Cultural Preferences for Chaperone Use during Breast Examinations: A Preliminary Study

Previous studies have demonstrated that use of chaperones by physicians occurs most consistently for pelvic and rectal exams than for breast examinations. Factors that may influence chaperone for breast examination include duration of doctor-patient relationship, gender of the examiner, and availability of an assistant. The purpose of this study is to characterize patient preferences, not previously reported, for chaperone use.A patient questionnaire was approved by the institutional IRB at NYU Langone Medical Center and Bellevue Hospital. It was translated into Chinese, Spanish, and Arabic. Responses were collected from 277 patients. Variables included age, marital status, highest level of education, income, family background, religion, primary language, and chaperone and examiner preferences. For the respondents who preferred a chaperone, education was categorized as some college or none, language was English or non-English-speaking, background was Caucasian or non-Caucasian, and religion was Christian or non-Christian. Descriptive analyses and Pearson's chi-square test was used to determine significance.Median age was 49 years, range 17-87 years. 28 (10%) respondents preferred to have a chaperone present. An equal proportion of respondents did not want a chaperone (N=95, 34%) or had no preference (N=95, 34%). An additional 19% (N=53) of patients indicated that they preferred to be asked about their wishes. 142 (52%) indicated that they preferred a female examiner, 2 (1%) preferred a male examiner, and 126 (46%) had no preference regarding the examiner's gender.Table 1. Respondent Characteristics (N=277)VariablesN (%)EDUCATION (N=256) Grade School10 (4%)High School44 (17%)College116 (45%)Graduate School86 (34%)FAMILY BACKGROUND (N = 251) Caucasian/European159 (64%)African-American18 (7%)Hispanic28 (11%)Middle-Eastern17 (7%)Asian28 (11%)Other1 (0%)RELIGION (N = 250) Christian137 (55%)Jewish, reform49 (20%)Jewish, orthodox16 (6%)Islam14 (5%)Buddhist5 (2%)Other22 (9%)LANGUAGE (N = 256) English198 (77%)Spanish15 (6%)Chinese9 (3%)Arabic12 (5%)Other22 (9%)CHAPERONE PREFERENCE (N = 277) Do not use95 (34%)Use28 (10%)No preference94 (34%)Like to be asked53 (19%)Unknown7 (3%)EXAMINER GENDER PREFERENCE (N = 273) Female142 (52%)Male2 (1%)No preference126 (46%)Unknown3 (1%) Of the 28 patients who did prefer a chaperone, there was a statistically significant difference, p=0.011, for family background that was non-Caucasian. There was no statistical finding for differences in education, religion, or language.Table 2. Characteristics of Respondents who Prefer a Chaperone (N = 28)VARIABLESP-VALUEEducation0.078Language0.409Family Background0.011*Religion0.161* Denotes Statistical SignificanceThe majority of women responding to our survey either did not want a chaperone present for a breast examination or had no preference. However, the majority of all respondents did prefer to have a female examiner. This may simply represent that these patients were comfortable with a woman performing the exam. Additional investigation will further evaluate possible cultural differences.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6080.

Mammographic Density and Lobular Involution in Older Women with Abnormal Breast Imaging

Mammographic density has been established as an independent risk factor for breast cancer, and there is data to suggest that the degree of lobular involution in the breast tissue may also function as an independent risk factor for the disease. The present study was designed to investigate the relationship between mammographic density and lobular involution in a population of mature women undergoing open biopsy for non-palpable breast lesions.A total of 199 women over the age of 60 who underwent breast biopsy with image-guided localization in 2008 at NYU Langone Medical Center formed the study population. Variables of interest included age, breast density, degree of involution, use of hormone replacement therapy (HRT) and biopsy histology (invasive ductal and lobular carcinoma and intraductal carcinoma vs. benign). Breast density was categorized according to BI-RADS classification as less dense (predominantly fatty and scattered fibroglandular elements) vs more dense (heterogeneously dense and extrememely dense). Degree of involution was classified as none (0%), partial (1-74%) and complete (>75%). All specimens were reviewed by a single pathologist who used the criteria of Hartmann, et al in evaluating degree of involution. Statistical analysis was performed using Pearson's Chi-square test and logistic regression analyses.In agreement with our previously presented data, we found an inverse relationship between breast density and age (p=0.02). In our cohort of women over 60 with abnormal breast imaging, we found a trend toward an inverse relationship between age and degree of lobular involution, but this did not achieve statistical significance. 129 of our patients had biopsies yielding malignant histology. There was no significant relationship between degree of lobular involution and biopsy histology. Use of HRT did not correlate with breast density in our cohort. There was no discernable relationship between degree of involution and history of prior or current HRT use.Association of lobular involution with age, density, histology, and HRT  INVOLUTION TOTALP-VALUE NONEPARTIALCOMPLETEN (%) AGE (YRS)      60-696337617 (9%)0.18270-797202959 (29%) 80-894618123 (62%) DENSITY     Less Dense143477125 (63%)0.177More Dense3254674 (37%) HISTOLOGY     Benign5194670 (35%)0.690Malignant124077129 (65%) HRT     Never11246398 (70%)0.774Ever3112741 (30%)  Our study reinforces the general observation that breast density decreases with age. Our data do not permit us to comment on the validity of lobular involution as a risk factor for breast cancer. However, the degree of lobular involution did not predict malignant histology in our cohort. There was a trend toward an inverse relationship between mammographic density and lobular involution. This observation suggests that other factors such as stromal features may be responsible for the increased mammographic density in these older patients. Further study is warranted to better understand the significance of lobular involution and its relationship with mammographic density in all age groups of women undergoing breast cancer screening.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6072.

Behavioral phenotype of maLPA1-null mice: increased anxiety-like behavior and spatial memory deficits

Lysophosphatidic acid (LPA) has emerged as a new regulatory molecule in the brain. Recently, some studies have shown a role for this molecule and its LPA(1) receptor in the regulation of plasticity and neurogenesis in the adult brain. However, no systematic studies have been conducted to investigate whether the LPA(1) receptor is involved in behavior. In this study, we studied the phenotype of maLPA(1)-null mice, which bear a targeted deletion at the lpa(1) locus, in a battery of tests examining neurologic performance, habituation in exploratory behavior in response to low and mild anxiety environments and spatial memory. MaLPA(1)-null mutants showed deficits in both olfaction and somesthesis, but not in retinal or auditory functions. Sensorimotor co-ordination was impaired only in the equilibrium and grasping reflexes. The mice also showed impairments in neuromuscular strength and analgesic response. No additional differences were observed in the rest of the tests used to study sensoriomotor orientation, limb reflexes and co-ordinated limb use. At behavioral level, maLPA(1)-null mice showed an impaired exploration in the open field and increased anxiety-like response when exposed to the elevated plus maze. Furthermore, the mice exhibit impaired spatial memory retention and reduced use of spatial strategies in the Morris water maze. We propose that the LPA(1) receptor may play a major role in both spatial memory and response to anxiety-like conditions.

Assessment of breast cancer risk prediction models in a high-risk population

Abstract #4074

Background: A variety of risk assessment models have been developed to quantify a woman's risk for developing breast cancer. Although the Gail model (GM) is the most widely utilized model, there are limitations. The Tyrer-Cuzick model (TCM), which has been validated in the United Kingdom (UK), addresses these limitations but its performance in other populations is unclear. The purpose of this study was to evaluate the predictive ability of the TCM in a cohort of high-risk women from the New York metropolitan area and compare the results to the GM.
 Methods: The Women At Risk (WAR) Registry provided the study population. Due to the age limitation of the Gail model, we excluded women who were under 35 and over 80 years of age. Calculation of lifetime Gail scores included the following: age, race, age at first menses, age at first live birth, number of first degree relatives with breast cancer, number of previous breast biopsies, and atypical hyperplasia. These variables were also included in the lifetime Tyrer-Cuzick scores as well as information on menopausal status, use of hormone replacement therapy, LCIS, and age at diagnosis for relatives with ovarian and breast cancer. The Receiver Operating Characteristic (ROC) and estimated area under the ROC curve (AUC) with 95% confidence intervals (CI) were used to assess prediction accuracy of both models.
 Results: Out of a total study population of 1523 women, 82 (5%) developed breast cancer during a median follow-up of 56 months. The median age of women without breast cancer was 49 years, and the median age of women who developed breast cancer was 54 years. The AUC and 95% CI for the Gail model was 0.547 (0.479 to 0.615) and 0.501 (0.433 to 0.569) for the Tyrer-Cuzick model. Our results indicate poor discriminatory accuracy for both models, which performed no better than pure chance (0.5).
 
 Discussion: Quantitative breast cancer risk assessment models are critically important in developing effective risk management strategies. Although the TCM addresses some limitations of the GM, it is unclear how well it performs in populations outside the UK due to the wide variation in international breast cancer rates. In addition, the TCM excludes more recently identified risk factors such as breast density. Bayesian techniques may ultimately lead to a better risk assessment tool as they allow continual modification of the model as new risk factors are identified. Accurate breast cancer risk prediction is a complex undertaking and further studies are warranted in order to achieve truly comprehensive and widely applicable models.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4074.

Identification of neural programmed cell death through the detection of DNA fragmentation in situ and by PCR

A universal feature in the development of multicellular organisms is a physiological form of cell death called programmed cell death (PCD). A subset of PCD is apoptosis, which is defined by characteristic morphological changes and genomic DNA fragmentation producing what are referred to as nucleosomal ladders. To understand how PCD operates in a developing tissue or in a tissue following an experimental procedure, dying cells must be identified in relation to their surviving neighbors. One way to accomplish this is to visualize fragmented DNA in situ, in conjunction with gel electrophoresis of isolated DNA to visualize the nucleosomal ladders associated with apoptosis. Two approaches are presented in this unit: in situ end-labeling plus (ISEL+), a technique to identify dying cells in tissue sections or cell cultures of central nervous system (CNS) tissue (optimized for embryonic samples); and the use of ligation-mediated polymerase chain reaction (LMPCR) to identify nucleosomal ladders from intact tissues. Also included are procedures for preparing thymocyte cell cultures for use as controls in the ISEL+ procedure and for isolating genomic DNA for LMPCR.

Lysophosphatidylcholine induces neuropathic pain through an action of autotaxin to generate lysophosphatidic acid

Lysophosphatidic acid receptor (LPA(1)) signaling initiates neuropathic pain and several pathological events in a partial sciatic nerve injury model. Recently, we reported that lysophosphatidic acid (LPA) induces neuropathic pain as well as demyelination and pain-related protein expression changes via LPA(1) receptor signaling. Lysophosphatidylcholine (LPC), also known as lysolecithin, which is hydrolyzed by autotaxin/ATX into LPA, induces similar plastic changes. Here, we attempted to clarify whether ATX and LPA(1) receptor signaling is involved in the LPC-induced neuropathic pain. In wild-type mice, a single intrathecal (i.t.) injection of LPC induced mechanical allodynia and thermal hyperalgesia 2 days after injection; this persisted for 7 days at least. On the other hand, LPC-induced mechanical allodynia and thermal hyperalgesia were completely abolished in mice lacking an LPA(1) receptor gene. Furthermore, the LPC-induced response was also significantly, but partially reduced in heterozygous mutant mice for the ATX gene. These findings suggest that intrathecally-injected LPC is converted to LPA by ATX, and this LPA activates the LPA(1) receptor to initiate neuropathic pain.

Analysis of sphingosine 1-phosphate receptors involved in constriction of isolated cerebral arteries with receptor null mice and pharmacological tools

BACKGROUND AND PURPOSE

Sphingosine 1-phosphate (S1P) selectively and potently constricts isolated cerebral arteries, but this response has not been pharmacologically characterized.

EXPERIMENTAL APPROACH

The receptor subtype(s) involved in S1P-induced cerebrovascular constriction were characterized using genetic (S1P(2) and S1P(3) receptor null mice) and pharmacological tools (phospho-FTY720, a S1P(1/3/4/5) receptor agonist; SEW2871, a S1P(1) receptor agonist, JTE-013, a S1P(2) receptor antagonist, VPC23019, a S1P(1/3) receptor antagonist). Isolated basilar or peripheral (femoral, mesenteric resistance) arteries, from either rat or mouse, were studied in a wire myograph.

KEY RESULTS

S1P concentration-dependently constricted basilar artery in rat, wild-type (WT) and S1P(2) null mice, but barely affected vascular tone in S1P(3) null mice. Vasoconstriction to U46619 (a thromboxane analogue) or to endothelin-1 did not differ between WT, S1P(2) and S1P(3) null mice. JTE-013 inhibited not only S1P-induced vasoconstriction, but also KCl-, U46619- and endothelin-1-induced constriction. This effect was observed in WT as well as in S1P(2) null mice. VPC23019 increased the concentration-dependent vasoconstriction to S1P in both rat and mouse basilar arteries with intact endothelium, but not in rat basilar artery without endothelium. Phospho-FTY720 concentration-dependently constricted rat basilar arteries, but not femoral or mesenteric resistance arteries, while SEW2871 did not induce any response in the same arteries.

CONCLUSIONS AND IMPLICATIONS

S1P constricts cerebral arteries through S1P(3) receptors. The purported S1P(2) receptor antagonist JTE-013 does not appear to be selective, at least in rodents. Enhancement of S1P-induced contraction by VPC23019 might be related to blockade of S1P(1) receptors and NO generation.

Effects of LPA and S1P on the nervous system and implications for their involvement in disease

Lysophosphatidic acid (LPA) and sphingosine 1-phosphate (S1P) are two well-studied lysophospholipids that are known to be important regulators of cellular events. Their actions are mediated by activating a family of G-protein coupled receptors present in many cell types and tissues. These receptors have diverse biological roles owing to the heterogeneity of their signal transduction pathways. Many of these receptors are expressed in subsets of cells in the developing and mature mammalian nervous system and are thought to have important functions in its formation and maintenance. They are also widely expressed within other organ systems such as the immune system. Growing interest in the field has stimulated the development of a number of molecules that act as agonists or antagonists to LPA and S1P receptors. These molecules may lead to the development of new therapeutic compounds. Indeed, one such compound (FTY720) is currently in clinical trials for use in preventing transplant rejection and treating multiple sclerosis. The purpose of this manuscript is to: 1) review effects elicited by LPA and S1P on cells and tissues with a particular emphasis on the nervous system, 2) examine possible roles of these lipids in the development of disease, and 3) summarize the existing literature describing their agonists/antagonists.

New developments in the biological functions of lysophospholipids

Lysophospholipids have long been recognized as membrane phospholipid metabolites, but only recently has their role as intercellular signaling molecules been appreciated. Two of the best-studied lysophospholipids, LPA and S1P, signal through cognate G-protein-coupled receptors to activate many well-known intracellular signaling pathways, leading to a variety of biologically important cell responses. Lysophospholipids and their receptors have been found in a wide range of tissues and cell types, indicating their importance in many physiological processes, including reproduction, vascular development, cancer and nervous system function. This article will focus on the most recent findings regarding the biological functions of lysophospholipids in mammalian systems, specifically as they relate to health and disease.

Aneuploidy in the normal and diseased brain

The brain is remarkable for its complex organization and functions, which have been historically assumed to arise from cells with identical genomes. However, recent studies have shown that the brain is in fact a complex genetic mosaic of aneuploid and euploid cells. The precise function of neural aneuploidy and mosaicism are currently being examined on multiple fronts that include contributions to cellular diversity, cellular signaling and diseases of the central nervous system (CNS). Constitutive aneuploidy in genetic diseases has proven roles in brain dysfunction, as observed in Down syndrome (trisomy 21) and mosaic variegated aneuploidy. The existence of aneuploid cells within normal individuals raises the possibility that these cells might have distinct functions in the normal and diseased brain, the latter contributing to sporadic CNS disorders including cancer. Here we review what is known about neural aneuploidy, and offer speculations on its role in diseases of the brain.

Randomized phase II trial of neoadjuvant vs. adjuvant docetaxel plus cisplatin in patients with locally advanced gastric carcinoma: An interim analysis

4030

Background: The perioperative treatment strategy for locally advanced gastric cancer (LAGC) has not been clearly established. We conducted a randomized phase II study of neoadjuvant vs. adjuvant docetaxel/cisplatin (DC) chemotherapy in LAGC. Methods: LAGC was radiographically defined by CT and PET. Pts were randomized to receive neoadjuvant or adjuvant DC (docetaxel 36 mg/m2 + cisplatin 40 mg/m2 on D1, D8, q 3 wks X 3 cycles) according Japanese staging system (IIIa, IIIb, IV M-, and IV with a single M+ node). Results: All planned 88 pts in 44 per each arm were enrolled between Jan 2003 and Nov 2005. One pt was not eligible. The median age was 57 yrs vs. 58 yrs, PS 1 90.7% vs. 84.1%, and stage III/IV 72.1%/27.9% vs. 70.5%/29.5% in the neoadjuvant and adjuvant arm, respectively. Clinical response rate of 42 evaluable pts in neoadjuvant arm according to WHO criteria was 64.3% (95% CI 49.8–78.8%) with CR 2.4%, PR 61.9%, SD 31.0%, and PD 4.7%. There was no treatment related death. Comparison of G3/4 adverse events in neoadjuvant vs. adjuvant arm were; leukopenia 14.0% vs. 32.4% (p=0.04), neutropenia 37.2% vs. 62.2% (p=0.02), febrile neutropenia 0% vs. 2.7%, diarrhea 2.3% vs. 10.8%, stomatitis 2.3% vs. 8.1% (p=NS). There were no difference in the postoperative morbidity and the duration of hospital stay between both arms, but surgery was delayed in one pt who developed tuberculosis during neoadjuvant chemotherapy. Downstaging of the T stage could be obtained in 6 (14.3%) among 42 evaluable pts in neoadjuvant arm, according to EUS. Conclusions: Both neoadjuvant and adjuvant DC chemotherapy were relatively well tolerated in LAGC, with the lower incidence of G3/4 toxicities in neoadjuvant arm. Neoadjuvant DC showed a high response rate and a modest downstaging effect. (Supported by National Cancer Center Grant; Docetaxel was provided by Sanofi Aventis Korea)

[Table: see text]

No significant financial relationships to disclose.

Apoptotic DNA fragmentation is detected by a semi-quantitative ligation-mediated PCR of blunt DNA ends

Apoptosis is a form of programmed cell death (PCD) characterized by morphological changes and stereotypical DNA degradation described as a nucleosomal ;ladder'. However, nucleosomal ladders have only been clearly demonstrated in vertebrate tissues when large numbers of cells die in synchrony. Their absence may be explained by asynchronous death under physiological conditions, or by distinct molecular mechanisms. In this study, nucleosomal ladders were revealed by a ligation-mediated polymerase chain reaction (LMPCR), that amplifies DNA fragments with blunt, 5' phosphorylated ends. Numerous tissues from different organisms were examined which demonstrated that nucleosomal ladders (a) accompany physiological cell death in mammalian tissues where previously DNA fragmentation has not been detected; (b) are produced during invertebrate cell death; (c) are invariably generated via the production of blunt, 5' phosphorylated double strand breaks. These results suggest that PCD in multicellular organisms consistently involves apoptotic mechanisms and that the endonuclease activity is evolutionarily conserved.

Orientational order of molecular assemblies on inorganic crystals

Surfactant micelles form oriented arrays on crystalline substrates although registration is unexpected since the template unit cell is small compared to the size of a rodlike micelle. Interaction energy calculations based on molecular simulations reveal that orientational energy differences on a molecular scale are too small to explain matters. With atomic force microscopy, we show that orientational ordering is a dynamic, multimolecule process. Treating the cooperative processes as a balance between van der Waals torque on a large, rodlike micellar assembly and Brownian motion shows that orientation is favored.

Incidence of cardiovascular disease in the dissecting room: A valuable teaching asset

The purpose of this study was to determine the incidence of cardiovascular pathology in 50 cadavers in the dissecting room of the Department of Anatomy at Guy's Campus, King's College, London, and to demonstrate the importance of dissection in teaching the anatomy of normal and pathological hearts. After external evaluation of each heart the four chambers were dissected and studied. The features noted included evidence of coronary atherosclerosis, myocardial infarction, variations in coronary artery anatomy, valvular disease, variations in left ventricular wall thickness and atrial dimensions, and atrial anomalies. All the hearts studied had at least one pathology. The majority had severe coronary atherosclerosis (44) and aortic valve pathology (23). A large number had left ventricular hypertrophy (13) and left atrial enlargement (9). A small number showed evidence of myocardial infarction (4). Anatomical anomalies were also found, and included persistent foramen ovale (1), three coronary arterial ostia (3), and anatomical variations of the orientation of the main stem of the left coronary artery (2). This study demonstrates that dissection is not only an excellent way of studying normal cardiac anatomy, but also a valuable method for introducing common cardiac pathologies to the medical student.

Biological effects of lysophospholipids

Lysophosphatidic acid (LPA) and sphingosine 1-phosphate (S1P) are potent biologically active lipid mediators that exert a wide range of cellular effects through specific G protein-coupled receptors. To date, four LPA receptors and five S1P receptors have been identified. These receptors are expressed in a large number of tissues and cell types, allowing for a wide variety of cellular responses to lysophospholipid signaling, including cell adhesion, cell motility, cytoskeletal changes, proliferation, angiogenesis, process retraction, and cell survival. In addition, recent studies in mice show that specific lysophospholipid receptors are required for proper cardiovascular, immune, respiratory, and reproductive system development and function. Lysophospholipid receptors may also have specific roles in cancer and other diseases. This review will cover identification and expression of the lysophospholipid receptors, as well as receptor signaling properties and function. Additionally, phenotypes of mice deficient for specific lysophospholipid receptors will be discussed to demonstrate how these animals have furthered our understanding of the role lysophospholipids play in normal biology and disease.