Showing papers on "Breast cancer published in 1983"
TL;DR: A quantitative description of ‘breast tissue age’ is suggested which brings the age–incidence curve of breast cancer into line with the common log–log cancers and explains quantitatively the known key risk factors.
Abstract: For most cancer sites there is a linear log-log relationship between incidence and age. This relationship does not hold for breast cancer, and certain 'key' breast cancer risk factors suggest that breast tissue does not 'age' in step with calendar time. A quantitative description of 'breast tissue age' is suggested which brings the age-incidence curve of breast cancer into line with the common log-log cancers and explains quantitatively the known key risk factors. The model also explains the 'anomalous' finding that although early first birth is protective, late first birth carries a higher risk than nulliparity. US breast cancer rates are some four to six times the rates in Japan--the model suggests that the key risk factors, when considered jointly with weight, can explain about 85% of the difference.
676 citations
TL;DR: Although the data came from different institutions and spanned over 35 years (1943–1977), the findings regarding metastatic involvement of specific organs are fairly similar.
Abstract: Breast cancer is known to metastasize to all organs of the human body, and its manifestations are protean. It is almost impossible to predict which organ system will be invaded. Since 1950, there are seven autopsy series of patients with breast carcinoma published in the English literature. All data came from American hospitals (total of 2,147 patients), and each report studied more than 100 patients with breast cancer. The reported incidence of involvement of different organ sites are presented in Table I. Although the data came from different institutions and spanned over 35 years (1943-1977), the findings regarding metastatic involvement of specific organs are fairly similar.
374 citations
TL;DR: Immediate reconstruction reduced the psychiatric morbidity assessed 3 months after operation, predominantly in women with unsatisfactory marriages, and women who underwent reconstruction had more freedom of dress and were less likely to be repulsed by their own naked appearance than women who did not undergo reconstruction.
373 citations
TL;DR: Use of combination-type OCs with a "low" progestogen component appears to increase breast-cancer risk little or not at all.
316 citations
TL;DR: Risk was lower among post menopausal women than among premenopausal women of the same age and increased with increasing age at menopause; bilateral oophorectomy reduced the risk more than hysterectomy alone.
Abstract: Since 1976, data were collected to evaluate risk factors for breast cancer in a hospital-based case-control study of 1185 women with breast cancer and 3227 controls. The risk of breast cancer increased with increasing age at first birth; this effect was not accounted for by parity. An early age at first birth appeared to reduce the risk relative to no pregnancy, whereas a late age at first birth was associated with a higher risk than not having a full-term pregnancy. High parity was associated with a reduction in the risk that was independent of that of age at first birth: for parity ≧5, compared with parity 1-2, the relative risk estimate was 0.7 (95% confidence Interval, 0.5-1.0). Late age at menarche was associated with a lower risk among premenopausal women but not among postmenopausal women. The relative risk decreased with increasing obesity among premenopausal women. Among postmenopausal women, the risk was higher among those who were obese, but there was no evidence of a trend with increasing body mass index. Risk did not vary materially according to history of abortion when gravidity was controlled. Risk was lower among postmenopausal women than among premenopausal women of the same age and increased with increasing age at menopause; bilateral oophorectomy reduced the risk more than hysterectomy alone. A positive history of benign breast disease, a positive family history of breast cancer, Jewish religion, and 12 or more years of education were each independently associated with an increased risk of breast cancer.
301 citations
TL;DR: Multivariate analyses support the conclusion that, while nodes and ER exert strong prognostic influences in both PF- and PFT-treated patients, the PR content of tumors is a stronger predictor of the effectiveness of PFT therapy than is ER content.
Abstract: In 1977 the National Surgical Adjuvant Breast and Bowel Project initiated a prospectively randomized clinical trial for women with primary operable breast cancer and positive axillary nodes. In this study 1891 patients were randomized to receive L-phenylalanine mustard and 5-fluorouracil (PF) either with or without tamoxifen (T). In this interim report findings are presented concerning disease-free survival (DFS) and survival as related to age and to estrogen receptor (ER) and/or progesterone receptor (PR) content of the tumor. The median follow-up time is 3 yr. Patients 50 yr of age or older with either 1-3 or more than 3 positive axillary nodes had a markedly longer disease-free survival on PFT than did those receiving PF adjuvant therapy (p less than 0.001). The effectiveness of PFT was related to the levels of tumor receptors. Patients 50 yr old or more with both tumor ER and PR levels of 10 fmole or more ("high") displayed the greatest benefit in disease-free survival from PFT (p = 0.004). Analyses b...
260 citations
TL;DR: An immunocytochemical method was used to screen smears obtained at primary surgery from multiple bone-marrow sites in 110 patients with breast cancer, finding patients in whom conventional criteria indicated a very poor prognosis seemed more likely to have micrometastases.
256 citations
TL;DR: There is no difference in survival or in relapse‐free survival between the two groups, but there were significantly more local recurrences in the group without internal mammary dissection, and there is therefore a difference in the prognostic value of the number of nodes invaded.
Abstract: A multicentric randomized trial evaluated the interest of internal mammary dissection on operable breast cancer patients. One thousand four hundred and fifty-three patients were included in the study and were followed for ten years. There is no difference in survival or in relapse-free survival between the two groups. There were significantly more local recurrences in the group without internal mammary dissection, but these recurrences occurred mainly on patients who developed metastases. A great difference between centers was observed in the number of nodes examined and there is therefore a difference in the prognostic value of the number of nodes invaded.
230 citations
TL;DR: Assessment of reproductive data from 4,225 women with breast cancer and 12,307 hospitalized women without breast cancer found that the age of approximately 35 years represents for every birth a critical point; before this age any full‐term pregnancy confers some degree of protection; after this ageany full-term pregnancy appears to be associated with increase in breast cancer risk.
Abstract: In an effort to assess the relative importance of age at first birth, age at subsequent births, and total parity to the occurrence of breast cancer, reproductive data from 4,225 women with breast cancer and 12,307 hospitalized women without breast cancer were analyzed by a multiple logistic regression model. Age at first birth was confirmed to be the most important reproductive risk indicator; it was associated with a 3.5 % increase of relative risk for every year of increase in age at first birth (the 95 % confidence interval of this estimate was 2.3 to 4.7 % increase per year). However, age at any birth after the first was also an independent and statistically significant risk indicator; it was associated with a 0.9% increase of relative risk for every year of increase in age at any (and every) birth (the 95 % confidence interval of this estimate was 0.4 to 1.5 % increase per year). There is evidence that the age of approximately 35 years represents for every birth a critical point; before this age any full-term pregnancy confers some degree of protection; after this age any full-term pregnancy appears to be associated with increase in breast cancer risk. The effect of parity is determined by the age of occurrence of the component pregnancies. While most pregnancies occur under the age of 35, the distribution varies from population to population, and this may account for the differences between populations in whether or not a protective effect is seen for births after the first, and if it is seen, its extent.
213 citations
TL;DR: Using the entire sample, stage of cancer at diagnosis was the best predictor of survival, however, when women aged 46-60 were eliminated from the analysis, stress and social involvement accounted for twice as much variance in survival as stage.
203 citations
TL;DR: As regards the risk of internal mammary nodes involvement, it appears that knowing the age, the size, and the axillary nodes status, it is possible to calculate with good approximation the probability of their invasion.
Abstract: The risk of internal mammary chain metastases according to some parameters and its prognostic relevance was evaluated on the basis of the experience collected at the National Cancer Institute of Milan where, from January 1965 to December 1980, 1085 patients were submitted to Halsted mastectomy plus internal mammary chain dissection. A multivariate analysis was carried out, resorting to a multiple linear regression with logistic transformation of the dependent variable. The selection of prognostic factors has been performed with a step-down approach. The frequency of metastases to internal mammary chain nodes was evaluated according to four criteria: age, site and size of primary tumor, and presence of axillary metastases. Data of this series indicate that the frequency of internal mammary node metastases is significantly associated with the age of the patients (younger patients have a higher risk) (p = 0.006) with the size of primary tumor (p = 0.006) with the presence of axillary node metastases (p = 10(-9). Patients with both axillary and internal mammary positive nodes have a very poor prognosis (10-year survival 37.3%) while patients with either axillary metastases only or internal mammary metastases only have an intermediate less grave prognosis (59.6% and 62.4%, respectively). As regards the risk of internal mammary nodes involvement, it appears that knowing the age, the size, and the axillary nodes status, it is possible to calculate with good approximation the probability of their invasion.
TL;DR: The high loco-regional control and good cosmesis supports the use of excisional biopsy and radiation therapy in patients with Stages I and II breast carcinoma.
Abstract: Between May, 1973 and December, 1980, 78 Stage I and 11 breast carcinomas in 76 patients were treated by biopsy and radiotherapy with curative intent. With a maximum follow-up of 10 years, a minimum of 212 years and a median follow-up of 3'/z years, a loco-regional control rate of 97% was obtained. Cosmetic results and treatment complications were studied. Patient characteristics, tumor size, excisional biopsy technique, axillary staging procedure and radiotherapy techniques were analyzed and all found to be important factors affecting cosmesis and complications. The most common complications included transient breast edema observed in 51 % of patients, breast fibrosis (usually mild) seen in 23 % of the population, axillary hematoma or seroma formation in 15 %, mild arm edema in 14% and basilic vein thrombosis in 10% of patients. The causes of these and other less frequent complications are discussed. The overall cosmetic result was excellent in 78%, satisfactory in 18% and unsatisfactory in 4 % of patients. Recommendations for improving cosmetic results and minimizing complications are made. In our prospective trial, the high loco-regional control and good cosmesis supports the use of excisional biopsy and radiation therapy in patients with Stages I and 11 breast carcinoma.
TL;DR: The mammographic findings in 16 new cases revealed a spectrum of changes that included solitary or multiple lesions, well demarcated or poorly marginated masses, and diffuse involvement of skin or parenchyma or both.
Abstract: Metastases to the breast are uncommon, with about 250 cases reported from clinical and autopsy series. The mammographic findings in 16 new cases revealed a spectrum of changes that included solitary or multiple lesions, well demarcated or poorly marginated masses, and diffuse involvement of skin or parenchyma or both. Diffuse disease was seen more frequently in this series (4/16), at times simulating inflammatory breast cancer. Although diagnosis of a primary malignancy usually preceded detection of the breast lesion, 40% (6/16) had no history of malignancy. Prognosis remains poor; however, it has improved in the lymphoma-leukemia group due to improved immunotherapeutic and chemotherapeutic regimens. The clinical, radiologic, and pathologic features are discussed. Some of the lesions encountered can be confused with a primary breast malignancy or a benign lesion, necessitating prompt and accurate biopsy to preclude unnecessary major surgery and to improve survival in cancers amenable to current therapy.
TL;DR: Age at first livebirth explained most associations, but some residual reduction in risk was noted for multiparous women and those with several births at an early age, and delays in birth after marriage increased risk, but this did not explain the high risk associated with late age at first birth.
Abstract: An interview study of 1,362 breast cancer cases and 1,250 controls identified through a multi-centre screening project allowed an evaluation of reproductive determinants of breast cancer. Risk increased linearly with age at first livebirth; women with a birth after age 30 showed 4-5-fold excess risks compared to those with a birth prior to 18, while the risk for nulliparous women resembled that for women whose first birth was in their late twenties. The protection conferred by an early first pregnancy prevailed for pregnancies that ended in a livebirth or stillbirth, but not for those that terminated in other outcomes. Among parous women, a first trimester abortion prior to a livebirth was not associated with an elevated risk, except in the event of multiple miscarriages (RR = 2.2, 95% Cl 0.9-5.1). Although numbers were limited, women who reported an induced abortion in the absence of ever having a livebirth showed some elevation in risk. Age at first livebirth explained most associations, but some residual reduction in risk was noted for multiparous women and those with several births at an early age. There was evidence that delays in birth after marriage increased risk, but this did not explain the high risk associated with late age at first birth.
Journal Article•
TL;DR: The data indicate that estrogen therapy for postmenopausal women does not increase the risk of breast cancer and may afford some protection, and added progestogen to post menopausal estrogen therapy significantly decreases the risk for this malignancy.
TL;DR: Pathologic and statistical evidence suggests that in most cases of breast or lung cancer pure leptomeningeal carcinomatosis is the result of cancer propagation from vertebral or paravertebral metastases, and in cases where deep CNS parenchymal metastases are present lepto-cancers follows cancer metastasis via the arterial route.
Abstract: This study determines the main routes by which cancer cells reach the pia-arachnoid in leptomeningeal carcinomatosis. Twenty-eight autopsy proven cases of pure carcinomatosis of the leptomeninges were reviewed and the collected data were compared to data derived from control groups of cases with lung or breast cancer, with and without central nervous system (CNS) parenchymal metastases. Pathologic and statistical evidence suggests that in most cases of breast or lung cancer pure leptomeningeal carcinomatosis is the result of cancer propagation from vertebral or paravertebral metastases; in most cases of primary gastrointestinal cancer metastasis to the leptomeninges takes place via perineural spaces; and in cases where deep CNS parenchymal metastases are present leptomeningeal carcinomatosis follows cancer metastasis via the arterial route. Direct spread of a primary cancer in proximity to the CNS accounts for a small proportion of cases of cancerous invasion of the pia-arachnoid. It is not certain if metastasis can take place via the choroid plexus or meningeal arteries.
TL;DR: During 1968-1980, 1176 women aged 16-50 years with newly diagnosed breast cancer and a like number of matched controls were interviewed at 9 teaching hospitals in London and Oxford and asked about their use of oral contraceptives.
Abstract: During 1968-1980, 1176 women aged 16-50 years with newly diagnosed breast cancer and a like number of matched controls were interviewed at 9 teaching hospitals in London and Oxford and asked about their use of oral contraceptives. The results were reassuring. A few statistically significant differences in oral contraceptive use were found between the breast cancer and control groups, but the data were subdivided in many ways so that some "significant" differences would have been expected through the play of chance alone. Certainly no patterns of risk emerged which would suggest that any of the associations were causal. It must be stressed, however, that the data are still sparse in some important subcategories--for example, only small numbers of both cases and controls had prolonged oral contraceptive use before their first term pregnancy. For this reason, it is important that information on the possible relationship between pill use and breast cancer should continue to be collected. Women who had never used oral contraceptives presented with appreciably more advanced tumours than those who had been using oral contraceptives during the year before detection of cancer, while past users were in an intermediate position. These differences in staging were reflected in the pattern of survival. Possible explanations for these observations include "surveillance bias" among oral contraceptive users leading to earlier diagnosis and a beneficial biological effect of oral contraceptives on tumour growth and spread. Women with breast cancer reported never having used any method of contraception and heavy cigarette smoking (greater than or equal to 15 per day) significantly less often than controls. We could find no obvious explanation for the former observation, but suspect that the latter reflects the unrepresentative smoking habits of our hospital controls rather than a protective effect of smoking against breast cancer.
Journal Article•
TL;DR: It is apparent that receptor status provides useful prognostic information in patients with early breast cancer and that ER and PR assays used in combination identify a subgroup of node-negative patients with poor prognosis who are likely to benefit from adjuvant therapy following mastectomy.
Abstract: Estrogen receptor (ER) and progesterone receptor (PR) levels have been measured in 374 tumors from patients with primary breast cancer and compared with axillary nodal status and other patient variables to determine their relationship to prognosis. Nodal status reliably predicted disease-free interval and overall survival, and both ER and PR status predicted overall survival both individually and within node-positive and node-negative subgroups. PR but not ER status was also able to predict disease-free survival both overall and in the node-positive subgroup. When the two receptor measurements were used in combination, a group of receptor-negative, (ER- and PR-negative), node-negative patients were identified with a significantly worse survival than that for an ER- and PR-positive group of node-positive patients. It is apparent that receptor status provides useful prognostic information in patients with early breast cancer and that ER and PR assays used in combination identify a subgroup of node-negative patients with poor prognosis who are likely to benefit from adjuvant therapy following mastectomy.
TL;DR: The prediction of individual outcome is a valuable capability in the comparison of clinical trials and the continuing evaluation of biologic changes in patients with metastatic carcinoma; such a method is described in this paper.
Abstract: Univariate and multivariate analyses were conducted on data collected from the records of 619 patients with metastatic breast cancer in whom an Adriamycin-containing chemotherapeutic regimen was used. Using a forward, stepwise logistic regression procedure, several models or equations in which a small number of pretreatment factors were incorporated were generated and the probability of response to therapy was accurately predicted. The predictive ability of these models was tested retrospectively in 546 of the 619 patients from whom the data were derived and prospectively in a new population of 200 patients with metastatic breast cancer also treated with a therapeutically equivalent Adriamycin combination. Using similar univariate techniques, pretreatment factors were correlated with the length of survival after therapy. The proportional hazard model of Cox was used to develop a regression model relating survival to pretreatment characteristics in much the same manner as that of the response model. The total population of the initial group of patients was divided according to four levels of hazard ratio, and survival distributions were compared. This model also was tested progressively and its predictive capability was confirmed. The prediction of individual outcome is a valuable capability in the comparison of clinical trials and the continuing evaluation of biologic changes in patients with metastatic carcinoma; such a method is described in this paper.
TL;DR: It is suggested that radiologists who wish to improve the cancer-detecting ability of their current breast imaging operation should upgrade their mammography to state-of-the-art status before adding an automated whole-breast ultrasound scanner.
Abstract: This prospective study, involving 1,000 women referred for routine mammography, compares the breast cancer detecting abilities of state-of-the-art mammography and sonography using an automated water-path scanner. Mammography was found to be the superior technique, detecting 62 (97%) of the 64 pathologically proven cancers, while sonography detected only 37 (58%). When considering those cancers most amenable to cure, mammography detected over 90% in all categories, but sonography detected only 48% of the cancers that had not yet spread to axillary lymph nodes, only 30% of the nonpalpable malignancies, and only 8% of the cancers smaller than 1 cm. These data indicate that sonography is not an acceptable substitute for mammography in the detection and diagnosis of breast cancer. The data further suggest that radiologists who wish to improve the cancer-detecting ability of their current breast imaging operation should upgrade their mammography to state-of-the-art status before adding an automated whole-breast...
TL;DR: The best approach to gestational breast cancer continues to be the team approach, with consultation from specialists in obstetrics, surgical oncology, anesthesiology, nuclear medicine, radiology, radiation oncOLOGY, pathology, and medical oncologists.
TL;DR: Relatives of premenopausal patients with bilateral disease had higher risk than relatives of patients with unilateral disease, irrespective of age at diagnosis in those with unilateral Disease.
TL;DR: High-dose dexamethasone therapy has useful application in alleviating the emetic effects of cancer chemotherapy.
Abstract: To assess the value of high-dose dexamethasone therapy in preventing the gastrointestinal (GI) side effects of chemotherapy, a randomized double-blind study was conducted in women receiving outpatient therapy for breast cancer. Single-dose dexamethasone sodium phosphate (10 mg) or placebo was administered intravenously in 57 trials in 22 women immediately before chemotherapy. Questionnaires (administered before therapy and 24 hours later) were compared for evidence of nausea, vomiting, and anorexia produced by chemotherapy. No GI intolerance to chemotherapy was noted in 24 (83%) of the 29 dexamethasone trials v 16 (57%) of the 28 placebo trials. Dexamethasone trials produced the following results: no side effects in 50% (14/29), insomnia the night after chemotherapy in 21% (6/29), an increase in energy levels in 24% (7/29), and an improvement in mood in 14% (4/29). High-dose dexamethasone therapy has useful application in alleviating the emetic effects of cancer chemotherapy.
TL;DR: Tissue prostaglandin content and production by human breast cancers were measured in 24 human mammary carcinoma specimens and results obtained may provide clues as to what direction future larger studies could take in the search for reliable prognostic indicators for breast cancer.
Abstract: Tissue prostaglandin (PG) content and production by human breast cancers were measured in 24 human mammary carcinoma specimens. The 5 compounds studied were PGE1, PGE2, PGF2 alpha, 6-keto-PGF1 alpha, and TXB2. The tissue content of all 5 compounds was higher in neoplastic tissue in comparison with the paired noncancerous breast tissue. However, microsomal PG synthetase activity in vitro in noncancerous and neoplastic breast tissue was comparable. Increased thromboxane formation was associated with three clinical variables--tumour size, axillary lymph node metastases and distant metastasis. A lesion negative for either oestrogen or progesterone receptor content tended to produce more TXB2 but lower PGE2 and 6-keto-PGF1 alpha. Results obtained in this pilot study may provide clues as to what direction future larger studies could take in the search for reliable prognostic indicators for breast cancer.
TL;DR: Patients treated for primary breast cancer as part of a prospective randomized clinical trial were questioned retrospectively as to their psychosocial adaptation to treatment, and there were no marked psychossocial differences detected between these groups.
Abstract: Thirty-eight patients treated for primary breast cancer as part of a prospective randomized clinical trial were questioned retrospectively as to their psychosocial adaptation to treatment. Twenty patients had received mastectomy and eighteen had received excisional biopsy plus radiation of the intact breast. Aside from body image concerns, there were no marked psychosocial differences detected between these groups. Previous studies emphasizing serious psychological problems in mastectomy patients and fewer such problems in nonmastectomy patients may be influenced by biases that are not present in a randomized study design.
TL;DR: It is suggested that most of the preinvasive cancers, without mammographically significant calcifications, are, and some of the invasive cancers situated in dense breasts may be, mammographically occult.
Abstract: Fifteen mammographically occult breast cancers, 3 of which were preinvasive and 12 invasive, and 52 breast cancers, which presented only microcalcifications mammographically without an associated tumor shadow (33 preinvasive and 19 invasive), were reviewed pathologically and radiologically. This study suggests that most of the preinvasive cancers, without mammographically significant calcifications, are, and some of the invasive cancers situated in dense breasts may be, mammographically occult. The mean diameter of the five mammographically occult invasive ductal carcinomas and the five invasive lobular carcinomas was 20 mm and 50 mm, respectively. Histologic characteristics, which may explain why invasive lobular carcinomas could be occult mammographically, even in an advanced stage, include a diffuse invasive pattern and, frequently, a poor desmoplastic reaction in contrast to the invasive ductal carcinomas. The implications of mammographically occult cancers on management of symptomatic and asymptomatic patients are discussed.
TL;DR: The data do not indicate an overall pattern of relative risks consistent with an effect on long-term second breast cancer risk of radiation exposure to the opposite breast incurred during adjunctive radiation therapy for a first breast cancer.
Abstract: Second breast cancer experience was examined for 27,175 primary breast cancer patients diagnosed in the State of Connecticut during 1935-75 with follow-up for second breast cancers through 1980. The overall ratio of observed to expected second breast cancers was 3.2. Relative risk was found to be inversely related to age at diagnosis and directly related to stage of the first breast cancer. The overall risk of second breast cancers was 711 per 100,000 person-years at risk. Risk of second breast cancers showed a similar relationship to age and stage as relative risk and was also directly related to calendar period of diagnosis of the first breast cancer. Some interactions were observed because patients less than 45 years old at diagnosis with positive nodes had elevated risks and relative risks in the early followup period, whereas less of an effect of stage on relative risk and risk was seen for older patients. The effect of the use of adjunctive radiation therapy on second breast cancer risk was also assessed by the ratio of the risk of second breast cancers for those patients who received both surgery and radiation to the risk of those patients who only received surgery being estimated for patients diagnosed during 1935-59 and for patients diagnosed during 1960-75. For both cohorts relative risks of 1.2-1.4 were found for the 5-year period immediately following diagnosis, likely resulting from the uncontrolled effect of stage in the analysis. Elevated long-term relative risks were not found for patients diagnosed during 1935-59. A long-term marginally statistically significant relative risk of 1.4 (greater than or equal to 10 yr after diagnosis) was found for patients diagnosed during 1960-75. The data do not indicate an overall pattern of relative risks consistent with an effect on long-term second breast cancer risk of radiation exposure to the opposite breast incurred during adjunctive radiation therapy for a first breast cancer.
TL;DR: An arbitrary delay of two years before recommending breast reconstruction to avoid masking local recurrence seems unjustified for pathologic Stage I patients.
Abstract: Sixty patients who had ipsilateral chest wall recurrence of breast cancer and no detectable distant metastases were evaluated retrospectively to determine the implications of chest wall recurrence as the first site of therapeutic failure. Mean time intervals between treatment of the primary breast cancer and discovery of local recurrence, between treatment of local recurrence and distant metastases, and between treatment of local recurrence and death in order and, respectively, in years for pathologic Stages I, II, and III patients were 6.2, 4.3 and 2.1; 4.2, 3.5, and 1.2; and 7.2, 6.0, and 2.5. Surgical resection resulted in the best local control. All patients eventually died of metastatic breast cancer, one as late as 23 years after treatment of the local recurrence. No Stage I patients recurred before two years. An arbitrary delay of two years before recommending breast reconstruction to avoid masking local recurrence seems unjustified for pathologic Stage I patients.
Journal Article•
TL;DR: It is concluded that, given similar concentrations of estradiol in plasma of normal and breast cancer subjects, the significant increase found in the unboundEstradiol fraction may result in a very small increment in tissue exposure to estrogens in breast cancer Subjects, however, even such a small increase in tissue Exposure to estradio may be significant, given the length of time required for breast tumor development.
Abstract: To investigate the possibility of increased tissue exposure to estrogen in breast cancer patients, plasma levels of estrogens and the percentage of unbound estradiol were measured in postmenopausal women with benign or malignant breast disease and compared with levels in normal postmenopausal women. The percentage of unbound estradiol in breast cancer patients [1.85 +/- 0.35% (S.D.)] was significantly higher (p less than 0.001) than in normal postmenopausal women [1.52 +/- 0.33%] and was still significantly higher when patients were matched with control subjects for weight (p less than 0.001) or ideal body weight (p less than 0.001). The binding capacity of sex hormone binding globulin was similar in both groups of women. No significant differences in the plasma levels of estrone, estradiol, or estrone sulfate were detected between breast cancer and normal subjects. It is concluded that, given similar concentrations of estradiol in plasma of normal and breast cancer subjects, the significant increase found in the unbound estradiol fraction may result in a very small increment in tissue exposure to estrogens in breast cancer subjects. However, even such a small increase in tissue exposure to estradiol may be significant, given the length of time required for breast tumor development.
TL;DR: All efforts should be directed towards minimizing complications and maximizing cosmesis without sacrificing relapse-free survival in patients receiving primary radiotherapy and adjuvant chemotherapy for early breast cancer.
Abstract: From 1978 to 1981, 46 patients received primary radiotherapy following excisional biopsy and axillary staging procedure for Stages 1 and II carcinoma of the breast. The patients were divided into 2 groups: 27 patients who received radiation and completed 12 cycles of adjuvant chemotherapy (CMF or CMFP) and 19 patients who received radiation alone. All patients received radiation to the breast and regional nodes (4600–5000 rod) and a boost to the site of the primary tumor (1500–2000 rod). Median follow-up from completion of radiation was 26 months in the non-adjuvant and 241 months in the adjuvant group with a range of 12 to 49 months. Cosmesis was judged to be good to excellent in 89 % ( 17 19 ) of the patients receiving radiation alone and 81 % ( 22 27 ) of the patients receiving adjuvant chemotherapy. Fair to poor cosmesis in the adjuvant group was attributed primarily to increased fibrosis and reduction of breast size. The single complication for which there was an increased incidence in the adjuvant group was arm edema (22 vs. 0% ). The incidence of arm edema was unrelated to T stage, type of axillary surgical procedure, number of positive nodes, addition of prednisone or sequencing of chemotherapy. Further efforts should be directed towards minimizing; complications and maximizing cosmesis without sacrificing relapse-free survival in patients receiving primary radiotherapy and adjuvant chemotherapy for early breast cancer.