Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “BREAST”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 703 records · Page 39Linked to original sources
PubMed1978

Immunologic relationship between breast carcinoma and benign breast disease as detected by the leukocyte migration inhibition assay.

Patients with benign diseases of the breast reacted in a migration inhibition assay with extracts of breast cancer and benign breast lesions and a human breast cancer-derived cell line, MCF-7. The incidence of reactivity of the patients with benign breast diseases against these antigens was similar to that of breast cancer patients. In addition, patients with breast cancer reacted to some extracts of benign breast lesions. The reactivity occurred in patients with several different histopathologic types of breast lesions, but was not found in women with no detectable pathologic lesions.

Adenofibroma↗
PubMed2001

Breast cancer risk in women with abnormal cytology in nipple aspirates of breast fluid.

BACKGROUND: We previously showed that women with abnormal cytology in breast fluid obtained by nipple aspiration had an increased relative risk (RR) of breast cancer compared with women from whom fluid was not obtained and with women whose fluid had normal cytology. This study extends the follow-up in the original study group (n = 4046) and presents the first follow-up for a second group of women (n = 3627). METHODS: We collected nipple aspirate fluid from women in the San Francisco Bay Area during the period from 1972 through 1991, classified the women according to the most severe epithelial cytology observed in fluid specimens, and determined breast cancer incidence through March 1999. We estimated RRs for breast cancer using Cox regressions, adjusting for age and year of study entry. All statistical tests were two-sided. RESULTS: For women in the first and second study groups, the median years of follow-up were 21 years and 9 years, respectively, and breast cancer incidences were 7.8% (285 cases in the 3633 women for whom breast cancer status could be determined) and 3.5% (115 of 3271), respectively. Compared with women from whom no fluid was obtained, whose incidences of breast cancer were 4.7% (39 of 825) and 3.3% (65 of 1950) for those in group 1 and group 2, respectively, incidences and adjusted RRs were 8.1% (34 of 422), with RR = 1.4 (95% confidence interval [CI] = 0.9 to 2.3), and 0% (0 of 31), respectively, for those with unsatisfactory aspirate specimens and 8.2% (148 of 1816), with RR = 1.6 (95% CI = 1.1 to 2.3), and 3.1% (25 of 811), with RR = 1.2 (95% CI = 0.8 to 2.0), respectively, for those with normal cytology in aspirates. Compared with women from whom no fluid was obtained, incidences and adjusted RRs for women in group 1 with epithelial hyperplasia and atypical hyperplasia in aspirates were 10.8% (52 of 483), with RR = 2.4 (95% CI = 1.6 to 3.7), and 13.8% (12 of 87), with RR = 2.8 (95% CI = 1.5 to 5.5), respectively, while those for women in group 2 were 5.5% (25 of 457) and 0% (0 of 22), respectively, with a combined RR = 2.0 (95% CI = 1.3 to 3.3). CONCLUSION: The results obtained with the newly followed women independently confirmed previous findings that women with abnormal cytology in nipple aspirates of breast fluid have an increased risk of breast cancer.

Adolescent↗
PubMed2003

Effects of tamoxifen on benign breast disease in women at high risk for breast cancer.

BACKGROUND: In 1998 the National Surgical Adjuvant Breast and Bowel Project (NSABP) demonstrated that tamoxifen treatment reduced the incidence of both invasive and noninvasive breast cancer in women at high risk for the disease. We examined the effect of tamoxifen treatment on the incidence of benign breast disease and the number of breast biopsies in the same group of women. METHODS: We examined the medical records of 13 203 women with follow-up who participated in the NSABP Breast Cancer Prevention Trial. Included in this analysis were women who had undergone a breast biopsy and who had histologic diagnoses of adenosis, cyst, duct ectasia, fibrocystic disease, fibroadenoma, fibrosis, hyperplasia, or metaplasia. The relative risk (RR) for each histologic diagnosis was estimated for women who received tamoxifen and for women who received placebo. We also tallied the number of biopsies that women in the placebo and tamoxifen groups underwent. RESULTS: Overall, tamoxifen treatment reduced the risk of benign breast disease by 28% (RR = 0.72, 95% confidence interval [CI] = 0.65 to 0.79). Tamoxifen therapy resulted in statistically significant reductions in the risk of adenosis (RR = 0.59, 95% CI = 0.47 to 0.73), cyst (RR = 0.66, 95% CI = 0.58 to 0.75), duct ectasia (RR = 0.72, 95% CI = 0.53 to 0.97), fibrocystic disease (RR = 0.67, 95% CI = 0.58 to 0.77), hyperplasia (RR = 0.60, 95% CI = 0.50 to 0.71), and metaplasia (RR = 0.51, 95% CI = 0.41 to 0.62). Tamoxifen therapy also reduced the risk for fibroadenoma (RR = 0.77, 95% CI = 0.56 to 1.04) and fibrosis (RR = 0.86, 95% CI = 0.72 to 1.03). Compared with the placebo group, the tamoxifen group had 29% (95% CI = 23% to 34%) fewer biopsies (1048 versus 1469) and 19% fewer women who underwent a biopsy (811 versus 1019). This resulted in a 29% reduction in the risk of biopsy in women treated with tamoxifen (RR = 0.71, 95% CI = 0.66 to 0.77). This risk reduction occurred predominantly in women younger than 50 years. CONCLUSION: Women in this study who received tamoxifen, especially younger women (i.e., <50 years), had a reduced incidence of clinically detected benign breast disease and underwent fewer breast biopsies.

Adult↗
PubMed2004

Probabilities of death from breast cancer and other causes among female breast cancer patients.

BACKGROUND: Among cancer patients, probabilities of death from that cancer and other causes in the presence of competing risks are optimal measures of prognosis and of mortality across demographic groups. We used data on breast cancer patients from the Surveillance, Epidemiology, and End Results (SEER) Program in a competing-risk analysis. METHODS: We determined vital status and cause of death for 395,251 white and 35,259 black female patients with breast cancer diagnosed from January 1, 1973, through December 31, 2000, by use of SEER data. We calculated probabilities of death from breast cancer and other causes according to stage, race, and age at diagnosis; for cases diagnosed from January 1, 1990, to December 31, 2000, we also calculated some such probabilities according to tumor size and estrogen receptor (ER) status. All statistical tests were two-sided. RESULTS: The probability of death from breast cancer after nearly 28 years of follow-up ranged from 0.03 to 0.10 for patients with in situ disease to 0.70 to 0.85 for patients with distant disease, depending on race and age. The probability of death from breast cancer at the end of the follow-up period generally declined with age at diagnosis; the probability among the oldest (> or =70 years) compared with the youngest (<50 years) patients was 33% lower for white and 46% lower for black patients with localized disease and 14% lower for white patients and 13% lower for black patients with distant disease. The probability of death from breast cancer exceeded that from all other causes for patients diagnosed with localized disease before age 50 years, with regional disease before age 60 years, and with distant disease at any age. The probability of death from breast cancer for patients diagnosed with localized or regional disease was statistically significantly greater in black patients than in white patients (all six P values < or =.01 for age groups 30-49 to 60-69 years; two P values < or =.04 for ages > or =70 years). Among patients with localized or regional disease and known ER status, the probability of death from breast cancer after nearly 11 years of follow-up ranged from 0.04 to 0.11 for patients with localized ER-positive tumors of 2 cm or less to 0.37 to 0.53 for patients with regional ER-negative tumors. CONCLUSIONS: The probability of death from breast cancer versus other causes varied substantially according to stage, tumor size, ER status, and age at diagnosis in both white and black patients.

Adult↗
PubMed2002

Trends in unilateral breast reconstruction and management of the contralateral breast: the Emory experience.

Recent trends in breast reconstruction have transitioned toward the skin-sparing type of mastectomy and immediate reconstruction using autologous tissue. This study was designed to document trends in the management of patients with unilateral breast cancer and to determine how they influence management of the contralateral breast. All patients who underwent unilateral breast reconstruction at Emory University Hospitals from January of 1975 to December of 1999 were reviewed. The cohort was stratified by timing of reconstruction (immediate versus delayed), method of reconstruction, and mastectomy type (skin-sparing versus non-skin-sparing). The methods of reconstruction included implant, latissimus dorsi flap, and transverse rectus abdominis musculocutaneous (TRAM) flap. Contralateral procedures to achieve symmetry included augmentation, mastopexy, augmentation/mastopexy, and reduction. A total of 1394 patients were evaluated, including 689 delayed and 705 immediate reconstructions. Sixty-seven percent of delayed-reconstruction patients (462 of 689) had a symmetry procedure performed on the opposite breast, compared with 22 percent for the immediate-reconstruction patients (155 of 705) (p </= 0.001). The percentage of times a contralateral procedure was performed was highest for implant reconstructions (89 percent delayed and 57 percent immediate) and lowest for TRAM flap reconstructions (59 percent delayed and 18 percent immediate). Augmentation mammaplasty was the most common symmetry procedure for implant reconstruction (41 percent), whereas reduction was the most common procedure for autologous tissue reconstruction (57 percent). Immediate unilateral breast reconstructions were stratified into non-skin-sparing mastectomy (n = 205) and skin-sparing mastectomy (n = 500). Thirty-four percent of patients with a non-skin-sparing mastectomy defect (70 of 205) underwent a contralateral breast procedure, compared with 17 percent of patients with a skin-sparing mastectomy defect (85 of 500) (p = 0.001). The percentage of times a contralateral procedure was performed in immediate reconstruction, stratified by mastectomy and reconstruction type, was only significant for TRAM flap reconstructions (25 versus 11 percent). Trends in the management of unilateral breast cancer from delayed to immediate reconstruction and from implants to autologous tissue have reduced the incidence of contralateral symmetry procedures. Reduction mammaplasty is the most common symmetry procedure used for autologous tissue reconstruction, with augmentation predominating when implants are used. The type of mastectomy also effects the management of the opposite breast, with skin-sparing mastectomy further reducing the incidence of contralateral procedures in immediate TRAM flap reconstruction, compared with non-skin-sparing mastectomy.

Breast Implants↗
PubMed2002

Complete one-stage, immediate breast reconstruction with prosthetic material in patients with large or ptotic breasts.

Immediate prosthetic breast reconstruction is a relatively simple, quick procedure with no donor site morbidity. This report discusses immediate one-stage breast reconstruction using prostheses in 18 patients (19 breasts) who also required a contralateral reduction or mastopexy. In all cases, an inverted-T pattern was applied to both breasts. The mean age of the patients was 49 years (range, 32 to 62 years), and the mean size of the gel implant used was 330 ml (range, 120 to 550 ml); the implant was inserted in a total submuscular pocket in seven patients and subcutaneously in 11 patients. In two patients with multiple risk factors, the prosthesis extruded, and one patient required removal for a periprosthetic infection. In 10 patients with early stage disease (T1 or T2) with tumors more than 5 cm from the nipple-areola complex, the original areola (n = 3) or nipple-areola complex (n = 7) was retained as a full-thickness skin graft. The breast shape after submuscular prosthesis insertion is different than that of the contralateral breast after a mastopexy or reduction, and nipple-areola complex symmetry was difficult to obtain; thus, this technique was abandoned in favor of the subcutaneous position (using a modified Wise keyhole pattern with a de-epithelialized portion, which still allows two-layer closure). In the subgroup of patients with large breasts or marked ptosis, a single-stage breast reconstruction procedure can be performed with symmetrical incisions. The subcutaneous position allows for symmetrical shape and nipple-areola complex symmetry to be obtained. When the tumors are small and situated in the periphery of the breast, the nipple-areola complex may be retained as a full-thickness graft.

Adult↗
PubMed2005

Cohesive silicone gel breast implants in aesthetic and reconstructive breast surgery.

BACKGROUND: Cohesive silicone gel breast implants are composed of a textured silicone elastomer shell and are filled with cohesive silicone gel. Cohesive gel is formed by increasing the number of cross-links between gel molecules, which results in an implant that has better retention of shape and is less likely to fold or collapse, especially in the upper pole. METHODS: The initial 150 consecutive patients who received cohesive gel breast implants by the senior author (Brown) were included in the study. A retrospective chart review was carried out to analyze patient demographics, diagnosis, indication for cohesive gel selection, procedure performed, implant selected, and complications. All implants were manufactured by Inamed Aesthetics and were either style 410, CML, or CMH. RESULTS: One woman underwent unilateral augmentation for breast asymmetry and 117 women underwent bilateral breast augmentation. Of the 235 implants used, all were model 410 anatomical implants, with the majority being MM, MF, FM, or FF styles. Complications occurred in four of 118 patients (3.4 percent). There was one immediate postoperative hematoma, two cases of unilateral Baker II contracture, and one case of asymmetry related to excessive lowering of an inframammary fold. There were no cases of rotation, malposition, infection, rippling, or loss of implant integrity. Thirty-two women underwent breast reconstruction with cohesive gel implants. A total of 50 implants were used in the 32 patients (27 style 410, 19 style CML, and four style CMH). Complications occurred in six of 32 patients (18.8 percent), although five of the six were minor and only one of 32 patients (3.1 percent) required a secondary procedure. There were two seromas, three capsular contractures, and one implant exposure following a skin-sparing mastectomy. CONCLUSIONS: Cohesive gel implants have the potential for providing a natural breast shape, minimizing the risk of postoperative rippling, and providing a greater degree of safety should the implant lose its integrity. The wide variety of implant shapes and sizes allows for great flexibility in reconstructive surgery, in cases of breast asymmetry, and in primary breast augmentation. Results in our initial 150 patients have been excellent, with a high degree of patient satisfaction, excellent aesthetic outcomes, and very few implant-related complications. Cohesive gel implants are likely to play an important role in aesthetic and reconstructive breast surgery when silicone gel implants are reintroduced into the North American market.

Adult↗
PubMed1999

Risk estimation as a decision-making tool for genetic analysis of the breast cancer susceptibility genes. EC Demonstration Project on Familial Breast Cancer.

For genetic counselling of a woman on familial breast cancer, an accurate evaluation of the probability that she carries a germ-line mutation is needed to assist in making decisions about genetic-testing. We used data from eight collaborating centres comprising 618 families (346 breast cancer only, 239 breast or ovarian cancer) recruited as research families or counselled for familial breast cancer, representing a broad range of family structures. Screening was performed in affected women from 618 families for germ-line mutations in BRCA1 and in 176 families for BRCA2 mutations, using different methods including SSCP, CSGE, DGGE, FAMA and PTT analysis followed by direct sequencing. Germ-line BRCA1 mutations were detected in 132 families and BRCA2 mutations in 16 families. The probability of being a carrier of a dominant breast cancer gene was calculated for the screened individual under the established genetic model for breast cancer susceptibility, first, with parameters for age-specific penetrances for breast cancer only [7] and, second, with age-specific penetrances for ovarian cancer in addition [20]. Our results indicate that the estimated probability of carrying a dominant breast cancer gene gives a direct measure of the likelihood of detecting mutations in BRCA1 and BRCA2. For breast/ovarian cancer families, the genetic model according to Narod et al. [20] is preferable for calculating the proband's genetic risk, and gives detection rates that indicate a 50% sensitivity of the gene test. Due to the incomplete BRCA2 screening of the families, we cannot yet draw any conclusions with respect to the breast cancer only families.

Adult↗
PubMed2002

Mitochondrial uptake of sestamibi distinguishes between normal, inflammatory breast changes, pre-cancers, and infiltrating breast cancer.

The evaluation of breast tissue using nuclear imaging is dependent upon the delivery and uptake of the isotope by breast tissue. This is dependent upon blood flow to the breast and functioning mitochondria. This 2-part study investigated (1) differences in uptake of sestamibi when blood flow is enhanced (breast enhanced scintigraphy test [BEST]), and (2) differences in isotope uptake in normal (Nl) breast tissue, inflammatory changes in breast tissue (ICB), and breast cancer (CA). In the first part of the study, 10 women were compared using both Miraluma and BEST imaging; in the second part, 195 people were studied using BEST imaging only. The results were compared with histopathologic specimens. Little difference was noted between Miraluma and BEST imaging in the first part. Women with ICB showed a statistically significant (P <.05) increase in isotope uptake using BEST imaging. This difference was even more significant (P <.005) in women with CA. During the second part of the study, BEST imaging demonstrated an exponential increase in tracer uptake. When maximal count activity was compared, there was a statistically significant (P <.001) difference between Nl and ICB, between ICB and atypia (A), and between A and CA. BEST imaging demonstrated significant increases in isotope delivery when compared with Miraluma imaging. These differences allowed differentiation of breast tissue, including the detection of early changes in breast tissue.

Adult↗
PubMed2001

Mammographic breast density as a biomarker of effects of isoflavones on the female breast.

Isoflavones possess both estrogenic and anti-estrogenic actions, and are hypothesized to protect against breast cancer. However, two intervention studies of markers of proliferation on breast tissue have raised concerns that soy isoflavones may have an estrogenic effect on breast tissue. Increased mammographic breast density is associated with an elevated risk of breast cancer, although the mechanism underlying this relationship has not been explained. Estrogens increase and anti-estrogens decrease breast density. Breast density may therefore serve as a biomarker of estrogenic or anti-estrogenic effects of a treatment on breast tissue. The effect of isoflavones on breast density is under investigation.

Biomarkers↗
PubMed1993

A link between breast cancer and local estrogen biosynthesis suggested by quantification of breast adipose tissue aromatase cytochrome P450 transcripts using competitive polymerase chain reaction after reverse transcription.

C19 steroids are converted to estrogens in a number of tissues by a specific form of cytochrome P450, namely aromatase cytochrome P450 (P450arom). Adipose tissue is the principal site of estrogen formation in postmenopausal women. Aromatase activity as well as P450arom transcripts primarily reside in the stromal cell component of the adipose tissue. Studies designed to investigate whether increased local aromatase activity in breast adipose tissue influences the growth of breast cancers have yielded discrepant results. In an attempt to clarify this controversy, adipose tissue was obtained from the four breast quadrants at the time of mastectomy (n = 13) performed for removal of a tumor. Breast fat P450arom messenger RNA levels were quantified and compared between the four quadrants within each specimen using competitive polymerase chain reaction after reverse transcription in which 10 micrograms human adipose total RNA together with 1 pg rat complementary RNA (internal standard) were reverse transcribed and coamplified. In 9 out of 13 patients (69%), highest P450arom transcript levels colocalized to the quadrants bearing tumors. This correlation was statistically significant (P < 0.001). The regional distribution of P450arom transcripts in breast adipose tissue of disease-free individuals, obtained during reduction mammoplasty (control group, n = 9), did not favor any particular region of the breast. We also quantified by morphometry the histological components of the adipose tissue samples from each quadrant in mastectomy specimens. The distribution of stromal cells significantly correlated with the distribution of P450arom transcript levels, in that quadrants containing highest proportions of stromal cells matched to highest transcript levels (P < 0.01). Although the quadrants bearing tumors contained the highest percentage of stromal cells, this correlation was not statistically significant. The adipose tissue surrounding a breast tumor displays increased estrogen biosynthesis, which may promote tumor growth. It is further suggested that the distribution of stromal cell components in breast adipose tissue gives rise to locally elevated P450arom expression, which in turn may favor neoplastic development and growth in these predisposed areas of the breast. The correlation between the presence of a tumor and elevated P450arom levels in the proximal adipose tissue is independent of tumor size, node involvement, histological type or grade, estrogen/progesterone receptor status, DNA index, or S-phase fraction.

Adipose Tissue↗
PubMed2006

Breast CT: potential for breast cancer screening and diagnosis.

Although screening mammography has been shown to be effective in reducing breast cancer mortality, a new technique called breast computed tomography (CT) is being studied in the hope that breast cancer can be detected even earlier. A prototype unit has been designed, fabricated and tested at the University of California, Davis, USA, and is currently being used in a Phase II clinical trial to study the feasibility of breast CT for breast cancer detection and diagnosis. A total of 46 volunteers and patients have been imaged, and the breast CT images show impressive anatomical detail of the breast that is not appreciated in mammography. The radiation dose levels needed to produce excellent image quality are equal to two-view mammography. Further study of breast CT is needed to better understand its potential role in breast cancer screening and diagnosis.

Breast↗
PubMed1990

Breast self-examination and breast examination by a health care provider: prevalence and predictors of screening in a randomly selected sample of Australian women.

Professional organizations recommend the practice of monthly breast self-examination (BSE), and examination of the breasts by a health care provider every three years for women up to the age of 40 and annually thereafter. These practices were examined in a randomly selected sample of 1454 women. Only 39% (95% confidence interval [CI], 36%-42%) of the sample reported monthly BSE. Women were more likely to examine their breasts each month if they had found a breast lump, believed they were likely to get breast cancer, were not single, or were frequent users of general practitioners. Only 51% (95% CI, 45%-53%) of women under the age of 40 reported receiving three-yearly breast examinations; of those women aged 40 or more, 31% (CI, 27%-35%) of those with no additional risk factors and 35% (95% CI, 27%-42%) of those with at least one additional risk factor reported annual examinations. Women were more likely to have received a breast examination in the past three years if they had previously had a breast lump, were not single, had reached a higher educational level, were more frequent users of general practitioners, had private health insurance, or were described as other than ill or retired. There was a substantial association between BSE and breast examination by a health care provider with 25% (95% CI, 23%-27%) practising BSE and being screened by a health care provider. Thirty-five per cent (95% CI, 32%-38%) of women were not being screened by either method. The implications of the results for health education campaigns are discussed.

Adolescent↗
PubMed1999

Squamous cell carcinoma of the breast following silicone injection of the breasts.

During the 1960s, injecting liquid silicone into the breasts for augmentation purposes was a common practice. Many women suffered complications, usually developing silicone mastopathy, but there have been reports of carcinoma as well. A case of squamous cell carcinoma of the breast is reported in a patient who had previously undergone injection of silicone into the breasts. Upon review of the literature, this is only the second reported case of squamous cell carcinoma of the breast following silicone injection. Squamous cell carcinoma of the breast is a very rare tumor comprising 0.04 to 0.075 percent of all breast malignancies. The tumor appears to develop from metaplasia of benign epithelial cells within the breast. Many theories are presented for the development of this metaplastic process. The clinical presentation, evaluation, and treatment of squamous cell carcinoma of the breast is quite similar to that of infiltrating ductal carcinoma of the breast of comparable stage and size.

Aged↗
PubMed1999

16-year mortality from breast cancer in the UK Trial of Early Detection of Breast Cancer.

BACKGROUND: The UK Trial of Early Detection of Breast Cancer (TEDBC) is a non-randomised study, which was set up in 1979 to investigate the effect of screening and education about breast self-examination on breast-cancer mortality. We report mortality results after 16 years of follow-up, including results by age at trial entry. METHODS: Eight centres (two screening, two breast self-examination, and four comparison) in England and Scotland recruited women aged 45-64 years into the initial cohort, with women reaching age 45 years during the 7-year study period included in later cohorts. The observed number of deaths from breast cancer in each centre was compared with the expected number, which was calculated by Poisson regression model; expected numbers were adjusted for pretrial breast-cancer mortality. Results were analysed by 5-year age-groups, and for women aged 45-46 years and 47-49 years at entry. FINDINGS: Breast-cancer mortality was 27% lower (rate ratio 0.73 [95% CI 0.63-0.84]), adjusted for pretrial rates, in cohort 1 in the two screening centres combined than in the comparison centres. No reduction in mortality in the two breast self-examination centres combined was seen (rate ratio 0.99 [0.87-1.12]). The mortality reduction in the screening centres did not differ significantly across age-groups; a 35% reduction was seen in women in all cohorts aged 45-46 years at entry (rate ratio 0.65 [0.50-0.86]). Results were similar when deaths were restricted to those in patients diagnosed within 10 years of trial entry. INTERPRETATION: The results from TEDBC support those from randomised trials in Edinburgh and elsewhere, and show that a reduction in breast-cancer mortality resulting from screening can be achieved in the UK. There was no evidence of less benefit in women aged 45-46 years at the start of screening; the effect of screening in this age-group begins to emerge after 3-4 years.

Age Factors↗
PubMed2000

Clinical breast examination. A contentious issue in screening for breast cancer.

BACKGROUND: Breast cancer is the commonest cancerous cause of mortality in Australian women. It is now well established that mammography is effective in reducing this mortality through screening. To this end all states of Australia have established breast cancer screening programs using mammography as their investigative modality. The purpose of this review is to determine the value of clinical breast examination as another screening tool available to general practitioners. OBJECTIVE: We identified and examined a large amount of literature relating to this subject through Medline search, the Cochrane Library and hand searching (using keywords 'breast neoplasm', 'screening', 'breast self examination' and 'clinical breast examination'). The review of articles was undertaken by both authors, one of whom has extensive experience as a breast physician. DISCUSSION: Clinical breast examination for symptomatic women shows a true positive rate or sensitivity of 85%, a false positive rate of 20% and specificity of 80% for detecting the probability of cancer. The positive predictive value of this test is 81% and the negative predictive value is 84%. The sensitivity would be lower for asymptomatic women. CONCLUSION: Much has been written about screening for breast cancer. However, the absence of comprehensive studies leaves the evidence for CBE somewhat in dispute. In the absence of any harm from the procedure, it is difficult to support the currently accepted Australian evidence based guidelines which discourage the practice of CBE. It would seem more prudent given the disagreement in the literature and the acceptability of CBE to both GPs and patients to consider that there is value in using CBE as a screening tool.

Adult↗
PubMed2003

Microsatellite changes in nipple aspirate fluid and breast tissue from women with breast carcinoma or its precursors.

PURPOSE: Loss of heterozygosity (LOH) and microsatellite instability (MSI) have been identified in a variety of human cancers. The purpose of this prospective study was to determine whether (a) DNA can be isolated from nipple aspirate fluid (NAF) and PCR amplified to large fragments, (b) LOH and MSI are detectable in NAF, and (c) LOH and MSI in tissue and NAF increase with disease progression from precursor lesions to cancer. EXPERIMENTAL DESIGN: Forty-six matched samples from breast lesions, normal breast, and NAF were microdissected, and DNA was extracted. Eleven microsatellite markers from seven chromosomes that have a high frequency of LOH/MSI in breast cancer were designed and respectively amplified. RESULTS: LOH and/or MSI were identified in 22 of 46 (48%) breast lesions, including LOH in 8 of 36 (22%) proliferative/papilloma (P/Pap) and 7 of 10 (70%) cancer specimens, whereas MSI was found in 14 of 36 (39%) P/Pap and 6 of 10 (60%) cancer specimens. LOH/MSI loci in which alterations were detected in the 22 tissue specimens were PCR amplified using matched NAF DNA. LOH/MSI was detected in NAF from both P/Pap (5 of 15; 33%) and breast cancer (3 of 7; 43%) samples. CONCLUSIONS: Our findings suggest that (a) DNA from NAF, a physiological fluid collected noninvasively, can be PCR amplified and used to screen for LOH and MSI alterations that are known to be linked to breast cancer, suggesting that this methodology might prove useful for breast cancer screening, and (b) similar to findings in breast tissue, LOH and MSI alterations increase in frequency with disease progression in NAF, which suggests that NAF is a surrogate for breast tissue which has important prognostic implications.

Biomarkers, Tumor↗
PubMed2003

Comparing thallium-201 spect mammoscintigraphy and ultrasonography to detect breast cancer in mammographical dense breasts.

The aim of our study was to compare the usefulness of thallium-201 (Tl-201) single photon emission computed tomography (SPECT) mammoscintigraphy and ultrasonography to detect breast cancer in mammographical dense breasts. This study included 32 Taiwanese female patients with indeterminate mammographic probability of malignancy due to mammographical dense breasts. Both Tl-201 SPECT mammoscintigraphy and ultrasonography were performed for each patient. Then, all of the 32 breast masses undervent biopsies or operations to obtain finally pathological diagnoses. Based on the finally pathological diagnoses, 24 masses were breast cancer and 8 masses were benign breast tumors among the 32 patients. Twenty-two cancers and one benign tumor had positive Tl-201 SPECT mammoscintigraphic findings. The sensitivity, specificity, and accuracy were 92%, 88%, and 91%. Twenty-two cancers and 5 benign tumors had positive ultrasonographic findings. The sensitivity, specificity, and accuracy were 92%, 38%, and 78%, respectively. To detect breast cancer in patients with non-diagnostic mammogram because of mammographically dense breasts, Tl-201 SPECT mammoscintigraphy and ultrasonography have the same sensitivity to screen breast masses. However, due to its higher specificity, Tl-201 SPECT mammoscintigraphy should be useful to confirm the ultrasonographic findings.

Adenocarcinoma↗