Epidemiology, prevention, and early detection of breast cancer

Diagnostic accuracy of non-contrast abdominopelvic computed tomography scans in follow-up of breast cancer patients

OBJECTIVES

To evaluate the effectiveness of follow-up with non-enhanced CT (NECT) in patients with breast cancer.

METHODS

The present retrospective study included 1396 patients with breast cancer. Group A included patients with no metastasis to evaluate the diagnostic performance of NECT in detecting newly developed metastasis. Group B included patients with known hepatic metastasis to evaluate the accuracy of NECT for the assessment of hepatic metastasis.

RESULTS

Group A included 895 patients (mean age 52.8 years). Among them, 145 patients had 160 metastases. The per-patient sensitivities for diagnosing newly developed metastasis were 68.3 and 53.8% according to the two reviewers, while the per-lesion sensitivities were 89.4 and 85.0%. Sensitivities for bone metastasis were 98.9 and 95.9%, while sensitivities for hepatic metastasis were 73.7 and 68.4%. In group B, the accuracy of hepatic metastasis response evaluation according to the RECIST criteria was 70.8% for reviewer 1 and 63.8% for reviewer 2.

CONCLUSIONS

NECT showed inadequate diagnostic performance in detecting newly developed metastasis and in evaluating the response of hepatic metastasis. However, NECT can be utilized as a follow-up modality in patients with decreased renal function or hypersensitivity to iodinated contrast media.

ADVANCES IN KNOWLEDGE

The risk of side effects of contrast media should be considered as important when NECT can be utilized as a follow-up modality in decreased renal function patients.

Adult daughters' reports of breast cancer risk reduction and early detection advice received from their mothers: an exploratory study

OBJECTIVE

Awareness of cancer family history is dependent upon communication between family members. Communication of this information and related decision-making could be important factors influencing breast cancer risk reduction and early detection behaviors. Using survey data from 2328 women (mean age 62.5 years) from 372 families enrolled in the Minnesota breast cancer family study, we explored adult daughter's reports of breast cancer risk reduction advice received from their mothers.

METHODS AND RESULTS

Approximately 212 (9%) of respondents reported receiving breast cancer risk reduction advice from their mothers and 130 (89%) reported acting upon such advice. Having a mother or first degree relative (FDR) with a history of breast cancer was significantly correlated with following advice to a higher degree as compared with those not having such family history (p=0.003). Most frequently reported types of advice were to have mammograms (36%) and to have clinical breast exams (35%). Using multivariable logistic regression and after accounting for non-independence of the sample, significant independent correlates of receiving advice included younger age, having an affected mother, and having a higher perceived breast cancer risk. Receiving advice was also correlated with engaging in a higher number of health promoting behaviors and ever having received a mammogram.

CONCLUSIONS

Our preliminary findings are consistent with social influence theory and suggest that mother-daughter communication about reducing risk, especially among those having a FDR with breast cancer, could be a potential pathway through which breast cancer family history is associated with the adoption of breast cancer screening and risk reduction behaviors.

A comparison of trends in incidence and mortality rates of breast cancer, incidence to mortality ratio and stage at diagnosis between Arab and Jewish women in Israel, 1979–2002

In Israel, breast cancer is the most common malignancy in women, but there are large intra-population differences. The aim of this study was to compare the incidence and mortality, incidence to mortality rate ratio and stage at diagnosis of breast cancer between Arab and Jewish women in Israel. Data on all cases of breast cancer, stage at diagnosis and mortality were obtained from the National Cancer Registry and the Central Bureau of Statistics. Trends in age-specific and age-adjusted incidence and mortality rates, rate ratios and stage at diagnosis were examined for Arab and Jewish women during 1979-2002. Five-year survival rates for 1995-1999 were compared by stage. Among Arab women, age-adjusted incidence rates increased by 202.1%, from 14.1 per 100,000 in 1979-1981 to 42.6 in 2000-2002. Among Jewish women, the rates increased by 45.7%, from 71.1 per 100,000 women in 1979-1981 to 103.6 in 2000-2002. Incidence to mortality rate ratio increased for both population groups, but it is still lower among Arab women. In every age group, Arab women were more likely to be diagnosed at a more advanced stage of the disease. The rise in breast cancer incidence and mortality rates and the later stage of diagnosis among Arab women emphasize the urgent need for increasing early detection of breast cancer in the Arab population by improving rates of compliance with screening mammography.

Genomic instability in invasive breast carcinoma measured by inter-Simple Sequence Repeat PCR

We have measured genomic instability in invasive breast carcinomas and assessed the relationship of genomic instability to known tumor prognostic factors. DNAs from tumors and adjacent normal tissue of 18 breast cancer patients were subjected to inter-Simple Sequence Repeat (inter-SSR) PCR for quantitation of tumor genomic instability. Associations between genomic instability level and known breast cancer prognostic factors were evaluated using the Pearson Product Moment Correlation, the Kruskal-Wallis test of independent samples and the Mann-Whitney non-parametric test. Genomic instability was detected by inter-SSR PCR in over 90% of the breast tumors. The mean instability index was 3.08% (0-7.59%), approximately the same mean value observed in studies of colorectal and thyroid carcinomas. Significantly higher levels of instability were associated with tumors exhibiting necrosis. Genomic instability as measured is detected in the majority of breast cancers at levels comparable to other tumor types. Hypoxia, such as that observed in necrotic regions of tumors, has been associated with elevated genomic damage. We hypothesize that the higher levels of genomic instability detected in necrotic tumors is a consequence of hypoxia-associated DNA damage.

Nutrition, Lifestyle, and Breast Cancer Risk Among Turkish Women

Breast cancer is the most common malignancy in women, with more than 1 million cases occurring worldwide annually. Cancer is one of the leading causes of mortality in Turkey; deaths due to breast cancer constitute 24.1% of all carcinoma cases reported among women. We conducted a case-control study of Turkish women with and without breast cancer to investigate the relationships of selected lifestyle and nutritional risk factors with breast cancer risk. Factors were chosen based upon published associations with breast cancer. Subjects were women in Izmir, Turkey. Cases were 123 women with breast cancer registered with the Department of Oncology, Ege University Hospital, in February through July 2004. The control group included 120 randomly selected women without a breast cancer diagnosis, registered with the Evka-4 Health Care Center and having similar sociodemographic characteristics. Inclusion criteria for participation consisted of 40 yr of age and over and willingness to participate. Chi2 tests and t-tests were used to determine statistical differences between cases and controls based on selected variables. Logistic regression was used to find the association between selected risk factors and breast cancer occurrence. Cases had smoked for more years, their age of first pregnancy was higher, and breast cancer occurrence was more common in first-degree relatives such as mothers and sisters of cases compared with controls. Cases were found to have consumed higher amounts of vegetable oil in contrast to controls. These findings are consistent with similar studies conducted in both developed and developing countries.

Re-expression of estrogen receptor alpha using a tetracycline-regulated gene expression system induced estrogen-mediated growth inhibition of the MDA-MB-231 breast cancer cell line

Estrogen receptor (ER)-negative breast carcinomas are often difficult to treat with antiestrogens. This work was performed to determine if the re-expression of the human ER alpha could restore the hormone response of these cells. We have transfected the human wild-type ER alpha to an ER-negative breast cancer cell line (MDA-MB-231) using a tetracycline-regulated gene expression system. We obtained a new cell line, MDA-A4-5/2. Cell count and flow cytometry "S" phase cell fraction showed that 17-beta-estradiol induced an inhibition on the proliferation of these cells; on the contrary, the antiestrogens ICI 182 780, and tamoxifen blocked this effect. Finally, we demonstrated an induction of the endogenous progesterone receptor gene when ER alpha was present. These results suggest that the re-expression of ER alpha in ER-negative breast cancer cells recreate, at least partially, a hormone-responsive phenotype and may be useful as a therapeutic approach to control this pathology.

Radiation-induced heart disease after Hodgkin’s disease and breast cancer treatment

BACKGROUND

People with Hodgkin's disease and breast cancer often receive therapeutic irradiation to the chest (mediastinum) as an element of treatment. While the therapy often cures the malignancy, it has been implicated in causing late-onset heart disease that may influence the provision of dental treatment.

TYPE OF STUDIES REVIEWED

The authors conducted a MEDLINE search of the years 1995 through 2002 using the key terms "Hodgkin's disease," "breast cancer," "radiation therapy," "cardiac valves" and "coronary artery" to define the pathophysiology of the disorder, its epidemiology and dental implications. The articles they selected for further review included those published in English in peer-reviewed journals.

RESULTS

Therapeutic irradiation of the chest results in the inadvertent inclusion of the heart within the irradiation field. Over the next 10 to 20 years, some of these people may experience pathological changes of the heart valves that could predispose them to endocarditis, accelerated atherosclerosis of the coronary artery that heightens their risk of experiencing a fatal myocardial infarction or both.

CLINICAL IMPLICATIONS

Dentists need to identify patients who have received therapeutic irradiation to the chest and consult with the patients' physicians to determine whether the therapy has damaged the heart valves or coronary arteries. Patients with radiation-induced valvular disease may require prophylactic antibiotics when undergoing specific dental procedures that are known to cause a bacteremia and a heightened risk of developing endocarditis. Patients with radiation-induced coronary artery disease should be administered only limited amounts of local anesthetic agents containing a vasoconstrictor, and they may require the administration of sedative agents and cardiac medications to preclude ischemic episodes.

Intravascular injections of a conditional replicative adenovirus (adl118) prevent metastatic disease in human breast carcinoma xenografts

We describe a study showing that the adenovirus adl118, lacking both E1B proteins, very efficiently kills human malignant cells 'in vitro' and 'in vivo'. Since many breast cancer patients do not have metastasis at the time of diagnosis, but finally develop it, we planned to study whether intravascular injections of adl118 could prevent metastatic development. We studied the effects of this mutant adenovirus in an orthotopic model of human breast carcinoma xenografts with the breast MB435-lung 2 cell line, which is highly metastatic in the lungs. In this study, all primary tumors were excised when they reached 50-100 mm3 volume in the animals. After surgery, 10(10) p.f.u. of adl118 was intravenously injected into a random group of animals, either three times during the first week only, or once every week. At death, almost all the control animals showed numerous lung metastases of large size, which were present in only 15-40% of the treated animals, depending on the size of the primary tumor at the time of excision. Overall survival was 50-70 days in control mice, and over 120 days in mice injected with adl118. Concomitant treatment with adl118 and cisplatin did not enhance the antitumor effects of adl118. With these results, we conclude that intravenous injection of conditional replicative adenovirus, after excision of the primary tumor, induces a clear decrease in the metastatic disease, and could be a new strategy in preventing tumor metastasis of breast carcinomas.