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Abstracts

Abstracts

Alcohol & the breast

Whereas beer consumption was not associated with breast cancer risk, increased risks were found at higher levels of both wine and liquor consumption.

Results support a positive association between alcohol and breast cancer among postmenopausal women. The increased risk was particularly found among women who consumed 30 g or more of alcohol daily.

Van-den-Brandt-PA.: Alcohol and breast cancer: results from The Netherlands Cohort Study. Am-J-Epidemiol. 1995 May 15; 141(10): 907-15.

Antioxidants & the breast

Antioxidants

Increasing evidence presents a relationship between nutrition and mammary resistance to infection. The role of nutrition in mammary resistance has been best defined for antioxidants.

Erskine-RJ.: Nutrition and mastitis. Vet-Clin-North-Am-Food-Anim-Pract. 1993 Nov; 9(3): 551-61.

Retinoids and carotenoids

A case-control study of the associations of retinoids and specific carotenoids with breast cancer using concentrations of these nutrients in breast adipose tissue was conducted among women attending a breast clinic in the Boston area in 1989-1992.


Inverse associations between breast adipose concentrations of retinoids and carotenoids and risk of breast cancer, although not all were statistically significant.

There was a nonsignificant positive correlation between breast adipose tissue concentrations of retinol and dietary intake of preformed vitamin A, including supplements measured by using a food-frequency questionnaire.

No correlation was found between breast adipose concentrations of carotenoids and intake of dietary carotenoids.

Data suggest that higher breast adipose concentrations of retinoids and some carotenoids may be associated with decreased risk of breast cancer and that further examination of these relations is warranted.

Zhang S et al., Measurement of retinoids and carotenoids in breast adipose tissue and a comparison of concentrations in breast cancer cases and control subjects. Am J Clin Nutr, 1997 Sep, 66:3, 626-32.

Benign disorders

Contents:

Benign lesions
Spectrum of benign disorders

Benign lesions

Most patients who consult their physician for "breast lesions" do not have a malignancy of the breast. The benign lesions of the breast include fibrocystic condition, macrocyst fibroadenomas, and intraductal papillomas. Nipple discharge is a common condition, and the diagnosis and treatment is discussed. Rarer benign tumors such as adenoid tumors, lipomas, neurofibromatosis, benign fibrous histiocytoma, and glandular cell tumors are discussed briefly.

Benign tumors of the breast. Isaacs-JH. Obstet-Gynecol-Clin-North-Am. 1994 Sep; 21(3): 487-97.

Spectrum of benign disorders

In a period of 2 years, 234 cases of benign breast disorder were studied.

Breast pain and modularity was the commonest group (70.1%) followed by fibroadenoma (17.5%).

Cyclical mastalgia (61.5%) is more common than non-cyclical mastalgia (38.5%). The age of the patients with cyclical mastalgia was significantly lesser than patients with non-cyclical mastalgia. Cyclical mastalgia was seen only in premenopausal females while non-cyclical mastalgia was also seen in postmenopausal females.

Treatment with vitamin E showed 41% response rate with minimal side-effects while treatment with danazol showed 72.1% response rate but was associated with side-effects in one third of the patients.

Khanna AK et al., Spectrum of benign breast disorders in a university hospital. J Indian Med Assoc, 1997 Jan, 95:1, 5-8.

Breast factors

Breast-feeding

Primary care physicians can integrate care of the breasts through a woman's life cycle. Early and frequent nursing and careful attention to the infant's suckling position during the postpartum period can prevent several common problems.

Neonatal jaundice, poor weight gain, mastitis, and candidiasis should be recognized and managed correctly.

Outside the puerperium, fibrocystic change, nonlactational mastitis, and benign breast masses are encountered commonly.

Problems related to silicone augmentation are discussed briefly.

Bedinghaus JM: Care of the breast and support of breast-feeding. Prim Care, 1997 Mar, 24:1, 147-60.

Breast health - an overview

There has been significant improvement in breast health care in the United States over the past few decades primarily due to advances in health research by diverse teams of basic scientists, physicians, pharmacists, industries, nurses, and social workers.

Increase in public awareness of breast cancer, an interest in women's health issues, advances in radiologic imaging, development of new chemotherapeutic agents and the availability of molecular genetic testings have brought remarkable opportunities to a new insight in breast cancer.

These efforts have resulted in earlier detection and prolonged disease-free intervals, however, the overall survival time has remained the same. This is mainly attributable to the wide range of individual therapy for breast cancer, which responds to a range of disease curable by surgery alone to one refractory to treatment and marked by rapid metastatic progression.

Attempts should also be made to promote clinical and population-based studies and to emphasize the value of effective delivery of health-care services to all women with benign, high risk, premalignant and malignant breast disease.

Masood S et al., Breast health. Challenges and promises. J Fla Med Assoc, 1996 Aug-Sep, 83:7, 459-65.

Breast size

The relationship between brassi?re size, as an indicator of breast size, and breast cancer risk was considered in a case--control study conducted between 1991 and 1994 in six Italian centres. Cases were 2,557 women, below age 75, with histologically confirmed breast cancer, and controls were 2,566 women admitted to hospital for a wide spectrum of acute, non-neoplastic, non-hormone-related diseases.

A slight inverse relationship was observed between breast size and the risk of breast cancer, with an OR of 1.37 for the smallest brassi?re size compared with the largest

There is a lack of appreciable association between breast size and breast cancer risk in this Italian population.

Tavani A et al., Breast size and breast cancer risk. Eur J Cancer Prev, 1996 Oct, 5:5, 337-42.

DNA fingerprinting

Paired blood and breast tissue samples from 96 patients undergoing surgical excision of a breast lesion were subjected to DNA fingerprint analysis using the minisatellite probes 33.6 and 33.15.

The 'fingerprints' of the blood and breast DNA were compared. DNA fingerprint changes seen were classified as band additions, band deletions or changes in band intensity. Significantly more DNA fingerprint changes were seen in malignant than in benign lesions (probe 33.6, P).

Sibbering M et al., DNA fingerprinting of benign and malignant breast lesions. Eur J Surg Oncol, 1996 Dec, 22:6, 574-7.

Diabetes & the breast

Insulin-dependent diabetics

Diabetic mastopathy represents less than 1% of benign breast diseases, but is more frequent (13%) in insulin-dependent diabetics.

In the male patients, diabetic mastopathy simulated gynecomastia.

Lymphocytic mastitis in diabetic mastopathy is thought to be a diabetes-induced reaction probably of autoimmune origin. Moreover, lymphocytic mastitis with or without diabetes mellitus may represent a lymphoepithelial lesion of the MALT-type which, under certain circumstances, is considered to bear a prelymphomatous potential.

Hunfeld KP & Bässler R: Lymphocytic mastitis and fibrosis of the breast in long-standing insulin-dependent diabetics. A histopathologic study on diabetic mastopathy and report of ten cases. Gen Diagn Pathol, 1997 Jul, 143:1, 49-58.

Fractal analysis

The increased use of screening mammography has led to increased pressure to differentiate between benign and malignant lesions. Even those lesions considered "suspicious" by qualitative radiologists' interpretations may prove malignant in less than 30% of cases.

Fractal analysis is a mathematical technique that quantifies complex shapes. The hypothesis tested is that fractal analysis can quantify the difference between the shapes of benign and malignant lesions as imaged by mammography.

Fractal analysis may be useful to evaluate mammographically discovered breast masses. A blinded, prospective trial will be needed to determine its ultimate usefulness.

Velanovich V: Fractal analysis of mammographic lesions: a feasibility study quantifying the difference between benign and malignant masses. Am J Med Sci, 1996 May, 311:5, 211-4.

Lipids status

Benign mammary gross cystic disease is the most common breast lesion; women with apocrine changes of epithelium lining the cysts are at higher risk for developing breast cancer than the normal population.

Total cholesterol, high- and low-density lipoproteins fractions, triglycerides and phospholipids, lipase activity and total lipid concentrations were measured in cyst fluids and sera from 89 women affected by gross cystic breast disease.

Total cholesterol and high-density lipoprotein content were significantly greater in pooled cyst fluids than normal sera.

Mannello F et al., Lipids status in human breast cyst fluids. Cancer Lett, 1996 Jan 2, 98:2, 137-43.

Differentiation

Contents:

Differentiation
Sonographic differentiation (2)

Differentiation (1)

Compared the accuracies of magnetic resonance (MR) imaging and scintimammography in differentiating benign from malignant breast lesions.

Twelve lesions were monitored with follow-up.

MR imaging was false-negative in one and false-positive in nine lesions.

Planar scintimammography was false-negative in 10 and false-positive in six lesions.

SPECT scintimammography was false-negative in four and false-positive in 10 lesions.

Sensitivities and specificities for malignancy were, respectively, 96% and 82% for MR imaging, 62% and 88% for planar scintimammography, and 83% and 80% for SPECT scintimammography.

Both MR imaging and scintimammography are useful in the evaluation of breast cancer. MR imaging is more sensitive and as specific as scintimammography.

Helbich TH et al., Differentiation of benign and malignant breast lesions: MR imaging versus Tc-99m sestamibi scintimammography. Radiology, 1997 Feb, 202:2, 421-9.

Sonographic differentiation

Differentiated breast lesions on sonography by measurements in two compression states that are perpendicular to each other.

Diameters of 100 breast lesions were measured preoperatively under lateromedial and craniocaudal compression with a new sonographic method. This method uses mammography-identical positioning of the breast and a reference structure for detection of changes of sound amplitude and velocity by through transmission of lesions.

Ninety-six percent of the malignant lesions appeared with ratios < or = 1.2, whereas 92% of the benign lesions had a ratio > 1.2. Further differentiation is possible by observation of velocity in lesions with ratios > 1.2.

Examination of lesions in two compression states that are perpendicular to each other allows discrimination of benign and malignant masses by measurements in most patients.

Richter K et al., Differentiation of breast lesions by measurements under craniocaudal and lateromedial compression using a new sonographic method. Invest Radiol, 1996 Jul, 31:7, 401-14.

Sonographic differentiation (2)

Sonography can be used for the accurate differentiation of many benign and malignant solid breast lesions. However, considerable experience, and close correlation with the physical examination and the mammogram, are required to do so.

Sixteen sonographic signs useful in this differentiation are reviewed.

Primary breast malignancies are divided into five categories according to their sonographic presentations:
(1) classic neoplasms with irregular borders, echoic rims, and usually posterior shadowing,
(2) small, round neoplasms with no echoic rim or posterior shadowing,
(3) neoplasms with mixed or increased echogenicity,
(4) cystic or intracystic carcinomas, and
(5) colloid carcinomas.

Methods for identification of these different types of invasive malignancy, and of in situ carcinomas, are presented.

The usefulness of sonomammography is considered in specific circumstances, including evaluation of mammographic or physical findings, dense breasts, post-radiation breasts, and women under 35 years of age.

Kelly KM: Sonographic evaluation of benign and malignant breast lesions. Crit Rev Diagn Imaging, 1996 Apr, 37:2, 79-161.


Luteal heat cycle

Wearing a special thermometric brassiere, selected women self-measured their breast surface temperature. These measurements were made during one hour each evening at home for one menstrual cycle under standard conditions of overclothing and room temperature.

To stage their cycle they also collected daily samples of saliva in their freezer for immuno-assay of progesterone concentration in the laboratory.

There were 4 groups, a control group (N = 25) and three 'disease' groups, namely: family history of breast cancer (14); benign breast disease (12); and a 'cancer-associated' group (31) who had had previous cancer surgery.

A significant breast temperature rhythm with a period at or about 28 days was in all groups.

Nevertheless, consistent rhythm abnormalities were found in the disease groups. Most evident was a hyperthermia throughout the cycle, a reduction in the rhythm amplitude, and a tendency for the breast temperature rhythm to be manifest 1-2 days earlier in the menstrual cycle.

Simpson HW The luteal heat cycle of the breast in disease. Breast Cancer Res Treat, 1996, 37:2, 169-78.

Radiation therapy

Presents the long-term risks of developing malignancies other than breast cancer after exposure to scattered doses of ionizing radiation.

The estimates were based on a cohort of 3,090 women who were diagnosed clinically with benign breast disease between 1925 and 1961. A total of 1,216 women were treated with radiation therapy. The breasts received a mean absorbed dose of 5.84 Gy. Mean absorbed doses owing to scatter to 14 other organs were also determined. The lung received the highest mean scattered dose (0.75 Gy; range 0.004-8.98 Gy) and rectum the lowest (0.008 Gy; range 0-0.06 Gy). Median age at first exposure was 40 years. The follow-up lasted up to 61 years after treatment (mean follow-up 27 years).

No increased risk was observed for leukemias. In two earlier reports, breast cancer incidence has been shown to be significantly increased in this cohort of irradiated women. Our results suggest that the scattered doses from the breast irradiation may have increased the risk of cancers of other sites, but the small number of cases in different locations precludes strong interpretations.

Mattsson A et al., Incidence of primary malignancies other than breast cancer among women treated with radiation therapy for benign breast disease. Radiat Res, 1997 Aug, 148:2, 152-60.

Risk factors & the breast

Assessed the relative risks associated with established risk factors for breast cancer, and whether the association between dietary fat and breast cancer risk varies according to levels of these risk factors.

Total fat intake (adjusted for energy consumption) was not associated significantly with breast cancer risk in any strata of these non-dietary risk factors.

A marginally significant interaction between total fat intake and risk of breast cancer according to history of benign breast disease; with fat intake being associated nonsignificantly positively with risk among women with a previous history of benign breast disease; no other significant interactions were observed.

Risks for reproductive factors were similar to those observed in case-control studies; relative risks for family history of breast cancer were lower.

No clear evidence in any subgroups of a major relation between total energy-adjusted fat intake and breast cancer risk was found.

Hunter DJ et al., Non-dietary factors as risk factors for breast cancer, and as effect modifiers of the association of fat intake and risk of breast cancer. Cancer Causes Control, 1997 Jan, 8:1, 49-56.

Vitamin E concentration

Vitamin E may be a protective factor against cancer. A low dietary vitamin E intake has been suggested to increase the risk of breast cancer.

Examined the dietary intake and the concentration of vitamin E in breast adipose tissue of women in Kuopio, Finland, diagnosed between 1990 and 1992 with benign breast disease (n = 34) and with breast cancer (n = 32).

In postmenopausal women, lower dietary intake and a smaller concentration of vitamin E in breast adipose tissue were observed in breast cancer patients than in subjects with benign breast disease.

Vitamin E concentration in the breast adipose tissue correlated positively with the dietary intake of vitamin E; indicating that the vitamin E concentration in breast adipose tissue reflects the dietary intake of vitamin E.

Zhu Z et al., Vitamin E concentration in breast adipose tissue of breast cancer patients (Kuopio, Finland). Cancer Causes Control, 1996 Nov, 7:6, 591-5.

Patient education

Determined the impact of distributing patient-education pamphlets to women with benign breast conditions in a large urban multidisciplinary breast clinic.

While only 29 of the 50 women interviewed reported receiving such materials, 27 of these 29 women reported reading them. The patient's level of education and whether the patient had friends/relatives with breast cancer were not different between the women who had read the pamphlets and the women who had not.

The women who had received and read the material scored significantly better than did women who had not on a brief breast cancer screening questionnaire. Of the former, all but three found the information of use; three-fourths of such women rated the materials 8 or higher on an increasing-usefulness scale of 1-10.

The most frequently reported benefit gained from the materials was the proper conduct of breast self-examination. Overall patient satisfaction with the pamphlets was 91%. Half of the women receiving such materials shared them with other women.

Patient-education pamphlets distributed at a multidisciplinary breast clinic result in high patient satisfaction and better patient knowledge of breast health. However, these materials were received and read by patients less often than was expected by staff.

The distribution of such materials is an important function of a multidisciplinary breast clinic.

Vetto JT et al., The impact of distribution of a patient-education pamphlet in a multidisciplinary breast clinic. J Cancer Educ, 1996 Fall, 11:3, 148-52.

Parasites

Documented the value of fine needle aspiration cytology (FNAC) in the diagnosis of parasites in breast aspirates.

Review of 8,364 breast aspirates studied over 15 years (1978-1992) for parasitic infections.

Eight cases of cysticercosis and 9 of filariasis were detected among 4,714 benign breast aspirates.

In rare cases, parasitic infections present as breast lumps and can be easily diagnosed by FNAC.

Kapila K & Verma K: Diagnosis of parasites in fine needle breast aspirates. Acta Cytol, 1996 Jul-Aug, 40:4, 653-6.

Fatty acids

Fatty acid composition of triglycerides (TGs) and phospholipids (PLs) in breast adipose tissue was analyzed

Results suggest that intake of the long-chain n-3 fatty acids (mainly derived from fish EPA, DHA) may have a protective effect against breast cancer, particularly in postmenopausal women.

Zhu-ZR. Et al: Fatty acid composition of breast adipose tissue in breast cancer patients and in patients with benign breast disease. Nutr-Cancer. 1995; 24(2): 151-60.

Low fat diet

Previous studies have shown that lipid abnormalities have a role in the pathogenesis of benign breast disease. However, few investigators have tried to reduce dietary fat to treat this disorder.

Used a low fat diet (less than 15% fat-derived calories) in the treatment of benign breast disease in patients who had been symptomatic for 6 months or more.

Phase I results showed that after 6 months none of the patients in the control group had experienced any alteration in their symptoms and signs but in the treatment group 12 out of 17 improved. In phase II improvement in pain (68 out of 97; 70%), nodularity (51 out of 79; 64%) and discharge (15 out of 19; 80%) was seen.

There was a significant decline in the mean values of total cholesterol and high-density lipoproteins at the end of 5 months of treatment.

A low fat diet improved the symptoms and lipid profile in patients with benign breast disease.

Mishra-SK.: Efficacy of low fat diet in the treatment of benign breast disease. Natl-Med-J-India. 1994 Mar-Apr; 7(2): 60-2.

Cysts & Benign Breast Disease

Cysts (1)

Interval breast cyst formation is not uncommon, and most of these benign lesions will undergo spontaneous regression or remain stable. Further intervention is not required for interval benign cysts.

Sonographic evaluation of the breast. Venta-LA et al., Radiographics. 1994 Jan; 14(1): 29-50.

Cysts (2)

Patients bearing macrocysts of the breast are at higher risk of later developing cancer. Breast cysts fluid (BCF) contains unusual amounts of steroid conjugates.

Measuring BCF cations (K+,Na+) allows categorization of cysts into two major subsets (type I and type II) that are associated with a different degree and/or turnover of apocrine metaplastic cells in the lining epithelium. Type I cysts (high K+/Na+ ratio) accumulate hugh amounts of androgen and estrogen sulfates. Conversely, type II cysts (low K+/Na+ ratio) contain more progesterone and pregnenolone.

Women with type I cysts have an increased breast cancer risk.

Steroid biochemistry and categorization of breast cyst fluid: relation to breast cancer risk. Angeli-A et al., J-Steroid-Biochem-Mol-Biol. 1994 Jun; 49(4-6): 333-9.
Cysts (3)

Gross cystic disease (GCD) represents an advanced form of fibrocystic disease of the breast. Bearers of macrocysts have been reported to be at risk of developing breast cancer. Natural killer (NK) cells are a lymphocyte subset deeply involved in immunosurveillance against neoplasia.

There was an immunosuppressive effect of breast cyst fluid (BCF), potentially leading to altered "local immunosurveillance".

Natural killer (NK) cell activity of women with gross cystic disease is inhibited in vitro by breast cyst fluid. Ardizzoja-M et al., Anticancer Res. 1994 Mar-Apr; 14(2A): 555-9.

Cysts (4)

Most women have fibrocystic changes in their breasts. Patients with proliferative changes with atypia are at an increased risk of breast cancer. The management of mastalgia is the challenge most frequently encountered in patients with fibrocystic changes. Clinically, the types and variants of fibrocystic changes are sometimes difficult to distinguish. When the diagnosis of fibrocystic changes is unclear, surgical biopsy, should be performed.

Fibrocystic changes. Fiorica-JV. Obstet-Gynecol-Clin-North-Am. 1994 Sep; 21(3): 445-52.

Cysts (5)

Gross cystic disease and breast cancer are hormonally induced diseases that may share a common biochemical environment conducive to abnormal proliferative responses. Breast cyst fluid samples were analyzed for specific growth factors and levels were compared with breast cancer risk.

The presence of multiple cysts was associated with increased mitogenic activity, increased epidermal growth factor (EGF) and TGF-beta breast cyst fluid levels, and recurrent cysts were associated with higher levels of EGF. Unique growth factor profiles were associated with each risk group or clinical state, suggesting that distinct proliferative environments, associated with different clinical outcomes, are present in the breast tissue of women with gross cystic disease.

Growth factor profiles in breast cyst fluid identify women with increased breast cancer risk. Hess-JC et al., Am-J-Surg. 1994 May; 167(5): 523-30.

Fibroadenomas & Benign Breast Disease

Fibroadenomas are benign breast tumors that are commonly diagnosed in young women and are associated with a slight increase in the risk of breast cancer.

Fibroadenomas with cysts, sclerosing adenosis, epithelial calcifications, or papillary apocrine changes were classified as complex.

Fibroadenoma is a long-term risk factor for breast cancer. The risk is increased in women with complex fibroadenomas, proliferative disease, or a family history of breast cancer.

Long-term risk of breast cancer in women with fibroadenoma. Dupont-WD et al., NEJM. 1994 Jul 7; 331(1): 10-5.

Fibrocystic Breast Disease

Fibrocystic Breast Disease (1)

Cancer patients were remarkably heavier, had a higher body mass index, increased menstrual irregularities, later menopause and a shorter school attendance. The cancer patients intake of poultry, fish, pastry, margarine and alcohol was increased while they consumed less milk, raw vegetables, pasta, sugar, butter and coffee. Cancer patients tend to be older than the fibrocystic breast disease patients.

"Nutrition and Lifestyle Factors in Fibrocystic Disease and Cancer of The Breast", Simard, A. et al., Cancer Prevention and Nutrition, 1990;567-572.

Fibrocystic Breast Disease (2)

Over 3800 women who had documented cystic breasts per aspiration were evaluated for their subsequent development of breast cancer. It was found that the subsequent breast cancer risk ratio was 1.77. Though women with documented cystic breasts have a higher subsequent breast cancer rate than expected, the observed increased risk is moderate and does not warrant increased surveillance in these patients.

Ciatto, S. et al., Risk of Breast Cancer Subsequent to Proven Gross Cystic Disease. European Journal of Cancer, 1990;26(5):555- 557.