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PubMed1982

Natural killer (NK) activity in peripheral blood lymphocytes of patients with benign and malignant breast disease.

Previous studies of natural killer (NK) activity in the peripheral blood of breast cancer patients have failed to show a reduction in cytotoxicity, an observation at variance with results obtained in other malignancies. Interpretation of the data however is complicated by the presence of treated and post-mastectomy patients in the groups studied.In this study, lymphocytes from preoperative blood samples of untreated women with benign and malignant breast disease were tested at various effector-to-target ratios for cytotoxicity activity against the NK sensitive erythromyeloid cell line, K562.A significant reduction in NK activity was observed between carcinoma patients and the control group (P=0·02). When the carcinoma group was further divided into pre- and postmenopausal patients, the reduction was found to be a feature only of premenopausal women (P=0·002). The levels of NK activity in patients with benign breast disease were not significantly different from those in controls, irrespective of menstrual status. There was no correlation between NK activity and tumour size, oestrogen-receptor or lymph-node status in the carcinoma patients.A preliminary analysis of NK activities in the control group suggests that women donating blood in the first half of their menstrual cycle show significantly reduced NK activity in comparison with those in the second half (P=0·001). This finding, coupled with the variation in NK activity shown between pre- and postmenopausal breast carcinoma patients, suggests that hormonal effects in conjunction with malignancy determine the level of NK activity in breast cancer.

Adult↗
PubMed1997

Breast irradiation in women with early stage invasive breast cancer following breast conservation surgery. Provincial Breast Disease Site Group.

GUIDELINE QUESTIONS: 1) Should breast irradiation be given to women with early stage invasive breast cancer (stage I and II) following breast conservation surgery (lumpectomy with clear resection margins and axillary dissection)? 2) Is there an optimal schedule for breast irradiation? 3) What is a reasonable interval between definitive surgery and the start of breast irradiation? 4) Are there patients who can be spared breast irradiation after lumpectomy? OBJECTIVE: To make recommendations about the use of breast irradiation in women with early stage invasive breast cancer following breast conservation surgery. OUTCOMES: Local control is the primary endpoint of interest. Survival, quality of life (addressed through the adverse effects of radiotherapy) and cosmesis are also considered. PERSPECTIVE (VALUES): Evidence was selected and reviewed by 6 members of the Breast Disease Site Group (Breast DSG) of the Ontario Cancer Treatment Practice Guidelines Initiative. Earlier drafts of the evidence-based recommendation were reviewed, discussed and approved by the Breast DSG, which comprises medical oncologists, radiation oncologists, surgeons, epidemiologists, pathologists and a medical sociologist. There was no participation by a community representative in the development of this guideline. QUALITY OF EVIDENCE: There are 5 randomized controlled trials (RCTs) and 1 meta-analysis comparing breast irradiation with no breast irradiation following breast conservation surgery; 6 randomized trials comparing breast conservation surgery plus breast irradiation with mastectomy are also included, as well as several retrospective studies. BENEFITS: All of the 5 RCTs showed a significant decrease in local recurrence rates among patients receiving radiotherapy. In the 4 trials with a median follow-up of 5 years or longer, the relative risk reduction with breast irradiation ranged from 69% to 88%. The absolute differences ranged from 16% (p < 0.001) to 25% (p < 0.001). Despite the effect on local recurrence, no difference in survival was detected in any of the 5 trials. Most of the patients with local recurrence in these trials underwent mastectomy. HARMS: Major adverse effects of breast irradiation occur very infrequently. PRACTICE GUIDELINE: Women with early stage invasive breast cancer (stage I and II) who have undergone breast conservation surgery should be offered postoperative breast irradiation. The optimal fractionation schedule for breast irradiation has not been established, and the role of boost irradiation is unclear. Outside of a clinical trial, 2 commonly used fractionation schedules are suggested: 50 Gy in 25 fractions to the whole breast, or 40 Gy in 16 fractions to the whole breast with a local boost to the primary site of 12.5 Gy in 5 fractions. Shorter schedules (e.g., 40 or 44 Gy in 16 fractions) have also been used routinely in some centres. The enrollment of patients in ongoing clinical trials is encouraged. Women who have undergone breast conservation surgery should receive local breast irradiation as soon as possible after wound healing. A safe interval between surgery and the start of radiotherapy is unknown, but it is reasonable to start breast irradiation within 12 weeks after definitive surgery. For women who are candidates for chemotherapy, the optimal sequencing of chemotherapy and breast irradiation is unknown. It is reasonable to start radiotherapy after the completion of chemotherapy, or concurrently if anthracycline-containing regimens are not used. For further information, please refer to Ontario Cancer Treatment Practice Guidelines Initiative's practice guideline "Surgical Management of Early Stage Invasive Breast Cancer (stage I and II)."

Breast Neoplasms↗
PubMed2005

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.

Adult↗
PubMed1989

Breast fluid cholesterol and cholesterol beta-epoxide concentrations in women with benign breast disease.

Because cholesterol 5,6-epoxides have been reported to be mutagenic, carcinogenic, and cytotoxic, we investigated the relationship of these substances in breast fluid to histopathologically defined breast disease. We measured cholesterol and its oxidation product, 5 beta,6 beta-epoxide, in breast fluids from 68 women with biopsied benign breast disease (BBD) and 135 women with no history of breast disease (controls). Each biopsy was classified according to the most severe epithelial change: (a) nonproliferative epithelia; (b) hyperplasia without atypia; or (c) hyperplasia with atypia. Similar to our previous findings in control women, breast fluid cholesterol and beta-epoxide concentrations in women with BBD were associated with factors of interest in relation to breast cancer: concentrations increased with age and were higher in white than nonwhite women and in women who were past or current smokers; concentrations were lower in women who had given birth or breastfed within 2 yr. Increased breast fluid cholesterol and beta-epoxide concentrations were significantly associated with proliferative BBD (hyperplasia with or without atypia) compared to controls. After adjustment for covariates, the odds ratio for proliferative BBD associated with detectable versus nondetectable beta-epoxide concentrations was 8.5 (95% confidence intervals, 1.1, 68.8). Our findings suggest that the histological progression from normal epithelium to hyperplasia without atypia to atypical hyperplasia is associated with progressively increasing concentrations of both cholesterol and cholesterol beta-epoxide.

Adult↗
PubMedDate not supplied

Efficacy of low fat diet in the treatment of benign breast disease.

BACKGROUND: 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. METHODS: Between 1990 and 1993, we conducted a prospective cohort study to find out the efficacy of 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. The study was conducted in two phases. In the first phase 36 patients were alternately assigned to control and treatment groups for 6 months and in the second phase 121 patients (including all those in phase I) were given treatment (median follow up 25 months, range 3 to 39 months). Detailed lipid profiles were studied at the time of presentation and at 4 and 5 months. RESULTS: 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. CONCLUSION: A low fat diet improves the symptoms as well as the lipid profile in patients with benign breast disease.

Adolescent↗
PubMedDate not supplied

Benign breast disease in the postmenopausal woman.

Breast symptoms are surprisingly common in the postmenopausal period, especially (but not only) when taking hormonal therapy. All of the common conditions of the premenopausal period may be seen. Clinical examination is usually easier and more precise in the postmenopausal woman. The importance of accurate clinical observation is stressed, as a diagnosis can usually be made in this way, supplemented by mammography and aspiration cytology where reliable services exist.

Breast Diseases↗
PubMed1992

Dehydroepiandrosterone sulphate plasma levels in normal women and patients with benign breast disease.

Dehydroepiandrosterone sulphate plasma levels were measured in patients with benign breast disease and in healthy women. In addition the adrenal secretion of dehydroepiandrosterone sulphate was assessed by means of an ACTH stimulation test in some patients and control subjects. The results obtained demonstrate that dehydroepiandrosterone sulphate plasma levels of patients with benign breast disease overlap those found in controls and that the adrenal response to ACTH of patients with breast pathology does not differ from that of healthy women.

Adrenocorticotropic Hormone↗
PubMed1984

Indirect leukocyte migration inhibition in breast cancer and benign breast disease patients by mouse mammary tumor virus grown in feline kidney cells.

Indirect migration inhibition assays were performed with normal and mammary tumor-bearing C3H/HeN mice and patients with breast disease to assess cellular immunity against three different mouse mammary tumor virus (MTV) preparations grown in feline kidney cell cultures and against a mouse-derived MTV preparation. MTV obtained after passage through feline kidney cells and the mouse-derived MTV were capable of eliciting macrophage migration inhibitory factor production by mouse spleen cells obtained from normal or mammary tumor-bearing C3H/HeN mice, thus demonstrating a similar degree of antigenicity of these preparations. In experiments with human breast cancer patients' leukocytes, leukocyte inhibitory factor (LIF) was produced by 32-50% of these patients in response to the mouse-derived MTV or to three different MTV preparations obtained after passage through feline kidney cells. A significant proportion (31-54%) of benign breast disease patients also reacted with both the mouse-derived and feline-derived MTV preparations. Patients with both malignant and benign breast disease, however, had a significantly different (P less than .05) pattern of reactivity to mouse- and feline-derived MTV preparations from that observed with normal donors. Finally, some LIF activity was also observed (but not statistically significant with the use of nonparametric analysis methods) when feline leukemia virus was used as antigen with these patients. The data suggest that both breast cancer and benign breast disease patients were reactive against antigens largely specific for MTV in the feline cells and, presumably, were not reactive against feline cellular components, although the second possibility cannot be completely ruled out.

Animals↗
PubMed1978

Oral contraceptives and breast disease in premenopausal Northern Albertan women.

The results of a prospective study on oral contraceptive use and breast disease in northern Alberta are presented. The study groups comprised all women aged 30 to 49 examined in diagnostic breast clinics at the Cross Cancer Institute between 1971 and 1974. Three hundred and one patients had breast cancer, 692 had a subsequent biopsy for a benign breast condition, and 548 had no subsequent biopsy. A tendency for an increased relative risk (RR) of breast cancer in women taking oral contraceptives for periods of 1 to 5 years was evident, with relative risk decreased or unaffected in users of less than 12 months (RR = 0.6) or more than 5 years (RR = 1.0). A slightly increased risk was apparent in patients using oral contraceptives within a year prior to attendance at the clinic (recent users); this increase was emphasized when recent users with a prior biopsy for benign breast disease were analyzed alone (RR = 5.0). In women with a prior breast biopsy, use of oral contraceptives for more than 5 years increased risk of breast cancer nine-fold. Former users who had taken oral contraceptives for less than a year showed a significant reduction in breast cancer risk (RR = 0.3). The risk of benign breast disease was also reduced in former users (RR = 0.6) as well as in long-term users (RR = 0.5).

Adult↗
PubMed2001

The diagnostic accuracy of mammography in the evaluation of male breast disease.

BACKGROUND: The role of mammography in the evaluation of male patients presenting with breast disease is controversial. This controversy is a function of the lack of specific data concerning the diagnostic accuracy of mammography when used in this clinical setting. The purpose of this study was to define the diagnostic accuracy of mammography in the evaluation of male breast disease. METHODS: One hundred and four prebiopsy mammograms from 100 patients with tissue diagnoses were read blindly by two independent radiologists, and placed into one of five predetermined categories: definitely malignant, possibly malignant, gynecomastia, benign mass, and normal. Radiologic/pathologic correlation was performed and the sensitivity (Sn), specificity (Sp), positive (Ppv) and negative predictive value (Npv), and accuracy (Ac) for each of the mammographic diagnostic category determined. RESULTS: The pathologic diagnoses were 12 cancers, including 1 patient with bilateral breast cancer, 70 cases of gynecomastia, 16 benign masses, and 6 normals. The accuracy data for the mammographic diagnostic categories are as follows: malignant (combined definitely and possibly malignant), Sn 92%, Sp 90%, Ppv 55%, Npv 99%, Ac 90%; and overall benignity (combined gynecomastia, benign mass, and normal), Sn 90%, Sp 92%, Ppv 99%, Npv 55%, Ac 90%. Six cancers (50%) coexisted with gynecomastia. CONCLUSIONS: Mammography can accurately distinguish between malignant and benign male breast disease. Although not a replacement for clinical examination, its routine use could substantially reduce the need for biopsy in patients whose mammograms and clinical examination suggest benign disease.

Breast Neoplasms, Male↗
PubMed1994

Bombesin plasma levels in patients with benign and malignant breast disease.

Some reports suggest a role for bombesin-like peptides in the pathology of breast tumors. Bombesin and related gastrin-releasing peptides have been shown to influence the inositol phospholipid signalling pathway and stimulate growth of some cells, including some human breast cancer cell lines. We measured the plasma concentration of bombesin in 23 breast cancer patients, 32 patients suffering from benign breast disease and in 21 healthy controls. The bombesin concentration in plasma taken from the thoracodorsal vein, in the vicinity of the tumor in breast cancer patients was higher than that in the peripheral circulation (mean +/- SEM, 91.3 +/- 54.3 vs. 40.9 +/- 27.4 pg/ml; p < 0.05). Bombesin concentrations in the cubital vein in breast cancer patients and in those with benign breast disease (61.7 +/- 49.3 pg/ml) was significantly higher than that in the control group (23.7 +/- 5.06 pg/ml; p < 0.05). Our findings suggest storage or synthesis of bombesin-like peptides within the affected breast and may confirm the role of these peptides in the growth of breast tumors.

Bombesin↗
PubMed2000

Breast diseases in males--a morphological review of 150 cases.

OBJECTIVE: This study was carried out to observe the prevalence breast diseases of males in our setup. METHOD: All cases of male breast disease diagnosed from 1991-97. RESULTS: One hundred and fifty (150) cases of male breast diseases were diagnosed. Age of the patients ranged from 4 to 90 years, with mean age 38.75 years (median = 33 years). Gynecomastia was the most common pathological abnormality of the male breast (58.66%). Most of the patients presented in the 3rd decade of life. Amongst the malignant conditions, infiltrating ductal carcinoma was most prevalent (82%). Most of the patients with malignancy presented in the 5th and 6th decades of life. CONCLUSION: Gynecomastia was the most prevalent male breast disorder, followed by infiltrating ductal carcinoma. Our findings correspond with that of world literature.

Adolescent↗
PubMed2003

Ultrasound in the management of breast disease.

Since its introduction in the 1960s, ultrasound (US) has never been more important in breast disease management as it is today. Its historical role as an adjunct modality to mammography in differentiating cystic from solid lesions has been widely expanded. US-guided sampling procedures represent widely accepted modalities in lesion evaluation. Preoperative localization under US guidance is one of the methods of choice for nonpalpable solid lesions. Screening breast US is currently being investigated and might prove useful for high-risk women and women with dense breasts. Continuous technologic advances, such as high-frequency transducers, new Doppler-based techniques, microbubble contrast agents, harmonic and compound imaging, three-dimensional US, elasticity imaging, US detection of microcalcifications, perfusion US imaging, and computer-aided diagnosis all carry promise of further increases in US utility in the diagnosis and detection of breast disease.

Breast↗
PubMed1980

Circulating immune complexes in sera of dogs with benign and malignant breast disease.

The Raji cell radioimmunoassay was adapted to measure circulating immune complexes (CIC's) in the sera of 74 dogs with benign and malignant breast disease. In dogs with recently diagnosed spontaneous breast cancer, 57% (29 of 51) had elevated CIC's, with some levels as high as those found in the sera of dogs with systemic lupus erythematosus. The sera of 10 of 23 dogs with benign breast disease also demonstrated elevated levels of CIC's. Two weeks following mastectomy, repeat CIC levels were obtained in 30 dogs. Elevated CIC levels returned to normal in all dogs with benign breast disease but in only 33% of dogs with breast cancer. Dogs with persistent elevation of CIC's were at greater risk of developing metastatic breast cancer. Serum total hemolytic complement was significantly higher (p < 0.05) in dogs with untreated breast cancer than in healthy dogs but did not correlate with the level of CIC's found. Two weeks after mastectomy, total hemolytic complement levels had returned to normal. By sucrose density gradient ultracentrifugation, the complexes were shown to sediment at 19 S. These studies indicate that the dog may be a good model for elucidating the significance of elevated CIC's in breast cancer.

Adenocarcinoma↗
PubMed1987

Major ambulatory surgery of the general surgical patient. Management of breast disease and hernias of the abdominal wall.

Procedures for management of breast disease and abdominal wall hernias are those that are done most commonly by the general surgeon and for which the ambulatory surgical unit is apt to be the preferred site. Surgical technique for the management of the various forms of breast disease is reviewed. Most hernias of the abdominal wall can be repaired safely, conveniently, and comfortably in the ambulatory surgical unit. Except for large hernias, no type of hernia should be categorically denied consideration for ambulatory care.

Abdominal Muscles↗
PubMed1984

Prolactin response to thyrotropin-releasing hormone stimulation and dopaminergic inhibition in benign breast disease.

Pituitary function was tested in predefined clinical groups of benign breast disease under strictly controlled clinical and laboratory conditions. Two different tests of prolactin storage and control mechanisms, direct stimulation by thyrotropin-releasing hormone (TRH) and inhibition of dopaminergic control by domperidone, indicate a significant abnormality in patients with severe cyclical mastalgia and nodular breast disease (P less than 0.05 and P less than 0.002), but not in those with noncyclical mastalgia. No abnormalities of thyroid function were found.

Adult↗
PubMed2001

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%.

Adult↗