Showing papers on "Breast cancer published in 1978"

Estrogen Control of Progesterone Receptor in Human Breast Cancer: Role of Estradiol and Antiestrogen*

Abstract: Estrogen antagonists are widely used in the treatment of breast cancer, and studies of their mechanism of action may provide clues to an understanding of tumor growth regulation and mechanisms ofnormal estrogen action. We have used human breastcancer cells in long term culture as an in vitro model tostudy the roles of estradiol and the antiestrogens, tamoxifenand nafoxidine, on cell growth and progesteronereceptor (PgR) induction.

The Relation between Estrogen Receptors and Response Rate to Cytotoxic Chemotherapy in Metastatic Breast Cancer

Abstract: In a retrospective study we determined the relation between estrogen receptors and the response rate to cytotoxic chemotherapy in 70 patients with metastatic breast cancer. Thirty-four of 45 patients with low or absent estrogen-receptor values (less than 10 fmol per milligram of cytoplasmic protein) had objective responses to chemotherapy, whereas only three of 25 patients with higher values (greater than 10 fmol per milligram of cytoplasmic protein) responded (P less than 0.0001). There were no statistically significant differences between the two groups in age, menopausal status, disease-free interval, Karnofsky index or prior therapy. Differences in sites of involvement or type of chemotherapy did not account for the increased response rate in receptor-negative patients. We conclude that estrogen-receptor values are an important predictor of response to cytotoxic chemotherapy in metastatic breast cancer.

Combined chemotherapy-radiotherapy approach in locally advanced (T3b-T4) breast cancer.

Abstract: Combined treatment modality was applied in 110 consecutive women with primary inoperable (T3b-T4) Breast cancer. Treatment was started with four cycles of adriamycin plus vincristine (AV). This was followed in responders by high-energy radiotherapy (RT). At the end of combined therapy, patients in complete remission (CR) were randomized to either no further treatment or six more cycles of chemotherapy. AV induced objective response in 89% of patients (complete 15.5%, partial 54.5%, improvement 19%). At the end of RT, 81% of 98 (82.7%) patients responding to AV were classified in CR. The median duration of CR was 15 months. The median free interval was statistically prolonged by additional chemotherapy. The three-year survival was 52.8%. Altogether, present findings indicate that combined treatment modality has improved the three-year survival compared to the previous series treated with radiotherapy alone. However, to achieve a satisfactory control of T3b-T4 breast cancer a more aggressive and prolonged treatment is required.

Conservative management of operable breast cancer: ten years experience at the Foundation Curie.

Abstract: 514 patients were treated for a surgically operable (T1, T2, T3, N0, N1a, N1b) infiltrating breast carcinoma at the Foundation Curie, Paris, France, from 1960 to 1970 inclusive. Patients with tumors 3 cm or less and without axillary adenopathy had lumpectomy followed by radiotherapy. Patients with larger tumors and all patients with clinically significant lymph nodes (N1b) had exclusive radiotherapy (without lumpectomy). 120 had lumpectomy and 394 had exclusive radiotherapy. The five and ten years absolute survivals, free of disease (N.E.D.), for the lumpectomy group are 85% and 75%, respectively. 12% had secondary surgery for local recurrence. The cosmetic results were satisfactory in 98%, with no severe radiation sequelae. The five and ten years, N.E.D., of the exclusive radiotherapy group are 68% and 43%. 55% had secondary surgery for persistent or recurrent disease. The cosmetic results were satisfactory in 85%. There were only three patients with severe radiation sequelae. The overall survival for 514 patients at five and ten years are 72% and 51%. Two-thirds of patients, alive at five years, had a preserved breast. Our conservative treatment resulted in survival at five and ten years comparable to those of radical surgery. Cancer 42:2045–2053, 1978.

Breast self-examination practices and breast-cancer stage.

Abstract: To determine the relation between breast self-examination performance and the clinical and pathological stage of breast cancer at first diagnosis, we studied 335 patients with breast cancer. Approximately one fourth of the patients reported that they had been practicing monthly breast self-examination, and half that they had never practiced breast self-examination. More frequent performance of breast self-examination was associated with more favorable clinical stage and fewer axillary-lymph-node metastases on histologic examination. On pathological examination, the age-adjusted maximum tumor diameter of patients practicing monthly breast self-examination was 1.97±0.22 cm (mean ± S.E.M.) as compared to 2.47±0.20 for those performing selfexamination less often than monthly and 3.59±0.15 for patients never performing breast self-examination. These data associating more favorable clinical and pathological stages of breast cancer with more frequent breast self-examination need to be extended by determ...

Relation Between Component Parts of Fibrocystic Disease Complex and Breast Cancer

Abstract: Specimens of benign breast disease obtained from biopsies performed at Vanderbilt Hospital (Nashville, Tenn.) between 1952 and 1959 were histologically reviewed and characterized as to individual component types of fibrocystic disease. Follow-up for information regarding breast cancer development was 94% successful. Carcinoma developed more often when epithelial proliferative lesions were present. Atypical lobular hyperplasia had a greater predictive value than other epithelial lesions and was associated with an elevated risk six times that expected prior to the age of 45 years and a tripling of risk after the age of 45 years. Various ductal hyperplastic lesions are associated with approximately a doubly increased risk that is present only if the lesions are identified at biopsy after the age of 45 years. Women with cysts, sclerosing adenosis, fibrosis, and other nonhyperplastic changes were at no greater risk for subsequent carcinoma than women in the general population.

Detection and significance of occult axillary node metastases in patients with invasive breast cancer

Abstract: Blocks of axillary lymph nodes from 78 patients with invasive breast cancer, which after “routine”pathological examination were regarded as negative for metastases, were step-sectioned at 20 u intervals. Occult metastases were detected in 24% of the cases. A significant association between such metastases and a lack of or slight degree of an intraductal carcinomatous component of the dominant cancer was noted. There was no relationship between occult metastases and 15 other histopathological and 3 clinical features investigated, including an average 5 year survival rate. Similarly there was no correlation between any of the possible discriminants investigated in the 24% of patients who have died of their diseases or are living with recurrence regardless of the presence of occult metastases. Factors accounting for the lack of universal survival in patients with Stage I (and those with occult metastases that might be designated as Stage 1 1/2) remain enigmatic. It is concluded that attempts to detect occult metastases by extending histopathological methods may be more academic than practical or therapeutically significant. Cancer 42:2025–2031, 1978.

Direct resorption of bone by human breast cancer cells in vitro

Abstract: OSTEOLYTIC bone metastases occur frequency in patients with advanced malignancy. Breast cancer, the most common malignant disease of women, metastasises to bone more frequently than to any other organ1, and over 80% of patients with advanced breast cancer develop bone metastases2–4. The cellular and molecular mechanisms of bone destruction in patients with cancer are not clearly understood. It has been postulated that there may be two mechanisms, one which is mediated by osteoclasts and one which occurs independently of osteoclasts5,6. We show here that cultured human breast cancer cells have the capacity to resorb directly in vitro, independently of osteoclast stimulation.

A study of diet and breast cancer.

Abstract: A case-control study has been conducted in four areas in Canada in which 400 cases of breast cancer matched by age and marital status with neighborhood controls were administered a medical and dietary history questionnaire, a 24-hour recall for dietary information and a four-day diet record. The Study has produced evidence of an association between an increased intake of nutrients, especially total fat, in both pre-menopausal and post-menopausal women with breast cancer. Reasons why a weak association might have been anticipated are discussed, and it is concluded that in reality the association is stronger. Furthermore, its consistency with other evidence, both experimental and international, suggests that it is causal.

Mental disorders in cancer patients: a study of 100 psychiatric referrals.

Abstract: Records of 100 consecutive hospitalized cancer patients referred for psychiatric consultation were reviewed. These patients constituted only 5% of those seen by the Psychiatry Consultation Service during the study period. Fifty-six percent of the referred patients were diagnosed as depressed and 40% as having organic brain disease. Twenty-six of the 100 patients were misdiagnosed by the referring physician as depressed but were classified by the staff psychiatrist as suffering from organic brain syndrome. When referral was studied by primary site of cancer, only patients with breast cancer were referred at a significantly higher than expected rate (p less than .001). The importance of the mental status examination as a routine procedure in all cancer patients is stressed so that an organic brain syndrome will not be missed. Suggestions for patient management are given.

Surgical adjuvant chemotherapy: results with one short course with cyclophosphamide after mastectomy for breast cancer.

Abstract: One single six-day course with cyclophosphamide (total dose 30 mg/kg) was given immediately after mastectomy to 507 breast cancer patients, with 519 randomized controls receiving no adjuvant chemotherapy. The control group now has 234 recurrences and 196 deaths, and the treatment group 175 recurrences and 146 deaths. The differences of 59 recurrences and 50 deaths in favour of the treatment group are significant with p values less than 0.001 and less than 0.01 respectively. The differences in recurrence rates increased gradually, reached 10.71% four years after mastectomy (p less than 0.001), and remained at the same level for another 6 years. The differences in death rates increased until 6 years after mastectomy, and was 10.48% after 10 years. With this pattern, the mechanism is probably not a delay in onset of clinical recurrences, but a definite reduction of recurrence rates due to tumoricidal chemotherapy. Prognostic factors or menstrual state had apparently no influence on the effect of this type of adjuvant chemotherapy. Side effects were of short duration and very moderate. Since there was a good effect in the prognostically most favourable groups of patients, treatment of such cases seems therefore also justified. The same chemotherapy course given 3 weeks after mastectomy seemed without effect.

Estimated Effect of Breast Self-Examination and Routine Physician Examinations on Breast-Cancer Mortality

Abstract: We examined the effects of breast self- examination and breast examination by physicians on the stage of breast cancer at diagnosis. Clinical and pathological-staging information was compared to interview data on method of initial detection for 293 women. Tumors were detected in clinical Stage I 53.8 per cent of the time when the detection method was routine physician examination, 37.7 per cent when it was self-examination and only 27.0 per cent when detection was accidental. Sixty-nine per cent of women practicing self-examination at the time of diagnosis discovered their tumor by this method. Differences were less apparent when pathological stage was considered. Tumors found during routine examination of the breast averaged 6.1 mm smaller in diameter than those discovered accidentally. We estimate that breast-cancer mortality might be reduced by 18.8 per cent to 24.4 per cent through self-examination or routine physician examination, respectively. (N Engl J Med 299:271–273, 1978)

Estrogen Receptors and Responses to Chemotherapy and Hormonal Therapy in Advanced Breast Cancer

Abstract: To determine the correlation between the estrogen-receptor status and responses to chemotherapy or hormonal therapy, we retrospectively analyzed the clinical data of 143 patients with advanced breast cancer. Receptor contents were determined by a sucrose-gradient method and designated arbitrarily as "rich" or "poor." The response rate to chemotherapy was significantly higher in receptor-rich tumors (86 per cent) than in receptor-poor tumors (36 per cent) (P<0.001). Patients with receptor-rich tumors also responded favorably to hormonal therapy. However, there was no correlation between the responses to hormonal therapy and to chemotherapy when they were used sequentially, a phenomenon that may be attributed to the changes in tumor receptor content during the clinical course. These data suggest that separate factors associated with the response to chemotherapy may coexist with estrogen receptors in breast cancer. (N Engl J Med 299:1330–1334, 1978)

Steroid Receptors in Human Breast Cancer

Abstract: The measurement of cytoplasmic estrogen receptor in tumors from patients with breast cancer is now well established Potential uses include prognosis of early recurrence following mastectomy, stratifying patients for adjuvant therapies, and selecting or rejecting endocrine therapy in advanced breast cancer The use of progesterone receptor measurements to improve our selection process has a good theoretical basis, and early reports now emerging indicate that the presence of both estrogen and progesterone receptor in a breast tumor predicts a high response rate to endocrine therapy Further work in this area is required, however, since patients with estrogen receptor but not progesterone receptor still have an appreciable response rate

An epidemiologic study of breast cancer

Abstract: A case-control study has been conducted in four areas of Canada in which 400 cases of breast cancer matched by age and marital status with neighborhood controls were administered medical and dietary questionnaires. The study is suggestive of an increased risk of breast cancer in post-menopausal women with younger age at menarche and an increased risk with delay of age at natural menopause. No protective effect of early age at first pregnancy was demonstrated in either pre- or post-menopausal women. An increased frequency of pregnancies of four months duration or less was found in cases compared to controls and a greater frequency in pre-menopausal cases compared to controls of a history of irregular menstrual periods. In pre-menopausal women no association has been found between increased height and weight as risk factors for breast cancer. For post-menopausal women, however, a weak association with increased height has been found, while a strong association with increased weight both at the time of menopause and the 12 months preceding diagnosis has ben confirmed.

Gowden's disease. A cutaneous marker of breast cancer

Abstract: Cowden's disease features facial trichilemmomas (a benign tumor of follicular epithelium), acral keratoses on the limbs, and oral mucosal papillomas and fibromas; it may also involve thyroid, gastrointestinal tract, ovaries, uterus, and breasts. Among 32 known cases of Cowden's disease, 21 are women, in 10 of whom breast cancer has already developed (bilateral in 4). The 11 women in whom breast cancer has not yet developed have fibroadenomas, fibrocystic disease, virginal hypertrophy of the breasts, and malformations of nipples and areolae. Their median age is only 36 years. Two have mothers with breast cancer and in one both mother and maternal grandmother had breast cancer. Dermatologic lesions, including pathognomonic multiple facial trichilemmomas, precede the development of malignancy and can identify women with a high risk of developing breast cancer.

Male breast cancer: a clinicopathologic study of 97 cases.

Abstract: From 1949 through 1976, 97 men have been treated at Memorial Hospital for primary operable breast cancer. Seven per cent had intraductal carcinoma. Of the patients with invasive carcinoma 30% were pathologic stage I, 54% stage II, and 16% stage III. Fourty-six per cent had pathologically negative axillary lymph nodes. The most common type of tumor was infiltrating duct carcinoma. Fourty per cent of the patients had microscopic gynecomastia. None of the eight patients with intraductal or intracystic carcinoma died of cancer. Survival of the entire group of men with invasive carcinoma was 40% after ten years. The ten year survival for men with negative nodes was 79%, for men with positive nodes 11%. Comparison with a series of 304 women with breast cancer operated on at Memorial Hospital in 1960 revealed no difference with regard to incidence of positive axillary lymph nodes or stage of disease. There was, however, a significantly lower survival rate for men. This poorer prognosis was limited to those men with pathologically positive axillary nodes.

Meningeal carcinomatosis in breast cancer.

Abstract: Twenty-five breast cancer patients with meningeal carcinomatosis seen over a period of 16 months were reviewed. In all cases, the clinical diagnosis was made in the presence of diverse neurological manifestations by the demonstration of malignant cells in the cerebrospinal fluid. In ten patients, the clinical diagnosis was documented at autopsy. All patients were receiving systemic chemotherapy at the time the diagnosis of meningeal carcinomatosis was made. In 9 of the 25 patients, meningeal involvement was associated with progression of systemic metastases, while 5 exhibited stable or partial remission from systemic metastases and 7 were in complete remission at the time of their CNS relapse. CNS involvement was the first manifestation of recurrent disease from breast cancer in 4 of 25 patients. Meningeal involvement can, therefore, occur at any time during the course of breast cancer. With increasing diagnostic awareness and the employment of several therapeutic strategies, the prognosis of these patients, though poor, was significantly improved over that of historical control patients.

The association of body weight with recurrent cancer of the breast

Abstract: 962 women who underwent surgery for breast cancer were divided according to body weight which was correlated to the recurrence of the cancer. The tendency for cancer to recur increased with body weight. Women under 65 kg had a significantly better prognosis than those over 65 kg (P < .005). The influence of body weight on later recurrence of cancer was particularly apparent in women without axillary lymph node metastases but was not evident in women who already had metastases at the time of the breast operation.

The Epidemiology of Breast Cancer in 785 United States Caucasian Women

Abstract: A retrospective case-control hospital study of 785 Caucasian breast cancer patients and 2,231 age-stratified controls was conducted in New York City from 1969-1975. Patients were grouped by pre- peri- and postmenopausal status at diagnosis for the analysis to make a distinctive separation for variables showing a pre- and postmenopausal differential. Demographic characteristics were similar for cases and controls. Previously recorded hormone-related risk variables for this disease were largely confirmed for pre- and perimenopausal women, i.e., late age at first birth (greater than 25), premenstrual symptoms of breast swelling and premenopausal chills and flushes. Mother's history of breast cancer was also found to be a risk variable. Nulliparity was a risk factor only perimenopausally. No risk was foun for absolute height, weight or for obesity (Quetelet Index), prior breast diseases or previous usage of exogenous hormones of any type and no "protective" effect was found for multiparous women and for nursing. Perimenopausally diagnosed patients (menopause to 10 years after) were similar to premenopausally diagnosed women on most risk factors. Risk variables determined by this and other case-control studies cannot account for the magnitude of differences in the international incidence of breast cancer.

Familial association of breast/ovarian carcinoma

Abstract: Twelve pedigrees which show clustering of breast/ovarian cancer among female relatives are analyzed from a medical-genetic standpoint. The significant linear decline in estimates of cumulative breast/ovarian cancer risk to females with diminishing genetic relationship to probands and index cases, plus the lack of excessive site-specific cancer risk to male relatives, supports a sex-limited genetic etiology. Breast/ovarian cancer typically occurred at an early age (x = 50.6 years) in these kindreds compared to the general population, which is another characteristic of hereditary cancer. Examples of apparent mother to daughter and father to daughter genetic transmission of proclivity for breast/ovarian carcinoma were prevalent in the 12 pedigrees. Excluding probands and index cases, the estimated cumulative risk of breast/ovarian cancer to female progeny of affected mothers was 46% for the age interval 20–80 years, suggesting that affected mothers in the pedigrees are transmitting a deleterious cancer-predisposing gene to one-half of their daughters. Eight sibships involving putative carrier males contain a total of 15 female progeny over age 20. Of these, six have manifested breast cancer and five have had ovarian cancer. These results underscore the need for physicians to be cognizant of both males and females as potential transmitters of cancer in this familial tumor association.

Estrogen Receptor Assay in Primary Breast Cancer and Early Recurrence of the Disease

Abstract: Estrogen receptor assays of primary breast tumors have been related to early recurrence of the disease. A significantly longer disease-free interval was found in women whose primary tumor was estrogen receptor positive. Although there was no relationship of receptor content to stage of disease at mastectomy, the greatest difference between recurrence rates was found when the tumor had spread to the lymph nodes, especially to those in the apex of the axilla or in the internal mammary chain. Presence of estrogen receptor is closely related to histologically well-differentiated tumors, but it was found that poorly differentiated estrogen receptor-negative tumors recurred earlier than poorly differentiated receptor-positive tumors and had a very unfavorable prognosis.

Tamoxifen: a review of its pharmacological properties and therapeutic use in the treatment of breast cancer.

Abstract: Synopsis: Tamoxifen1 is a triphenylethylene oestrogen antagonist which has partial oestrogen agonist activity in some species. Most therapeutic trials with tamoxifen have involved postmenopausal women with advanced breast cancer, about 25 to 60% of patients showing some improvement while receiving treatment (usually 20 or 40mg daily); however, poorly defined assessment criteria in some studies make it difficult to compare the results of different authors. 7 to 18% of patients have had complete clinical remissions lasting for a few months to several years.

Hormones in breast cancer: update 1978.

Abstract: The role of cytoplasmic estrogen receptor (ER) assays in determining therapeutic strategies for advanced breast cancer is certainly well established. The use of ER assays in the primary breast tumor specimen to predict for early recurrence and ultimate survival is a new finding, however, and will probably be employed in future trials of adjuvant therapy. The prevalence and significance of nuclear-bound ER still requires additional clarification. Our previous suggestion that progesterone receptor measurements might be a useful marker for hormone dependence in advanced breast cancer is gaining support and may soon have a place in routine therapeutic decision-making. The emphasis on early adjuvant therapy has hastened the search for a safe endocrine therapy that would have good patient compliance and achieve remission rates comparable to previous agents and procedures. Antiestrogens show promise of meeting these requirements. We are now beginning an era in which primary and secondary systemic therapies for breast cancer can be based on sound biologic principles. The empirical approach is out-dated.

Incidence rates and risk factors of benign breast neoplasms

Abstract: A case-control study of benign breast disease was conducted in Greater Boston in 1968-1969. Cases were nearly all women living in the reference population who were initially diagnosed as having fibrocystic disease, fibroadenoma or a "mixed" lesion during the study period. Controls were a random sample of the entire reference population. A mail questionnaire was completed for 678 cases and for 1807 controls. For fibrocystic disease the age-standardized incidence rate was 89.4 per 100,000 woman-years; for fibroadenoma it was 32.8. Fibrocystic disease rises in incidence to age 45 and then declines sharply. The incidence rate of fibroadenoma peaks during the 20's, while that of mixed tumors has a mode at 30 to 34. Among young women, the highest rates occur in married nulliparae, but this is not so at higher ages. Neither for fibroadenoma nor fibrocystic disease was there a consistent relationship of risk with parity or with age at first birth. Fibrocystic disease risk was strongly and directly related to age at natural menopause, directly but not strongly related to an index of socioeconomic status, and was increased among women who gave a history of arthritis. Both fibrocystic disease and fibroadenoma were much less frequent in more obese women. Neither fibrocystic disease nor fibroadenoma has an epidemiologic pattern which corresponds closely to that of breast cancer. Therefore, it seems reasonable to suggest that the apparent increased risk of breast cancer among women with benign breast disease is concentrated within a subset of these women.