Risk analysis of breast cancer and breast fibrocystic change in female primary Sjögren's syndrome patients

Sjögren's syndrome is an autoimmune disease with the chronic inflammation of glandular tissues, typically salivary and lacrimal glands. Since mammary tissue shares the glandular structure, Sjögren's syndrome may also target mammary tissue to cause breast diseases. We therefore determined whether primary Sjögren's syndrome (pSS) is associated with the increased risk of breast cancer (BC) and breast fibrocystic change (FC). Total 282 female patients with pSS were recruited from a medical center in Taiwan, and patients' medical records were reviewed to identify BC and ultrasonographic breast FC. The prevalence, incidence and risk factors for BC and breast FC in pSS patients were determined, and the risk factors for these breast diseases were subsequently analyzed. Our results showed that pSS patients had the increased prevalence and incidence of BC, and high anti-SSA(Ro) antibody titers were found to be associated with the increased risk of BC. Breast FC was also found highly prevalent in these patients. Comorbidity analysis as risk factor for BC in pSS patients showed diabetes mellitus was strongly associated with the increased risk of BC (odds ratio = 10.4, P = .0006), whereas breast FC was inversely associated with the risk of BC (odds ratio = 0.077 P = .0158). These data indicated that pSS is association with the increased risk of BC and with the high prevalence of ultrasonographic breast FC. Our results also suggest that, in pSS patients, the high anti-SSA(Ro) antibody titers and diabetes mellitus confer the increased risk of BC, whereas the absence of ultrasonographic breast FC predicts the higher risk of BC.

Positive association between SRA1 rs801460 variant and proliferative type of benign breast disease with atypia in Ukrainian females

AIM

To investigate the association between SRA1 rs801460 and rs10463297 variants and proliferative type of benign breast disease with atypia development in Ukrainian females.

MATERIALS AND METHODS

83 individuals diagnosed with proliferative type of benign breast disease with atypia and 115 without atypia were enrolled in the study. The rs801460 and rs10463297 variants genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism analysis. Hematoxylin and eosin, toluidine blue and van Gieson's picrofuchsin methods were used for sections staining.

RESULTS

It was revealed that SRA1 rs801460-variant is associated with proliferative type of benign breast disease with atypia development both before and after adjustment for risk factors (age, body mass index, age of menarche, oral contraceptives intake and burdened history of breast cancer). The risk for mentioned disease in the individuals with rs801460 TT-genotype is 2.2 times higher (confidence interval 1.010-4.800; p = 0.047) than in individuals with the CC and CT genotypes. No link between SRA1 rs10463297 and proliferative type of benign breast disease with atypia occurrence in Ukrainian females was found.

CONCLUSION

The present study specified that SRA1 rs801460, but not rs10463297, can be the strong genetic predictor for benign breast disease with atypia in Ukrainian females.

Do Women taking Hormone Replacement Therapy (HRT) have a Higher Incidence of Breast Cancer than Women who do not?

An estimated one third of all American and United Kingdom women take hormone therapy. In sharp contrast to these numbers, as many as one half of women diagnosed with breast cancer have taken hormones. Little additional information is available regarding the risk of breast cancer and even less is known about the association between hormone therapy and fibrocystic (FCD) disease or atypia of the breast. Three hundred women between 30 and 50 years of age were enrolled in this study, including 120 taking hormone replacement (HRT) therapy and 180 women who had never taken hormone therapy. These women were divided into four categories including those with normal breast tissue, those with FCD disease, those with cellular atypia, and those with breast cancer. Another group of women were also identified who had breast implants. Using breast enhanced scintigraphy (BEST) imaging, changes in breast tissue were determined and compared according to the use of HRT. Forty percent (122 of 300) had “normal” breasts, of whom 68.8% (84 of 122) did not take HRT. This accounted for 46.7% (84 of 180) of the women not taking hormone therapy, while only 31.7% (38 of 120) of the women taking HRT had normal breasts. This difference was statistically (p.001) significant. There was a greater incidence of breast abnormality in women taking HRT and a lower incidence in pathology among women not taking HRT when cumulatively analyzed for FCD, cellular atypia, and breast cancer. This difference was statistically significant (p.001) for women with breast cancer where 62.5% (10 of 16) were women taking HRT. Although the study was relatively small, it is the first such study to compare a continuum of changes in breast tissue according to the use of HRT. The study suggests that the initial empirical observations regarding higher incidence of HRT among women with breast cancer, may have a relationship to underlying changes in breast tissue that are associated with differences in mitochondrial content and activity. Further investigation is needed.

[Immediate and long-term results of surgical treatment of benign breast disease]

Sector resection of the breast is the standard surgical treatment of benign breast disease, but often it has unsatisfactory outcomes. The aim of the study was a comparative analysis of the effectiveness of surgical treatment of patients with benign breast diseases after sector resection and after modification of the procedure. Classical sector resection was performed on 45 women, 106 - underwent operations with using of plastic surgery elements. The effectiveness of treatment was defined by the presence of complications in the early postoperative period; the quality of life was studied using questionnaires--The Short Form Medical Study (SF-36) and The Breast Evaluation Questionnaire (BEQ)--before surgery and after 3 and 12 months after surgery. After sector resection was 44% of the complications in the early postoperative period, after the developed techniques - 17%. 3 months after the operation quality of life and aesthetic satisfaction of breast in patients of both groups decreased. 1 year after sector resection the rates of satisfaction of breast aesthetic appearance were significantly lower than the preoperative level. In patients after modified operations at 1 year was observed a significant improvement in well-being and satisfaction of aesthetic appearance of breast. The method of sector resection has a greater number of complications; it leads to deterioration of the aesthetic appearance of the breast in 1 year after surgery. Surgery techniques with elements of mammaplasty have fewer complications and improve quality of life after surgery.

Benign breast disease and the risk of breast cancer in the next 15 years

AIM

Fibrocystic mastosis (FCM) is defined by the totality of dystrophic changes of the mammary tissue, the grouping in the form of fibrosis of epithelial, cystic, metaplastic and hyperplastic alterations. A very good estimation of the cancer risk is related specifically to the microscopic aspect. Other factors, the family history as well as the presence of an inherited gene determining the increase in the risk of breast cancer are also considered. But, if a woman known with fibrocystic mastosis has not undergone any biopsy, then it is impossible to calculate the specific individual risk of developing cancer.

MATERIAL AND METHODS

The data collected as a study material and considered refer to: the total num- ber of cases investigated and diagnosed with fibrocystic mastosis, the annual distribution of this disease cases, the distribution of the cases according to age groups, admission reasons, clinical examination, personal pathologic history clinically significant for the basic disease (the main diagnosis), the family medical history significant for the basic disease, the anatomopathological diagnosis.

RESULTS

Between 2004 and 2006, at "Cuza Vodă" Obstetrics and Gynecology Hospital of Iaşi, a maximum number of cases is noticed in 2006, when there were 147 cases, and the lowest number of cases was in 2005. There was high frequency of the anatomopathological examinations that highlighted the presence of fibrocystic lesions (both proliferative and non-proliferative), and the second most often diagnosis is fibroadenoma. Though fibrocystic mastosis is not clearly defined, it is still admitted that in order to support this diagnosis it is first compulsory to exclude malignant tumours.

CONCLUSIONS

Only in 5% of the women with fibrocystic mastosis cellular changes can be revealed in the form of atypical hyperplasia, which are a risk factor for cancer. The lesion that delimits cancer from non-cancer is ductal carcinoma in situ. An incidence of over 20% is present in the countries that use mammographic screening programmes, mammographic surveillance programmes and programmes for the guided localization of nonpalpable lesions of the mammary gland.

Breast cancer risk after diagnosis by screening mammography of nonproliferative or proliferative benign breast disease: a study from a population-based screening program

Benign breast disease increases the risk of breast cancer. This association has scarcely been evaluated in the context of breast cancer screening programs although it is a prevalent finding in mammography screening. We assessed the association of distinct categories of benign breast disease and subsequent risk of breast cancer, as well as the influence of a family history of breast cancer. A retrospective cohort study was conducted in 545,171 women aged 50-69 years biennially screened for breast cancer in Spain. The median of follow-up was 6.1 years. The age-adjusted rate ratio (RR) of breast cancer for women with benign breast disease, histologically classified into nonproliferative and proliferative disease with and without atypia, compared with women without benign breast disease was estimated by Poisson regression analysis. A stratified analysis by family history of breast cancer was performed in a subsample. All tests were two-sided. The age-adjusted RR of breast cancer after diagnosis of benign breast disease was 2.51 (95 % CI: 2.14-2.93) compared with women without benign breast disease. The risk was higher in women with proliferative disease with atypia (RR = 4.56, 95 % CI: 2.06-10.07) followed by those with proliferative disease without atypia (RR = 3.58; 95 % CI = 2.61-4.91). Women with nonproliferative disease and without a family history of breast cancer remained also at increased risk of cancer (OR = 2.23, 95 % CI: 1.86-2.68). An increased risk of breast cancer was observed among screening participants with proliferative or nonproliferative benign breast disease, regardless of a family history of breast cancer. This information may be useful to explore risk-based screening strategies.

Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study

Atypical hyperplasia is a high-risk premalignant lesion of the breast, but its biology is poorly understood. Many believe that atypical ductal hyperplasia (ADH) is a direct precursor for low-grade ductal breast cancer, whereas atypical lobular hyperplasia (ALH) serves as a risk indicator. These assumptions underlie current clinical recommendations. We tested these assumptions by studying the characteristics of the breast cancers that develop in women with ADH or ALH. Using the Mayo Benign Breast Disease Cohort, we identified all women with ADH or ALH from 1967 to 2001 and followed them for later breast cancers, characterizing side of breast cancer versus side of atypia; time to breast cancer; type, histology, and grade of breast cancer, looking for patterns consistent with precursors versus risk indicators. A total of 698 women with atypical hyperplasia were followed a mean of 12.5 years; 143 developed breast cancer. For both ADH and ALH, there is a 2:1 ratio of ipsilateral to contralateral breast cancer. The ipsilateral predominance is marked in the first 5 years, consistent with a precursor phenotype for both ADH and ALH. For both, there is a predominance of invasive ductal cancers with 69% of moderate or high grade. Twenty-five percent are node positive. Both ADH and ALH portend risk for ductal carcinoma in situ and invasive breast cancers, predominantly ductal, with two thirds moderate or high grade. The ipsilateral breast is at especially high risk for breast cancer in the first 5 years after atypia, with risk remaining elevated in both breasts long term. ADH and ALH behave similarly in terms of later breast cancer endpoints.

Alcohol intake between menarche and first pregnancy: a prospective study of breast cancer risk

BACKGROUND

Adult alcohol consumption during the previous year is related to breast cancer risk. Breast tissue is particularly susceptible to carcinogens between menarche and first full-term pregnancy. No study has characterized the contribution of alcohol consumption during this interval to risks of proliferative benign breast disease (BBD) and breast cancer.

METHODS

We used data from 91,005 parous women in the Nurses' Health Study II who had no cancer history, completed questions on early alcohol consumption in 1989, and were followed through June 30, 2009, to analyze breast cancer risk. A subset of 60,093 women who had no history of BBD or cancer in 1991 and were followed through June 30, 2001, were included in the analysis of proliferative BBD. Relative risks (RRs) were estimated using Cox proportional hazard regression.

RESULTS

We identified 1609 breast cancer cases and 970 proliferative BBD cases confirmed by central histology review. Alcohol consumption between menarche and first pregnancy, adjusted for drinking after first pregnancy, was associated with risks of breast cancer (RR = 1.11 per 10 g/day intake; 95% confidence interval [CI] = 1.00 to 1.23) and proliferative BBD (RR = 1.16 per 10 g/day intake; 95% CI = 1.02 to 1.32). Drinking after first pregnancy had a similar risk for breast cancer (RR = 1.09 per 10 g/day intake; 95% CI = 0.96 to 1.23) but not for BBD. The association between drinking before first pregnancy and breast neoplasia appeared to be stronger with longer menarche to first pregnancy intervals.

CONCLUSIONS

Alcohol consumption before first pregnancy was consistently associated with increased risks of proliferative BBD and breast cancer.

Is hyperandrogenemia protective for fibrocystic breast disease in PCOS?

The aim of this study is to evaluate the fibrocystic breast disease rates and its association with different clinical, endocrine and metabolic parameters between main polycystic ovary syndrome (PCOS) phenotypes. One hundred thirty two consecutive women were included in the study. Body mass index, serum follicle-stimulating hormone, luteinizing hormone (LH), progesterone, estradiol, testosterone, dehydroepiandrosterone sulphate, fasting glucose, low density lipoprotein (LDL-C), total cholesterol, high density lipoprotein, insulin, insulin sensitivity and fibrocystic breast disease rates were compared among different phenotypes of PCOS. Group 1: Polycystic ovaries (PCO)-anovulation (n = 32), Group 2: Hyperandrogenemia (HA)-anovulation (n = 28), Group 3: HA-PCO (n = 29), Group 4: HA-PCO-anovulation (n = 43). There were statistically significant differences between the different phenotype groups in terms of waist-hip ratio (p = 0.006), serum LDL-C (p = 0.008), LH (p = 0.002), estradiol (p = 0.022), fasting glucose (p = 0.001), progesterone (p = 0.007), free testosterone levels (p < 0.001) and Ferriman-Gallwey (FG) scores (p < 0.001). Different phenotype groups had significantly different fibrocystic breast disease rates. (p = 0.016). Higher free testosterone >3 pg/dl was protective for fibrocystic disease (RR = 0.316, 95:% CI 0.109-0.912, p = 0.033). Higher FG scores were more protective for fibrocystic disease (RR = 0.005, 95:% CI 0.001-0.042, p < 0.001). Group 3 ovulatory PCOS patients with PCO and hyperandrogenemia phenotype had lower risk to develop fibrocystic disease, while higher rates were observed in group 1 anovulatory-normoandrogenemic PCOS patients. Hyperandrogenemia is protective for fibrocystic diseases in PCOS.

Breast disorders in the female adolescent

Breast disorders in the adolescent female can cause significant anxiety for the patient and her family and pose a clinical challenge for her health care provider. Care and consideration given to the emotions of the patient and family, as well as minimizing trauma and injury to the developing breast, are paramount. This article addresses the gamut of concerns that involve the adolescent breast. As benign breast disease is the most common breast disorder, conservative management should be entertained whenever possible. Patients should be referred to providers comfortable in treating the adolescent patient with breast disease or concerns.

[Association of polymorph variants of CYP1A2 and CYP1A1 genes with reproductive and thyroid diseases in female workers of petrochemical industry]

The article presents results obtained in study of relationship between polymorph variants of CYP1A1 and CYP1A2 genes with reproductive and thyroid diseases risk in female workers of petrochemical industry, when compared with reference group females. Variants TD and DD of CYP1A2 gene appeared to be associated with nodes formation in uterus and breast in female workers and reference group females. Following liability markers are obtained: homozygous in rare allele genotype CC of CYP1A1 gene for reproductive and thyroid diseaes (fibrous cystic mastopathy and nodular goitre), heterozygous genotype AG of CYP1A1 gene in uterine myoma and fibrous cystic mastopathy, homozygous in deleted T genotype of CYP1A2 gene in autoimmune thyroiditis. Occupational hazards and long length of service at hazardous industries increase effects of rare alleles of the genes studied.

Topographical, morphological and immunohistochemical characteristics of carcinoma in situ of the breast involving sclerosing adenosis. Two distinct topographical patterns and histological types of carcinoma in situ

AIM

To examine the histopathological features of 24 surgically resected carcinoma in situ (CIS) involving sclerosing adenosis (SA), with special reference to the topographical relationship between CIS and SA.

METHODS AND RESULTS

In 13 (54%) lesions, CIS was entirely surrounded by SA (type A) and in 11 (46%), CIS involved SA at least focally but was not confined to the SA area (type B). The mean size of CIS in type B (30.45 mm) was significantly larger than in type A (18.00 mm). The mean size of SA in type A (39.46 mm) was significantly larger than in type B (19.54 mm). Most type A CIS were non-high-grade, and the oestrogen receptor (ER)(+)/progesterone receptor (PgR)(+)/HER2(-) immunophenotype predominated. Most type B CIS were high-grade and six (54%) were ER(-)/PgR(-). Most type A were bcl-2(+)/p53(-) in both SA and CIS areas, but two (18%) apocrine ductal CIS of type B were bcl-2(-)/p53(+) in both SA and CIS areas. Expression of ER and cyclin D1 in SA was not different from that of SA unassociated with cancer.

CONCLUSIONS

Most CIS involving SA arises within SA and high-grade DCIS tends to grow beyond SA. Occasional CIS may arise outside SA and secondarily involve SA.

Histomorphological spetrum of breast lesions

BACKGROUND

Cancer of the breast is the second most common cause of cancer in women. Mass in the breast, whether benign or malignant is a cause of anxiety to the patients and the family members. All breast lumps are considered to be carcinomas until proved otherwise and are the causes of concern both for the patient and surgeon.

METHODS

This is a retrospective study conducted in Kathmandu Model Hospital for a total duration of three years from August 2007 to August 2010.

RESULTS

114 sample of breast tissue sent for histopathology were studied. Peak incidence of benign lesion was in between 21-30 years and malignant lesions in between 31-50 years. No breast lesions were seen in the first decade of life. Cancer of the breast was seen in 12.28% of cases. Fibroadenoma and fibrocystic disease were the commonest benign lesion and infiltrating ductal carcinoma was the commonest malignant lesion. Specimens from 10 male breasts were received. Gynaecomastia was the most common lesion encountered in males. Infiltrating ductal carcinoma was seen in a 70 year old male.

CONCLUSIONS

Breast cancer is one of the commonest causes of breast lump particularly in women and is growing public health problem in Nepal.

Breast diseases in Southern Yemen

OBJECTIVE

To investigate the magnitude of breast diseases, and its frequency distribution in different age groups in Hadramout, Yemen.

METHODS

This is a prospective study conducted at the Central Laboratory of Ibn-Sinna Hospital, Hadramout, Yemen from January 2006 to December 2009. Patients attending surgical units for breast problems were eligible. Patients were assessed clinically and referred to the laboratory center to confirm the diagnosis by histopathology. The data were collected from the patients and referral sheets.

RESULTS

A total of 635 cases of breast disease were diagnosed. This includes 604 female and 31 male patients. Benign breast diseases (BBD) was the most common lesion found in this study comprising 493 cases (77.6%), and 142 (22.4%) comprised malignant cases. Among BBD, the most common lesion was fibroadenoma (40.5%) followed by fibrocystic changes (16%), other benign breast lesions (10%), and inflammatory lesion (8%). The age groups affected by BBD were: 20-29 years for fibroadenoma; 30-39 years for fibrocystic change; 20-29 years for other benign breast lesions; and 30-39 for inflammatory lesions, and carcinoma of the breast was common in the 40-49 age group. The left breast was affected in 331 (52%) cases, the right in 283 (45%), while in 3%, both breasts were affected.

CONCLUSION

Fibroadenoma was the most frequently diagnosed benign breast lesion in Hadramout. An educational program is needed to alert patients of the significance of breast masses.

[Fibrocystic breast disease--breast cancer sequence]

Fibrocystic breast disease has developed a major issue: the breast cancer sequence. Its involvement regarding the increse of breast cancer risk has 2 aspects: it may be either the marker of a prone tissue or a premalignant hystological deffect. Difficult differential diagnosis of benign proliferative breast lession and carcinoma led to the idea of sequency between the two: cancer does not initiate on normal mammary epithelia; it takes several proliferative stages for it to occur. In our series we analized a number of 677 breast surgical procedures where the pathologic examination reveals 115 cases (17%) of coexistence between cancer and fibrocystic breast disease. This aspect has proved to be related to earlier debut of breast cancer, suggesting that epithelial hyperplasia is a risk factor for breast cancer.

A clinicopathologic study of breast lumps in Bhairahwa, Nepal

BACKGROUND

Various types of lesion from inflammation to carcinoma can affect breast. Some lesions are common in young females while others in elderly age group. Early presentation and prompt diagnosis is essential to relieve anxiety of non-neoplastic conditions, and in case of carcinoma, it can save the patient from metastases. Many cases related to breast lesions from the region are reported in the surgery clinics of this institute and various breast diseases are being managed in the clinical departments. Analysis of pattern and prevalence will be a valuable guideline for clinicians of this location to compare with that of others.

METHODS

In the retrospective clinical study during 9 years period, the cases of breast lesions and lumps underwent fine needle aspiration cytology. Pap staining was done in alcohol fixed smears. The doubtful cases 65 were diagnosed through histopathological examinations by conventional method of fixation, processing and staining with routine hematoxylin and eosin. The cases with undetermined and inconclusive material were excluded from the study.

RESULTS

In the study of total 243 cases, inflammatory conditions 22.6%, fibrocystic change 41.2%, fibroadenoma 21.8%, other benign breast disease 4.5%, gynaecomastia 2.5% and carcinoma 7.4% were detected.

CONCLUSION

Fibrocystic change was the commonest lesion in this study with 33 years as the average age of presentation. However, malignancy was detected above 40 years of age.

Benign breast disease among first-degree relatives of young breast cancer patients

Benign breast disease is associated with increased risk of breast cancer. To further clarify whether there is a genetic link between benign and malignant breast lesions, the authors identified 14,648 first-degree female relatives of 8,807 patients in whom breast cancer was diagnosed at <50 years of age by using Danish nationwide cancer and population registers. Hospital register data were used to follow the relatives for occurrence of benign breast disease from 1977 to 2003 and to calculate rates of benign breast disease in the general population of Danish women for comparison. Risk for relatives was increased for benign breast diseases (observed/expected ratio = 1.54, 95% confidence interval: 1.42, 1.66), particularly for relatives aged <40 years. Higher risks were observed after breast cancer had been diagnosed in the family; however, an increased risk for relatives aged <50 years (observed/expected ratio = 1.24, 95% confidence interval: 1.02, 1.51) was present before breast cancer was diagnosed in the family. Enhanced surveillance of close relatives of breast cancer patients seems to be an important factor to address when investigating the association between benign breast disease and familial breast cancer. A genetic link between benign breast disease and breast cancer was indicated by our data but needs to be confirmed in future studies.

[Metabolic syndrome and breast cancer risk in post-menopausal women]

Lipid metabolism disorders--breast cancer risk association in postmenopausal women was searched in many studies; the HDL-cholesterol value triggered most of controversies. Some authors plead for increased breast cancer risk in overweight/obese postmenopausal women if HDL is higher while others plead for higher risk if HDL is lower then in general population.

MATERIAL AND METHOD

We studied a 110 subjects female population aged between 41 and 69, and determined height, weight, body mass index (BMI), abdominal perimeter (AP), lipid parameters (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). All women performed mammography and breast echography. Imagery divided the subjects in three groups: 30 breast cancer patients (first diagnosis)--group 1, 50 breast dysplasia women--group 2, and normal breast patients--group 3.

RESULTS

HDL-cholesterol proved significantly higher in group 2 compared to group 3 (control group), by the third and the fourth quartile; the same when it came to overweight/obese post-menopausal women. Nevertheless, more lipid disorders clustered in group 1 obese/overweight postmenopausal women.

CONCLUSIONS

High HDL in breast dysplasia women is reported in international studies too. High menopause prevalence in group 3, implying abdominal obesity and lipid disorders may explain the small difference between group 1 (breast cancer patients) and group 3 (control group). High clustering in group 1 pleads for increased breast cancer risk in metabolic syndrome postmenopausal women. Comparing HDL values and the clustering phenomenon in group 1 to the other two groups considered as a control population (as done in international published studies), we can conclude that low HDL--abdominal obesity association increases breast cancer risk after the menopausal age.

Clinicopathologic features of breast disease in Jamaica: findings of the Jamaican Breast Disease Study, 2000-2002

OBJECTIVE

To describe the clinicopathologic profile of breast disease in Jamaica.

METHODS

The Jamaican Breast Disease Study is an ongoing prospective, multidisciplinary investigation of breast disease at the University Hospital of the West Indies (UHWI). The initial phase was a prevalence survey comprising all consenting patients referred to the Surgical Outpatient Department (SOPD) UHWI, for breast disease. Demographic, clinical, radiologic and pathologic information were recorded for each patient and the data for the first three years (2000-2002) were analyzed.

RESULTS

A total of 1189 patients was enrolled for the study period (28.8% of all new SOPD patients). The age range was 10 to 93 years (mean/SD = 36.5 +/- 16.4 years) with a female : male ratio of 14:1. Most patients (67.8%) presented with a palpable lump and the clinical diagnosis was benign in the majority (70.4%) of patients. Fibroadenoma was the most common benign histologic result (39.4% of all biopsies) followed by non-proliferative (fibrocystic) disease (19.3% of all biopsies). Proliferative disease without atypia, complex fibroadenoma and atypical ductal hyperplasia accounted for 6.9%, 2.6% and 0.4% of biopsies respectively. Overall, 23.4% of biopsies showed malignant histology (10.8% patients); invasive ductal carcinoma accounted for the majority of these cases (69.5%).

CONCLUSIONS

The majority of patients with breast disease in Jamaica are young women with clinically benign disease. There was a low prevalence of clinically significant premalignant disease. This is the first study to prospectively describe the clinicopathologic features of breast disease in Jamaica and supports the need for advocating breast cancer screening to facilitate detection of significant premalignant disease and early stages of breast cancer.

Benign breast lesions in Eastern Nigeria

OBJECTIVE

To characterize benign breast diseases in Eastern Nigeria and to highlight the age variations of these lesions as base line data.

METHODS

The Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Enugu caters for over 30 million African blacks and receives 2000 surgical pathology specimens yearly. Seven hundred and twenty-two benign breast specimens were analyzed over 5 years from 1st January 2000 to 31st December 2004, out of 1050 breast samples received.

RESULTS

Of 1050 breast specimens received, 722 (68.8%) were benign. Fibroadenoma was the most common lesion with 318 cases (44%), occurring at a mean age of 16-32 years. Next was fibrocystic changes with 165 cases (22.9%) at a mean age of 23-45 years. Normal breast in the axillary tail region was seen in 32 cases (4.4%), represented as no pathology, with a mean presentation age of 20-46 years. Low grade Phyllodes tumor had 28 cases (3.9%), presenting at an average mean age of 17-32 years. Lactating adenoma had 19 (2.6%) cases. Other lesions made up less than 3% each. Benign breast lesions peaked at the 20-24 age range and then declined. Most were females.

CONCLUSION

Benign breast lesions occur more frequently than malignant breast lesions with a ratio of 2.3:1 and were presented 20 years earlier than their malignant counterparts. Fibroadenoma was the most common benign lesion followed by fibrocystic disease, similar to the findings in Western Nigeria. In Northern Nigeria, fibrocystic breast disease was more common.

[Study on mental stress life events in patients with cyclomastopathy of liver stagnation syndrome type]

OBJECTIVE

To observe the changes of mental stress life events (MSLE) in patients with cyclomastopathy of liver stagnation syndrome type (LSS).

METHODS

Clinical epidemiological research method was adopted, the changes of MSLE were observed in cyclomastopathy patients of LSS or non-LSS, classified by syndrome differentiation of TCM.

RESULTS

Not only the mean age (33.38 +/- 6.76 years) of patients with LSS was obviously lower than that of patients with non-LSS (38.36 +/- 9.89 years, P < 0.01), but also the mean age of patients with moderate and serious symptoms of LSS (33.96 +/- 7.31 and 37.43 +/- 7.38 years) were higher than that of patients with mild symptoms of LSS (31.67 +/- 5.39 years, P < 0.05 and P < 0.01). MSLE score of patients with LSS (32 scores) was significantly higher than that of patients with non-LSS (22 scores, P < 0.01). MSLE score of patients with moderate and serious LSS was 34.69 +/- 17.78 scores and 51.65 +/- 20.75 scores respectively, both were significantly higher than that of patients with mild LSS (26.57 +/- 15.85 scores, P < 0.05 and P < 0.01).

CONCLUSION

The high incidence age of cyclomastopathy is under 40 years, and most of cyclomastopathy patients are classsified to LSS by TCM syndrome differentiation. So age and life event scores may be the objective bases for syndrome typing and liver stagnation syndrome grading in patients with cyclomastopathy.

[About correlation of dysfunction of the thyroid gland with fibrocystic diseases in women]

The reference data contain a lot of information on the interrelation between destroying of a thyroid gland and fibrocystic diseases. However contradictions in these data proves that this issue is not solved completely. The aim of the given study was the investigation of interrelations between frequency of occurrence of pathology of a functional condition of the thyroid gland and the frequency of occurrence of fibrocystic diseases. 90 women aged 23-50 were investigated. Concentration of thyroxin (FT4), thyrotrophic hormone (TSH), titers of antibodies to thyreoperoxidase, microsomal fraction of thyreocytes and thyreoglobulin were measured by ELISA. Palpation and ultrasonic investigations of thyroid and mammary glands were used, morphology of central formations of mammary glands according to indications was also carried out. A special questionnaire was completed for each patient. Our investigations showed that along with the declining of function of thyroid gland and the increased level of TSH in the blood, the risk of development of fibrocystic diseases is increased twice.

Profile of breast lesions among women with positive biopsy findings in Yemen

This study described the profile of breast pathology based on records from a reference histopathology laboratory in Yemen of 773 women with positive biopsy or mastectomy findings. Cancers were classified according to the International classification of diseases for oncology. Benign lesions were found in 79.9% of cases. Fibroadenoma was the most prevalent lesion (30.0%) with a mean age at presentation of 22.2 years, followed by fibrocystic disease (27.4%) and breast inflammation (13.1%). Invasive carcinoma was found in 155 cases (20.1%), at a mean age of 44.7 years.

Early life factors and incidence of proliferative benign breast disease

Proliferative benign breast disease is a marker of increased breast cancer risk, yet little is known about its etiology. Most studies of benign breast disease have focused only on risk factors in adulthood, despite growing evidence that factors in early life influence breast cancer risk. We explored the relations of several early life factors with incidence of proliferative benign breast disease among 71,896 premenopausal women in the Nurses' Health Study II who recalled their body fatness at young ages, physical activity in adolescence, birthweight, and history of being breastfed. Between 1991 and 1997, 901 of these women were identified as having proliferative benign breast disease from a centralized pathology review. Relative risks (RR) and 95% confidence intervals (95% CI) were estimated from Cox proportional hazards models. Greater childhood body fatness (ages 5-10) was associated with decreased risk of proliferative benign breast disease; the multivariate RR (95% CI) for the most overweight compared with the most lean was 0.61 (0.44-0.86; P(trend) < 0.0001) and remained significant after adjustment for current body mass index. Body mass index at age 18 was also inversely associated with incidence of proliferative benign breast disease, with a multivariate RR (95% CI) of 0.67 (0.52-0.88) for those who were > or =25 kg/m(2) compared with those who were <19 kg/m(2) (P(trend) = 0.001). There were no clear associations for physical activity in adolescence, birthweight, or being breastfed. These results indicate that premenopausal women who were heavier at young ages have lower incidence of proliferative benign breast disease, consistent with previous findings for breast cancer.

Focal fibrosis of the breast diagnosed by a sonographically guided core biopsy of nonpalpable lesions: imaging findings and clinical relevance

OBJECTIVE

The purpose of this study was to evaluate the frequency of focal fibrosis of the breast diagnosed by a sonographically guided core biopsy of nonpalpable lesions, to characterize imaging features, and to evaluate their clinical relevance.

METHODS

In a retrospective review of 724 lesions that underwent sonographically guided core biopsy of nonpalpable breast lesions, 62 cases had a diagnosis of focal fibrosis. Two radiologists analyzed the sonographic and mammographic findings according to the Breast Imaging Reporting and Data System. The results were compared with histologic findings at surgery or imaging findings during surveillance.

RESULTS

The incidence of focal fibrosis was 8.6% (62/724). Sonographic films were available in 56 cases, so 56 cases were reviewed for their sonographic findings. Among the mammograms reviewed, 64.7% (33/51) had negative findings. Among the sonograms reviewed, the most common features were oval shape (32/56, 57.1%), parallel orientation (36/56, 64.3%), microlobulated margin (24/56, 42.9%), abrupt interface (50/56, 89.3%), isoechoic pattern (42/56, 75.0%), and a lack of posterior acoustic features (45/56, 80.4%). The Breast Imaging Reporting and Data System final assessment was category 3 in 27 (48.2%) and category 4 in 29 (51.8%). Most of the category 4 lesions were category 4A (26/29, 89.7%). Surgical excision (n = 7) and follow-up for at least 1 year (n = 49) showed no malignancy.

CONCLUSIONS

Focal fibrosis was found in 8.6% by a sonographically guided core biopsy of nonpalpable breast lesions. Most of the lesions were categorized as probably benign (category 3) or having a low suggestion of malignancy (category 4A). Focal fibrosis diagnosed at core biopsy can be managed with a 6-month follow-up protocol.

The prevalence of benign breast disease in women with polycystic ovary syndrome: a review of a 12-year follow-up

A cross-sectional study of benign breast disease (BBD) was conducted to determine the actual prevalence and follow-up importance of BBD among women with polycystic ovary syndrome (PCOS) in conjunction with an ongoing prospective cohort study. The present study involved a subset of the original group of 244 women with a diagnosis of PCOS and 244 control women matched by age and race. A total of 240 women (116 cases and 124 controls) were included in the present analysis. The majority of women in each group were Caucasians (93 and 96%, respectively). The median age was 46 years in the cases and 47 years in the controls. Screening mammography begins at the age of 40 and has been carried out in 69% of cases and 66% of controls since the study began. Family history of breast disease was observed in 27 cases of both the groups (p > 0.05). Neither fibrocystic breast disease, lump thickening, calcification, fibroadenoma, pain, redness, discharge nor hyperplasia showed a significantly higher prevalence rate in cases than in controls. Eleven (9%) women with PCOS and 21 (17%) controls underwent diagnostic or curative surgery (relative risk: 0.56). These results, in contrast to the previously published literature, do not allow us to conclude that there is a higher risk for BBD among women with PCOS, and the proportion of women with a positive family history of breast cancer was significantly greater in women with PCOS compared with controls. Our observation is that having PCOS does not appear to affect surgeons' decisions to remove BBD.

Silicone Thorax Due to a Ruptured Breast Implant

A woman with a history of bilateral mastectomy and silicone implants for fibrocystic disease and a history of atrial septal defect repair presented with pleural nodules on a chest radiograph. A thorascopic biopsy performed for possible mesothelioma demonstrated chronic inflammation and focal pleural fibrosis due to a foreign-body reaction secondary to silicone. This was confirmed using scanning electron microscopy and energy-dispersive radiograph elemental analysis. As the population ages, the increasing frequency of ruptured silicone implants and the need for heart surgery may result in a corresponding increase in the risk for fibrothorax secondary to inadvertent silicone introduction during surgery.

A case-control study of risk factors for fibrocystic breast conditions: Shanghai Nutrition and Breast Disease Study, China, 1995-2000

This study was conducted to identify reproductive and dietary factors associated with benign proliferative mammary epithelial cell changes. Subjects were women enrolled in a randomized trial of breast self-examination in Shanghai, China. Women who developed fibrocystic breast conditions classified as nonproliferative (175 women), proliferative (181 women), or proliferative with atypia (33 women) between 1995 and 2000 and 1,070 unaffected trial participants were administered general risk factor and food frequency questionnaires. Conditional logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals. High parity and consumption of fresh fruits and vegetables were more strongly associated with a reduced risk of proliferative and atypical lesions than with nonproliferative conditions. For the fourth quartile of consumption versus the first, odds ratios for lesions diagnosed as nonproliferative, proliferative, and proliferative with atypia were 0.4 (95% confidence interval (CI): 0.2, 0.7), 0.2 (95% CI: 0.1, 0.4), and 0.1 (95% CI: 0.03, 0.5), respectively, for fruit intake and 0.6 (95% CI: 0.3, 1.1), 0.4 (95% CI: 0.2, 0.7), and 0.1 (95% CI: 0.1, 0.9), respectively, for vegetable intake. Reduced but nonsignificant risks in relation to soy products were observed for proliferative and atypical lesions. No single nutrient or botanical family was appreciably more strongly associated with proliferative conditions than with nonproliferative conditions, after results were controlled for total fruit and vegetable consumption. A diet rich in fruits and vegetables may reduce cellular proliferation in the mammary epithelium; this is one mechanism by which such a diet could reduce risk of breast cancer.

[Experience with a quality control system for mammography in a private practice setting]

Design and performance of a private audit of mammography utilizing the BI-RADS classification in a private practice setting are presented. By using a combination of physical examination,mammography and, whenever necessary, additional views and sonography, the goals of the BI-RADS audit were met. Practical issues of this audit are addressed.

Benign gynecological tumors: estimated incidence. Results of the German Cohort Study on Women's Health

OBJECTIVE

To analyze the lifetime incidence of benign gynecological tumors.

STUDY DESIGN

The German Cohort Study on Women's Health was launched in 1998 as historic cohort study with prospective follow up. The study ascertained self-reported information on tumors by calendar time. The incidence of benign gynecological tumors was calculated from the data of the first cohort period.

RESULTS

The cohort comprised 396000 women-years of observation and 1676 benign tumors were observed. This lead to incidence estimates of 27.0, 18.6, and 23.3 per 100000 women-years of observation for all benign tumors of the uterus, ovary, and breast respectively.

CONCLUSION

In absence of other data, it is reasonable to use incidence rates generated by a large cohort of German women as a best estimate for the population up to 65 years of age.

[Breast cysts--diagnostic and therapeutic management and risk for subsequent development of breast carcinoma]

Cystic breast disease is a relatively widespread pathological condition in the female sex, it has an incidence of around 7% and predominantly affects women aged between 35 and 50 year old. The diagnosis is based on the standardised protocol including breast examination, mammography, fine-needle aspiration cytology and pneumocystography. While the majority of cysts can be managed by simple aspiration, a small percentage (0.3-1.4%) are malignant. The clinical and pathological features of 7 cases of intracystic carcinoma of the breast which are 0.73% of all cases of cystic breast disease between 1996-2001, are considered in the present article.

Comparison of full-field digital mammography to screen-film mammography with respect to diagnostic accuracy of lesion characterization in breast tissue biopsy specimens

RATIONALE AND OBJECTIVES

This study was performed to investigate whether full-field digital mammography (FFDM) is at least as accurate as screen-film mammography with respect to breast lesion characterization.

MATERIALS AND METHODS

Seventy-nine breast surgical specimens were obtained by means of preoperative needle localization with surgical excision from 79 patients. The specimens were imaged with both screen-film mammography and FFDM. Six radiologists specialized in breast imaging analyzed both sets of images and characterized the visualized lesions on a five-point scale: 1, definitely not malignant; 2, probably not malignant; 3, possibly malignant; 4, probably malignant; and 5, definitely malignant. Receiver operating characteristic curve analysis of the data was then performed to assess for differences between modalities in the radiologists' ability to predict breast malignancy.

RESULTS

The areas under the receiver operating characteristic curves for the prediction of breast malignancy in surgical biopsy specimens were not statistically significantly different for FFDM and screen-film mammography.

CONCLUSION

The results demonstrate that with breast surgical specimens, FFDM is similar in diagnostic accuracy to screen-film mammography.

[Fine-needle biopsy of the breast in the material of Gynecology and Obstetrics Hospital in Walbrzych]

OBJECTIVES

Since the year of 2000 we have done more than 500 fine-needle aspiration biopsies in our hospital.

DESIGN

The main cause was a breast lesion interpreted as suspicion of cancer in ultrasonography or mammography and its verification between benign tumor and a cancer.

MATERIALS AND METHODS

508 women with clinical findings of breast tumor were qualified for fine-needle biopsy procedure.

RESULTS

The most common diagnosis was a benign cystic tumor found in 183 cases and the second one--fibro-cystic mastopathy (132 cases). Surgical operation of the breast was performed in 32 cases. In 17 we found breast cancer and in 14 the diagnosis was suspicion of breast cancer.

CONCLUSIONS

Fine-needle biopsy is valuable for diagnosis of breast cancer and can be easily learned and used by the clinician. It's safe, cost-effective, and accurate technique, which has no counter-indications and causes little discomfort. Results are available in a short time so the decision about the necessity for excisional biopsy or mastectomy is made quickly.

Improved reporting methods for atypia and atypical ductal hyperplasia in breast core needle biopsy specimens. Potential for interlaboratory comparisons

The incidence of atypia and atypical ductal hyperplasia (ADH) in breast core needle biopsies varies widely (900%). I sought to identify methods to reduce the dependence of this measure on variability in the patient population. The results of all breast core needle biopsies with a diagnosis of ADH or atypia not otherwise specified for a 50-month period were reviewed. These were separated into different groups by age, and the variability of different reporting methods was compared. Of 3,026 cases, 216 were diagnosed as ADH or atypia not otherwise specified. The overall incidence of atypia by age group varied significantly from 0.029 to 0.10. The variability was reduced when atypia was expressed in relation to ductal carcinoma in situ (range, 1.0-2.1) or fibrocystic changes (range, 0.15-0.28). However, variability by age was the least when atypia was expressed in relation to the number of cases performed for calcifications (range, 0.13-0.17). Variability in atypia rates associated with age is reduced significantly when atypia is expressed in relation to the number of biopsies done for calcifications. This method of reporting atypia may allow interlaboratory comparisons with less dependence on the characteristics of the patient population.

Benign breast diseases in an Afro-Caribbean population

BACKGROUND

The diagnosis and effective treatment of benign breast disease still remains a clinical challenge and the need for surgical intervention has not been clearly defined.

OBJECTIVES

To determine the patterns of benign breast disease in an Afro-Caribbean population in order to define the patterns of disease encountered and to review the approach to diagnosis and treatment.

METHODS

A review of all breast biopsy operations performed for benign disease at the Kingston Public Hospital, Jamaica was made by examining a total of 333 patient records over a two year period.

RESULTS

Of the cases reviewed this study clearly showed that the majority of benign breast lesions were due to fibrocystic disease (41%) and fibroadenomas (33%). Intraduct papillomatosis which accounted for 6.7% was the next in frequency. Other diseases found included fat necrosis 12 (4.4%) with breast abscess and mammary duct ectasia in eight patients (3%) each. Fourteen patients (5%) had no diagnostic abnormality. The mean age of patients with fibroadenoma was 20 years whereas the mean age of patients with fibrocystic disease was 40 years. The co-existence of fibrocystic disease with malignancy was reported in 15 cases.

CONCLUSION

Benign breast disease in this population occurs mainly in young women less than 30 years of age. Eighty per cent of breast biopsies done in patients with palpable lumps are for benign disease. The data support a more conservative approach to diagnosis and management of these patients.

The significance of malignancies incidental to microcalcifications in breast spot localization biopsy specimens

BACKGROUND

Incidental breast cancer is occasionally found in spot localization biopsy specimens adjacent to mirocalcifications in benign breast disease. Because this phenomenon could prove problematic for percutaneous sampling of microcalcifications without excisional biopsy, we studied surgical specimens from patients with cancers incidental to microcalcifications and compared them with specimens with microcalcifications within the malignancy.

METHODS

The pathology database at the Mount Sinai Medical Center from January 1993 to July 1998 was reviewed to identify breast cancer patients who underwent spot localization biopsy for microcalcifications. Patients presenting with microcalcifications within malignancy (determinate) were compared with patients with mirocalcifications in benign breast tissue adjacent to malignancy (incidental).

RESULTS

Thirty-two (13%) of the 241 specimens had microcalcifications in benign tissue adjacent to malignancy and 209 (87%) had microcalcifications within the malignancy. Fifty-six percent of the incidental cases and 65% of the controls had ductal carcinoma in situ. Infiltrating lobular carcinoma accounted for 25% of the incidental cancers and 2% of the determinate cancers (P <0.001). Fifty-seven percent of the infiltrating carcinomas incidental to mammographic findings were infiltrating lobular carcinoma compared with 7% of the nonincidental infiltrating carcinomas. None of the incidental invasive carcinomas were poorly differentiated (P = 0.002). There were no significant differences with regard to age, tumor size, stage, differentiation, estrogen and progesterone receptors, type of surgery and final margin status. In none of the patients with incidental malignancies did local or distant recurrences develop.

CONCLUSIONS

Incidental carcinomas were found in 13% of spot localization biopsy specimens obtained for suspicious mammographic microcalcifications and have a favorable prognosis. Infiltrating lobular carcinomas are more commonly found with incidental microcalcifications than with determinate microcalcifications, and incidental invasive carcinomas are less likely to be poorly differentiated. The majority of malignancies, both determinate and incidental to microcalcifications, are due to ductal carcinoma in situ. Incidental malignancies commonly occur adjacent to fibrocystic changes and their other pathologic characteristics are not significantly different from nonincidental carcinomas. Despite the absence of radiographic findings, these patients can be successfully treated with breast conservation.

Association between polycystic ovary and fibrocystic breast disease

OBJECTIVE

The aim of this study was to assess whether or not there was an association between a polycystic ovary (PCO) and fibrocystic breast disease based on ultrasound findings, both pelvic and mammographic.

DESIGN

Prospective case-control study.

POPULATION

Women aged between 18 and 30 years not using oral contraceptives attending the outpatient ultrasound clinic from January 1996 to December 1998.

MAIN OUTCOME

Confirm the association between PCO and fibrocystic breast disease.

RESULTS

According to the ultrasound findings, women were allocated to three groups: 351 out of 456 showed normal-appearing ovaries (group A), 93 had polycystic-appearing ovaries/PCO (group B) and 12 had PCO syndrome (group C). In group A, 24 (6.83%) women showed breast pathology. In group B, there was an association between PCO and breast pathology in 53 (56.98%) women, while in group C it was noted in 11 out of 12 (91%).

CONCLUSION

This study showed a significant association between PCO and benign pathology. This should encourage the performance of a screening breast sonography on women with PCO.

Benign breast disease at Wesley Guild Hospital, Ilesha, Nigeria

A prospective survey of 225 patients carried out over a period of 7years (1992 - 1999) to determine the pattern and outcome of benign breast diseases. Two hundred and seventeen (96.4%) were females and 8 males, with the age ranging from 14-63 years, mean 28.7 SD+10.6 years. The mean age for patients with fibroadenoma was 24 years and 31.6 years for fibrocystic disease of the breast. One hundred and ninety six patients (87.2%) presented with breast lumps or mass, non-menstrual cycle and menstrual cycle related pain in 39(17.3%) and 32(13%) patients respectively and nipple discharge in 60 patients (26.7%). Mean duration of symptoms was 0.91+0.64 years, 2 + 1.2 weeks for inflammatory lesions and 0.86 + 0.56 yers for benign tumours and also menstrual cycle related breast pain. Right side was involved in 162 patients (72%), 85(38%) left side and 77(34.2%) bilateral. Clinical diagnosis was fibrocystic disease 96(42.7%). Fibroadenoma 89 (39.5%), inflammatory conditions 35(15.7%), galactocele in 9(40%) and gynaecomastia in 7(3%) of the patients. Excisional or incisional biopsy was carried out in 197 patients (87.5%), antibiotic and analgestic administration in 35(15.6%) and 29(13%), respectively. Histopathologic analysis showed fibroadenoma in 91 (46.2%), fibrocystic disease 83 (42.2%), and others in 23 (11.6%) cases. The mean follow-up period was 10 months for tumours and I month for others. Postoperative complications were infrequent, there were recurrence either on the ipsilateral or contralateral breast in 10(4.4%) patients of which 3(1.3%) cases were malignant.

CONCLUSION

Fibroadenoma was the most common benign breast disease, followed by fibrocystic disease of the breast. Postoperative complications were uncommon.

Pattern of breast diseases in a teaching hospital in Jeddah, Saudi Arabia

OBJECTIVE

The aim of this case series study is to evaluate the outline and pattern of male and female breast diseases in Saudi Arabia. Also to compare 8 studies of literature discussing the profile of malignant and benign female breast diseases in the Kingdom. We hope that this study will assist us to appreciate the prototype breast diseases in our region.

METHODS

Our study consisted of 1084 consecutive male and female breast lesions. Data on these specimens, received in the time frame of 15 years between January 1984 and March 2000, was retrieved from the records of the laboratory. The outline of breast lesions were tabulated and classified into inflammatory, benign and malignant lesions.

RESULTS

In female breasts, benign lesions comprised 57% of all lesions (mean age 28.5), most commonly reported being fibroadenoma 47%, fibrocystic disease 22% and fibroadenosis 14%. Malignant lesions comprised 32.5% of all lesions (mean age 48.49), most commonly reported being ductal carcinoma 88% and lobular carcinoma 4.5%. Inflammatory lesions comprised 11% of all lesions (mean age 35.0), most commonly reported lesion being chronic mastitis 31% and ductectasia 19%. Male benign lesions comprised 55 cases (87%). Eight cases (13%) of malignant lesions, 6 ductal carcinomas and 2 metastatic adenocarcinomas, were also identified.

CONCLUSION

The rates for female breast lesions varied in different studies but benign fibroadenoma constituted the most common breast lesion and secondly ductal carcinoma. The mean age for malignant lesion in 7 different studies came to be 44.05. In the male breast, carcinomas constituted 3% of all breast carcinomas. Gynecomastia being the most common male breast lesion constituting 54%.

Characteristics of cystic breast disease with special regard to breast cancer development

BACKGROUND

This prospective study compares the characteristics of cystic disease of the breast (CDB) of patients who developed breast cancer (BCa) during the follow-up (1.25-4 years) period with those who did not.

MATERIALS AND METHODS

K+, Na+, albumin, dehydroepiandrosterone (DHA), DHA-sulphate, oestrone, oestradiol, testosterone and progesterone levels were determined in breast cyst fluid (BCF). Patients presented data about their menstrual status, reproductive history, lactation period, date of first and the number of BCF aspirations, gynaecological interventions, use of oral contraceptives, family history of cancer, smoking habits and coffee consumption. The BCa incidence of patients was compared with the expected number of BCas in an age-matched group of 5143 women.

RESULTS

Out of 147 patients 6 developed BCa. The standardized incidence rate was 6.29. There were significant differences in testosterone, oestrone and progesterone levels and also reproductive history of patients who developed BCa compared with patients without BCa.

CONCLUSION

The above markers outline a subgroup of patients with the highest BCa risk.

[The relationship between benign breast proliferation (fibrocystic mastopathy) and the appearance of breast carcinoma]

Fibrocystic mastopathy (FM), a benign lesion, is considered by many author like a premalignant lesion. Breast carcinoma (CA) represents the most frequent female tumor and the second mortality cause through cancer, after the bronchopulmonary cancer. At the Department of Pathology from Tg. Mureş, we selected 190 cases, for 10 month: 102 presented FM, 41 CA and 47 CA + FM. In every case, we have examined 2 slides stained with HE. In difficult cases, we performed special stains (van Gieson, H-PAS, Alcian). We studied the pulmonary tumor, adjacent mammary tissue and axillary lymph nodes. The present data of literature and the experience of the Department of Pathology from Tg. Mureş showed a strong relationship between the presence of FM and the appearance of CA: both lesions have a common field of hormonal disfunction and intraductal and intralobular hyperplasia (an microscopic feature of mastopathy) increase the risk of CA.

[Incidence of fibrocystic disease of the breast in women with polycystic ovary. Clinico-instrumental study]

BACKGROUND

The aim of this study was to assess whether or not there was an association between polycystic ovaries (PCO) and fibrocystic breast disease. It is known that hyperestrogenism and anovulation are involved in the etiology of the fibrocystic breast disease; we evaluated the incidence of this disorder in women with PCO or Polycystic Ovary Sindrome (PCOS) based on ultrasound findings both pelvic and mammographic.

METHODS

From January 1995 to December 1997 we performed in our outpatient ultrasound service (I Divisione I Istituto di Clinica Ostetrica e Ginecologica, Università di Roma "La Sapienza") pelvic standard scan on 980 women. Patients between 18 and 30 years of age, not using oral contraceptives, both with Normal Appearing Ovariest (NAO) or with PCO Polycystic Appearing Ovaries (PAO) enrolled in the study, informed and agreed to undergo ultrasound mammography. All the subject were examined using an Aloka SSD ZOOO and Esaote AU3 ultrasound equipment with 3.5 MHz and 10 MHz probes for pelvic and mammographic scan respectively. The relationship between pelvic and mammographic scan findings were studied and the chi 2 analysis was used to examine them.

RESULTS

Women by the US findings were allocated into three groups: 203 over 264 showed NAO (group A); 54 had PAO/PCO (group B) and 7 had PCOS (group C). In group A (6.83%) women showed breast pathology. In group B there was association between PCO and breast pathology in 30 (56.98%) women, while in group C on 6 over 7 (91.66%).

CONCLUSIONS

This study showed a significant association between PCO and benign pathology. This should encourage the performance of a screening breast sonography in women with PCO.

Risk factors for benign proliferative breast disease

BACKGROUND

As part of a nested case-control study of benign proliferative breast disease (BPBD) conducted within the cohort of women participating in the Alberta breast screening programme, an analysis of all women who had a benign breast biopsy between 1990 and 1995 was undertaken to identify the epidemiological risk factors for BPBD.

METHODS

The breast biopsies of all eligible women were re-reviewed by a panel of four pathologists using Page's classification for benign breast disease. Cases were 165 women whose biopsies, upon review, showed benign breast tissue changes ranging from sclerosing adenosis to atypical ductal hyperplasia. Controls were 217 women whose biopsies showed no evidence of any proliferative or neoplastic changes. In-person interviews were conducted with all study subjects.

RESULTS

Women with >/=25% fibroglandular breast tissue density, as compared to women with <25% density, experienced nearly a doubling in risk of BPBD (OR = 1.91, 95% CI : 1.24-2.94). All other possible risk factors examined were not associated with BPBD.

CONCLUSION

This study suggests that fibroglandular tissue density may be a risk factor, or marker, for increased risk of BPBD.

A cohort study of oral contraceptive use and risk of benign breast disease

The purpose of the cohort study reported here was to investigate the association between oral contraceptive use and risk of benign breast disease (BBD), overall and by histological subtype, within the 56,537 women in the Canadian National Breast Screening Study (NBSS) who completed self-administered lifestyle and dietary questionnaires. The NBSS is a randomized controlled trial of screening for breast cancer in women aged 40-59 at recruitment. Cases were the 2,116 women in the dietary cohort who were diagnosed with biopsy-confirmed incident BBD. For comparative purposes, a subcohort consisting of a random sample of 5,681 women (including 197 subjects with incident BBD) was selected from the full dietary cohort. After exclusions for various reasons, the analyses were based on 2,116 cases and 5,338 non-cases. There was an inverse association between use of oral contraceptives and risk of all types of BBD combined. The reduction in risk was confined largely to proliferative forms of BBD (BPED), and in particular, to those forms of BPED without histological atypia, in whom there was a progressive reduction in risk with increasing duration of use (the IRR (95% CI) for use of more than 7 years was 0.64 (0.47-0.87)); risk of BPED with atypia was increased somewhat in association with oral contraceptive use (the IRR (95% CI) for use of more than 7 years was 1.43 (0.68-3.01 )), but not in a dose-dependent manner. The results were similar when examined separately in the screened and control arms of the NBSS and for screen-detected and interval-detected BPED.

Risk of breast cancer in women with palpable breast cysts: a prospective study. Edinburgh Breast Group

BACKGROUND

7% of women in the western world develop palpable breast cysts. Studies of the relation between cysts and breast cancer have conflicting results. There are two clearly defined types of cyst. We investigated whether one cyst type is associated with a higher rate of breast-cancer development than the other.

METHODS

We studied 1374 women with palpable breast cysts presenting between 1981 and 1987, who had cysts aspirated between 1981 and 1989. Cysts were classified as type I if the sodium/potassium (Na+/K+) ratio in the cyst fluid was less than 3, or type II if the Na+/K+ ratio was 3 or more. Data on incidence of breast cancer were available until January, 1995, and we compared them with the expected numbers of cancers calculated from age-specific breast-cancer incidence in Scotland in 1988.

FINDINGS

65 cancers developed during follow-up. The overall standardised incidence rate of breast cancer in patients with palpable cysts was 2.81 (95% CI 2.17-3.59). The relative incidence rate was increased for all cyst types. The standardised incidence rate of developing breast cancer among women younger than 45 years was highest at 5.94 (2.97-10.63), with a significant trend for decreasing relative incidence rate with age (p<0.05). Women older than 54 years had a standardised incidence rate of 1.73 (0.86-3.10). The standardised incidence rate of breast cancer was highest in the first year after aspiration (7.02 [3.73-12.00]) but the risk was still raised after 5 years (2.68 [1.84-3.76]).

INTERPRETATION

Women with breast cysts are at an increased risk of breast cancer, especially at younger ages. The type of cyst did not alter the associated relative incidence rate of breast-cancer development.

Alcohol consumption and risk of benign proliferative epithelial disorders of the breast: a case-cohort study

OBJECTIVE

To study the association between alcohol consumption and risk of benign proliferative epithelial disorders (BPED) of the breast (conditions which are thought to have premalignant potential).

DESIGN

Case-cohort study.

SETTING

The study was undertaken within the 56,537 women in the Canadian National Breast Screening Study (NBSS) who completed self-administered dietary questionnaires. (The NBSS is a randomized controlled trial of screening for breast cancer in women aged 40-59 years at recruitment.)

SUBJECTS

The study subjects were the 657 women in the dietary cohort who were diagnosed with biopsy-confirmed incident BPED. For comparative purposes, a subcohort consisting of a random sample of 5681 women was selected from the full dietary cohort. After exclusions for various reasons, the analyses were based on 557 cases and 5028 non-cases.

RESULTS

When compared to non-drinkers, rate ratios (95% CI) for those consuming > 0 and < or =10 g of ethanol day(-1), >10 and < or =20 g day(-1), >20 and < or =30 g day(-1) and >30 g day(-1) were 0.35 (0.27-0.45), 0.26 (0.18-0.39), 0.29 (0.18-0.48), and 0.23 (0.13-0.40), respectively (the associated P value for the trend was 0.089). Similar findings were obtained from analyses conducted separately in the screened and control arms of the NBSS, in premenopausal and postmenopausal women, and for non-atypical and atypical forms of BPED, and there was little difference between the results for screen-detected and interval-detected BPED.

CONCLUSIONS

Alcohol consumption was associated with a non-dose-dependent reduction in risk of BPED.