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Biomedical subjects

D W Kinne

Publications and source records attributed to D W Kinne.

At least 73 records · Page 4Linked to original sources
PubMed1984

Breast carcinoma in women 35 years of age or younger.

The relationship of the age at diagnosis and prognosis in breast carcinoma remains controversial. A widely held perception is that the disease has a particularly unfavorable prognosis in young women. To examine this question we have studied 166 women treated for primary operable breast carcinoma who were 35 years of age or younger at the time of diagnosis. Groups of patients treated consecutively in each of two time periods nearly a decade apart (1964-1970 and 1976-1979) have been studied. Differences between the patient groups in primary surgical treatment and postoperative adjuvant therapy were characterized in the 1970s by the increasing use of modified radical mastectomy and replacement of postoperative radiation therapy by systemic adjuvant chemotherapy. A trend to earlier stage of disease was found among patients treated in 1976 to 1979, but 5-year recurrence and survival rates were not significantly different from those of young women treated in the 1960s. Comparison of Stage II patients treated in 1964 to 1970 with postoperative radiotherapy with comparable women given adjuvant chemotherapy from 1976 to 1979 revealed no significant difference in disease-free survival in the first 3 years after surgery. It remains to be seen whether these changes in therapy will diminish the frequency of recurrences after 5 years, leading to an improvement in overall survival. When compared with historical controls from this and other institutions, the 5-year and 10-year survival rates of approximately 75% and 60%, respectively, found in this study of young women with primary operative disease were not appreciably different from those of women treated for breast cancer at a later age when the disease is more common.

Adult↗
PubMed1984

Breast carcinoma in elderly women: pathology, prognosis, and survival.

There is a widely held belief that breast carcinoma occurring in elderly women is characterized by a relatively favorable prognosis and unusual histologic types of tumors. To assess these topics in a single patient group, 169 women (greater than or equal to 75 years) treated by mastectomy for primary operable breast carcinoma at Memorial Hospital (1964 to 1970) were identified. Followup revealed that 117 patients (70 percent) died. Thirty-eight women (22 percent) developed recurrent breast carcinoma and 35 (21 percent) were known to have died of the disease. Death was attributable to a cause other than breast carcinoma in 82 cases (49 percent). Remaining alive were 48 patients (28 percent) including 3 with recurrent carcinoma. Four patients (2 percent) were lost to followup. The age-adjusted survival experience of our elderly breast cancer patients was significantly poorer than that of a standard population when compared by the life table method. This difference appeared largely to reflect the mortality effect of breast cancer. Median times to recurrence (25 mo) and to death from breast carcinoma (27 mo) were not prolonged. Pathologic analysis revealed that some tumor types with a relatively favorable prognosis (mucinous, papillary, infiltrating lobular) occur more often in elderly women. However, this probably has little bearing on overall prognosis in the group since infiltrating duct carcinoma which constitutes nearly three-quarters of the tumors was responsible for 86 percent of deaths due to breast carcinoma.

Axilla↗
PubMed1983

Endotoxin-induced in vitro release of interleukin-1 by cancer patients' monocytes: relation to stage of disease.

The in vitro release of IL-1 by monocytes in response to endotoxin was subnormal in many patients with breast cancer, malignant melanoma or colorectal cancer but not in patients with benign tumors of the breast or colon. In each of these groups, IL-1 release was low in patients with early cancer, normal in patients with regional metastases, and low in patients with disseminated cancer.

Adult↗
PubMed1983

Surgical management of primary breast cancer.

The approach to primary operable, or potentially curable breast cancer is a controversial field of oncology and is subject to a number of ongoing clinical experiments in many centers. This report discusses the recommended treatment for patients with this disease who are evaluated at the Breast Service of Memorial Sloan-Kettering Cancer Center. The most widely practiced treatment is modified radical mastectomy, with radical mastectomy reserved for patients having more advanced lesions. Modified radical mastectomy is defined as total mastectomy plus axillary lymph node dissection either with preservation of the pectoralis minor muscle or its removal. The latter allows a more thorough axillary dissection and is preferred for patients with invasive carcinomas. In either case, axillary node sampling is not advocated and will miss a significant percentage of axillary metastases. In patients with negative axillary lymph nodes, who are not candidates for adjuvant systemic therapy, breast reconstruction is possible within a few months of mastectomy. For patients with involved axillary nodes, trials of adjuvant chemotherapy (perhaps with antiestrogen therapy for estrogen-receptor positive primary tumors) seem to offer the best hope for improved survival. With available follow-up of such trials to date, there seems little doubt that at a minimum, such treatment prolongs disease-free interval. The role of adjuvant radiation therapy is more controversial, and the difficulty in combining this with chemotherapy is apparent.

Axilla↗
PubMed1983

The relationship between family history, exposure to exogenous hormones, and estrogen receptor protein in breast cancer.

Eight-hundred and thirteen patients were prospectively studied to examine the influence of family history and the prior use of exogenous hormones as covariables in the subsequent expression of estrogen receptor protein (ERP) in the primary tumor of patients with breast cancer. Cases were divided by menstrual status; there were 385 pre- and perimenopausal and 428 postmenopausal patients. The influence of prior exposure to estrogen replacement therapy (ERT) in postmenopausal patients or oral contraceptives (OC) in pre- and perimenopausal patients on tumor ERP was analyzed controlling for family history: none, first degree (1 degree, mother or sister), second degree (2 degrees, grandmother or aunt), or both 1 degree and 2 degrees relatives. The results showed no influence of the prior use of ERT in postmenopausal women on subsequent tumor ERP. Among pre- and perimenopausal women, those with a family history of breast cancer in only a 1 degree relative, showed a borderline significant association between prior OC usage and subsequent tumor ERP. The use of OC was consistently associated with ERP negative tumors (9/9) whereas of 29 patients who had no prior OC exposure 17 had ERP negative tumors (P = 0.04, Fisher's Exact Test). Analysis of the prior exposure to OC, verified with the primary care physician or pharmacist, showed that these patients first used OC at the mean age of 32.2 years, had used OC for a mean duration of 41.9 months and stopped OC use a mean of 79.5 months before being diagnosed as having breast cancer. These results suggest that in a subset of patients with breast cancer, and a first degree relative only who had breast cancer, prior exposure to OC may influence the subsequent ERP status of the tumor. This is not due to exogenous estrogen saturation of receptors as there was a long latent period between exposure and diagnosis. Alternative hypotheses as to the mechanism of selection of subsequent tumor ERP may be either inhibition of ERP positive preneoplastic or tumor cell clones early in the evolution of the tumor or early selection of a tumor capable of endogenous estrogen synthesis with receptor saturation.

Breast Neoplasms↗
PubMed1983

Murine mammary tumor virus related antigen in human male mammary carcinoma.

An antigen immunologically related to mouse mammary tumor virus (MuMTV) and the major envelope glycoprotein, gp52 of MuMTV, was identified in tissue sections of human male and female mammary carcinomas using the peroxidase-antiperoxidase technique. The specificity of the reaction was established by absorption studies. Positive reactions with the gp52 antiserum were seen in mouse and human mammary carcinomas, but not in normal mammary tissues, mammary tissues with benign diseases and in other primary malignant neoplasms. Almost all (32/36, 89%) male mammary carcinomas were positive for the gp52 related antigen. A lesser proportion of tumors among female patients (14/50, 28%) were positive. The gp52 positive tumors were significantly larger than the gp52 negative tumors in female patients (P less than 0.05). Gp52 positive tumors were also larger than gp52 negative tumors in male patients, but the difference was not statistically significant. Gp52 reactivity was also detected in metastatic mammary carcinoma in axillary lymph nodes of male and female patients. The presence of gp52 related antigen was not apparently related to tumor grade or lymphocytic infiltrate in the primary tumor. The data do not permit a firm conclusion regarding nodal status in men; no correlation of gp52 activity and nodal status in women was evident. These results indicate that mammary carcinomas in men as well as in women have an antigen related immunologically to MuMTV gp52. Other than tumor size, the antigen seems to be unrelated to major prognostic factors. The significance of the antigen with respect to etiologic features and prognosis in breast cancer remains to be determined.

Adenocarcinoma↗
PubMed1983

Discontinuous or "skip" metastases in breast carcinoma. Analysis of 1228 axillary dissections.

Patterns of axillary lymph node metastases were analyzed in 1228 recently performed modified, radical, and extended radical mastectomies. In these specimens the position or level of lymph nodes was designated intraoperatively by the surgeon. No lymph node metastases were found in 720 (58) of the specimens while the remainder (508 or 41%) had at least one affected lymph node. The distribution of involvement by level showed progressive spread from level I to III as the number of positive lymph nodes increased. Discontinuous or "skip" metastases not following this pattern occurred in 1.6% of all cases and 3% of those with lymph node metastases (95% confidence interval, 1-5%). Half of those with "skip" metastases had tumor limited to level II. The presence of "skip" metastases was not related to the size, location in the breast, or histologic type of the primary tumor. It is apparent that the potential risk from "skip" metastases is not great and that this should not be a major consideration in therapeutic decisions. The risk is likely to be negligible for women treated by axillary dissections that include level II.

Adult↗
PubMed1982

A pathologic study of benign breast diseases in Tokyo and New York.

Two hundred thirty-two biopsies of benign breast conditions from the National Cancer Center Hospital in Tokyo and 263 comparable biopsies from Memorial Hospital in New York City were reviewed. The component lesions of benign breast disease were identified and evaluated according to their relative frequency for different ages. Apocrine cysts, apocrine hyperplasia, intraductal hyperplasia, sclerosing adenosis, blunt duct hyperplasia, and atypical lobular hyperplasia were at least twice as common in biopsies from American women. Solitary papillomas were twice as common among biopsies from Japanese patients and tended to show more epithelial proliferation and sclerosing papillomatosis than did Americans. No major differences were found in the frequency of cysts, duct stasis, periductal mastitis, sclerosing intraductal papillomatosis, fibroadenomatoid mastopathy or fibroadenomas. Assuming intraductal hyperplasia and atypical lobular hyperplasia may represent premalignant epithelial changes, the high frequency of these lesions in New York biopsies when compared to Tokyo biopsies correlates well with the higher rate of breast cancer in the United States as compared to Japan. The greater frequency of lobular proliferative lesions and apocrine disease in New York suggests that these lesions may be produced by factors which also predispose American women toward breast cancer.

Adenofibroma↗
PubMed1982

Epidemiology of breast carcinoma III: relationship of family history to tumor type.

Previous breast carcinoma in at least one female relative was reported by 31% of 1024 women treated consecutively for breast carcinoma at Memorial Hospital. Eighty (7.9%) of their mothers had had breast cancer. Maternal breast cancer was significantly (P less than 0.006) more frequent among women with medullary carcinoma than those with other tumor types and among those who were pre- or perimenopausal at diagnosis (P less than 0.001). Among the 727 patients who had one or more sisters, 12% had a sister who had been treated for breast cancer. The highest frequency of carcinoma in at least one sister occurred in patients with lobular carcinoma while the medullary carcinoma group had the least number of patients with an affected sister (P less than 0.03). Occurrence of breast cancer in a sister was almost twice as common in patients who were postmenopausal at diagnosis (P less than 0.005) than in premenopausal patients. When stratified by histologic type, the mean age at diagnosis of the patients did not differ appreciably from the age at diagnosis of their sisters. Detailed analyses of histologic type and other more distant familial relationships were also obtained but were considered to be less reliable because of problems in ascertainment and there were fewer affected relatives. No single histologic type of carcinoma was consistently linked to a disproportionately high or low frequency of carcinoma in all classes of relatives. It is possible that studies of family history limited to information available when the patient is first treated present an incomplete picture of familial aggregation. Further follow-up after diagnosis is needed to obtain a more reliable measure of the extent to which relatives are affected by breast cancer and patterns of family distribution associated with specific tumor types.

Adult↗
PubMed1982

Juvenile papillomatosis of the breast and family history of breast carcinoma.

Eighty-four patients included in the Juvenile Papillomatosis Registry were reviewed. The age of diagnosis ranged from 10-44 years (mean, 21). Sixty-nine percent of patients were less than or equal to 20 years of age. The left breast was affected slightly more often (52%) than the right (48%) when the lesion was unilateral. Two patients had bilateral lesions. Patterns of menarche, marital history, parity, and use of birth control pills were not exceptional for women in this age group. No instance was found of maternal use of estrogens during pregnancy. There were no instances of carcinoma developing after biopsy of juvenile papillomatosis, but a newly diagnosed patient had secretory carcinoma arising from juvenile papillomatosis. Two other examples of concurrent carcinoma were previously reported (ipsilateral lobular carcinoma in situ and contralateral secretory carcinoma). Particularly noteworthy is the finding that 26% of patients wih information available reported that breast carcinoma had occurred in one or more female relatives. The major were older, secondary relatives (grandmothers, great aunts), although maternal breast carcinoma (five cass) was also reported. The mothers of both girls who had secretory carcinoma associated with juvenile papillomatosis had been treated for breast cancer. These findings, based on incomplete reporting, are cause for concern in two respects: the findings suggest that juvenile papillomatosis may be a marker for breast cancer for the patient's family, and they indicate a need for continued long-term follow-up of juvenile papillomatosis patients who may themselves be at increased risk.

Adolescent↗
PubMed1982

Occult axillary lymph node metastases from breast cancers with intramammary lymphatic tumor emboli.

Serial sections were performed on the axillary lymph nodes from 28 women with mammary carcinoma and intramammary lymphatic tumor emboli. Occult metastases were demonstrated in nine women (32%), all less than 2 mm in diameter. During the 10 years of follow-up, no difference in recurrences was found between this group (33%) and those without occult metastases (37%). Serial sectioning of lymph nodes in this group of patients does not appear to be helpful in prognosis.

Axilla↗
PubMed1982

Multicentricity and bilaterality in invasive breast carcinoma.

Multicentricity and bilaterality are well-established characteristics of breast carcinoma, but little is known about the relationship of these variables with each other. This question was explored by analyzing the data pertaining to 880 women with invasive breast carcinoma. Patients with multicentric carcinoma had bilateral disease more often than those whose carcinoma was apparently limited to a single quadrant. Among women who had lobular carcinoma in situ coexisting with infiltrating duct carcinoma or infiltrating lobular carcinoma, bilaterality and multicentricity were significantly more common than they were among patients whose only lesion was infiltrating duct or medullary cancer. Other variables associated with bilaterality and multicentricity were degree of ductal differentiation, tumor size, nodal status, type of tumor margin, intensity of lymphoid infiltrate, and menstrual status. Age at diagnosis and estrogen receptors were related to bilaterality but not to multicentricity. The following variables proved to be unrelated to bilaterality and multicentricity: family history of breast carcinoma, height, weight, and parity. The data obtained in this study tend to support a conclusion that multicentricity and bilaterality are manifestations of similar factors involved in the neoplastic transformation of mammary gland epithelium leading to the development of breast cancer.

Age Factors↗
PubMed1982

Modified radical mastectomy for carcinoma of the breast.

The technique of modified radical mastectomy (total mastectomy and axillary dissection) as carried out by members of the Breast Service at Memorial Sloan-Kettering Cancer Center is presented. As described by Patey, the pectoralis minor muscle is removed to facilitate dissection of the upper levels of the axilla. Care is taken to preserve the principal neurovascular bundle to the pectoralis major muscle. Indications for and complications of the procedure are indicated, with particular emphasis given to selection of patients for modified radical mastectomy or radical mastectomy.

Axilla↗
PubMed1981

Estrogen receptor protein in breast cancer as a predictor of recurrence.

Estrogen receptor protein (ERP) determinations of primary cancers of 1034 patients with primary breast cancer were done. ERP-positive patients tended to have a lower recurrence rate and had significantly improved survival. This difference was most apparent in patients with four or more axillary nodes involved. ERP-positive patients who recurred had a better survival. ERP did not influence response that adjuvant chemotherapy, nor did the presence of progesterone receptor or femtomole level of ERP affect recurrence.

Breast Neoplasms↗
PubMed1981

Lobular carcinoma in situ of the breast: preliminary results of treatment by ipsilateral mastectomy and contralateral breast biopsy.

This report describes the follow-up of 108 women who underwent ipsilateral mastectomy for lobular carcinoma in situ (LCIS). Twenty-four women found to have concurrent contralateral carcinoma underwent bilateral mastectomy. The contralateral breast was available for follow-up in the remaining 84 cases, including 33 patients who underwent contralateral biopsy and 51 others who did not have a biopsy of the opposite breast at the time of initial treatment. Five of these 84 patients later developed invasive cancer. Three had had a biopsy that revealed either atypia (two cases) or LCIS (one case). In the two other cases, there had not been a prior biopsy. Two of the 26 patients who had had a benign breast biopsy were found to have LCIS, but none subsequently had intraductal or invasive carcinoma, and none of the 26 women died of breast carcinoma. In this series, 64% of the women retained their contralateral breast; deaths due to contralateral breast carcinoma occurred with half the frequency that had been observed in a prior study of women with LCIS who did not have a contralateral biopsy. These results tend to support our current recommendation to treat LCIS by ipsilateral mastectomy and contralateral biopsy. However, it would be necessary to study these patients for approximately ten more years before results can be considered conclusive. Concurrently, prospective controlled investigations should be pursued to confirm these results, to identify patients most at risk in developing invasive carcinoma, and to determine whether nonsurgical therapy can modify the course of LCIS.

Adult↗
PubMed1981

Estrogen receptor protein in visceral metastases from breast carcinoma.

Estrogen receptor protein assays were done on 1,243 tissue specimens, 34 of which represented metastases from primary breast carcinoma to parenchyma of liver, lung or brain. Eight of these specimens contained significant amounts of estrogen receptor protein. Most (4 of 5 evaluable cases) of the ERP-positive patients responded to endocrine ablation, as compared with 13 percent (2 of 16 evaluable cases) of the ERP-negative patients. We conclude that biopsy of liver and lung metastases may be useful in some circumstances and that endocrine manipulation frequently provides palliation when these metastases are ERP-positive.

Brain Neoplasms↗