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Gross cystic disease is a common benign breast disease that is associated with a twofold to fourfold increase in breast cancer risk. Both diseases are hormonally induced and may share a common biochemical environment conducive to abnormal proliferative responses. A large collection of breast cyst fluid samples was analyzed for growth factors associated with cell proliferation: epidermal growth factor (EGF), insulin-like growth factor I (IGF-I), insulin-like growth factor II (IGF-II), platelet-derived growth factor (PDGF), transforming growth factor-[alpha] (TGF-[alpha]), and transforming growth factor-[beta] (TGF-[beta]). The data demonstrate that significant amounts of proliferative growth factors are present in breast cyst fluid of all cyst subtypes. The presence of IGF-II, PDGF, and TGF-[beta] in breast cyst fluid was confirmed for the first time. EGF, PDGF, and TGF-[beta] concentrations in breast cyst fluid were several times greater than reported for serum; IGF-I and IGF-II concentrations were several times lower. In the first 100 samples tested, no TGF-[alpha] was detected. Only EGF and IGF-II levels demonstrated a consistent correlation with apocrine type 1 cysts. These results demonstrated that effective concentrations of proliferative growth factors are in breast cyst fluid and suggest that adjacent breast tissue may be a probable source of synthesis. Growth factor profiles of breast cyst fluid may indicate the presence in breast tissue of a hormonal and proliferative environment permissive to subsequent cancer growth.

Her-2/neu protein producft was immunocytochemically analyzed in 139 breast cancers. Epidermal growth factor receptors were similarly analyzed in 74 breast cancers from the same patient pool. These results were also separated on the basis of estrogen receptor proteins and of combined aneuploidy with elevated S-phase from flow cytometry. Invasive breast cancer yielded a positive label for Her-2/neu protein (26%) and for epidermal growth factor receptor (25%), with no significant difference. Correlations with estrogen receptor labeling yielded differences significant inversely for both Her-2/neu protein (p, The biology of growth factors and oncogenes is an active area of breast cancer research. Oncogenes are variants of normal cell genes which under certain conditions have the ability to change normal cells into cancer cells. Expression of one oncogene, Her-2/neu, in the tumor has been linked to higher than expected rates of breast cancer recurrence and mortality. The level of epidermal growth factor found in the fluid in macrocysts (large breast cysts) has been correlated with other factors of increased risk for future breast cancer. The clinical features of epidermal growth factor have not been extensively studied. A study was undertaken on 139 breast cancer patients; all specimens were analyzed for Her-2/neu, and 74 of these were also analyzed for epidermal growth factor receptors. Invasive cancers showed no significant difference between Her-2/neu and epidermal growth factor receptor; both factors were inversely related to hormone (estrogen) receptor status. Epidermal growth factor receptor status seemed to identify a group of breast cancers with a worse prognosis than did Her-2/neu labeling. When epidermal growth factor receptor and Her-2/neu protein were both found in the same cancer, there was usually a poor prognosis. These findings suggest that epidermal growth factor receptor study provides additional information regarding prognosis to that available from identification of Her-2/neu level, meaning that the information supplied by these two analyses is not redundant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast cyst fluid from 35 women was stratified into risk groups based on personal and family history of breast cancer. Mitogenic activity in breast cyst fluid of women at highest risk to develop breast cancer was significantly higher than the activity in the lowest-risk group. There was a direct dose-dependent relationship between mitogenic activity and increased risk of developing breast cancer. Size-exclusion chromatography showed that breast cyst fluid from women at highest risk contained two peaks of growth factor activity: less than 6 kilodaltons (kd), identified as human EGF (epidermal growth factor), and 6 to 18 kd. Moderate-risk group samples demonstrated only the single less than 6 kd peak, whereas the lowest-risk group had insignificant growth-promoting activity. Breast cancer tissue analyzed in a similar manner revealed a predominant 6- to 14-kd peak of mitogenic activity demonstrating the same acid- and heat-stability found in breast cyst fluid., In spite of an increasing emphasis on mammography (X-ray of the breast to detect cancer at an early stage) and self-examination, breast cancer rates continue to rise. Early diagnosis remains the best method of increasing optimally effective treatment. Tumor cells from cancers confined to the breast grow more slowly than cells from tumors that have spread to the axilla (armpit) or to other organs. It is possible that growth factors in breast cyst fluid contribute to the spread of malignancy. To determine whether the fluid in breast cysts could serve as a biological marker for subsequent malignancy, samples were taken from 35 women, and tissue culture tests were performed. The women were grouped into three categories by risk of developing breast cancer as a result of personal and family history of that disease. The tissue culture test measured the extent to which the cyst fluid promoted mitosis (cell division) in a well-characterized cell line. Additional studies were performed to evaluate the mitogenic activity of malignant tumors removed from other subjects during cancer treatment. Results showed a direct relationship between risk category and mitogenic activity; the cyst fluid from women at highest risk for developing cancer had the greatest mitogenic activity. Moreover, the three groups had a marked difference in mitogenic activity of the cyst fluid. Analyses of the cyst fluid samples showed that substances of two molecular weights comprised the mitogens. One of these weights corresponded to the point of greatest mitogenic activity from the cancer tissue samples that were also analyzed. Identification of a growth factor in breast cyst fluid could aid in predicting malignancy, as well as in evaluation of treatment effectiveness. Other implications of the findings are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast cancer is frequently treated with breast-conserving techniques, including lumpectomy, axillary dissection, and radiation therapy. Mastectomy with lymph node dissection remains the treatment of choice in many patients, however. To [...]

This study assessed the relationship of race and patterns of care, defined by an expert NCI-appointed committee, for 7,781 patients with breast cancer treated in 107 hospitals in 45 communities between 1982 and 1985. After control for age and stage of disease, black patients had significantly different care from white patients for four of the ten patterns examined. They were less likely to have a progesterone receptor assay or to be referred for postmastectomy rehabilitation, two patterns deemed desirable for all patients. Black patients were also more likely to receive liver scans and radiation therapy in situations in which these procedures were labeled “less appropriate (as defined in the text).” Black patients differed significantly from whites on their health insurance, hospital, and physician characteristics; these factors were also significantly associated with the patterns of care. However, after controlling for these variables, the association between race and care persisted for three patterns. The patterns that showed racial differences were not the most clinically significant of the ten studied. Different treatment for black and white patients may help to explain differences in survival rates of black and white women with breast cancer.

Breast-conserving surgery (BCS) with radiation (BCSR) requires a multidisciplinary care approach between surgeons and radiation oncologists. This retrospective cohort study examined the use of preoperative radiation oncology consultation and whether use of or distance to this care was associated with treatment choice among 1188 women age ≥ 65 years who were diagnosed with local or regional breast carcinoma in Washington State in 1994 and 1995. Study outcomes included rates of BCSR; BCS alone; and mastectomy; and radiation therapy among women who underwent BCS. Only 29% of patients in the current study consulted with a radiation oncologist preoperatively, and less than half of the patients (46.6%) consulted with either a medical oncologist or a radiation oncologist. Among women who underwent either BCSR or mastectomy, the odds of undergoing BCSR among women who had a preoperative radiation oncology consultation were 6.7 times the odds of women who did not have the consultation (P ≤ 0.001). Similarly, the odds of receiving radiation therapy among women who underwent BCS and had a preoperative radiation oncology consultation were 5 times the odds of women who did not have the consultation (P < 0.001). The 3.4% of women who lived > 50 miles from the radiation therapy center had the lowest BCSR rate (15.8%) and had the lowest radiation therapy rate among women who underwent BCS (54.5%), although these findings were not statistically significant in adjusted analyses. A preoperative visit with a radiation oncologist was associated strongly with BCSR use. More should be done to evaluate the role of multidisciplinary consultation in the decision to use BCSR. Cancer 2004;100:701–9. © 2004 American Cancer Society.

Estimating the incidence of lobular carcinoma in situ(LCIS) of the breast is challenging because it lacks both clinical and mammographic signs and is usually an incidental finding in breast biopsies performed for other reasons. In general, population-based studies are believed to provide the most accurate measures, but few documenting changes in LCIS incidence rates over time have been reported. Age-adjusted age-specific LCIS incidence rates among women with no prior history of in situor invasive breast carcinoma from 1978 to 1998 were obtained from nine population-based cancer registries that participate in the Surveillance, Epidemiology, and End Results (SEER) Program. Linear trends were evaluated using negative binomial regression. Overall, LCIS incidence rates increased fourfold (95% confidence interval, 2.9–5.6) over the study period. Specifically, they rose from 0.90/100,000 person-years in 1978–80 to 2.83/100,000 person-years in 1987–89, but then increased only modestly up to 1996–98 where the incidence rate was 3.19/100,000 person-years. However, among women 50–79 years of age, LCIS incidence rates increased continuously over the study's duration. In 1996–98, 50–59 year-olds had the highest incidence rate (11.47/100,000 person-years) and experienced the greatest absolute increase in incidence over the study period (9.48/100,000 person-years). LCIS incidence rates have steadily increased from 1978 to 1998 only among postmenopausal women. Further research is required to assess what factors are contributing to these trends.

OBJECTIVE: To determine if local control of breast cancer can be regained in patients with locally advanced and recurrent tumors using aggressive surgical treatment and reconstruction. DESIGN: A retrospective review of 15 consecutive patients. Patients were followed up from 8 to 32 months. SETTING: A university tertiary care facility in a metropolitan area. PATIENTS: All patients with locally advanced or recurrent breast cancer without known metastatic disease who underwent radical surgical resection of locally advanced breast cancer with reconstruction. MAIN OUTCOME MEASURES: Primary outcome measures were pathological findings, type of surgery, length of hospital stay, complications, local recurrence, and survival. RESULTS: Pathological findings showed 12 adenocarcinomas (80%) and three sarcomas (20%). Thirteen patients (86.7%) had undergone previous surgery, 11 (73.3%) had undergone previous radiation therapy, and all adenocarcinomas were progressing while patients were receiving chemotherapy. Full-thickness chest wall resection that included bone was required in 46.7%. The average hospital stay was 11.5 days. While 10 patients (66.7%) eventually manifested metastatic disease, local recurrence developed in only one. Minor complications occurred in six patients (40%) and major complications occurred in three (20%). There were no perioperative deaths. CONCLUSIONS: Patients presenting to our service had locally aggressive tumors that were recalcitrant to maximal medical management. With radical surgical treatment and reconstruction, there were no deaths, significant morbidity was low, and all but one patient regained local control. We found that aggressive surgical treatment and reconstruction is not only feasible in patients with locally advanced breast cancer but may be the only hope for local control in these patients who are difficult to treat.(Arch Surg. 1994;129:582-587)

• Needle-wire localization of foreign bodies and nonpalpable breast lesions is commonly used to allow for more accurate excision or biopsy. We present three examples of complications of the localization procedure: (1) wire migration into the chest wall with retained fragment, (2) transection of a wire during biopsy with retained hook fragment, and (3) wire migration within the thigh soft tissues with breakage at the hooked end. Recommendations to minimize the incidence of these complications and their sequelae include (1) bending the hookwire 90° at the skin surface following localization, (2) transferring the patient between the radiology suite and the operating room via a stretcher, with minimal movement of the body part localized, and (3) accounting for the entire length of wire by the surgeon, pathologist, and radiologist following the procedure to exclude retained fragments.(Arch Surg 1988;123:775-779)

Reports that state legislative leaders are urging the United States federal government to move ahead on banning ozone-destroying health devices such as inhalers as environmentally safe alternatives become available. Incentives drawn up by the government to encourage private sector efforts to discover the alternatives; Provisions of the United Nations' Montreal Protocol in 1987 to protect the ozone layer.

Presents a question and answer advisory on timing belts in Upper Saddle River, New Jersey. Factors considered for timing belt changes; Recommendation of the manual.