Showing papers on "Breast cancer published in 1969"

Soft-Tissue Sarcomas, Breast Cancer, and Other Neoplasms: A Familial Syndrome?

Abstract: c Four families were identified in SUMMARY w h i c h a p a j [ r o f c h i l d r e n h a d s o f t . tissue sarcomas: three sets of sibs and one set of cousins. One parent of each affected child developed cancer; carcinoma of the breast occurred in three mothers under 30 years of age. Other young adults in these families had a high frequency of cancer, with no evidence of underlying genetic disorders known to carry a high risk of neoplasia. The increased familial susceptibility to cancer was manifested not only by the large number of members affected but by a seeming excess of multiple primary neoplasms. These findings suggest a new \"familial\" syndrome of neoplastic diseases in which heredity or oncogenic agents, or both, may have a causal role.

Cancer of the breast: size of neoplasm and prognosis.

Abstract: In this study we utilized information obtained from more than 2000 operable breast cancer patients who had been entered since 1957 into the National Breast Project by 45 institutions. The purpose was to further evaluate the concept that the size of breast neoplasms influences patient prognosis. Only 5% of patients had tumors smaller than 1.0 cm, 48% were larger than 2.9 cm, and 28% exceeded 4.0 cm. The findings, when compared with those previously reported by others, suggest that little progress has been made since about 1950 relative to the removal of smaller breast tumors. Since these data are probably more nearly representative of the size of breast tumors at surgery in this country during the past decade than most other data that are available, they provide a baseline for the evaluation of the worth of a variety of recently employed and proposed diagnostic procedures. Results obtained categorically agree with current thinking that the larger the tumor the more likely that axillary nodes will be positive, that 4 or more rather than 1-3 nodes will be involved, and tumor recurrence and mortality rates will be greater. Such an unqualified statement, however, is an oversimplification of the findings, provides no indication of the magnitude of recurrence and mortality differences to be anticipated from tumors of various sizes, and should be accepted only with reservation. It is speculated, as a result of the data presented and certain assumptions, that if all tumors 2.0 cm or larger (70% of the total) had been removed when they were 1.0-1.9 cm in size, at the end of 5 years the recurrence rate for all patients entered might have only decreased by 10-18%, and the overall survival might have increased 11-20%. From certain considerations and the results obtained, it is concluded that size may not necessarily relate to “earliness” or “lateness” of a tumor, nor is it as consequential to the fate of the patient as are other factors relative to the tumor and /or host that may be present from its inception and which determine the development of metastases. Such a conclusion does not deprecate effort toward earlier diagnosis and tumor removal. It does emphasize, however, that the reasons for such an endeavor may be different from those generally considered at present.

Cancer Mortality Among Nuns: Role of Marital Status in Etiology of Neoplastic Disease in Women

Abstract: To clarify the role of marital status in human carcinogenesis a 1968 Cancer Institute study analyzed the cancer mortality experience of 31658 white Catholic nuns from 41 religious orders in the U.S. from 1900-1954. The national white female population was used for cause-specific comparison and both groups were assigned cohorts depending upon the year of birth. When examined by 10-year age groups rates for cancer at all sites was generally lower for nuns than for controls aged 59 or 69 but were substantially higher at older ages. Postmenopausal nuns (aged 69 and over) displayed a higher rate (38.6%) of cancer of the large intestine than did controls (22.6%) but had a lower proportion of deaths from cancer of the biliary passages and liver (13.0% vs. 22.6%). Nuns displayed a striking excess in breast cancer mortality over the age span of 40-74 years and had consistently higher rates than controls for each age group above 39 years. Lower cervical cancer rates for nuns (10.8%) than for controls (56.6%) seemed related to coital factors. Cancer of the uterus accounted for 63% of the genital cancer deaths among sisters. Overall the genital cancer mortality rates for nuns were consistent with high mortality rates for the single white female population of the U.S. The increased risk of breast cancer and cancers of the corpus uteri and ovary would seem to reflect an established link with infertility. Combination of these factors with the excess incidence of cancer of the large intestine among postmenopausal nuns suggests a common pathogenic mechanism of a hormonal nature operating in some women.

Lactation and reproductive histories of breast cancer patients in greater Athens, 1965-67.

Abstract: As part of an international collaborative study, an attempt was made to identify all cases of breast cancer among residents of the Cities of Athens and Piraeus newly diagnosed in a period of 2 1/2 years. A total of 956 cases was identified, giving an annual average incidence rate of 34.9 per 100,000 female population. Rates by age and marital status are reported. Of these cases 799 (84%) were interviewed, along with 2,470 controls. The controls were residents of Athens and Piraeus under treatment in the same hospitals as the breast cancer cases but for conditions other than breast cancer. In relation to the controls, the breast cancer cases were of low fertility. After adjustment for this difference there was no difference between cases and controls in any of a variety of measures of lactation experience. The cases differed significantly from the controls in having higher socio-economic status, earlier menarche, later first pregnancy, later menopause and greater height and weight. The ranges of these variables were associated with variations in breast cancer risk of the order of two or three fold.

Epidemiology of Cancer of the Ovary

Abstract: Etiology and epidemiology are often intertwined. Therefore an introductory discussion is devoted to these subjects.

Classification of patients with disseminated cancer of the breast.

Abstract: Some of the presenting findings of patients with breast cancer at die time of the initial diagnosis of disseminated disease have been collected on 920 patients from 8 centers. These findings have been correlated with survival. This study indicates that the interval between initial diagnosis of the primary disease and the clinical diagnosis of disseminated cancer, and die number and type of organ sites involved, influence the survival from the onset of metastases. It also indicates that if more complete information on the history and clinical course of breast cancer patients were available in studies involving therapeutic trials than presently is used in cooperative studies, the results of such studies might be more meaningful. A useful staging of disseminated cancer for the evaluation of therapeutic trials may be developed for several types of disseminated cancer by utilizing such information.

The influence of social class in the survival of cancer patients.

Abstract: This paper presents data from the California Tumor Registry on the relationship between social class and survival of cancer patients. The registry was started in 1947 with cases admitted after 1942. It now includes 57 hospitals in California. Abstracts of about 20000 new patients a year are received an estimated third of the cancer cases in the state. (Skin cancers are excluded from the registry. ) 300000 cases are on file. A 1963 report noted that patients in private hospitals had a more favorable early diagnoses and survival rate than patients in county hospitals. This difference was confirmed by comparing breast cancer groups of the same ages race and known mortality rates. Other possible causes of mortality were calculated by using 3 different life tables. Rates varied with the different tables but all indicated that patients of higher social class survive breast cancer better than lower class patients. It is assumed that patients in private hospitals are from higher social classes than those in county hospitals. Data indicate that a single life table should not used to compare the survival of groups of cancer patients which differ in social class.

Identification of women at high risk for breast cancer

Abstract: This paper reviews factors which appear to affect a womans risk of developing breast cancer. The low rate in Japan as compared to the West is noted particularly in the post-menopausal period. The stability of mortality in the U.S.A. has been ascribed to an increase in survival balanced by an increase in incidence especially among younger women. In New York City breast cancer morbidity is particularly high among Jewish women. Cancer of the breast is less common among American Negroes. In Asian countries breast cancer is more frequent among upper income groups. It has been suggested that single as well as infertile married women have a somewhat higher risk than fertile married women as much as 2-fold. Pregnancy below 20 years of age may result in a lower risk of the disease than pregnancy after 25. Prolonged nursing particularly over a total of 36 months reduces the risk of breast cancer. Castration of a woman before age of 37 may reduce the risk. A patient with fibrocystic disease of the breast requires special surveilance. Obesity in post-menopausal women is a controversial parameter. Women who have already had cancer of the breast have a 7 per 1000 per year chance of getting cancer in the other breast. Women whose mothers or sisters have developed breast cancer are also a high risk group. Colon cancer may have some association and long-term estrogen therapy is being considered as of possible significance. Laboratory studies of hormone steroids and glucose tolerance have been of value in estimating risk. The postulation that a womans fat intake may be a factor is supported by some animal experiments. Dietary factors especially in terms of lipids may play an important role. With the exception of women with previous breast cancer and those with breast cancer in the immediate family no particular group appears to require more surveillance than the average woman.

Bilateral breast cancer.

Abstract: The bilateral nature of breast cancer is generally accepted. Early detection of second primary breast cancers through repeated physical and x-ray examinations is difficult and uncertain. A significant number of occult second primary breast cancers have been detected in their earliest stages through generous surgical biopsy of the opposite breast at the time of initial mastectomy for a proven breast cancer. Some of these early cancers were not detected by either careful physical examination or adequate x-ray mammography. Biopsy of the contralateral breast is a minor nondeforming operation which is well-accepted by the patient. The second mastectomy is more readily accepted by the patient after a positive biopsy has been obtained. Simultaneous, generous excisional biopsy of the opposite breast at the time of initial mastectomy for breast cancer represents a practical approach to the problem of bilateral breast cancer. However, a negative biopsy of the opposite breast does not rule out the possibility of subsequent development of a new primary in this breast at a later date. All patients undergoing mastectomy for breast cancer should be followed closely, with particular emphasis on the opposite breast. There is an urgent need for the development of more efficient methods for detecting early breast cancer, preferably, during its long, silent noninfiltrating phase of development.

Histological grading in breast cancer.

Abstract: ImagesFigs. 1-2Figs. 3-4Figs. 5-6

A ten-year study of 5-flurouracil in disseminated breast cancer with clinical results and survival times..

Abstract: The clinical results of 676 patients with widely disseminated breast cancer treated with 5-fluorouracil (5-FU) alone or with any additional therapy over the past ten years are presented. One observes a significantly increased survival in the 23.1 percent that improved and the 23.1 percent that were unchanged compared to the 53.8 percent that had progression on 5-FU therapy. To eliminate the beneficial influence on survival as a result of any other treatment, all patients who improved or were unchanged by other therapy were deleted, leaving a “corrected” group which showed a pattern almost identical to the overall total group, correlating increased survival with 5-FU responsiveness.

Therapeutic implications from a mathematical model characterizing the course of breast cancer

Abstract: A mathematical model was developed to characterize the course of human breast cancer. A brief description of the model in nonmathematical language is given, results of a test of the model are presented, and some therapeutic implications are discussed. The model utilized observations from collaborative clinical trials to obtain estimates of several parameters that describe events in the course of the disease which are not directly observable. Results indicated that two types of breast cancer can be distinguished: 1. a slow growing form (Type B), and 2. a rapid growing form (Type A). About one‐fifth of the population were of Type A. These patients had a shorter delay time, a twofold faster tumor doubling time, and risks of nodal involvement and of occult metastases which were several times greater than in Type B. A primary implication is that in many patients, subclinical metastasis has already occurred before surgery. Indications for new approaches to therapy for clinical trials are discussed.

Cancer of the breast. Statistical and epidemiological data

Abstract: This article provides statistical and epidemiological data on breast cancer incidence mortality and end-results including material on various systems of clinical staging and trends with time in broad categories of types of treatment. Among women in the United States the breast is the leading site of cancer in both incidence and mortality. Breast cancer is the leading cause of death among 40-44 year old women and a frequent cause from ages 30 to 34. It is 100 times as frequent in women as in men. Single women have a relatively greater risk of 1.35-2.3 to 1 compared to ever-married women; infertile ever-married women have a risk of 1.15-1.6 to 1 as compared to fertile women; fertile women under age 35 have a higher rate. Women with 3 or more children have a lower rate by 1.5-2 times and women with a first pregnancy after age 25 have a double risk over those with a first pregnancy before age 20. Excess risk has been found in those less than 12 years at menarche compared with those 15 and older at menarche. Also those with 30 or more years of menstrual activity have greater risk. Those who have nursed 3 or more years have a reduced risk. Artificial menopause may reduce risk 50-60% particularly if produced before age 37. A history of cancer among mothers or sisters of patients doubles the risk and cystic disease of the breast increases the risk 2.64 times. Endocrine factors and genetic influences are considered important. The world-wide probability of breast cancer occurrance rises with advancing age but in the United States the largest number of cases occur for age groups 45-49 through 55-59. Detailed rates are given by country and by regions of the United States. Breast cancer rates have been found to be inversely related to cervical cancer rates; however cancers of the body of the uterus ovary or colon do not show this variation. Various studies give 5-yr survival rates ranging from 38% to 61-71%. In more recent years reported survival rates are increasing. Differences between the International system and the American system of classification are noted; a major difference is that tumors exceeding 5 cm diameter and with no evidence of spread are assigned to Stage 3 under the International system and to Stage 1 under the American. Pathologic information frequently modified clinical evaluation and may be a better index of prognosis. Of cases among men survival rate adjusted for age was about the same as for women; for negro men less. Among women the left breast was more frequently involved by among men it was the right. Immunochemical detection techniques earlier detection methods newer hormones ways of increasing host resistance and especially prevention are under study.

Atypical epithelial hyperplasia associated with breast cancer and fibrocystic disease.

Abstract: Sections from grossly uninvolved areas of 100 radical mastectomies for breast cancer and sections from 100 partial mastectomies or biopsies for fibrocystic disease were randomized and reviewed for specific histologic features. The patient groups (all women) ranged in age from 30-90 (mean age 61.7 from 1959-1969) in the cancer groups and from 18-81 (mean 49.8 years from 1964-1969) in the cystic group. Slides showing frank invasive carcinoma were excluded. Cystic changes inflammation or fat necrosis apocrine metaplasia sclerosing adenosis lobular hyperplasia papillomatosis and atypical epithelial hyperplasia were recorded; then slides showing atypical epithelial hyperplasia were graded according to degree extent and number of mitoses. Cystic disease was found in only 79% of cystic cases yet in 71% of cancer cases. Except for duct papillomatosis fibrocystic types of proliferative changes were more common in cystic slides. Of 42 atypical duct hyperplasias 12 cancer and 11 benign slides were rated moderate 5 cancer and 7 benign were graded marked but 7 cancer and 0 benign slides were graded borderline-precancerous. This study supported the concepts that breast cancer may develop multifocally from large duct hyperplasia.

Cancer of the breast in philadelphia hospitals 1951-1964

Abstract: 9003 patients were enrolled in a registry for cancer of the breast maintained by the Philadelphia County Medical Society from 1951 through 1964. This is an analysis of a 10 percent random sample of cases. Information on survival status was obtained for more than 95 percent and the registry encompassed about 85 percent to 90 percent of all mammary cancer cases in Philadelphia during the study periods. The yearly average was 800 of whom 600 were area residents. 90 percent of the tumors were diagnosed by the patient herself. A mass in the breast was the presenting symptom in almost all cases. Approximately 25 percent were 2 cm or less in diameter; 40 percent were localized at the time of diagnosis; 6 percent were dissemenated. Approximately 3 or 4 were treated by radical mastectomy involving removal of axillary contents and pectoralis muscles with the breast with or without postoperative radiation. Analysis of the 10 percent random sample indicates that the series resembles other large registers in average age symptomatology frequency of delay and 5-year survival. Groups showing a relatively high proportion of delay were older patients non-Caucasians men pregnant women and patients with simultaneous bilateral carcinoma. Delay was considered to have occurred if 1 month or more elapsed between the first sign or symptom and diagnosis or treatment. About 40% came to diagnosis and treatment without reported delay. Most of the delay was due to delay by patients but in a fifth of cases physician delay was noted. As the extent of delay increased 5-year survival decreased from 64% of those diagnosed promptly to 41% for those with 1 year or more of delay. In almost a fifth of cases disseminated at the time of diagnosis no apparent delay had occurred. The professional-technical group reported symptoms earlier. The overall relative 5-year survival was 63%. For stage 1 it was 83% for stage 2 it was 52% and for stage 3 it was 8%. Among patients whose stage of disease was not determined the 5-year survival rate was 50%. Size of tumor was not related to survival in stage 1 but large tumors in stage 2 had a poorer prognosis. Survival was less for women under age 35. The main determinant of survival was stage at diagnosis. However several histologic subtypes particularly the colloid intraductal and lobular carcinoma showed an advantage in 5-year-survival. Unspecified types were 88%. 473 patients were pregnant or within a 6-month postpartum period. Negro patients constituted 35.6% of these. There had been a disproportionate number of delayed diagnosed cases among them. Those in stage 1 had a similar 5-year survival rate as the whole registry but those in state 2 had a very poor survival rate 22% reaching 5 years. Enrolled were 85 patients (about 1%) with simultaneous bilateral mammary carcinomas. Their mean age was 59.5 years and their survival was poorer than the group as a whole. However half of these subjected to radical mastectomy survived 5 years. 72 men had mammary cancers. Their mean age was 64 compared with 56.1 for women. Delay in diagnosis was appreciably greater although the proportion of localized tumors was higher. Relative survival rates were similar. Major advances will depend on greater understanding of etiological factors and an ability to diagnose patients earlier. X-ray mammography xerography and thermography may lead to important advances.

Estradiol Production after Ovariectomy for Carcinoma of the Breast

Abstract: Measurements of estradiol production rates before and after castration in women with breast cancer indicated that postmenopausal ovaries made no contribution to estrogen production. A review of previous reports of estrogen measurements and of beneficial responses after ovariectomy in postmenopausal women gave little evidence to support the policy of therapeutic castration in such patients with breast cancer. Therapeutic oophorectomy without adrenalectomy is probably not justified in postmenopausal women with breast cancer.

Thermal patterns of the female breast.

Abstract: A knowledge of the thermal patterns to be expected in the normal female breast is of assistance in the identification of thermal abnormalities due to breast carcinomata. An analysis of the thermal patterns of the breasts of 442 normal women shows that there are a number of fairly well-defined pattern types which are related to the age and hormonal activity of the subject. In cases of malignant disease there is usually a general enhancement of the normal thermal pattern, due to increased blood flow in the major veins, with or without an increase in temperature over the tumour itself. The use of infrared photography is of assistance in the interpretation of thermographs of the breasts, particularly where the breasts are very vascular. Measurement of the difference between the infraclavicular temperature and the mean breast temperature is useful for following changes in the thermal pattern due to the monthly cycle, pregnancy or the contraceptive pill. Thermographs were made of 304 women with breast ...

Clinical trial of Δ1‐testololactone (NSC 23759), medroxy progesterone acetate (NSC 26386) and oxylone acetate (NSC 47438) in advanced female mammary cancer: A report of the cooperative breast cancer group

Abstract: Three hundred and nineteen women with advanced and metastatic carcinoma of the breast were treated according to the protocol of the Cooperative Breast Cancer Group with one of three compounds: Δ1‐testololactone, micronized medroxy progesterone acetate or oxylone acetate. Drugs were supplied by the Cancer Chemotherapy National Service Center. NSC 23759: 17 alpha‐oxa‐D‐homandrosta‐1, 4‐diene‐3, 17 dione; NSC 26386: Pregna‐4‐ene‐3, 20‐dione, 17‐hydroxy‐6, alpha‐methyl‐, acetate; NSC 47438: 9 alpha‐pregna‐1, 4‐diene‐3, 20‐dione, 9‐fluoro‐11 beta, 17‐dihydroxy‐6 alpha‐methyl‐, 17 acetate. The oxylone produced 19.4% objective remissions, the progesterone 9.3% and the Δ1‐testololactone, 4.9%. Women who responded to therapy with any of these drugs had a better survival experience than those who did not since 50% of the responders were dead 21 months from the start of therapy but 50% of the non‐responders were dead 6 months thereafter. Although oxylone caused a moderate degree of difficulty with steroid effects, it might be considered effective therapy for advanced mammary cancer, especially as secondary therapy.