Showing papers on "Breast cancer published in 1981"
TL;DR: From these results, mastectomy appears to involve unnecessary mutilation in patients with breast cancer of less than 2 cm and no palpable axillary lymph nodes.
Abstract: From 1973 to 1980, we carried out a controlled study at the National Cancer Institute in Milan to consider the value of a conservative procedure in patients with breast cancer of small size. We randomized 701 patients with breast cancer measuring less than 2 cm in diameter and with no palpable axillary lymph nodes to Halsted radical mastectomy or to "quadrantectomy" with axillary dissection and radiotherapy to the ipsilateral residual breast tissue. We treated 349 patients with Halsted mastectomy and 352 with quadrantectomy. The two groups were comparable in age distribution, size and site of primary tumor, menopausal status, and frequency of axillary metastases. There were three local recurrences in the Halsted group and one in the quadrantectomy group. Actuarial curves showed no difference between the two groups in disease-free or overall survival. From these results, mastectomy appears to involve unnecessary mutilation in patients with breast cancer of less than 2 cm and no palpable axillary nodes.
1,451 citations
TL;DR: It is indicated that it is necessary to administer combination chemotherapy at a full dose to achieve clinical benefit and there was a clear dose-response effect, indicating that CMF was useful only when given in a full or nearly full dose.
Abstract: We retrospectively analyzed the role of the dose level of CMF (cyclophosphamide, methotrexate, and fluorouracil) in postoperative adjuvant chemotherapy for breast cancer and in chemotherapy for metastatic breast cancer. There was a clear dose-response effect, indicating that CMF was useful only when given in a full or nearly full dose (≥85 per cent of the planned dose). Those given adjuvant therapy with 12 cycles of CMF at this dose level had a five-year relapse-free survival of 77 per cent, as compared with 45 per cent of patients treated only with radical mastectomy (P = 0.0001). In contrast, a subgroup receiving less than 65 per cent of the planned dose had a five-year survival without relapses of 48 per cent and a five-year survival with relapses of 67 per cent. These results are similar to those observed in a control group. With each dose level, the results at five years were influenced by the number of axillary lymph nodes involved but not by menopausal status. Our findings indicate that it...
729 citations
TL;DR: Three hybridomas producing monoclonal antibodies (IgG), reacting with components of the human mammary milk fat globule have been isolated and show negative reactions with fibroblasts, lymphoblastoid cells, and a large number of epithelial cell lines of non‐breast origin.
Abstract: Three hybridomas producing monoclonal antibodies (IgG), reacting with components of the human mammary milk fat globule have been isolated. When tested for binding to a wide range of human cell lines and strains, all three antibodies show negative reactions with fibroblasts, lymphoblastoid cells, and a large number of epithelial cell lines of non-breast origin. Two of the antibodies (1.10.F3 and 3.14.A3) reacted with seven out of eight breast cancer lines tested, and with epithelial cells cultured from human milk. The other antibody (3.15.C3) reacted with only two of the breast cancer cell lines.
617 citations
TL;DR: Although the therapeutic goal in intracerebral metastases is generally palliative, it appears that there are categories of cases that may benefit from more aggressive treatment.
Abstract: In order to determine the natural history and results of treatment of intracerebral metastases in solid-tumor patients, the records of 191 patients with an antemortem diagnosis of intracerebral metastasis made during the period from August 1974 to November 1978 were reviewed. Malignancies included lung (122 patients), breast (26), unknown primary (16), melanoma (8), colorectal (6), hypernephroma (4), and others (12). Favorable prognostic factors included solitary brain metastasis (P less than 0.001), ambulatory performance status (P less than 0.001), symptoms of headache (P less than 0.001), or visual disturbances (P less than 0.02), and estrogen receptor positivity in breast cancer patients (P = 0.055). Poor prognostic factors included advanced age (P less than 0.04) and evidence of impaired consciousness, i.e., disorientation, lethargy, stupor, or coma (P less than 0.007). Median survival time after diagnosis of intracerebral metastasis was 3.7 months for the entire series. In those patients with a single intracerebral metastasis and minimal tumor burden, the type of treatment used had a significant impact on survival. Those cases treated with surgery and radiation had a median survival time of 9.7 months versus 3.7 months for those treated with radiation alone (P less than 0.02). When using a proportional hazard regression analysis to adjust for the three most important prognostic factors, treatment (surgery and radiation versus radiation alone) still appeared to be important. Intracerebral metastases were the immediate or contributing cause of death in 50% of the patients in this series. Patients at greater risk of dying of intracerebral metastases included those in whom the brain was the first site of distant metastasis, those with an intracerebral metastasis from an unknown primary site, and those whose presentation of malignancy was with symptoms of a brain metastasis. Although the therapeutic goal in intracerebral metastases is generally palliative, it appears that there are categories of cases that may benefit from more aggressive treatment.
558 citations
TL;DR: No difference was found in either in the length of disease‐free or overall survival in the two series of patients, and in no subgroups was a statistically significant difference found.
Abstract: From January 1964 to January 1968, 737 patients with breast cancer were randomized at the Cancer Institute in Milan to undergo either Halsted mastectomy or Halsted mastectomy with internal mammary node dissection; 716 were considered evaluable. The series was part of an international cooperative study. The two groups of patients were comparable in age, menopausal status, quadrant distribution, and frequency of axillary metastases. No patients received postoperative radiotherapy or adjuvant treatments. At ten years, no difference was found in either in the length of disease-free or overall survival in the two series. The overall survival was 60.7% in patients treated with Halsted mastectomy and 57.0% in patients treated with Halsted mastectomy plus internal mammary dissection. In no subgroups was a statistically significant difference found. In the series treated by extended mastectomy, the incidence of internal mammary metastases was 20.5% (24.6% in cases with tumor in medial or central quadrants and 17.7% in cases with tumor in lateral quadrants). The follow-up of the patients treated by Halsted mastectomy showed that only 15 had a parasternal recurrence; the expected number was 75. In nine patients, parasternal recurrences were the first site of relapse of the disease. All of them were treated with radiotherapy, and in four a complete control was obtained.
272 citations
TL;DR: A representative sample of 4657 adults greater than or equal to 45 years of age from the 5 main ethnic groups in Hawaii were interviewed during 1977-1979 regarding their diets, and significant positive associations were found for 6 of the cancer sites.
Abstract: A representative sample of 4657 adults greater than or equal to 45 years of age from the 5 main ethnic groups in Hawaii (Caucasians, Japanese, Chinese, Filipinos and Hawaiians) were interviewed during 1977-1979 regarding their diets. Quantitative food-consumption histories were obtained, from which average daily intakes of fat (saturated, unsaturated, cholesterol, meat, dairy, fish, animal, vegetable and total), protein (animal, meat, fish, dairy and total), carbohydrate, and vitamins A and C (including supplements) were calculated using food-consumption data from standard sources. Multiple regression analysis, with sex as a controlled variable, was used to assess the statistical relationship between these ethnic-sex-specific intakes and corresponding population-based cancer incidence rates of 15 selected sites for which nutrient components are suspected to be either causal or protective. Based on pre-set criteria for establishing important relationships, significant positive associations were found for 6 of the cancer sites: breast cancer with fat (saturated, unsaturated, animal, total) and protein (animal), corpus-uteri cancer with the same components as breast cancer, prostate cancer with fat (saturated, animal) and protein (animal, total), stomach cancer with fat (fish only) and protein (fish only), lung cancer with cholesterol, and laryngeal cancer with cholesterol. Breast and corpus-uteri cancers also showed significant negative associations with carbohydrate intake. The implications of these findings for future research are discussed.
207 citations
TL;DR: In a hospital-based case-control study of the epidemiology of breast cancer undertaken in Connecticut from 1977 to 1979, there was no evidence of an increase in risk for breast cancer among women who had used oral contraceptives or estrogen-replacement therapy.
Abstract: In a hospital-based case-control study of the epidemiology of breast cancer undertaken in Connecticut from 1977 to 1979, there was no evidence of an increase in risk for breast cancer among women who had used oral contraceptives or estrogen-replacement therapy. In fact, there was some suggestion of a decrease in risk for breast cancer with increasing length of use of oral contraceptives. Higher than average risks were found among women who had never give birth to a child, women with a late age at menopause, women, with an early age at menarche, women who had given birth to their first child at a relatively late age, women with previous benign breast disease, and women with a history of breast cancer in a sister or mother. Heavy women were at high risk for premenopausal breast cancer. The association between heaviness and postmenopausal breast cancer was strongest among women who had had their last menstrual period more than 5 years before the diagnosis of breast cancer.
206 citations
TL;DR: The association of total beef and pork consumption with breast cancer was not materially affected by controlling for age at first birth, family history of breast cancer, previous benign breast biopsy or socioeconomic status, and the intake of Beef and pork reported in adult life was higher among those with a lower age at menarche or a older age at natural menopause.
Abstract: As part of a case-control study in northern Alberta, Canada, 577 women aged 30-80 with breast cancer diagnosed during 1976-77 and a population-based age-stratified random sample of 826 disease-free female controls were questioned about certain aspects of their diet. Computing relative risks (RRs) by tertiles, significant increasing trends were found with more frequent consumption of beef (RRs of 1.0, 2.3, 1.5; test for trends, p less than 0.001), pork (RRs of 1.0, 1.6, 2.2; test for trend, p less than 0.001), and sweet desserts (RRs of 1.0, 1.3, 1.5; test for trend, p = 0.01). Elevated risks were also noted for use of butter at the table and for frying with butter or margarine, as opposed to vegetable oils. The association of total beef and pork consumption with breast cancer was not materially affected by controlling for age at first birth, family history of breast cancer, previous benign breast biopsy or socioeconomic status. Nor was the association reduced by controlling for ages of menarche and menopause, even though within the control series the intake of beef and pork reported in adult life was higher among those with a lower age at menarche or a older age at natural menopause.
194 citations
TL;DR: Recurrence and survival data at 10 years were examined for 147 women with single axillary lymph node metastases found in a modified radical or standard radical mastectomy and major prognostic difference emerged after stratification by tumor size.
Abstract: Recurrence and survival data at 10 years were examined for 147 women with single axillary lymph node metastases found in a modified radical or standard radical mastectomy. The cases were identified through a review of all patients with primary operable breast cancer treated at Memorial Hospital from 1964 to 1970. The patients were stratified into groups according to size of the primary tumor and of the metastatic deposit (micro less than or equal to 2 mm; macro greater than 2 mm) as well as level of the positive node. In the entire series, there was a significantly poorer prognosis among those patients with single macrometastases (30/77 patients; 39% recurrence rate) when compared with those having micrometastases (17/70 patients: 24% recurrence rate). A major prognostic difference emerged after stratification by tumor size. Within the first six years of the follow-up period, T1 patients with negative nodes and those with single micrometastases had similar survival curves, significantly better than those with macrometastases. However, at 12 years, the survival rats of those patients with either a micro- or macrometastases was nearly identical, and significantly worse than for those patients with negative lymph nodes. On the other hand, among women with primary tumors 2.1-5.0 cm (T2), patients with negative lymph nodes or single micrometastases had survival curves that did not differ significantly throughout the course of the follow-up period. Both had an outcome significantly better than observed for patients with macrometastases. These findings have important implications for our understanding of the clinical behaviour of breast cancer and for the stratification of patients entered into randomized treatment trials.
184 citations
TL;DR: A retrospective review was undertaken of 129 patients with isolated local‐regional recurrence of breast cancer following radical or modified radical mastectomy, finding that a single recurrence, the size of the largest recurrences, and the time interval between mastectomy and recurrence (disease‐free interval) had definite prognostic significance.
Abstract: A retrospective review was undertaken of 129 patients with isolated local-regional recurrence of breast cancer following radical or modified radical mastectomy. The overall survival and disease-free survival for these patients five years from the time of local-regional recurrence was 36 and 13%, respectively. The clinical stage at initial diagnosis, the number of histologically positive nodes at mastectomy, menopausal status, and the location of the recurrence (chest wall vs. nodal) were all found to have no significant effect on survival or disease-free survival. On the other hand, the number of recurrences, the size of the largest recurrence, and the time interval between mastectomy and recurrence (disease-free interval) had definite prognostic significance. A single recurrence, the size of the largest recurrence being less than or equal to 1 cm, and a disease-free interval of longer than 24 months predicted a good prognosis; on the other hand, multiple recurrences, the size of the largest recurrence being greater than 1 cm, and a disease-free interval of less than 24 months predicted a bad prognosis. Eighty-one percent of the patients ultimately developed distant metastases; the incidence of distant metastases was the same for patients with factors predicting a good prognosis as it was for those with factors predicting a bad prognosis. The time to appearance of distant metastases, however, was significantly longer in the former group of patients than in the latter. The information from this analysis should be useful in designing future clinical trials involving patients with isolated local-regional recurrence of breast cancer.
TL;DR: Two‐hundred‐seventeen women with primary breast carcinoma had an estrogen receptor determination tested by both the dextran‐coated charcoal assay and sucrose density gradient, and the results were correlated with the disease‐free interval, survival, response to hormone therapy or chemotherapy, and site of recurrent disease.
Abstract: Two-hundred-seventeen women with primary breast carcinoma had an estrogen receptor determination tested by both the dextran-coated charcoal assay and sucrose density gradient. The results were correlated with the disease-free interval, survival, response to hormone therapy or chemotherapy, and site of recurrent disease. The disease-free interval (DFI) was significantly longer in premenopausal patients with estrogen receptor positive (ER+) determination compared with premenopausal patients with estrogen receptor negative (ER-) determinations, irrespective of nodal involvement (P less than 0.05). There was no difference between the postmenopausal patients. The survival of the ER+ patients was statistically longer than that of the ER- patients (P less than 0.05). Statistical significance remained when the patients were grouped according to menopausal status or nodal involvement (P less than 0.002 or less). Sixty-two patients were treated with hormonal therapy, either ablative or additive. Forty-eight percent of patients with ER+ responded compared with 6% of patients with ER- (P less than 0.0005). Seventy-nine patients received chemotherapy; 52% of the ER+ and 57% of the ER- patients responded (P less than 0.5). ER+ tumors had a predilection to metastasize in skin and bone, while ER- tumors metastasized more commonly to the viscera and brain.
TL;DR: Those who had practiced breast self‐examination (BSE) had earlier cancer than did those who had not practiced BSE, and the practice of BSE increased as the educational level rose and diminished as age advanced.
Abstract: In this study of 2092 women with cancer of the breast, those who had practiced breast self-examination (BSE) had earlier cancer than did those who had not practiced BSE. This was true for both black and white races, all educational and economic levels, each age group, and within each period of delay between first symptom and medical consultation. The practice of BSE increased as the educational level rose and diminished as age advanced. A higher percentage of whites than blacks used the procedure. Breast self-examination is safe and without cost to the women who practice it. It has the potential for helping more women to find their breast cancer early than any other method now available and feasible for widespread use. Cancer 47:989–995, 1981.
TL;DR: No statistically significant relationship was observed between proliferative activity of the primary tumor and risk of relapse in postmenopausal patients, and the thymidine‐3H labeling index (LI) was not generally correlated to tumor size.
Abstract: The relationship between primary tumor proliferative activity and clinical and pathologic characteristics was analyzed in relation to menopausal status for 541 breast cancer patients. The thymidine-3H labeling index (LI) showed significantly higher median values in cancers from premenopausal (4.2%) and paramenopausal (4.2%) patients in comparison to that of cancers from postmenopausal (1.8%) patients. The LI was not generally correlated to tumor size. The only significant correlation was limited to tumors with negative axillary lymph nodes from premenopausal patients. The proliferative activity of primary tumors was neither correlated to the presence nor the extension of axillary metastasis. The prognostic significance of the primary tumor LI was assessed in 145 untreated patients with cancers without axillary metastases. A higher median value of LI was observed in tumors from patients who relapsed (5.7%) within 52 months than in tumors from those who did not relapse (2%). However, the difference was statistically significant (P less than 0.01) in premenopausal patients, but not in postmenopausal patients. Similarly, a significantly (P less than 0.0005) higher rate of relapse (67.4%) was observed in patients with tumors that had a LI above the median value of 4.6% in comparison to that (0%) of tumors with a LI below the median value in premenopausal patients. No statistically significant relationship was observed between proliferative activity of the primary tumor and risk of relapse in postmenopausal patients.
Journal Article•
TL;DR: The results of present study failed to indicate that surgery per se improved the overall results including local control, over radiotherapy in a combined modality setting.
Abstract: In a prospective randomized study, the efficacy of two combined modality approaches (chemotherapy plus radiotherapy or chemotherapy plus mastectomy) was tested in a total of 132 women with locally advanced breast cancer. Chemotherapy consisted of Adriamycin plus vincristine (AV) administered for three cycles before either local-regional modality and subsequently for seven additional cycles. Although a higher proportion of women achieved complete remission after mastectomy (100%) compared to women given radiotherapy (60%), the total response rate at the end of combined modality was identical (75%). There was no significant difference between the two treatment groups in terms of patterns of treatment failure, median duration of response, and total survival. Treatment was not influenced by menopausal or estrogen receptor status. Two patients of the surgical group showed Adriamycin-induced cardiomyopathy after cumulative doses less than 500 mg/m2. The results of present study failed to indicate that surgery per se improved the overall results including local control, over radiotherapy in a combined modality setting.
TL;DR: Taped transcripts of interviews, independently rated, using a revised anger rating scale, demonstrated a significant difference between patients with benign breast disease and those with breast cancer in expression of anger, suggesting that cancer patients are more stressed by impending biopsy.
TL;DR: To investigate the nature of the association of involuntarily delayed first birth and risk of breast cancer, 1083 white women who had been evaluated and treated for infertility from 1945-1965 were followed prospectively through April 1978 to ascertain their breast cancer incidence.
Abstract: In order to investigate the nature of the association of involuntarily delayed first birth and risk of breast cancer, 1083 white women who had been evaluated and treated for infertility from 1945-1965 were followed prospectively through April 1978 to ascertain their breast cancer incidence. These women were categorized as to the cause of infertility into two groups, those with endogenous progesterone deficiency (PD) and those with nonhormonal causes (NH). Women in the PD group had 5.4 times the risk of premenopausal breast cancer compared to women in the NH group. This excess risk could not be explained by differences between the two groups in ages at menarche or menopause, history of oral contraceptive use, history of benign breast disease or age at first birth. Women in the PD group also experienced a 10-fold increase in deaths from all malignant neoplasms compared to the NH group. The incidence of postmenopausal breast cancer did not differ significantly between the two groups.
TL;DR: The data suggest that menarchesal and menopausal age may have a common relationship to nutritional status and to constitutional features that predate the onset of menarche and persist into later life.
Abstract: Early menarche and late menopause are risk factors for the development of breast cancer. An adequate hormonal mechanism for those observations has not been described. Because obesity has also been associated with increased breast cancer risk, we examined the relationship among height, weight, adiposity, and menstrual cycle characteristics in women who prospectively recorded menstrual cycle intervals and reproductive events as part of the Menstrual and Reproductive History Research Program. Within this study cohort, adult height, weight, and a derived index of adiposity were related to both earlier age at menarche and later age at menopause. The association of early age at menarche with adiposity persisted from age 18 yr through middle age and into the menopausal years. There was no relationship between body mass and age at first pregnancy, another breast cancer risk factor. Women who were heavier at 18 yr of age and thereafter gained 5 lb or more had significantly greater mean menstrual cycle length and variability during the 7-yr period after menarche than the other members of the cohort. There was no obvious relationship between weight indices and menstrual cycle pattern during mature reproductive life or during the 7 yr before menopause. Our data suggest that menarcheal and menopausal age may have a common relationship to nutritional status and to constitutional features that predate the onset of menarche and persist into later life.
TL;DR: In this paper, a detailed analysis of failures occurring in the patients treated with radiotherapy, with or without surgery, showed that most of the failures were because of inadequate doses of irradiation, the use of fields that were too small, and the lack of elective irradiation to the chest wall and supraclavicular fossa.
Abstract: Obe hundred fifty-seven patients with local-regional recurrence of breast cancer but without co-existing distant metastases were reviewed. The incidence of failure to control the local-regional recurrence was essentially the same whether the recurrence was treated with radiotherapy alone (62% ), surgery alone (76% ), or with a combination of the two (60 % ). A detailed analysis of the failures occurring in the patients treated with radiotherapy, with or without surgery, showed that most of the failures were because of a) inadequate doses of irradiation, b) the use of fields that were too small, and c) the lack of elective irradiation to the chest wall and supraclavicular fossa. Of the 100 patients with uncontrolled local-regional disease, 62% developed clinical symptoms that markedly impaired the quality of life. All of these symptoms were directly caused by the uncontrolled local-regional disease. Specific recommendations for the treatment of isolated local-regional recurrence are made.
TL;DR: No advantage was demonstrated for treating brain metastases patients with favorable prognoses with more than one week of whole‐brain irradiation with higher doses, andalyses of neurologic function control rates failed to show a significant benefit of higher doses.
Abstract: Five whole-brain irradiation schedules ranging from 2000 rad in one week to 4000 rad in four weeks were evaluated in 1830 patients with cerebral metastases treated in two randomized studies by the Radiation Therapy Oncology Group. The duration of palliative effectiveness among those patients with favorable survival prognosis was investigated. Favorable subgroups were identified consisting of 123 ambulatory breast cancer patients with no soft tissue metastases, 373 ambulatory lung cancer patients with primary absent or no extracerebral metastases, and 65 ambulatory patients with other primaries and no extracerebral metastases. This group of 561 patients had a median survival of 28 weeks compared with 11 weeks for the remaining patients. Analyses of neurologic function control rates failed to show a significant benefit of higher doses. No advantage was demonstrated for treating brain metastases patients with favorable prognoses with more than one week of whole-brain irradiation.
TL;DR: The regular practice of BSE was associated with a one‐third reduction in the likelihood of diagnosis of disease with positive nodes, which translated to a 10% decline in five‐year mortality for whites and a 17% decline for nonwhites.
Abstract: Data from 996 newly diagnosed breast cancer patients indicated a highly significant association (P less than 0.001) between periodic breast self-examination (BSE) and pathologic stage of disease. Among women reporting periodic BSE, only small differences were noted between those who practiced monthly and those who practiced several times annually. Average maximum tumor diameter and frequency of tumors 4 cm or large were significantly greater (P less than 0.01) among women who rarely or never practiced BSE. The relationship between the periodic practice of BSE and the diagnosis of breast cancer before nodal involvement was present even after controlling for a wide variety of variables. The regular practice of BSE was associated with a one-third reduction in the likelihood of diagnosis of disease with positive nodes. This difference translated to a 10% decline in five-year mortality for whites and a 17% decline for nonwhites.
Journal Article•
TL;DR: It is suggested that lesions which are composed 90% or more of tubular carcinoma may be treated by simple mastectomy, and that axillary dissection is not necessary, and for all carcinomas with a lower proportion of Tubular elements, at least total mastectomy and axillarydissection are indicated, although the safest treatment probably is radical mastectomy.
Abstract: One hundred tubular carcinomas were reviewed, analyzed and compared with previously reported studies in the literature. Our cases were subdivided into five groups, according to the proportion of the carcinoma which was tubular. In the case of pure or almost pure tubular carcinomas (76% or more), tumor size was small, no metastases were found, no recurrences developed, and there were no deaths attributable to the carcinoma. As the proportion of the carcinoma which was tubular decreased, the size and biologic aggressiveness of the tumor increased; this it is likely that tubular carcinoma may represent an early form of carcinoma. A right-sided preponderance was found of the "pure tubular" carcinomas; and lesions of the central sector of the breast were rare in all five groups. The incidence of bilateral cancer was greater than that expected for breast cancer in general and included three patients with bilateral tubular carcinomas. On the basis of our findings, we suggest that lesions which are composed 90% or more of tubular carcinoma may be treated by simple mastectomy, and that axillary dissection is not necessary. For all carcinomas with a lower proportion of tubular elements, at least total mastectomy and axillary dissection are indicated, although the safest treatment probably is radical mastectomy.
TL;DR: In this article, an immunoassay based on monoclonal antibodies to human estrophilin was proposed to provide a simple, inexpensive procedure for the routine analysis of breast cancer specimens.
Abstract: Quantitative determination of the estrogen receptor (estrophilin) content of an excised tumor specimen provides information useful in selecting the type of systemic therapy best suited to the individual patient with advanced breast cancer. Women whose tumors contain low or negligible amounts of estrophilin rarely respond to endocrine ablation or other hormone therapy, whereas most but not all patients with receptor-rich cancers receive benefit from endocrine treatment. Properly interpreted, estrophilin assay predicts hormone dependency correctly in 85 to 90 percent of the cases. Analysis of the primary tumor at the time of mastectomy not only serves as a guide to subsequent therapy if metastases should appear but it also provides a clue to the probability and rapidity of recurrence. Because present methods for receptor determination have certain limitations, we are developing an immunoassay, based on monoclonal antibodies to human estrophilin, that promises to provide a simple, inexpensive procedure for the routine analysis of breast cancer specimens.
TL;DR: The hypothesis that long-term use of CE is associated with increased breast cancer risk is supported by the examination of the records of women with newly diagnosed breast cancer and healthy controls belonging to a prepaid health plan.
Abstract: The relationship between conjugated estrogen(s) (CE) and breast cancer was investigated by the examination of the records of 345 women with newly diagnosed breast cancer and 611 healthy controls belonging to a prepaid health plan. Use of CE was associated with a 40% elevation in risk [relative risk (RR) = 1.4; 95% confidence interval-1.0-2.0]. The RR was 1.3 for menopausal women with intact ovaries and 1.5 for those with ovaries removed. There was statistically significant evidence of a dose-response relationship with the three measures of dose evaluated. RR's rose to about twofold for women with 10 or more CE prescriptions noted in their charts, for those with 5 years or more between their first and last prescription, and for those with a usual daily dose of 1.25 mg or more. The RR associated with having ever used CE and with long-term use was highest among those women with a family history of breast cancer. These data support the hypothesis that long-term use of CE is associated with increased breast cancer risk.
TL;DR: The relationship between risk factors for breast cancer incidence and the subsequent prognosis of breast cancer among patients in a randomized controlled trial of adjuvant ovarian ablation was examined in this paper.
Abstract: We have examined the relationship between risk factors for breast cancer incidence and the subsequent prognosis of breast cancer among patients in a randomized controlled trial of adjuvant ovarian ablation. Body weight was the only risk factor found to be associated with statistically significant differences in survival. This finding could not be explained by a disproportionate number of anatomically more advanced tumors in the heavier women. In premenopausal women aged 45 years or more, the only group to benefit from adjuvant ovarian ablation, there was an interaction of treatment and weight, suggesting that weight exerts its influence on prognosis by a hormonal mechanism. The prognostic effect of weight was generally most marked in patients with tumors whose prognostic characteristics were favorable, and in these patients weight loss as an adjuvant treatment may reduce the frequency of disease recurrence.
TL;DR: Estrogen receptor protein (ERP) determinations of primary cancers of 1034 patients with primary breast cancer were done and ERP‐positive patients tended to have a lower recurrence rate and had significantly improved survival.
Abstract: To assess the value of estrogen receptor protein (ERP) as a predictor of tumor recurrence, 556 patients treated by mastectomy between 1973 and 1978 for primary operable breast cancer had ERP determination of their tumors. All patients had histologically negative nodes. Two hundred fifty-six patients were ERP-positive, 233 were ERP-negative, and 67 were ERP-borderline. ERP-borderline patients showed recurrence and survival figures similar to ERP-negative patients and were grouped with them in the analysis. With a median follow-up of 75 months, overall survival for the entire group at 72 months was 93% with a disease-free survival of 85%. No difference in either overall survival or DFS was noted between the ERP-positive (94% and 83%, respectively) and ERP-negative (91% and 86%, respectively) groups. The incidence of recurrence in premenopausal women was 12% (14/115) in the ERP-negative patients versus 17% (9/48) among the ERP-positive patients. This contradicts the current impression that ERP-negative, premenopausal patients have a poorer prognosis than ERP-positive patients. Postmenopausal patients had a 16% recurrence in both ERP-negative (27/171) and ERP-positive (31/202) categories. On the basis of 6-year median follow-up, it was concluded that ERP status is not an indicator of recurrence. In particular, patients with negative nodes should not be considered for adjuvant chemotherapy on the basis of negative estrogen receptor status of their primary tumors.
TL;DR: It is recommended that carcinoma found in an axillary node should be treated as a breast cancer, even in the absence of the breast tumor, despite whether the primary tumors were discovered.
Abstract: Twenty-nine cases were reviewed in which carcinoma manifested first as the enlargement of an axillary node from an occult breast carcinoma. A small hidden breast cancer was identified in 16 patients. In the remaining 13, the breast tumor was never discovered. Regardless of whether the primary tumors were discovered, the metastasis-free survival rates were comparable to those of patients with breast carcinoma with axillary nodal metastasis. The authors recommend that carcinoma found in an axillary node should be treated as a breast cancer, even in the absence of the breast tumor. Extensive investigative procedures in an attempt to uncover an extramammary primary site were largely unproductive and should either be omitted or performed selectively. Mammography, if positive or suspicious, can lead to the primary tumor in 75% of the patients, but, when negative, it does not necessarily exclude the breast as the source of the carcinoma. A carcinoma of the breast was found by pathologic examination in 44% of the patients with negative mammograms.
TL;DR: Analysis of disease‐free survival rates in 374 women with operable breast cancer revealed that preoperative weight, particularly in combination with serum cholesterol, is a significant prognostic determinant.
Abstract: Analysis of disease-free survival rates in 374 women with operable breast cancer revealed that preoperative weight, particularly in combination with serum cholesterol, is a significant prognostic determinant. Overall, women weighing under 150 pounds had a significantly higher cumulative five-year disease-free survival rate (67%) compared with women weighing more (49%) (z = 2.2298, P = 0.026). Women with low serum cholesterol levels had better cumulative five-year disease-free survival (67%) than women with high serum cholesterol levels (58%) (z = 1.1008, P = 0.27). The combination of high weight and high serum cholesterol levels was associated with an extremely poor cumulative five-year disease-free survival (32%) compared with that observed for women in whom values of either, or both, variables were low (68%) (z = 3.7843, P = 0.0004). These patterns in disease-free survival persisted even after controlling for tumor stage. The findings indicate that weight and cholesterol, in addition to their previously reported effect on the risk of breast cancer development, influence significantly the subsequent course of the disease.
TL;DR: Aggressive, comprehensive radiation therapy is indicated for locally recurrent breast cancer, and Comprehensive radiation therapy enhanced the local control rate for the entire group and the survival probability for patients with isolated chest wall recurrence compared with limited radiation therapy fields.
Abstract: One hundred twenty-one patients with local or regional recurrence of carcinoma of the breast without evidence of distant metastases were treated with megavoltage radiation therapy. All patients had radical or modified radical mastectomy as their initial treatment. The 10 year survival probability of this group of patients is 26%, with a local control probability of 46%. Within this group of patients with recurrent disease, factors found to be associated with a poorer prognosis include peripheral nodal recurrence, advanced initial disease stage and short disease free interval. Contrary to expectation, patients with recurrence within the mastectomy scar (as opposed to chest wall recurrence wide of the scar) or a history of previous radiotherapy had poorer local control rates (although not statistically significant), without effect upon overall survival. Comprehensive radiation therapy (peripheral lymphatic plus chest wall) enhanced the local control rate for the entire group and the survival probability for patients with isolated chest wall recurrence compared with limited radiation therapy fields. (Five year survival probability: chest wall irradiation only = 27%; chest wall and peripheral lymphatic = 54%). Patients given systemic therapy at the time of local recurrence showed no survival benefit. Aggressive, comprehensive radiation therapy is indicated for locally recurrent breast cancer. More effective systemic therapy is needed, especially for higher risk patients.