Abstract P3-06-20: The correlation between body mass index (BMI) and breast cancer in both premenopausal and menopausal women in Okinawa

Introduction

Much of the longevity advantage in Okinawa is thought to be related to a healthy lifestyle including traditional foods which is low in calories and dense in nutrition. However, dietary change since World War II has been largely deleterious, with younger Okinawan people developing a higher risk of obesity and other chronic disease risk factors than older Okinawan people. In addition, breast cancer incidence and mortality are gradually increasing in Okinawa. Therefore we examined the correlation between BMI and breast cancer in both premenopausal and postmenopausal women in Okinawa.

Methods

The cases were 3422 female breast cancer patients without any previous breast cancer history, and the control subjects were 5622 women, who initially visited Nahanishi Clinic Okinawa in Okinawa, Japan, between May 1996 and March 2013. The median ages were 53 years old (21-99) in the breast cancer group and 44 years old (18-90) in the control group. Based on the World Health Organization classification, 25≤BMI<30 is considered as overweight and 30≤BMI as obesity. We examined the association between BMI and breast cancer risk by odds ratio. In addition, we also stratified and examined the BMI according to menstruation and age by student t test.

Results

Table.1 summarized the results of the association between BMI and breast cancer risk.

Association between BMI and breast cancer risk. CancerControlP ValueOdds[95%CI]All patients34225622  Overweght10201028p<0.0011.89 [1.72-2.10]Obesity285253p<0.0011.93[1.62-2.30]Overweight+Obesity13051281p<0.0012.09[1.90-2.29]Premenopausal    Overweight146498p = 0.0021.37[1.12-1.67]Obesity44141p = 0.0641.41[0.99-1.99]Overweight+Obesity190639p<0.0011.42[1.18-1.70]Postmenopausal    Overweight618527p<0.0011.59[1.38-1.83]Obesity179112p<0.0011.96[1.54-2.51]

Being overweight, or obese, increased the odds of breast cancer, as well as these put together, in the postmenopausal group (p<0.001, respectively). As for the premenopausal group, being overweight and also overweight grouped with obese increased the odds of breast cancer significantly (p = 0.002 and p<0.001, respectively) and a tendency was detected in the obese (p = 0.064). Table.2 summarized the results of BMI according to menstruation and age.

BMI according to menstruation and age CancerControlp valueTotal24.3±4.122.7±3.8p<0.001Premenopausal22.9±3.922.1±3.7p<0.001Postmenopausal25.4±4.123.9±3.7p<0.001Year<3021.1±0.520.7±0.1p = 0.53930≤year<4022.5±3.921.7±3.6p<0.00140≤year<5023.2±3.822.7±3.5p<0.00150≤year<6024.6±0.123.7±6.1p<0.00160≤year<7025.5±3.924.5±3.8p<0.00170≤25.7±4.224.7±3.5p<0.001

The BMI of the breast cancer group were statistically higher than that of the control group in those over 30 years old, and in the pre and post menopausal (p<0.001, respectively).

Conclusion

The results of this study suggested that weight gain and consequently being overweight or obese might increase the odds for breast cancer in both premenopausal and postmenopausal women ages over 30 years old in Okinawa.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-20.

Abstract P2-12-07: The correlation between Myriad Genetic Laboratories, Inc. mutation prevalence table and clinicopathological characteristics of breast cancer patients in Okinawa

Introduction

The two major susceptibility genes for breast cancer and ovarian cancer, BRCA1 andBRCA2 were discovered in 1994 and 1995, respectively. Various risk prediction algorithms and models have been developed to identify putative BRCA1/2 mutation carriers. Myriad Genetic Laboratories, Inc. released Mutation Prevalence Tables (http://www.myriad.com/lib/brac/brca-prevalence-tables.pdf#search = ‘Myriad+Genetic+Laboratories%2C+Inc.+Mutation+Prevalence+Table’) through its clinical testingservice. To the best of our knowledge, this is the first study to examine the correlation between this risk prediction model and clinicopathological characteristics of breast cancer patients.

Methods

The cases were 148 female breast cancer patients without any previous breast cancer history who initially visited Nahanishi Clinic Okinawa in Okinawa, Japan, between May 2012 and March 2013. The median ages were 55 years old (26-84). We examined the correlation between Myriad Genetic Laboratories, Inc. released Mutation Prevalence Tables and clinicopathological characteristics including age, ER, PgR, HER2, triple negative status, histological grade and Ki67. The presence of ER and PgR was determined by nuclear staining with positive cases defined as more than 1% staining according to ASCO CAP. With regard to HER2 evaluation, membranous staining was graded as 0-1+, 2+, and 3+. Samples scored as 2+ were subjected to FISH. Positivity was defined as a HER2:CEP17 signal ratio>2.2. Ki-67 labeling index was obtained by selecting the hot spots after evaluation at low power magnification and counting 1000 tumor cells in the hotspots.

Results

There was statistically negative correlation between the risk prediction rates and age (r = -0.480, r2 = 0.230, p<0.001). The risk prediction rates of ER negative and positive were 2.93±4.12% and 4.06±9.53% with statistically significant differences (p = 0.049).On the other hand, tendency was detected in PgR status (p = 0.058), and the risk prediction rates were 3.21±1.92% of PgR negative and 4.24±3.34% of PgR positive, respectively. The risk prediction rates of triple negative cases and non triple negative cased were 2.58±0.94% and 4.06±3.11% with statistically significant differences (p<0.001). There were not statistically significant differences in HER2 status, histological grade and Ki67, respectively.

Conclusion

Previous studies demonstrated that BRCA1/2 mutation was associated with triple negative and high grade malignant breast cancer. However, the results of this study suggested that Myriad Genetic Laboratories, Inc. released Mutation Prevalence Tables was not associated with triple negative and/or high risk breast cancer patients in Okinawa.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-12-07.

Abstract P2-03-02: A non-invasive modality the US virtual touch tissue quantification (VTTQ) for evaluation of breast cancer

Introduction

Acoustic radiation force impulse (ARFI) imaging is a newly developed ultrasound-based modality which could evaluate the wave propagation speed and tissue stiffness more precisely and objectively. ARFI does not require any external compression, and so even in deep tissues could, provide complementary information to conventional ultrasound (US), potentially improving the characterization of tissue and focal lesions. The generated waves can provide quantification of the shear wave velocity, termed Virtual Touch Tissue Quantification (VTTQ). VTTQ is an intrinsic and reproducible property of the tissue, and this tissue quantification could provide objective and reproducible data. This is the first study to evaluate the biological features of breast tissues using newly developed non-invasive diagnostic system VTTQ.

Methods

180 patients including 115 invasive ductal carcinoma (IDC), 30 ductal carcinoma in situ (DCIS), 4 mucinous carcinoma, 7 invasive lobular carcinoma (ILC), 8 fibroadenoma (FA), 12 fibrocystic change (FCC) and 4 intraductal papilloma were studied at Nahanishi Clinic Okinawa. We first compared results of VTTQ according to each histological subtype, and determined the optimal cutoff values for VTTQ to distinguish benign from malignant tissues using the receiver operating characteristic (ROC) method. In addition, we also examined the correlation between VTTQ velocities and Ki-67, estrogen receptor (ER), progesterone receptor (PgR) or human epidermal growth factor receptor 2 (HER2) in the cases of IDC using the linear regression analyses and Student's t test.

Results

There were statistically significant differences of VTTQ velocities between IDC and DCIS (P = 0.003), mucinous carcinoma (P = 0.009), FA (P<0.001), papilloma (P<0.001) or FCC (P<0.001). There were significant differences between DCIS and FA (P = 0.016), papilloma (P<0.001) or FCC (P<0.001). Significant differences were also detected between mucinous carcinoma and papilloma (P<0.001) or FCC (P = 0.003), between ILC and papilloma (P = 0.012) or FCC (P = 0.003) and between FA and papilloma (P = 0.030). VTTQ velocities were statistically higher in malignant cases than in benign cases (p<0.05, respectively) and the best cutoff value for the VTTQ velocity which could differentiate benign from malignant cases was 2.89 m/second. There were statistically significant correlations between VTTQ velocity and Ki-67 labeling index (r = 0.338, r2 = 0.114 and P<0.001), and significant inverse correlations between VTTQ and ER (r = -0.311, r2 = 0.097 and P<0.001) or PgR (r = -0.361, r2 = 0.131 and P<0.001) status of IDC. There was also a significant differences of the average velocities between HER2 positive (6.39±1.44 m/second) and negative (4.43±1.41 m/second) cases (P<0.001).

Conclusion

VTTQ was valuable for examination of breast cancer pathology in a non-invasive fashion. The results still could suggest the value of VTTQ examination in the clinical management of breast cancer patients. VTTQ has huge potential for examining axillary lymph node status instead of sentinel lymph node biopsy, and examining the responsiveness of neoadjuvant chemotherapy in midcourse evaluation without invasive biopsy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-03-02.

Abstract P6-05-14: Estrogen-induced genes in ductal carcinoma in situ(DCIS): their comparison with invasive ductal carcinoma

It is well known that estrogens play important roles in both the pathogenesis and development of invasive ductal carcinoma (IDC) of human breast. However, molecular features of estrogen actions have remained largely unclear in pure ductal carcinoma in situ (pDCIS), regarded as a precursor lesion of many IDCs. This is partly due to the fact that gene expression profiles of estrogen-responsive genes have not been examined in pDCIS. Therefore, we first examined the profiles of estrogen-induced genes in estrogen receptor (ER)-positive pDCIS and DCIS (DCIS-c) and IDC (IDC-c) components of IDC cases (n = 4, respectively) by microarray analysis. Estrogen-induced genes identified in this study were tentatively classified into three different groups in the hierarchical clustering analysis, and 33% of the genes were predominantly expressed in pDCIS rather than DCIS-c or IDC-c cases. Among these genes, the status of MYB (c-MYB), RBBP7 (RbAp46) and BIRC5 (survivin) expression in carcinoma cells was significantly higher in ER-positive pDCIS(n = 53) than that in ER-positive DCIS-c (n = 27) or IDC-c (n = 27) by subsequent immunohistochemical analysis of the corresponding genes (P < 0.0001, P = 0.03 and P = 0.0003, respectively). In particular, the status of c-MYB immunoreactivity was inversely (P = 0.006) correlated with Ki-67 in the pDCIS cases. These results suggest that expression profiles of estrogen-induced genes in pDCIS may be different from those in IDC, and c-MYB, RbAp46 and survivin may play particularly important roles among estrogen induced genes in ER-positive pDCIS.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-05-14.

The weather dependence of particle size distribution of indoor radioactive aerosol associated with radon decay products

This study was performed to measure the activity size distribution of aerosol particles associated with short-lived radon decay products in indoor air at Nagoya University, Nagoya, Japan. The measurements were performed using a low pressure Andersen cascade impactor under variable meteorological conditions. The results showed that the greatest activity fraction was associated with aerosol particles in the accumulation size range (100-1000 nm) with a small fraction of nucleation mode (10-100 nm). Regarding the influence of the weather conditions, the decrease in the number of accumulation particles was observed clearly after rainfall without significant change in nucleation particles, which may be due to a washout process for the large particles.

Field test of quantum key distribution in the Tokyo QKD Network

A secure communication network with quantum key distribution in a metropolitan area is reported. Six different QKD systems are integrated into a mesh-type network. GHz-clocked QKD links enable us to demonstrate the world-first secure TV conferencing over a distance of 45km. The network includes a commercial QKD product for long-term stable operation, and application interface to secure mobile phones. Detection of an eavesdropper, rerouting into a secure path, and key relay via trusted nodes are demonstrated in this network.

Abstract P3-10-38: Histopathological Subclassification of Triple Negative Breast Carcinoma Using Prognostic Scoring System

Purpose: Triple negative breast carcinoma (TNBC) is currently being required to be classified pluralistically in order to provide the most appropriate therapy to the patients. We attempted to subclassify TNBC cases into subgroups based on clinical outcome or prognosis of the patients with TNBC using archival specimens. Materials and Methods: We analyzed 102 Japanese cases of invasive TNBC who underwent surgery between January 1998 and December 2007. The clinicopathological factors and clinical information of these patients were retrospectively retrieved from charts of the patients. Immunohistochemical staining was performed for estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor 1 (EGFR1), CK5/6, Ki-67 and CD31 for microvessel density (MVD). Results: Median follow-up time of the patients was 68.5 months. Multivariable analysis demonstrated that the pathologic node status was the most significantly associated with relapse-free survival (RFS) and breast cancer-specific survival (BCSS) of the patients. Pathological tumor size, basal-like type, Ki-67 labeling index (LI) and MVD were also independently associated with RFS and BCSS. Based on these results, we devised the Risk Score system reflecting Hazard ratios (HRs) of these prognostic factors above.

Multivariate analysis and the Risk Score for TNBC patients.

With this system, TNBC patients in this study were classified into three subgroups; patients with score 0-3 are in low risk group, score 4-7 in intermediate risk group and score 8- in high risk group. These three groups had statistically significant differences for risk of relapse and breast cancer-specific death, respectively.

Conclusions: We propose the Risk Score system, which incorporated pathologic nodal status, size of the primary tumor, the presence or absence of basal-like features, Ki67 LI and MVD of the patients in order to predict postoperative clinical course of the Japanese patients with TNBC. Such a classification which can be performed in diagnostic pathology laboratory can be useful as a decision-making tool for triple negative patients.

Abstract P1-02-01: Vasohibin-1 in Human Breast Carcinoma: A Potential Negative Feedback Regulator of Angiogenesis

Background: Vasohibin-1 is a recently identified negative feedback regulator of angiogenesis induced by vascular endothelial growth factor (VEGF)-A. This is the first study to evaluate immunoreactivity and mRNA expression of Vasohibin-1 in human breast disorders. Material and Methods: We examined 251 breast specimens including invasive ductal carcinoma (IDC: 148), ductal carcinoma in situ (DCIS:62), fibroadenoma (FA:16), inflammatory lesion (6), fibrocystic change(9) and non-pathological breast tissue(7). We immunolocalized vasohibin-1 and compared its immunoreactivity to that of VEGF-A, VEGF receptor 2 (Flk-1), CD31 and Ki-67. The correlation of vasohibin-1 immunoreactibity with overall survival (OS), and disease free survival (DFS) of the breast carcinoma patients was also evaluated. In addition, we evaluated Ki-67 and CD31, and Ki-67 and vasohibin-1 double-immunostaining for further characterization of neovascularization. We also evaluated mRNA expression of Vasohibin-1 using a real-time quantitative RT-PCR with LightCycler system.

Results: Vasohibin-1 was detected in endothelial cells of human breast and its immunodensity was significantly higher in IDC and inflammatory lesion than the other types (P<0.001). As for DCIS, there was a significant positive correlation between vasohibin-1 expression level and nuclear grade or Van Nuys classification of carcinoma cells (P<0.001). In addition, a significant positive correlation was detected between vasohibin-1 and VEGF-A, Flk-1 or Ki-67 (P<0.001). There was also positive associations between vasohibin-1 and OS (P=0.004) and DFS (P<0.001). Results of double-immunostaining demonstrated the ratio of Ki-67-positive cells among vasohibin-1-positive endothelial cells (46.5%) was significantly higher than those among CD31-positive cells (23.5%). In addition, there was a significant positive correlation between Vasohibin-1 mRNA level and Ki-67 or high nuclear grade(P<0.001).

Discussion: This is the first study demonstrating the status of vasohibin-1 in human breast lesions, which indicates that vasohibin-1 is associated with neovascularization and may especially play important roles in the regulation of intratumoral angiogenesis in human breast cancer. Vasohibin-1 is supposed to be induced in the downstream of VEGF-A/Flk-1 signaling pathway and considered an appropriate biomarker for intratumoral neovascularization. In addition, these results clearly indicated that vasohibin-1 expression may become one of the prognostic markers for metastasis and prognosis, and also become one of the appropriate biomarker of the potential of subsequent stromal invasion of carcinoma cells.

Figures available in online version.

Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies

OBJECTIVES

To assess whether smoking is a risk factor for developing rheumatoid arthritis (RA).

DESIGN

Meta-analysis.

METHOD

DATA SOURCES

were observational studies that examined the association between smoking history and the risk of developing RA identified through Medline and EMBASE (from 1966 to December 2006), relevant books and a reference search. Two authors independently extracted the following: authors' names, publication year, sample size, participant characteristics, odds ratios (OR) or relative risks, adjustment factors, study design and area where the study was conducted. Data syntheses were based upon random effects model. Summarised syntheses effects were expressed by OR.

RESULTS

Sixteen studies were selected from among 433 articles. For men, summary OR for ever, current and past smokers were 1.89 (95% CI 1.56 to 2.28), 1.87 (1.49 to 2.34) and 1.76 (1.33 to 2.31), respectively. For rheumatoid factor-positive (RF+) RA, summary OR for ever, current and past smokers were 3.02 (2.35 to 3.88), 3.91 (2.78 to 5.50) and 2.46 (1.74 to 3.47), respectively. Summary OR for 20 or more pack-years of smoking was 2.31 (1.55 to 3.41). For women, summary OR for ever, current and past smokers were 1.27 (1.12 to 1.44), 1.31 (1.12 to 1.54) and 1.22 (1.06 to 1.40), respectively. For RF+ RA, summary OR for ever, current and past smokers were 1.34 (0.99 to 1.80), 1.29 (0.94 to 1.77) and 1.21 (0.83 to 1.77). Summary OR for 20 or more pack-years of smoking was 1.75 (1.52 to 2.02).

CONCLUSION

Smoking is a risk factor for RA, especially RF+ RA men and heavy smokers.