Adverse Clinico-Pathological Features in Breast Cancer Patients under the Age of 35

IntroductionBreast cancer in younger patients is a unique disease entity, associated with aggressive biologic phenotype and poorer prognosis. The aim of this study was to analyse age as a prognostic factor in pre-menopausal breast cancer specifically in regards to pre-menopausal patients under the age of 35.MethodsA 7 year prospective audit of pre-menopausal patients presenting to the symptomatic breast clinic in St. James's Hospital between 2001 and 2008 was conducted. The Clinico-pathological features of pre-menopausal patients presenting under the age of 35 versus over 35 where compared. All cancer diagnoses were discussed at the breast multidisciplinary conference, and all clinico-pathological treatment details and follow-up information were entered by a full-time data manager.ResultsPre-menopausal patients under the age of 35 (n=55) were more likely to present with higher grade (p<0.05), oestrogen receptor negative (p<0.05), HER-2 receptor negative (p<0.05) and stage IV disease (p<0.05) relative to the older premenopausal group (n=250). This group also had a non-significant increased rate of lymphovascular invasion and negative progesterone receptor status compared to the older premenopausal group (p> 0.05). Pre-menopausal patients over the age of 35 were twice as likely to have lobular carcinoma as opposed to their younger counterparts. Tumour size, nodal status and axillary node burden was not significantly different between groups. Patients under-35 with breast cancer were more likely to be nulliparous.ConclusionThis data demonstrates that breast cancer in pre-menopausal patients under the age of 35 is associated with adverse clinicopathological features relative to the older pre-menopausal patients. Further studies should be aimed at assessing the prognosis, disease recurrence, disease free survival and distinct genetic profile in age related breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3043.

Is metabolic syndrome the link between obesity and postmenopausal breast cancer?

Abstract #5040

Background
 Obesity is associated with an increased incidence of postmenopausal breast cancer and a poorer prognosis. The mechanism by which body weight affects breast cancer outcome is complex and incompletely understood. While there is convincing evidence that an obesity induced increase in estrogen production contributes to this risk, recent literature also recognizes other factors such as hyperinsulinaemia, increased IGF-1, high triglycerides and greater abdominal fat accumulation. The clustering of these risk factors is the cornerstone of metabolic syndrome (MetS) diagnosis. Although studies on MetS and cancer are scarce, the components of MetS have individually being linked to the development of cancer and combined these metabolic abnormalities may have an additive effect leading to a more aggressive tumor phenotype.
 Objective
 The primary aim of this study was to describe for the first time the incidence of MetS and central obesity in women with postmenopausal breast cancer and examine the relationship between its presence and tumor size, pathological stage and axillary nodal involvement in an Irish population.
 Design & Setting
 This was a prospective study of patients that presented to a specialist Breast Cancer Unit, in St James's Hospital, Dublin, with postmenopausal breast cancer between March 2007 and May 2008. Individuals underwent a metabolic and nutritional assessment. Studies performed included anthropometry, segmental body composition analysis by bioelectrical impedance, and quantification of fasting lipids, glucose, insulin, C-reactive protein and Serum Amyloid A.
 Results
 Seventy-nine female post-menopausal breast cancer patients were recruited. The median age was 68 years (Range 41-84). The mean Body Mass Index was 28.1 ± 5.1 kg/m2, with 70% patients overweight or obese and a further 84% centrally obese. There was no difference in method of detection, diagnosis or treatment between obese and non-obese patients. Over a third of patients (36%) had MetS, which exceeds the population norms reported at 21%. MetS was significantly associated with an adverse metabolic profile as well as increased total fat, trunk fat, an 8cm greater waistline, insulin resistance and hypertension. Moreover the presence of metabolic syndrome was significantly associated with larger tumors (P=0.006), a later stage of disease (P=0.010), lymphovascular invasion (p=0.006) and axillary node involvement (P=0.014) compared to patients without MetS.
 Conclusion We report for the first time, a high prevalence of MetS and central obesity in a cohort of Irish postmenopausal breast cancer patients. The presence of the MetS seems to be associated with a more aggressive tumor phenotype. The prevalence of these altered metabolic profiles may be a key factor in determining the metastatic potential and prognosis of postmenopausal breast cancer. Therapeutic strategies that correct these abnormalities represent an exciting avenue for future prevention and treatment of breast cancer.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5040.

Triple negative breast cancers: comparative study of clinical features and overall survival in an Irish population

Abstract #2083

Introduction 
 Triple negative breast cancers (TNBC) are defined by a lack of estrogen, progesterone and Her2 receptors and account for 15% of breast cancers. They present at an earlier age and a higher stage and are associated with a poorer survival compared to non-TNBC's. There is a paucity of information available on outcomes of TNBCs managed with up to date oncology treatment.
 Aims
 To investigate TNBCs in an Irish cohort of patients and to compare their clinicopathological features and survival outcomes with non TNBCs.
 Methods
 Using a prospectively gathered database all patients treated for invasive breast cancer in our unit between 2001 and 2007 were included. The median age and pathological stage at presentation, histological features and overall survival in the TNBC and non-TNBC groups were compared.
 Results
 Between 2001 and 2007 1081 patients were treated for breast cancer at St. James's Hospital. Follow up and full clinical data was available on 934 patients. 121(13%) patients were identified as having TNBCs, 625 (67%) were Her2-ve, hormone receptor +ve and 187 (20%) were Her2 +ve.
 Age, stage, tumour size and histological grade were similar in the TNBC and the Her2+ groups with the Her2-ve, hormone receptor +ve group having a more favourable pathological profile. Overall survival in TNBC group was significantly worse at 5 yrs compared with the non-TNBC groups.
 
 Conclusions:
 In our patients TNBC's present at a similar age and stage as Her2 + patients. The 5 year survival is worse in the TNBC group. The survival in the Her2+ group is similar to the Her2 – group suggesting that targeted therapy with herceptin is effective. These results highlight the need for a targeted therapy to treat TNBCs.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2083.

Objective assessment of progression in Huntington's disease: a 3-year follow-up study

Objective measures to assess progression of Huntington's disease (HD) are desirable. The authors have previously found that patients with HD with higher Unified Huntington's Disease Rating Scale (UHDRS) motor scores exhibited higher variability of isometric grip forces while grasping an object. Therefore, the authors assessed grip force variability during this task in 10 HD patients with a 3-year follow-up. Grip force variability increased in all patients at the follow-up. Thus, grip force variability during grasping might be an objective and quantitative measure to assess motor deficits associated with the progression of HD.

Type and incidence of cracks in posterior teeth

STATEMENT OF PROBLEM

The use of magnified vision in the operatory has enhanced the early diagnosis of structural defects in the dentition and in existing restorations. There is little in the literature to guide the clinician on the significance of cracks and other interruptions in the integrity of teeth.

PURPOSE

This study characterized the type and incidence of cracks in posterior teeth and identified possible etiologic factors.

MATERIAL AND METHODS

An observational cross-sectional survey of 51 patients from a private practice examined during an 18-month period was used to identify 4 types of cracks in posterior teeth. The study identified both patient- and tooth-level variables present in each patient examined. The data were subjected to statistical analysis to determine whether correlations existed between the variables and cracks.

RESULTS

Cracks in teeth were shown to have chronicity and can be classified according to appearance. Variables such as the presence of a Class I or II restoration and the presence of excursive interferences were shown to significantly increase (P< .0001) the chances of a crack being present. Combinations of variables, such as interferences and a restoration, also increased the chance of a crack being present.

CONCLUSION

Within the limitations of this study, the presence of cracks in teeth was associated with the placement of a Class I or II restoration and with the presence of excursive interferences. Age played a role in the presence of stained or symptomatic cracks, which suggests that cracks have chronicity. Although many questions remain regarding prevention, it is evident that protecting teeth from excursive interferences and parafunction may thwart premature breakdown.

Type 2 diabetes: epidemiology, pathophysiology, and diagnosis

Type 2 diabetes is a major global health problem that affects over 124 million individuals worldwide. In the United States, type 2 diabetes affects 90% of the 15.6 persons with diabetes, of which approximately one half remain undiagnosed. Type 2 diabetes is increasing exponentially especially among minority populations. In addition, type 2 diabetes, which is normally associated with older adults, is becoming more common in children and adolescents. There are a variety of environmental and genetic factors that seem to mediate the development of type 2 diabetes. This article explores the epidemiology, pathophysiology, and diagnosis of type 2 diabetes and identifies risk factors associated with the development of this disorder.

Pharmacologic management of the patient with type 2 diabetes

The United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that the benefit of optimal glucose control in type 2 diabetes is a significant reduction in diabetes-related complications. In addition, the UKPDS also demonstrated that type 2 diabetes is a progressive disorder. Whereas many patients may initially receive good glucose control from a single medication, they are likely to require multiple medications to maintain this same level of glucose control as the disease progresses. The recent introduction of several new classes of glucose-lowering medications has allowed health care providers to explore the use of these medications alone and in combination to help patients with type 2 diabetes maintain optimal glucose control. Therefore, it is important to understand the physiologic actions, benefits, and risks of these medications in the treatment of type 2 diabetes.

Exercise and physical activity in the treatment of type 2 diabetes

Exercise has been recommended as a treatment for type 2 diabetes for centuries. It is only in the last 2 decades, however, that the powerful role exercise and physical activity play in treating and preventing type 2 diabetes has been fully appreciated. The molecular understanding of exercise in relation to type 2 diabetes is evolving, as is knowledge about the best mode, frequency, and duration of exercise to treat and prevent this disorder. In addition, there is a growing appreciation for the role of diverse types of exercise, such as strength training, in type 2 diabetes. Although people with diabetes-related complications have been discouraged from exercising in the past, there are a variety of activities that allow for safe exercise in a supervised setting. As such, individualized exercise training can become an integral part of the treatment plan for the management of type 2 diabetes.

Glycemic control and heart disease

The leading cause of death among patients with diabetes is cardiovascular disease with approximately 80% of all deaths being attributed to coronary heart disease. Acute myocardial infarctions (AMIs) in patients with diabetes are associated with an increased rate of reinfarction than those without diabetes. Following AMI, patients with diabetes are more likely to develop severe heart failure. The Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) clinical trial examined the relationship between intensive insulin and conventional therapy following AMI. Results of the DIGAMI study clearly identify the need for tight glucose control following AMI in improving clinical outcomes and mortality.

Diabetes emergencies in the patient with type 2 diabetes

Type 2 diabetes has traditionally been associated with the development of hyperglycemic hyperosmolar nonketotic syndrome (HHNKS), yet evidence suggests that diabetic ketoacidosis (DKA) is increasing among this population. Patients with type 2 diabetes may develop DKA or HHNKS and require hospitalization. In addition, patients with type 2 diabetes, hospitalized for other medical or surgical conditions, are clearly at risk for the development of metabolic decompensation during hospitalization. This article explores the acute complications of type 2 diabetes and some of the issues associated with managing these patients in the hospital setting.

Altered movement trajectories and force control during object transport in Huntington's disease

Individuals with Huntington's Disease (HD) have difficulty grasping and transporting objects, however, the extent to which specific impairments affect their performance is unknown. The present study examined the kinematics and force coordination during transport of an object in 12 subjects with HD and 12 age-matched controls. Subjects grasped an object between their thumb and index finger, transported it 25 cm forward, replaced and released it while their fingertip forces and the object's position were recorded. Five trials were performed with each of three weights (200 g, 400 g, and 800 g). While bradykinesia was evident in subjects with HD, this slowness was not consistently observed in all phases of the movement. The slowness of movement seen during the task appears to be due to impairments in sequencing and the movement strategies selected by the subjects. Compared to control subjects, subjects with HD produced highly curvilinear hand paths and more variable grip forces that were dependent on the weight of the object. Isometric force development and movement speed during transport were unaffected by the disease. The results suggest that prolonged task durations in subjects with HD are not necessarily due to slowness of movement, per se. These findings have clinical implications for understanding the task-specific nature of movement impairments in HD and developing effective intervention strategies.