Abstract 1557: High mobility group box 1 secretion supports tumor progression of human malignant mesothelioma

Human malignant mesothelioma (MM) is an aggressive and highly lethal cancer, often associated with exposure to asbestos and erionite. Prognosis is poor, due to late-stage diagnosis and resistance to current conventional therapies. We previously showed that high-mobility group box-1 protein (HMGB1), a damage-associated molecular pattern (DAMP) protein, is involved in the early stages of mesothelial cell transformation. Here we show that HMGB1 establishes an autocrine circuit in MM cells influencing tumor cell proliferation and survival. MM cells express HMGB1 at high levels and secrete HMGB1 into the extracellular space. Accordingly, HMGB1 levels in MM patients’ sera are significantly higher than in those of healthy individuals. In addition, motility, survival and anchorage-independent growth of HMGB1-secreting MM cells were inhibited in vitro by a monoclonal antibody (mAb) against HMGB1, by the recombinant HMGB1 competitive antagonist BoxA and by antibodies against the receptor for advanced glycation end products (RAGE). Inhibition of HMGB1 reduced the growth of MM xenografts in SCID mice and extended survival. Our findings indicate that MM cells become “addicted” to HMGB1 and that targeting HMGB1 can be a promising novel therapeutic approach for MM.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1557. doi:1538-7445.AM2012-1557

Equol production changes over time in pre-menopausal women

Equol (EQ) is a metabolite produced by gut bacteria through the chemical reduction of the soya isoflavone daidzein (DE), but only by 30-60% of the population. EQ is believed to provide benefits derived from soya intake and its production is widely viewed as a relatively stable phenomenon. In a randomised, cross-over intervention with soya foods, seventy-nine pre-menopausal women were challenged with a high-soya and a low-soya diet each for 6 months, separated by a 1-month washout period. Overnight urine was collected at three time points during each diet period and analysed for DE and EQ by liquid chromatography tandem MS. Remaining an EQ producer (EP) or non-producer (NP) or changing towards an EP or NP was assessed using an EQ:DE ratio of ≥0·018 combined with a DE threshold of ≥2 nmol/mg creatinine as a cut-off point. We observed 19 and 24% EP during the low-soya and high-soya diet periods, respectively, and found that 6-11% of our subjects changed EQ status 'within' each study period (on an average of 1·2 times), while 16% changed 'between' the two diet periods. The present finding challenges the widely held conviction that EQ production within an individual remains stable over time. The precise factors contributing to changes in EQ status, however, remain elusive and warrant further investigation.

[Clinical effects of treatment with phytoestrogens in postmenopausal women]

AIM AND METHODS

Phytoestrogens are plant substances that have estrogenic properties; they haven't steroid structure but they are heterocyclic phenols and for this reason are similar to 17 β estradiol from the functional and structural point of view; they compete for the same receptor sites of endogenous estrogens, but with an activating capacity a thousand times lower. For this reason, the isoflavones are an alternative to hormone-replacement treatment: they are prescribed to all those women who cannot be treated with HRT for several contraindications, such as thrombosis or breast tumor familiarity. The aim of our study was to demonstrate the effectiveness of soy isoflavones on menopausal symptoms.

RESULTS AND CONCLUSION

In our experience, literature data were confirmed, with a 40% reduction of the vasomotor symptoms after 6 months of treatment. Associated with this improvement, there is also the reduction in the degree of insomnia and depressive symptoms. The musculoskeletal pains, however, are not reduced significantly as no positive change was found on vaginal dryness, a major cause of dyspareunia in postmenopausal period.

Mammographic density, parity and age at first birth, and risk of breast cancer: an analysis of four case-control studies

Mammographic density is strongly and consistently associated with breast cancer risk. To determine if this association was modified by reproductive factors (parity and age at first birth), data were combined from four case-control studies conducted in the United States and Japan. To overcome the issue of variation in mammographic density assessment among the studies, a single observer re-read all the mammograms using one type of interactive thresholding software. Logistic regression was used to estimate odds ratios (OR) while adjusting for other known breast cancer risk factors. Included were 1,699 breast cancer cases and 2,422 controls, 74% of whom were postmenopausal. A positive association between mammographic density and breast cancer risk was evident in every group defined by parity and age at first birth (OR per doubling of percent mammographic density ranged between 1.20 and 1.39). Nonetheless, the association appeared to be stronger among nulliparous than parous women (OR per doubling of percent mammographic density = 1.39 vs. 1.24; P interaction = 0.054). However, when examined by study location, the effect modification by parity was apparent only in women from Hawaii and when examined by menopausal status, it was apparent in postmenopausal, but not premenopausal, women. Effect modification by parity was not significant in subgroups defined by body mass index or ethnicity. Adjusting for mammographic density did not attenuate the OR for the association between parity and breast cancer risk by more than 16.4%, suggesting that mammographic density explains only a small proportion of the reduction in breast cancer risk associated with parity. In conclusion, this study did not support the hypothesis that parity modifies the breast cancer risk attributed to mammographic density. Even though an effect modification was found in Hawaiian women, no such thing was found in women from the other three locations.

Malignant mesothelioma: facts, myths, and hypotheses

Malignant mesothelioma (MM) is a neoplasm arising from mesothelial cells lining the pleural, peritoneal, and pericardial cavities. Over 20 million people in the US are at risk of developing MM due to asbestos exposure. MM mortality rates are estimated to increase by 5-10% per year in most industrialized countries until about 2020. The incidence of MM in men has continued to rise during the past 50 years, while the incidence in women appears largely unchanged. It is estimated that about 50-80% of pleural MM in men and 20-30% in women developed in individuals whose history indicates asbestos exposure(s) above that expected from most background settings. While rare for women, about 30% of peritoneal mesothelioma in men has been associated with exposure to asbestos. Erionite is a potent carcinogenic mineral fiber capable of causing both pleural and peritoneal MM. Since erionite is considerably less widespread than asbestos, the number of MM cases associated with erionite exposure is smaller. Asbestos induces DNA alterations mostly by inducing mesothelial cells and reactive macrophages to secrete mutagenic oxygen and nitrogen species. In addition, asbestos carcinogenesis is linked to the chronic inflammatory process caused by the deposition of a sufficient number of asbestos fibers and the consequent release of pro-inflammatory molecules, especially HMGB-1, the master switch that starts the inflammatory process, and TNF-alpha by macrophages and mesothelial cells. Genetic predisposition, radiation exposure and viral infection are co-factors that can alone or together with asbestos and erionite cause MM. J. Cell. Physiol. 227: 44-58, 2012. © 2011 Wiley Periodicals, Inc.

[Polycystic ovarian syndrome incidence in young women with non-alcoholic fatty liver disease]

AIM

Recently, numerous studies have shown significant correlation between hyperandrogenism and elevated insulin levels in many patients with polycystic ovarian syndrome (PCOS). Insuline-Resistance (IR) results in increased circulating levels of this hormone and it is the basis of the metabolic syndrome, characterized by the presence of fatty liver disease (NAFLD), which is pathologically characterized by the accumulation of triglycerides as macro or micro vesicles, in more than 5% of hepatocytes. The aim of our study was to evaluate the incidence of NAFLD in young women with PCOS, who were lean, overweight or obese.

METHODS

Particularly, the levels of glucose and insulin, the lipidic profile, and all liver function indices were evaluated; the severity and degree of steatosis were established on the basis of parenchymal echogenicity and the view of intrahepatic venous circulation.

RESULTS

Our study showed that NAFLD is a common disease in women with polycystic ovaries, especially with high BMI, but an incidence rate of 40% in lean women too was found. Because steatohepatitis is a risk factor for the developmente of cirrhosis and hepatocellular carcinoma, it is therefore prudent to carry out an ultrasound evaluation of liver in all young patients suffering from polycystic ovary syndrome, regardless of their BMI and the results of serological evaluation of liver.

CONCLUSION

This collateral diagnosis that accompanies the diagnosis of Polycystic Ovary Syndrome seems important since this type of patients could be treated with metformin or with thiazoles to reduce insulin-resistance and steatosis as well.

Mammographic density and risk of breast cancer by adiposity: an analysis of four case-control studies

The association of mammographic breast density with breast cancer risk may vary by adiposity. To examine effect modification by body mass index (BMI), the authors standardized mammographic density data from four case-control studies (1994-2002) conducted in California, Hawaii and Minnesota and Gifu, Japan. The 1,699 cases and 2,422 controls included 45% Caucasians, 40% Asians and 9% African-Americans. Using ethnic-specific BMI cut points, 34% were classified as overweight and 19% as obese. A single reader assessed density from mammographic images using a computer-assisted method. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) while adjusting for potential confounders. Modest heterogeneity in the relation between percent density and breast cancer risk across studies was observed (p(heterogeneity) = 0.08). Cases had a greater age-adjusted mean percent density than controls: 31.7% versus 28.5%, respectively (p <0.001). Relative to <20 percent density, the ORs for >35 were similar across BMI groups whereas the OR for 20-35 was slightly higher in overweight (OR = 1.69, 95% CI: 1.28, 2.24) and obese (OR = 1.62, 95% CI: 1.12, 2.33) than in normal weight women (OR = 1.49, 95% CI: 1.11, 2.01). Furthermore, limited evidence of effect modification by BMI of the OR per 10% increase in percent density (p(interaction) = 0.06) was observed, including subgroup analyses by menopausal status and in analyses that excluded women at the extremes of the BMI scale. Our findings indicate little, if any, modification by BMI of the effects of breast density on breast cancer risk.

[Clinical effectiveness of N-oleyl-phosphatidyl-ethanolamine (NOPE) in obesity: our experience]

Adjustment and maintenance of body weight are the result of many process combination, that affect both the gastrointestinal system and other mechanisms in the central nervous system. Often a diet modification alone is not sufficient to guarantee significant changes in body weight. For this reason, it sometimes necessary to make other interventions, in order to help an individual to adhere to the diet as much as possible and to achieve the objectives established. The N-oleyl-phosphatidyl-ethanolamine (NOPE) is a phospholipid. It can be endogenous or exogenous, and it is present in cell membranes and in much of the food. Food intake increases its production; in fact, because of certain stimuli, it is sometimes produced by the epithelial intestine cells too. Another substance whose activity is comparable to NOPE is the epigallocatechin gallate (EGCG), an abundant catechin present in the green tea, which allows a lipid lowering and antioxidant action, and acts on energy consumption as well. The aim of our study was to evaluate the effectiveness of NOPE and EGCG pharmaceutical formulation in a population of obese women, administering the supplement twice daily before meals, for a period of 60 days. The comparison between the effectiveness of the results in a homogeneous group of patients treated with diet and placebo, allows to confirm the data reported in the literature regarding the effectiveness of the pharmaceutical formulation and the absence of side effects.

Equol production changes over time in postmenopausal women

Equol (EQ) is produced by intestinal bacteria from the soy isoflavone daidzein (DE) in 30%-60% of the population and is believed to provide benefits from soy intake. A robust EQ status definition is lacking, and it is uncertain whether EQ is formed consistently within an individual and ceases upon oral antibiotic treatment. In a randomized, double-blind, placebo-controlled soy intervention trial with 350 postmenopausal women, DE and EQ were analyzed by liquid chromatography/tandem mass spectrometry at baseline and every 6 months over 2.5 years in overnight urine, spot urine and plasma. Equol production changes and status (remaining an EQ producer or nonproducer or changing towards an EQ producer or nonproducer) were assessed. Equol status was determined most dependably by overnight urine applying as cutoff a ratio of EQ/DE≥0.018 with a DE threshold ≥2 nmol/mg creatinine: the soy and placebo groups had approximately 30% consistent EQ producers during the study, but 14% and 35%, respectively, changed EQ status (mean 1.4-1.7 times), while 27% and 17%, respectively, had antibiotic treatment (P<.01 for inverse association). No significant trend in change of EQ production or status was observed when overnight urine was limited to collections closest to before and after antibiotic treatment. Similarly, antibiotic type or class, duration, dose or time between antibiotic treatment and overnight urine collection showed no consistent influence on EQ production. Equol production can markedly change intraindividually over 2.5 years, and antibiotic treatment impacts it inconsistently. Factors other than antibiotic treatment must be considered as causes for EQ production changes.

[Psychic aspects of the premenstrual dysphoric disorders. New therapeutic strategies: our experience with Vitex agnus castus]

AIM

The premenstrual dysphoric disorder (PMDD) is one of the main problems of the premenstrual phase. It consists of symptoms that sometimes invalidate the scope of employment, social and psycho-affective of patients, requiring thus a diagnostic and therapeutic approach as detailed and accurate as possible. The therapeutic strategies available for this disease are many, but recently the emphasis has been on Vitex agnus castus (VAC), considered by many as evidence drug of choice for both PMS and for the PMDD, being with satisfactory therapeutic properties and small side effects.

METHODS AND RESULTS

Our study evaluated a group of patients suffering from PMDD and the clinical efficacy of treatment with VAC (and compared the effectiveness of the results of a more homogeneous group of patients treated with fluoxetine).

CONCLUSION

This study confirms the data reported in the literature regarding the effectiveness of VAC therapy with no side effects.

Effects of myo-inositol supplementation on oocyte's quality in PCOS patients: a double blind trial

BACKGROUND

Polycystic ovary syndrome is the most common cause of chronic anovulation infertility in women in fertile period, and it's characterized by an increased production of androgens and estrogens. The administration of myo-inositol, a B complex vitamin, was associated with a decreased of serum testosterone and simultaneously, due to its ability to increase insulin sensitivity, women who received myo-inositol showed a great improvement of the ovulary function. Besides, the supplementation of inositol improves the oocytes' quality and increase the number of oocytes collected after ovarian stimulation in patients undergoing IVF (in vitro fertilization).

AIM

The aim of this study is to determine the effects of myo-inositol on oocyte's quality on a sample of women with polycystic ovary syndrome.

MATERIAL AND METHODS

The patients were divided into two groups: patients of Group A in-took 2 g of myo-inositol + 200 microg of folic acid (Inofolic, LO.LI. Pharma, Rome, Italy) while Group B only 200 microg of folic acid, both groups took the treatment twice a day, continuously for 3 months.

RESULTS

At the end of treatment, the number of follicles of diameter > 15 mm, visible at ultrasound during stimulation, and the number of oocytes recovered at the time of pick-ups were found to be significantly greater in the group treated with myo-inositol, so as the aver-age number of embryos transferred and embryo Score S1. Significantly reduced was the average number of immature oocytes (vesicles germ and degenerated oocytes) too.

CONCLUSIONS

These data suggest that myoinositol may be useful in the treatment of PCOS patients undergoing ovulation induction, both for its insulin-sensitizing activity, and its role in oocyte maturation.

Factors affecting survival among women with breast cancer in Hawaii

BACKGROUND

Given previous reports of ethnic differences in breast cancer survival among Hawaii's population, we investigated the role of adherence to treatment standards, treatment toxicity, preexisting chronic conditions, and obesity in the survival of 382 prospectively studied breast cancer patients representing six ethnic groups.

METHODS

Participants were recruited from several hospitals in Honolulu. Information on tumor characteristics and treatment was abstracted from medical records. Based on the Physicians Data Query (PDQ®), we assessed compliance with recommended treatment guidelines. Vital status and cause of death data were obtained through linkage with the Hawaii Tumor Registry. Cox proportional hazard models were used to compute hazard ratios for predictors of survival.

RESULTS

After a median follow-up time of 13.2 ± 3.7 years, 115 deaths had occurred, 43 from breast cancer and 72 from other causes. After adjustment, we observed only small differences in survival by ethnicity that were not statistically significant. In addition to advanced disease stage, obesity at diagnosis was a significant independent predictor of worse and receiving PDQ-recommended treatment of better breast cancer-specific and all-cause survival. Developing high-grade toxicity was associated with worse breast cancer survival, whereas comorbidity and older age at diagnosis were associated with higher all-cause mortality. Hormone receptor status, menopausal status, and type of health insurance were not associated with survival.

CONCLUSIONS

These findings suggest that given access to healthcare, breast cancer patients experience similar survival rates. Although more information about mechanisms of action would be useful, it appears reasonable to recommend weight control to breast cancer survivors.

Mammographic density and hormone receptor expression in breast cancer: the Multiethnic Cohort Study

BACKGROUND

It is unclear whether mammographic breast density, a strong risk factor for breast cancer, predicts subtypes of breast cancer defined by estrogen receptor (ER) and/or progesterone receptor (PR) expression.

METHODS

In a nested case-control study, we compared the breast density of 667 controls and 607 breast cancer cases among women of Caucasian, Japanese, and Native Hawaiian ancestry in the Hawaii component of the Multiethnic Cohort Study. A reader blinded to disease status performed computer assisted density assessment on prediagnostic mammograms. Receptor status was obtained from the statewide Hawaii Tumor Registry. Tumors were classified into ER+PR+ (n=341), ER-PR- (n=50), ER+PR-/ER-PR+ (n=64), and unstaged/unknown (n=152). Mean percent density values were computed for women with more than one mammogram. Polytomous logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) while adjusting for confounders.

RESULTS

Mean percent density was significantly greater for ER+PR+ but not for ER-PR- tumors compared to controls after adjusting for age: 37.3%, 28.9% versus 29.4%, respectively. The overall OR per 10% increase in percent density were similar for ER+PR+ and ER+PR-/ER-PR+ tumors: 1.26 (95% CI 1.17-1.36) and 1.23 (95% CI 1.07-1.42), respectively. However, percent density was not found to be a predictor for ER-PR- tumors (OR 1.00, 95% CI 0.84-1.18). The results did not differ by ethnicity, nor by menopausal status, parity, or HRT use.

CONCLUSIONS

Our findings indicate that within a multiethnic population, women with higher breast density have an increased risk for ER+PR+ but not ER-PR- tumors.

[Effects of inositol on oocyte quality in patients affected with polycystic ovary syndrome]

AIM

Polycystic ovary syndrome is the most common cause of chronic anovulation infertility in women in fertile period. The supplementation of inositol, due to its ability to increase insulin sensitivity, improves the oocytes' quality and increase the number of oocytes collected after ovarian stimulation in patients undergoing IVF (In Vitro Fertilization). The aim of our study is to determine the effects of myo-inositol on oocyte's quality on a sample of women with polycystic ovary syndrome.

METHODS

The patients were divided into two groups: patients of Group A intook 2 g of myo-inositol + 400 μg of folic acid 2 times a day, continuously for 3 months, while Group B only 400 μg of folic acid.

RESULTS AND CONCLUSION

At the end of treatment, the number of follicles of diameter >15 mm, visible at ultrasound during stimulation, and the number of oocytes recovered at the time of pick-ups were found to be significantly greater in the group treated with myo-inositol, so as the average number of embryos transferred and embryo Grade G1. Significantly reduced was the average number of immature oocytes (vesicles germ and degenerated oocytes) too.

[Innovative genetic, clinical and endocrinologic aspects in young females affected by premature ovarian insufficiency]

AIM

Heterogeneity premature ovarian insufficiency (POI) is one of the reasons why there are different causes that contribute in determining this type of hormonal disorder. Although the causes have already been established for many types of premature ovarian failure, are still uncertain causes in most cases of idiopathic forms, despite the description of several candidate genes, including BMP-15 gene. The gene under study is precisely the BMP-15, which is part of the superfamily of Transforming Growth Factors-beta or the TGF-β, which also belong to the growth differentiation factors (GDFs).

METHODS

This study examined a sample of Sicilian women suffering from POI, carefully selected according to their age, since in these cases, the genetic factor probably has a greater impact.

RESULTS AND CONCLUSION

Identify a mutant gene that causes ovarian failure may be important to make a diagnosis that can predict the possible future development of the disease. The outcome of the studies, however, has not found the gene in question, but it is hypothesized that this may be a direct consequence of the limited amount of women that was done the study, a case which may be rebutted by increasing the number of patients.

Abstract B25: Mammographic density and risk of breast cancer by body weight: A combined analysis of four case-control studies

Background. Breast density assessed from mammography is a strong predictor of breast cancer risk, but the strength of the association may vary with adiposity. To examine effect modification by adiposity, we combined data from four case-control studies on breast density that represented an ethnically diverse population with a wide variation in level of adiposity as measured by body mass index (BMI, kg/m2).

Methods. We combined data from four case-control studies representing different locations: California, Hawaii and Minnesota in the United States, and Gifu in Japan. All studies included incident breast cancer cases diagnosed between 1994 and 2002 and matched controls representing the underlying case population. One mammographic image per subject was selected, specifically the mammogram at diagnosis for the studies from California, Minnesota, and Japan and the closest prediagnostic mammogram for Hawaii. Percent density was measured by one reader, who was blinded to case status, using a computer-assisted method. Self-reported anthropometric measures were used to classify women as normal, overweight, and obese according to ethnic-specific BMI cut points (&lt;23, 23-27.4, and ≥27.5 for Asian women and &lt;25, 25-29.9, and ≥30 for other ethnic groups). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) and to evaluate interactions using the likelihood ratio while adjusting for potential confounders, including age and ethnicity. Heterogeneity across studies was marginally significant as assessed by examining density-by-study interaction (P = 0.09) and, therefore, we also adjusted for study-site.

Results. The study included 1,699 cases and 2,422 controls of diverse ethnicity: 45% Caucasian, 40% Asian, 9% African-American, and 7% Other. Of these women, we classified 34% as overweight and19% as obese. Age-adjusted mean percent density was significantly greater for cases than for controls: 31.7% versus 28.9%, respectively (P &lt; 0.001). BMI was inversely associated with breast density; the estimated age-adjusted mean percent density was 36.5%, 26.8%, and 19.3% for normal, overweight, and obese, respectively (Ptrend &lt; 0.001). The overall OR for a 10% higher percent density was 1.15 (95% CI: 1.05, 1.18) with higher estimates in overweight (OR: 1.19, 95% CI: 1.09, 1.29) and obese (OR: 1.25, 95% CI: 1.11, 1.41) than normal BMI (OR: 1.11, 95% CI: 1.05, 1.18). The effect modification by BMI was statistically significant (Pinteraction = 0.01).

Conclusions. Our findings confirm that the elevated risk of breast cancer associated with breast density differs by level of adiposity, with a higher risk for overweight and obese than normal BMI. Further research is needed to understand the underlying biological reasons for these noted differences in association by adiposity.

Citation Information: Cancer Prev Res 2010;3(12 Suppl):B25.

Urine accurately reflects circulating isoflavonoids and ascertains compliance during soy intervention

BACKGROUND

Isoflavonoids (IFL) may protect against chronic diseases, including cancer. IFL exposure is traditionally measured from plasma (PL), but the reliability of urine is uncertain. We assessed whether IFL excretion in overnight urine (OU) or spot urine (SU) reliably reflects IFLs in PL and the usefulness of the three matrices to determine soy intake compliance.

METHODS

In a randomized, double-blind, placebo-controlled soy intervention trial with 350 postmenopausal women, IFLs (daidzein, genistein, glycitein, equol, O-desmethylangolensin, dihydrodaidzein, dihydrogenistein) were analyzed by liquid chromatography/mass spectrometry in OU, SU, and PL collected at baseline and every 6 months over 2.5 years.

RESULTS

High between-subject intraclass correlations between all three matrices (median, 0.94) and high between-subject Pearson correlations (median r(OU-PL) = 0.80; median r(SU-PL) = 0.80; median r(OU-SU) = 0.92) allowed the development of equations to predict IFL values from any of the three matrices. Equations developed from a randomly selected 87% of all available data were valid because high correlations were found on the residual 13% of data between equation-generated and measured IFL values (median r(OU-PL) = 0.86; median r(SU-PL) = 0.78; median r(OU-SU) = 0.84); median absolute IFL differences for OU-PL, SU-PL, and OU-SU were 8.8 nmol/L, 10.3 nmol/L, and 0.28 nmol/mg, respectively. All three matrices showed highly significant IFL differences between the placebo and soy intervention group at study end (P < 0.0001) and highly significant correlations between IFL values and counted soy doses in the intervention group.

CONCLUSIONS

OU and SU IFL excretion reflect circulating PL IFL levels in healthy postmenopausal women accurately.

IMPACT

Noninvasively-collected urine can be used to reliably determine systemic IFL exposure and soy intake compliance.

Abstract 2780: Mammographic density and breast cancer tumor characteristics in the Multiethnic Cohort Study

Mammographic density (MD), a strong risk factor for breast cancer, may reflect proliferation of breast epithelial and stromal cells in response to cumulative exposure to endogenous and exogenous hormones. Whether MD predicts subtypes of breast cancer defined by expression of the estrogen (ER+) and/or progesterone (PR+) receptor is unclear. Because factors associated with higher MD are associated with ER+PR+ breast cancers, we hypothesized that women with higher percent MD (dense breast tissue area to total breast area) would have a higher risk for ER+PR+ and a lower risk for ER-PR- breast cancers as compared to women with lower percent MD. In a nested case-control study, we compared the MD of 667 controls and 607 breast cancer cases among women of Caucasian, Japanese and Native Hawaiian ancestry in the Hawaii component of the Multiethnic Cohort Study. A reader blinded to disease status performed computer assisted density assessment on prediagnostic mammograms. Receptor status for breast cancers was obtained from the statewide Hawaii Tumor Registry. Tumors were classified into ER+PR+ (n=341), ER-PR- (n=50), ER+PR-/ER-PR+ (n=64) and unstaged/unknown (n=152). Mean density values were computed for women with more than one mammogram and modeled using polytomous logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) while adjusting for confounders. Mean percent MD was significantly greater for ER+PR+, but not for ER-PR- breast cancers compared to controls after adjusting for age: 37.3%, 28.9%, versus 29.4%, respectively. The overall ORs for a 10% increase in percent MD were similar for all breast cancer cases and for ER+PR+ and ER+PR-/ER-PR+ cancer subtypes: 1.22 (95% CI, 1.14-1.30), 1.25 (95% CI, 1.16-1.35) and 1.23 (95% CI, 1.07-1.42), respectively. Percent MD was not found to be a predictor for ER-PR- subtypes (OR for a 10% increase = 1.00, 95% CI, 0.84, 1.18). Our findings indicate that within a multiethnic population, women with higher MD have an increased risk for ER+PR+, but not ER-PR- breast cancer. Breast cancer subtypes are suspected to have diverse etiologies that respond to different treatments. Our findings support specific models of hormone-related triggers for the increased breast cancer risk associated with MD. Research supported by NCI grants: R37CA54281, R01CA85265 and R25CA90956.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2780.

Breast Cancer Treatment Among Women of Different Ethnicity in Hawaii

BACKGROUND

An analysis of breast cancer survival for Hawaii's multiethnic women in the 1970s and 1980s showed that Hawaiian and Filipino women experienced a worse survival than their Caucasian and Japanese counterparts even after controlling for stage at diagnosis. We conducted this study to test for ethnic differences in treatment compliance with established guidelines while adjusting for stage at diagnosis and other disease characteristics.

METHODS

A total of 406 newly diagnosed breast cancer patients identified through the Hawaii Tumor Registry were available for this project. Two hundred fifty-nine patients of the sample were from Hawaii's predominant fee-for-service multiple private office/community hospital setting and 147 patients were members of a Health Maintenance Organization (HMO). The primary measures assessed were treatment received, ethnicity, age at diagnosis, cancer stage, hormone receptor status, comorbidity, and treatment toxicities. Physician's Data Query (PDQ) guidelines were used as the standard of care. We examined whether there were ethnic-related differences in compliance with PDQ treatment guidelines according to stage at diagnosis.

RESULTS

Overall, 25 percent of the sample did not receive treatment that was specifically recommended by PDQ guidelines and 7 percent received treatment that was not recommended by PDQ for the patients' stage of disease. There were no statistically significant ethnic-related differences in compliance with PDQ guidelines. Although not statistically significant, Caucasians and Japanese were less likely than other groups to receive axillary lymph node sampling/dissection and Chinese were more likely than other groups to receive chemotherapy when it was not specifically recommended by the PDQ. There was no difference in adherence to PDQ guidelines between the sample treated in a fee-for-service setting and the sample treated by the HMO. Hawaiians and Chinese experienced lower levels of Grade 3 and 4 chemotherapy-related toxicities than other groups.

CONCLUSION

The results of this study do not suggest that treatment compliance with established guidelines differs by ethnicity. Our unexpected finding that Hawaiian and Chinese women experienced lower levels of Grade 3 and 4 chemotherapy-related toxicities deserves further investigation.

[Resistance surveillance of Neisseria gonorrhoeae in a hospital in Santa Fe province, Argentina: 1997-2004]

Resistance phenotypes characterized by minimum inhibitory concentration, disk diffusion and beta-lactamase production were determined in 434 isolates from patients attending the Sexually Transmitted Disease Service at Dr. José Maria Cullen Hospital in Santa Fe, Argentina. Susceptibility tests to penicillin, tetracycline, ciprofloxacin, espectinomycin, azithromycin and ceftriaxone were performed. Pulsed-field gel electrophoresis was conducted made to on three ciprofloxacin-resistant isolates. Epidemiologically speaking, three interesting events should be highlighted: during 1997, plasmid-mediated high level tetracycline-resistant strains were observed (33.3%); from 2002 to 2004 a significant increase of plasmid-mediated penicillin-resistant strains was registered (9.7% to 34.8%); and in the year 2000 the first two quinolone-resistant strains emerged in the province. In our hospital, the first azithromycin-resistant isolate emerged in 2004. We therefore emphasize the importance of the Clinical Microbiology Laboratory in order to provide information for the empiric treatment of this infection.

Breastfeeding patterns in a community of Native Hawaiian mothers participating in WIC

Although Hawaii has high breastfeeding initiation rates (89%), Native Hawaiian WIC participants have much lower initiation (64%) rates. Little is known about why these disparities occur. The study's aim was to describe the breastfeeding patterns of Hawaiian/part-Hawaiian women enrolled in the WIC who had initiated breastfeeding. Retrospective descriptive data (N=200) were gathered from WIC records. Descriptive and parametric statistics with univariate and multivariate analysis of breastfeeding patterns were completed. Mothers exclusively breastfeeding at initiation weaned significantly later and were significantly more likely to breastfeed for 6 months than were mothers who partially breastfed. Practice and policy implications of these findings are discussed.

Lifestyle risk factors for chronic disease in a multiethnic population: an analysis of two prospective studies over a 20-year period

OBJECTIVE

This study investigated changes in risk factors in Hawaii over 20 years and compared health behaviors among ethnic groups with well-documented differences in disease risk.

DESIGN

Comparison of scores of a Chronic Disease Risk Index (CDRI) in the population of two large population-based cohorts.

PARTICIPANTS

The respective sample sizes for the two cohorts were 19,319 and 97,746 persons ages > or = 40 years of White, Chinese, Filipino, Japanese, and Native Hawaiian ancestry.

MAIN OUTCOME MEASURES

The CDRI included smoking status, alcohol use, meat intake, fruit and vegetable consumption, and body mass index. Mean total and component scores were compared over time and by ethnic group after adjustment for age and education.

RESULTS

We found a reduction in overall CDRI scores, ie, improved health profiles, for both men and women over time. Men, Native Hawaiians, and Whites had higher CDRI scores than women and Japanese, Chinese, and Filipinos due to their higher scores for smoking, alcohol use, and overweight, whereas nutritional intakes were similar in all ethnic categories. Smoking, alcohol use, and overweight increased over time in both men and women, whereas dietary composition appeared to improve.

CONCLUSIONS

This analysis suggests an overall reduction in modifiable dietary and lifestyle risk factors in Hawaii over time. Persistent differences by sex and ethnic category indicate that interventions to modify lifestyle factors need to tailor messages to the groups at highest risk.

IGF-I and mammographic density in four geographic locations: A pooled analysis

Insulin-like growth factor (IGF-I) and prolactin have been found to be associated with breast cancer risk and with mammographic density. In a pooled analysis from 4 geographic locations, we investigated the association of percent mammographic density with serum levels of IGF-I, IGFBP-3 and prolactin. The pooled data set included 1,327 pre- and postmenopausal women: Caucasians from Norway, Arizona and Hawaii, Japanese from Hawaii and Japan, Latina from Arizona, and Native Hawaiians from Hawaii. Serum samples were assayed for IGF-I, IGFBP-3 and prolactin levels using ELISA assays. Mammographic density was quantified using a computer-assisted density method. After stratification by menopausal status, multiple regression models estimated the relation between serum analytes and breast density. All serum analytes except prolactin among postmenopausal women differed significantly by location/ethnicity group. Among premenopausal subjects, IGF-I levels and the molar ratio were highest in Hawaii, intermediate in Japan and lowest in Arizona. For IGFBP-3, the order was reversed. Among postmenopausal subjects, Norwegian women had the highest IGF-I levels and women in Arizona had the lowest while women in Japan and Hawaii had intermediate levels. We observed no significant relation between percent density and IGF-I or prolactin levels among pre-and postmenopausal women. The significant differences in IGF-I levels by location but not ethnicity suggest that environmental factors influence IGF-I levels, whereas percent breast density varies more according to ethnic background than by location. Based on this analysis, the influence of circulating levels of IGF-I, IGFBP-3, and prolactin on percent density appears to be very small.

Ethnic and geographic differences in mammographic density and their association with breast cancer incidence

The objective of this pooled analysis was to compare differences in dense areas and percent mammographic densities to breast cancer incidence in populations at different breast cancer risk. The data set included 1,327 women aged 40-80: Caucasians from Norway, Arizona, and Hawaii, Japanese from Hawaii and Japan, Latina from Arizona, and Native Hawaiians from Hawaii. One reader performed computer-assisted quantitative density assessment for all mammographic films. Multiple linear regression models evaluated the influence of the covariates on breast density. Spearman correlation coefficients (r (s)) estimated the association between breast density and breast cancer incidence for the seven populations. After adjustment for covariates, ethnicity, but not location, was significantly associated with breast density. In the full model, 19% of the variation in the dense areas and 46% in the variation of percent densities were explained by measured risk factors. Native Hawaiians had the largest dense areas and women in Japan the smallest, whereas percent densities were highest among Native Hawaiians and Japanese in Hawaii and lowest among Norwegian women. The mean age-adjusted dense area had the strongest association with breast cancer incidence (r (s) = 0.93, P = 0.003); the relation with percent density was considerably weaker (r (s) = 0.32, P = 0.48). The correlation between age-adjusted dense area and breast cancer incidence remained strong after selectively removing individual data points. This comparison of mammographic densities suggests that, on a group level, age-adjusted dense areas may reflect breast cancer incidence better than percent densities.