Biomedical subjects
Publications and source records attributed to J N Wolfe.
Breast parenchymal patterns can be divided into four groups: N1, P1, P2 and DY. Although there is evidence that the P2-DY group favors the development of cancer, the risk classification changes when one considers prevalent vs. incident breast cancers. In a purely incident series, a gradual diminution will be seen in the number of N1-P1 cancer cases and a corresponding rise in cancer patients from the P2-DY group.
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Using the Wolfe breast pattern classification, a study was conducted to test the reproducibility of this classification in view of its likely significance for breast screening and rescreening programs. The results are highly encouraging, and there was good agreement. Reclassification from low risk occurred in 1% of the cases; reclassification from high risk to low risk occurred in 1.4%. There was a variance of 2.4% in the low-risk group and 0.6% in the high-risk group.
A total of 143 breast biopsies were compared with xeroradiographic images. N1 breasts showed normal stroma, ducts, and lobules; P1 breasts had mild to moderate perioductal and perilobular fibrosis with some atypical lobules and other low-grade lesions; P2 was similar to P1 but with more fibrosis and higher-grade atypical lobules; and DY was generally similar to P2 but with more high-grade atypical lobules and extensive, confluent fibrosis. The highest grades of precancerous epithelial abnormality appear to be found in P2 and DY, seldom in P1, and very rarely in N1. Xeroradiographic and histological risk grades show very close correlation.
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In a study of the effects of beam filtration on the entrance exposures encountered in xeroradiography of the breast, it was found that increasing the total filtration to 3.2 mm of aluminum reduced entrance exposures by a factor of three compared to the xeroradiographic techniques without added filtration. Changes in the processing parameters were found to restore much of the lost contrast observed when filtration was increased, resulting in clinically acceptable mammograms at reduced entrance exposures.
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1) By breast parenchymal patterns one can isolate women at significantly high and low risk for developing breast carcinoma from the general population. 2) Basically the risk classification does not change with aging. 3) Radiographic screening studies should be concentrated in the high risk groups. 4) The highest risk group, DY, should be considered for aggressive surgical ablation of the tissue capable of generating a breast cancer.
This study was undertaken to determine the relationship between thyroid supplements and breast cancer. The incidence of breast cancer among the patients who received thyroid supplements was 12.13%, while in the control group it was 6.2%. The incidence rate of breast cancer was 10%, 9.42%, and 19.48% among patients who received thyroid supplements for one to five, 5 to 15, and for more than 15 years, respectively. The incidence of breast cancer among nulliparous women who received thyroid supplements was 33%, while in the nulliparous women without thyroid supplements the incidence was only 9.25%. Even in a specific age group, the incidence rate of breast cancer was higher among patients receiving thyroid supplements, when compared to the control patients in the same age group.
Mammography is presented for the primarily nonradiologic audience. A brief historical review calls attention to some of the milestones in mammography and how it has changed. Xerororadiography is discussed, as it is one of the newer developments and is rapidly gaining broad acceptance in the United States. Clinical applications are included, with a discussion of the various entities which the radiologist can identify on the mammogram. Although the mammographic examination can be extremely accurate in the hands of interested examiners, some carcinomas will not be identified; of these, some can be discovered by routine physical examination. If mammography is made to stand alone, without a physical examination, some women with breast cancer will not be identified and will not receive prompt, adequate treatment. Mammography is an adjunct and a complement to the physical examination. Breast cancer screening appears to be effective in finding small, nonpalpable tumors, many very early in their growth. Definite evidence is now available that early diagnosis of breast cancer leads to prolonged survival. There is promise of further developments in the field of mammography.
A classification of risk for developing breast cancer has been devised based solely on the appearance of the breast parenchyma by mammography. Four groups of patients were isolated. The study encompassed a five-year period and was done by reviewing the mammograms of all women over the age of 30 who had been examined at Hutzel Hospital, Detroit. The average time of followup would be approximately 2 1/2 years. Four groups had an incidence of developing breast cancer of 0.1, 0.4, 1.7, and 2.2. These parenchymal patterns are described and criteria for their identification are given.
The appearance of the breast parenchyma was studied in 955 women to determine whether it changed with age. It was found that women initially classified as being at either a low risk or a very high risk of cancer do not demonstrate changes in the breast parenchyma pattern with age. However, breasts in young women which exhibit dysplastic changes on the initial examination (QDY) frequently do change, occasionally to a relatively lower-risk category but often to a normal or near-normal appearance. Such changes generally occur between the ages of 35 and 50.
The radiographic appearance of the breast parenchyma provides a method of predicting who will develop a breast cancer. This paper describes a restrospective study of 7,214 patients. On the basis of the radiographic appearance of the breast parenchyma, patients were placed into one of four groups of risk for developing carcinoma of the breast. Follow-up studies revealed a stepwise progression in the incidence of developing carcinoma of the breast at least 6 months after the radiographic examination. In one of the two substudies, there was a 37 times greater incidence for those at highest risk compared to the low risk group. The classifications presented are thought to be of value in the everyday practice of mammography as well as in planning screening programs.