Breast cancer prediction and the Wolfe classification of mammograms

Mammographic parenchymal patterns have been proposed as a method of determining women at high risk of developing breast cancer. Wolfe's original report of relative risks as high as 37:1 for "dysplastic" breasts (DY) as compared with adipose breasts (N1), with intermediate values of P1 and P2, were not uniformly confirmed by others. (Relative risks are used here as the equivalent of odds ratios.) A case-control study of 706 breast cancers, each with two matching controls, drawn from 40,000 participants in four Breast Cancer Detection Demonstration Project clinics, was conducted to assess the role of the Wolfe classification of breast parenchymal patterns as a breast-cancer risk factor together with a set of well-established risk factors for breast cancer. Relative risks of 3.1 for DY to N1, 3.5 for P2 to N1, and 2.0 for P1 to N1 were determined. These are comparable to or greater than other known risk factors found in the same population. The Wolfe classification of parenchymal patterns strengthens the basis for clinical judgment, but should not be used exclusively to determine intervention in an individual patient's care.     

Percutaneous needle localization of clustered mammary microcalcifications prior to biopsy

Mammography occasionally reveals the presence of suspicious appearing clustered microcalcifications without an associated mass. Clinical localization of these microcalcifications within the breast is difficult, even using the 2 dimensional effect of a mammogram. Percutaneous needle localization of these microcalcifications is recommended for its accuracy, patient acceptance, and reduction in size of the biopsy specimen. No complications of this procedure have been encountered.     

Effective breast cancer detection with film-screen mammography

Non-visualization of the retromammary space and ribs has been a source of concern to mammographers. In six years, 186 cancers were detected in our experience of 10 034 self-referred asymptomatic women at the University of Michigan Breast Cancer Detection Demonstration Project. These cancers were used to analyze the need to visualize the retromammary space and ribs, or both sites, if adequate technical factors were used. All the cancers were analyzed for position on the film, number of films required for visualization, relationship of the tumor to the posterior edge of the film, number of occult tumors, tumor size, histologic type, sensitivity of detection method and the number of interval cancers. Of the 186 cancers, 168 (90%) were detected on mammograms. All of the cancers were visualized on the mediolateral view; three were not visualized on the craniocaudal view. Six per cent of the cancers were within 1 cm of the posterior edge of the film; the remaining 94% were located more anteriorly in the breast. The imaged tumors were smaller and had a significantly higher percentage of non-invasive cancers than found in a symptomatic clinical population. Therefore, mammography, using proper technique, will consistently permit visualization of cancer in the breast, regardless of tumor size, histologic type, or location in the breast.     

Racial differences in the early detection of breast cancer in metropolitan Detroit, 1978 to 1987

This population-based study presents trends in stage at diagnosis of invasive female breast cancer during the decade from 1978 to 1987 in the Detroit metropolitan area. Its purpose is to determine whether there has been an increase in early breast cancers: those that are smaller than 2 cm at diagnosis and have no axillary lymph node involvement. Trend analyses of tumor size, node status, year of diagnosis, age, and race were performed for 17,216 incident cases drawn from the Metropolitan Detroit Cancer Surveillance System (MDCSS). Although trends toward earlier diagnosis of breast cancer are observed, less improvement is seen for black women than white women in the presentation of breast cancer at smaller, node-free stages. Implications for breast cancer screening are discussed.     

Thymus leukemia antigen controls intraepithelial lymphocyte function and inflammatory bowel disease

Intestinal intraepithelial lymphocytes (IEL) bear a partially activated phenotype that permits them to rapidly respond to antigenic insults. However, this phenotype also implies that IEL must be highly controlled to prevent misdirected immune reactions. It has been suggested that IEL are regulated through the interaction of the CD8αα homodimer with the thymus leukemia (TL) antigen expressed by intestinal epithelial cells. We have generated and characterized mice genetically-deficient in TL expression. Our findings show that TL expression has a critical role in maintaining IEL effector functions. Also, TL deficiency accelerated colitis in a genetic model of inflammatory bowel disease. These findings reveal an important regulatory role of TL in controlling IEL function and intestinal inflammation.     

A comparison of alkaline phosphatase and radiolabelled gene probes with bioassays for enterotoxigenic Escherichia coli

Alkaline phosphatase-conjugated oligonucleotide probes (APO), 32P-labelled oligonucleotide (RO) and cloned polynucleotide (RP) probes were evaluated for their ability to detect enterotoxigenic Escherichia coli (ETEC) as defined by bioassay. These three sets of probes were applied to 301 E. coli strains that had previously been defined by the Y1 adrenal cell assay for heat-labile enterotoxin (LT) and the infant mouse assay for heat-stable enterotoxin (ST). The correlation of the APO probe for LT with the bioassay was 98% with five discrepancies and a positive predictive value (PPV) of 100%. For the APO/ST probe the correlation with the bioassay was 98% with seven discrepancies and a PPV of 96%. The correlation of the RO probe for LT was 99% with four discrepancies and a PPV of 100%, while the overall correlation for the two RO/ST probes was 97% with eight discrepancies and a PPV of 97%. For the RP probes, the correlation for LT was 99% with four discrepancies and a PPV of 100% and for ST was 98% with seven discrepancies and a PPV of 98%. These findings suggest that the APO probes were as sensitive as the RO and RP probes in detecting ETEC by colony hybridization and could be a practical alternative to bioassays and radiolabelled probes for ETEC since they do not require expensive equipment or extensive technical training.     

Physical and psychosocial functioning and adjustment to breast cancer. Long-term follow-up of a screening population

The effects of age, recency of breast cancer (BC) diagnosis, and severity of the disease on adjustment outcomes were investigated in a sample of 349 women from the 10,056 women screened for BC by the University of Michigan Breast Cancer Detection Demonstration Project between 1974 and 1981. In the 1985 follow-up, data were collected from the 173 surviving BC patients who had invasive BC, and from a matched control group of 176 women who were asymptomatic of BC. Fifty-five percent of the BC patients were 5 years past diagnosis and treatment at the time of data collection. The BC patients group as a whole did not differ from the asymptomatic control group on indicators of mental health, social and psychological well-being, or physical functioning. However, the BC group reported a greater number of diagnosed medical conditions that limited their activities, and taking more medications, than the asymptomatic group. Within the BC group, severity and recency of the cancer had strong independent adverse effects on several of the indicators of mental health and physical functioning. Advanced age had the same main effects in both groups: greater number of medications and diagnosed medical conditions that cause limitations in activities, but, in contrast, better mental health and well-being. Age had interactive effects with the recency and with severity of BC: more recent and severe cases of BC appeared to produce particularly serious difficulties in psychological adjustment for younger patients, and particularly serious medical problems and physical difficulties in adjustment for older patients.