde das je eine zusätzliche Kinderleukämie in zwei Jahren bedeuten.

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L'étude «post-Tchernobyl» des leucémies infantiles

Résumé De nombreux registres du cancer européens se sont associés pour évaluer avec précision les tendances actuelles de l'incidence des leucémies infantiles, suite à l'accident de Tchernobyl. L'étude est coordonnée par le Centre international de recherche sur le cancer. L'objectif premier est d'établir si l'accident provoque une augmentation du nombre de cas. Les résultats permettront également d'évaluer les clusters qui seraient signalés. D'après les estimations, l'accident pourrait conduire à une augmentation de 0.8% de la fréquence des nouveaux cas, en moyenne, dans les régions européennes couvertes par l'étude. Pour l'ensemble de la Suisse, cette augmentation correspondrait à 0.5 cas supplémentaires par an.

     

Increased risk of colon cancer after external radiation therapy for prostate cancer

Radiotherapy can induce second cancers. Controversies still exist regarding the risk of second malignancies after irradiation for prostate cancer. We evaluated the risk of developing colon and rectum cancers after prostate cancer in irradiated and nonirradiated patients. Using data from the population-based Geneva cancer registry, we included in the study all men with prostate cancer diagnosed between 1980 and 1998 who survived at least 5 years after diagnosis. Of the 1,134 patients, 264 were treated with external radiotherapy. Patients were followed for occurrence of colorectal cancer up to 31 December, 2003. We calculated standardized incidence ratios (SIR) using incidence rates for the general population to obtain the expected cancer incidence. The cohort yielded to 3,798 person-years. At the end of follow-up 19 patients had developed a colorectal cancer. Among irradiated patients the SIR for colorectal cancer was 3.4 (95% confidence intervals [CI] 1.7-6.0). Compared to the general population, the risk was significantly higher for colon cancer (SIR = 4.0, 95% CI: 1.8-7.6), but not for rectal cancer (SIR = 2.0, 95% CI: 0.2-7.2). The risk of colon cancer was increased in the period of 5-9 years after diagnosis (SIR = 4.7, 95% CI: 2.0-9.2). The overall SIR of secondary cancer in patients treated with radiotherapy was 1.35 (p = 0.056). Nonirradiated patients did not have any increased risk of rectal or colon cancer. This study shows a significant increase of colon but not rectum cancer after radiotherapy for prostate cancer. The risk of second cancer after irradiation, although probably small, needs nevertheless to be carefully monitored.     

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Tolerance,hemodynamic changes,and safety of dobutamine stress perfusion imaging

Background

Dobutamine myocardial perfusion perfusion imaging is being used increasingly for assessment of coronary artery disease. Heretofore, there have been no large series documenting its tolerance and safety. The aims of this study were to assess the tolerance, hemodynamic changes, and safety of dobutamine stress in conjunction with myocardial perfusion imaging.

Methods and Results

The tolerance, hemodynamic changes, and safety of dobutamine myocardial perfusion imaging were investigated in a consecutive series of 1012 patients. Dobutamine was infused at incremental doses of 10, 20, 30, and 40 μg/kg/min at 3-minute intervals. Perfusion tomography was performed according to standard protocols with either ²⁰¹Tl or ^99mTc-labeled sestamibi. Seven hundred twenty-nine patients (72%) reached a maximal dobutamine dose of 40 μg/kg/min. Dobutamine significantly increased heart rate (76±14 beats/min to 127±20 beats/min; p<0.001) and systolic blood pressure (141±20 mm Hg to 168±36 mm Hg; p<0.001) from baseline to peak infusion rate. The most common side effects were chest pain (31%), headache (14%), dyspnea (12%), palpitations (10%), and flushing (10%). There was no death, myocardial infarction, pulmonary edema, ventricular fibrillation, sustained ventricular tachycardia, or cerebral vascular accident. Nonsustained ventricular tachycardia occurred in 43 patients (4.2%) but did not cause any hemodynamic instability.

Conclusion

When done with the necessary caution, dobutamine myocardial perfusion imaging is a safe diagnostic test, although side effects are common.     

Tumor Location of the Lower-Inner Quadrant Is Associated with an Impaired Survival for Women With Early-Stage Breast Cancer

Background There is growing evidence that tumors of the inner quadrants (especially the lower-inner quadrant) metastasize more often to the internal mammary chain (IMC). As these metastases are not investigated, patients with lower-inner quadrant tumors have an increased risk of being under-staged and under-treated and may therefore have a higher risk of death from breast cancer. Methods We identified all 1522 women operated for stage I breast cancer between 1984 and 2002 recorded at the population-based Geneva Cancer Registry. We compared breast cancer mortality risk by tumor location with multivariate Cox regression analysis that accounted for all factors linked to tumor location and survival. Results Ten-year disease-specific survival was 93% (95%CI: 91–94%). Patients with breast cancer of the lower-inner quadrant (n = 118; 7.8%) had an importantly increased risk of dying of breast cancer compared to women with breast cancer of the upper-outer quadrant (multiadjusted Hazard Ratio: 2.3, 95%CI: 1.1–4.5, P = 0.0206). The over-mortality associated with this quadrant was particularly evident for tumors >10 mm (multiadjusted HR: 3.6, 95%CI: 1.6–7.9, P = 0.0016). There was no increased breast cancer mortality risk for tumors located in other quadrants. Conclusions Tumor location in the lower-inner quadrant is an independent and important prognostic factor of stage I breast cancer. Further research is needed to evaluate if the over-mortality of patients with stage I cancer of the lower-inner quadrant is indeed a result of under-treatment due to undetected IMC metastases. If so, patients with stage I breast cancer of the lower-inner quadrant are good candidates for systematic IMC investigation. Part of this study was presented as a poster at the 28^th San Antonio Breast Cancer Symposium, December 8-11, 2005.     

Breast cancer family history leads to early breast cancer detection and optimal management

Purpose

We investigated whether the relationship between family history (FH) of breast cancer and survival of women with breast cancer is related to the quality of care received, once adjusted for other prognostic variables using data from the Geneva population-based cancer registry and quality of care indicators defined by the European Society of breast cancer specialists (EUSOMA).

Methods

We included non-metastatic malignant breast tumor patients who had their surgery between 2001 and 2010. We assessed the association between FH and patient and tumor characteristics on one hand, and each quality of care indicator and an overall score of quality of care, on the other hand, through logistic regression. We assessed the impact of FH and the quality of care-score on 5-year survival with Cox regression adjusting for patient and tumor characteristics.

Results

2,672 patients were included in the study. Women with a positive FH were younger, more likely from Switzerland, screen detected, had positive estrogen and progesterone receptor status, and had smaller and ductal tumors. A positive FH was also associated with better management for several quality indicators. Women with a positive FH had a better crude survival (Hazard Ratio 0.61, p = 0.006). This association was not substantially affected when adjusting for quality of care. However, the effect of FH did not persist when also adjusting for patient and tumor characteristics.

Conclusions

A positive FH of breast cancer is associated with earlier breast cancer diagnosis, better tumor features, and higher quality of care. These factors explain the better survival observed among breast cancer women with a positive FH as compared to women without positive FH.