Immunohistochemical study on the expression of c-erbB-2 oncoprotein in breast cancer

Expression of the c-erbB-2 oncogene protein was investigated by immunohistochemistry in 110 paraffin-embedded blocks of primary breast cancer. 25 (22.7%) of 110 tumors were stained positively with c-erbB-2 protein antibody. There was no correlation between c-erbB-2 immunostaining and age at diagnosis, menopausal status, hormone receptor status, tumor size, or clinical stage. The tumors with an extensive intraductal component showed a higher incidence of the c-erbB-2 expression than those without. A significantly shorter overall survival was obtained in patients with the expression of c-erbB-2 protein than in patients without. Staining of c-erbB-2 protein is an effective prognostic indicator in patients with breast cancer.

Subcutaneous mastectomy with axillary dissection for early breast cancer

From 1983 to 1990, subcutaneous mastectomy with axillary dissection was carried out for 46 patients with early breast cancer including three bilateral breast cancer patients (four breasts). Cancer cells were recognized histopathologically in the resection margins of small mammary gland resting under the nipple in four cases, and the remaining 42 cases underwent a curative resection. Multicentric lesions were found out histopathologically by continuous sections in five cases (six breasts). There was no difference in the prognosis using the case-control comparison method between 34 patients with ipsilateral invasive carcinoma who underwent a subcutaneous mastectomy in this study group and 34 patients who underwent a radical or modified radical mastectomy in the control group. Cosmetic results of the subcutaneous mastectomy were evaluated in 37 patients, and 9 were excellent, 17 were good, 9 were not so good and 2 were poor. Subcutaneous mastectomy with axillary dissection was an effective operation for early breast cancer including multicentric lesions and some non-invasive ductal carcinomas from the prognostic and cosmetic standpoints.

Effect of mass screening for breast cancer from the aspect of psychosocial assessment of the quality of life

To assess the quality of life (QOL) in patients with breast cancer receiving mass screening, a collaborative matched case-control study was conducted in nine hospitals throughout Japan. A total of 122 patients detected by mass screening (study group) and 226 patients found in out-patient clinics (control group) were assessed psychosocially on the basis of questionnaire information. The incidence of patients with early stage breast cancer was significantly higher in the study group than in the control group (P < 0.05). Chest wall pain was observed in 35.2% of the study group and in 46.5% of the control group (P < 0.05). Although control patients were more optimistic than study group patients, disturbed daily life and anxiety about recurrence were a little more frequent in the former group than in the latter. In particular, shoulder stiffness was frequently seen in the control group (P < 0.05). Early detection and information do not create anxiety in mass screening patients (P < 0.01). We should recommend mass screening to patients to detect early stage breast cancer and provide better QOL.

[Nuclear DNA content in breast carcinoma by fine needle aspiration biopsy]

The usefulness of the measurement of nuclear DNA content by fine needle aspiration biopsy was evaluated through a comparative study of fine needle aspirated and tissue samples. Nuclear DNA content was measured in patients with 28 primary and 2 metastatic lesions of breast carcinoma using fluorescent cytophotometry with Feulgen stain. The rate of correspondence on DNA ploidy pattern of aspirates and tissue samples was 86.7%. There was a significant correlation with DNA index (DI) (R = 0.85, p < 0.001) and S-phase fraction (%S) (R = 0.79, p < 0.001). The rate of correspondence of DI subgroups (3 aneuploid subgroups and diploid) was 80.8%. No tumor size affected values of DI and %S of aspirates. However, %S of papillotubular carcinoma showed small difference compared with values of tissue samples. Nuclear DNA content of fine needle aspirated samples had a significant correlation with that of tissue samples, providing the estimation of the original ploidy pattern and DI. Fine needle aspiration biopsy is an easy technique and able to be carried out repeatedly. Thus, the measurement of nuclear DNA content using aspirates is useful for broad practical purposes.

[Phase I study of NK 622 (toremifene citrate)]

A phase I study of NK 622 (toremifene citrate), a novel antiestrogen, was conducted in female patients with cancer. Patients received a single oral dosing or daily once oral dosing for five consecutive days. Any adverse effects were not experienced in the single dosing of 40 or 60 mg of NK 622. In the daily administration of 10, 20, 40, 60, 120, 240 and 480 mg/day, one of three patients who received 20 mg/day experienced grade 1 anorexia, three of four patients received 240 mg/day experienced adverse effects: Grade 1 leukopenia in one patient, Grade 1 general hot flush in one patient, and Grade 1 nausea, hot flush in the face and vertigo, Grade 2 anorexia, fatigue, dull headache and general hot flush in another one patient. These symptoms recovered to normal levels after treatment. Serum hormone levels were examined in postmenopausal patients, and a significant increase of the sex hormone binding globulin level was observed in the patients received 120 and 240 mg/day doses. Serum levels of NK 622 determined as free base (TOR) reached the peak levels in 2 to 4 hours after administration on the 1st and 5th day in daily treatment, while a metabolite N-demethyltoremifene (TOR-1) reached the peak level in 4 to 170 hours. Maximum serum levels and area under the concentration versus time curves of TOR and TOR-1 increased dose-dependently. These values also increased by repetition of the treatment. Half-lives of TOR and TOR-1 in serum ranged in 74.5 to 148.9 hours and 154.1 to 653.1 hours, respectively. From these results, it was concluded that safety and efficacy of NK 622 should be assessed by using 240 mg or less doses in clinical phase II studies where breast cancer patients received long term treatment with NK 622.

Clinicopathologic characteristics and prognosis of breast cancer patients associated with pregnancy and lactation: analysis of case-control study in Japan

Clinicopathologic characteristics and prognosis of breast cancer patients associated with pregnancy and lactation were clarified by means of a case-control study of matched non-pregnant and non-lactating patients with breast cancer. From 18 institutions in Japan, a total of 192 subjects with breast cancer diagnosed during pregnancy (72 cases) and lactation (120 cases) were collected between 1970 and 1988, accounting for 0.76% of all breast cancer patients. The duration of symptoms was longer and tumor size was larger in the study subjects. Although the disease-free interval was longer than that in the control patients, the survival time was shorter. There was no characteristic difference in histologic type. Vascular invasion and lymph node metastasis were found more frequently in the subjects. The positive rates of estrogen receptor and progesterone receptor were lower in the subjects. The 5- and 10-year survival rates of the study patients were 65% and 55%, respectively, and these survivals were significantly lower than those of the control (P < 0.001). The survival rates were poorer in the subjects, in accordance with stage and lymph node metastasis. The results suggest that most of the patients with breast cancer diagnosed during pregnancy and lactation are in a more advanced stage because of a delay in detection and diagnosis, and hence have unfavorable prognosis. Therefore, it is important to diagnose and treat early for improvement of prognosis in patients with breast cancer during pregnancy and lactation.

1 alpha-hydroxyvitamin D3, hypercalcemia, and growth suppression of 7,12-dimethylbenz[a]anthracene-induced rat mammary tumors

1 alpha-hydroxyvitamin D3 [1 alpha(OH)D3] was administered to female Sprague-Dawley rats with 7,12-dimethylbenz[a]anthracene (DMBA)-induced mammary tumors. 1 alpha(OH)D3 suppressed the growth of the rat mammary tumors dose-dependently, and in the high dose groups treated with 0.5-1.0 micrograms/kg of 1 alpha(OH)D3, significant inhibition of tumor growth was observed. But daily oral administration of 1 alpha(OH)D3 for four consecutive weeks caused side effects such as hypercalcemia and weight loss. We compared 0.5 microgram/kg of 1 alpha(OH)D3 three times weekly with the same dose six times weekly to discover whether or not the side effects can be reduced by treatment schedule. Both groups showed a significant oncostatic effect, compared with the control group, while the side effects were relieved in the three times weekly group. Regarding estrogen receptors (ER) in the tumors, there was no significant difference among the groups. These results suggested that the antitumor effect of 1 alpha(OH)D3 on DMBA-induced mammary tumors was not related to ER status. Combined use of 1 alpha(OH)D3 with 5-fluorouracil (5-FU) or medroxyprogesterone acetate (MPA) was also examined. No significant augmentation of the antitumor effect was seen in the two combinations, although the combined therapy with MPA showed a significant inhibition of weight loss in the rats.

The effect of breast self-examination on early detection and survival

To investigate the effect of breast self-examination (BSE), we compared the stages, survival, and the risk of death for 355 patients with breast cancer detected by BSE with those for 1,327 patients with breast cancer detected by chance. The early stages of the disease were found to be more common among the symptomatic breast cancer patients detected by BSE than those by chance. The 5-year overall survival rate was 94.4% for the symptomatic patients detected by BSE, and was significantly higher by 8.7% than that (85.7%) for patients detected by chance (P less than 0.001). The 10-year survival rate was 81.6% for patients detected by BSE, and 76.6% for cases detected by chance (the difference was not significant). The overall difference between the two survival curves was statistically significant by the logrank test (P less than 0.01). A multivariate analysis using the Cox proportional hazards model showed that the risk of death for patients detected by BSE was smaller by 0.570 times than that for patients detected by chance, which was statistically significant (P less than 0.05). The effect of biases inherent to BSE in the survival analysis cannot be controlled completely even after conducting multivariate analysis. These results suggest that BSE may contribute to the reduction of the risk of death through early detection of breast cancer. However, further examination should be conducted by other methods to obtain conclusive evidence.

Intersite variation of estrogen receptors in human breast cancers and response to endocrine therapy. Which section of a large tumor is the best for estrogen receptor assay?

Estrogen receptor (ER) assays were performed by sucrose gradient centrifugation method at multiple sites in large breast cancers. Intersite variation of ER in a tumor was observed in 24 out of 35 cases. 16 tumors with relatively low ER levels showed different ER status with multiple assays. The results suggest that an assay performed on a small random part of a large tumor may not yield the true ER status. ER value at the largest cross-section was almost the same as the average ER values in each tumor. In addition, 21 cases were examined in relation to ER values at multiple sites in the large tumors and response to endocrine therapy. As the ER value at the largest cross-section was highly correlated with the therapeutic response to endocrine therapy of breast cancer, it would represent true ER status and level. The results suggest that the ER assay at the largest cross-section of a large tumor is an appropriate method to predict response to endocrine therapy.

Antitumor effects of a nonsteroidal aromatase inhibitor (CGS 16949A) on 7, 12-dimethylbenz[alpha]anthracene-induced mammary tumors in rats

The effects of a nonsteroidal aromatase inhibitor, CGS 16949A, on female Sprague-Dawley (SD) rats with 7, 12-dimethylbenz[alpha]anthracene (DMBA)-induced mammary cancers were examined in relation to estrogen receptors (ER). Rat tumor sizes in each treated group were significantly smaller (P less than 0.05) and rat body weights in most treated groups were significantly increased (P less than 0.05) compared to those in the control group (no treatment) at all measurement points during treatment. Rat uterine weights in each treated group decreased significantly compared with those in the control group (P less than 0.05). There was no significant difference between ER-positive and ER-negative groups in tumor size, body weight or uterine weight. At increased doses of CGS 16949A in the experiment, further increases in testosterone levels and further decreases in estradiol levels were shown to occur. The results suggest the mechanisms of CGS 16949A action not to be influenced by the presence or absence of ER, but to be due to its potent aromatase inhibition of the conversion of androgens to estrogens.

The effect of mass screening for breast cancer: results of a multivariate analysis

To evaluate the life-prolonging effect of mass screening for breast cancer, we compared the risk of death for the patients detected by mass screening with that for the patients diagnosed in out-patient clinics, after adjusting for other relevant factors simultaneously by using the Cox regression model. A multivariate analysis using the Cox regression model in which clinical staging of disease was taken as one of the independent variables, showed that the risk of death for patients detected by mass screening was smaller by 0.765 times than that for patients found in out-patient clinics although the reduction was not statistically significant. This small reduction might be partly due to the effect of mass screening through early detection even within the same stage, and partly due to length bias, lead time bias and self-selection bias. When clinical staging of disease was removed from the independent variables, the risk of death for patients detected by mass screening was reduced from 0.765 times to 0.677 times that for patients diagnosed in out-patient clinics, which was statistically significant (P greater than 0.01). For asymptomatic patients detected by mass screening, such as reduction of the risk of death was from 0.789 times to 0.555 times that for patients found in out-patient clinics (P less than 0.05). These results suggest that mass screening for breast cancer may contribute to the reduction of the risk of death, although the effect of biases inherent in periodic screening was not removed completely in the present analysis.

DNA ploidy level and S-phase fraction as prognostic factors in breast cancer

Imprint smears from sixty cases of breast cancer made after mastectomy were stained by the Feulgen method and the nuclear DNA content measured by a cytofluorometer equipped with an incident illumination system. After logarithmic transformation of the fluorescence intensity, the ploidy level and S-phase fraction (SPF) were calculated with a microcomputer and the correlation between the ploidy level or SPF and the clinicopathological prognostic factors studied. Patients with tumors of a larger diameter and more extensive lymph node involvement had higher levels of ploidy and SPF and the ploidy level in the metastatic lymph nodes was higher than that in the primary lesion. Moreover, a significant increase in SPF was observed in the metastatic lymph nodes and a high ploidy level found to be associated with tumors having a negative estrogen receptor. When the tumors were divided into a diploid group and an aneuploid group, the diploid group showed a significantly better prognosis than the aneuploid group, in 6-year survival. Similarly, the groups in which SPF was less than 20.0 per cent had significantly better prognoses than the group in which SPF was 20.1 per cent or more. These prognostic factors were evaluated with Cox's proportional hazard model and a significant correlation observed in lymph node status, ER status, ploidy level and S-phase fraction. It was thus concluded that ploidy level and SPF are important and independent prognostic factors for predicting the postoperative course of breast cancer patients.

[Role of cancer thermography for detection of breast cancer]

Out of one hundred and sixty-two patients that examined by contact thermography, forty-five cases involving 55 cancers were assessed for malignancy. The sensitivity and the specificity of this method of testing were 81.5% and 83.5%, respectively. False negative cases included early stage, small sized and papillotubular carcinomas. Twenty-five per cent of the fibroadenoma and mastopathy cases showed false positive findings. Further, half of the phyllodes tumor and mastitis cases also showed false positive findings. Two of six T0, Tis cases (33.3%) were diagnosed as malignant tumors by thermography. Contact thermographic examinations will be more widely used in the near future.

[Relationship of breast cancer and HLA in Japanese females]

One hundred and thirty-seven female breast cancer patients have been HLA-typed by a cytotoxicity test. Over all, no specific HLA antigen was found, though when the patients were divided into two groups, i.e., into those with bilateral or unilateral cancers, A24 and Cw7 was found to be significantly increased in the bilateral group. Further, a haplotype of A24-Cw7 was frequently seen in the bilateral group. No specific HLA antigen, however, was found in patients stratified by a familial history of cancer. It thus was concluded that bilateral breast cancer patients that have developed from patients with a unilateral cancer are detectable by HLA typing.

[Mass screening for breast cancer in Gunma prefecture--the results for 8 years and future problems]

In Gunma prefecture, mass screening for both breast and thyroid cancer at the same time was conducted between April 1980 and March 1988 with the cooperation of the Gunma Cancer Society. In this paper, the results of mass screening for breast cancer and further problems are reported and discussed. The total number of subjects during these eight years was 191, 603 on the first screening with physical examination alone. Of these, 18,208 (9.5%) examinees were required to attend the second examination. Breast cancer was detected in 159 cases. The detection rate was 0.08% among total subjects. Also thyroid cancer was detected in 244 (0.13%). The detection rate for breast cancer was approximately twice as high at the initial screening (0.11%) than at the subsequent periodic screening (0.06%). Patients with breast cancer detected by mass screening showed an earlier stage and a better prognosis compared with those of our ordinary outpatients. The 8-year disease-free survival rate in mass screening and in outpatient cases was 94.9% and 83.2%, respectively, but there was no significant difference between the two groups. Interval breast cancer was also found in 19 cases (Tis; 1, Stage I; 8 and Stage II; 10) and 5 patients had nodal metastases. This mass screening program is a useful means for early discovery and early treatment of breast cancer. Hereafter, we should intend to increase the number of initial examinees and women aged 60 and over. Also it is important to make and train physicians for such screening, and to educate women about the practice of breast self-examination.

[Recent trends in breast cancer surgery in Japan]

In the past ten years, extended or conventional radical mastectomies have decreased, being replaced by modified radical mastectomies (muscle-preserving mastectomies) such as Auchinoloss' operation and Patey's operation. Furthermore, limited surgeries for early cases such as partial mastectomy, lumpectomy etc. also have increased in the recent three years. The indications for these operations, the surgical techniques, postoperative functional and cosmetic problems were presented. And future problems as to partial mastectomy were also discussed. In contrast, aggressive surgery such as extensive resection of the chest wall for locally advanced breast cancer is useful as one of the therapeutic measures in the recent multidisciplinary treatments for breast cancer, in order to prolong the patient's survival and improve the quality of life. The techniques including the reconstruction using musculocutaneous flaps were also presented.

Corticotropin-releasing factor levels in the peripheral plasma and hypothalamus of the rat vary in parallel with changes in the pituitary-adrenal axis

Impressive evidence has emerged indicating that immunoassayable and bioassayable CRF, which is immunoneutralizable, is present not only in the hypothalamus but in many peripheral tissues as well. Using highly specific and sensitive RIAs and immunoaffinity chromatography to investigate whether this extrabrain CRF circulates in the rat, we found low but clearly measurable levels in peripheral plasma (mean, 11.4 +/- 0.8 pg/ml). Immunological findings were corroborated by fast protein liquid chromatography, which resolves peptides by both hydrophobicity and ionic charge. With this approach the major immunoreactive peak was eluted at the position of synthetic rat CRF standard. To assess whether levels of peripheral plasma CRF-like immunoreactivity (CRF-LI) vary in parallel with those of hypothalamic CRF-LI, we performed studies with low and high dose dexamethasone administration and withdrawal, adrenalectomy, and hypophysectomy. Seven days after oral administration of dexamethasone, there was a decrement in the levels of peripheral plasma and hypothalamic CRF-LI. Depending on the dose, recovery was also found 7 days after cessation of the treatment. After either adrenalectomy or hypophysectomy, there were increments in the levels of CRF-LI in both peripheral plasma and hypothalamus. Thus, concentrations of CRF-LI in the peripheral plasma and in the hypothalamus vary in parallel in response to alterations in the pituitary-adrenal axis.

[Changes of growth hormone-releasing factor (GRF) in rat peripheral blood--effect of hypophysectomy]

Accumulating evidence has emerged indicating that growth hormone-releasing factor (GRF) is present not only in the hypothalamus but in other tissues as well. Using highly specific and sensitive radioimmunoassays and immunoaffinity chromatography, we found low but clearly measurable GRF-like immunoreactivity (GRF-LI) levels in rat peripheral plasma. In order to verify the immunological findings, the peripheral plasma GRF-LI was characterized using fast protein liquid chromatography. The immunological peak was eluted at the position of synthetic rat GRF standard. These findings demonstrate that rat peripheral plasma GRF is immunologically and chromatographically indistinguishable from authentic rat GRF. Moreover, we performed studies with hypophysectomy to assess whether peripheral plasma GRF-LI changes in physiological status. At 4 weeks after hypophysectomy, there was a significant (p less than 0.05) increment in the rat plasma GRF-LI [12.4 +/- 0.5 (+/- SEM) pg/ml in hypophysectomized rats as opposed to 5.8 +/- 0.4 pg/ml in sham-operated control rars]. On the other hand, hypothalamic GRF-LI fell significantly as compared that of controls (36.1 +/- 1.0 vs. 78.3 +/- 3.0 pg/mg wet weight tissue). A similar pattern of changes in GRF-LI at 10 weeks after hypophysectomy was also revealed. The source of rat peripheral plasma GRF has not yet been elucidated. Our results, however, may suggest that GRF levels are modulated by negative feedback at the level of the hypothalamus by a pituitary factor, presumably growth hormone (GH) and that hypothalamic GRF release exceeds its synthesis in hypophysectomized rats.

[Selection of therapeutic procedures according to the clinicopathological features of breast cancer]

The therapeutic guidelines for breast cancer do not depend on histological type, by which prognosis can differ according to minor variations. Treatment for breast cancer is subdivided into two categories; one is for primary breast cancer which is curable by surgery and the other is for advanced or recurrent breast cancer. In the former category, the surgical method and adjuvant therapy are selected according to stage. In the latter, endocrine therapy, chemotherapy, immunotherapy and radiotherapy are indicated in single or combined use. Main factors of selection in such cases are menopausal status, estrogen receptor status and site of distant metastasis.

[Evaluation of a tumor-associated antigen CA 15-3 in the sera of patients with breast cancer]

Serum levels of CA 15-3 were determined in normal women and patients with breast cancer and other diseases. The serum concentration of normal subjects was 9.8 +/- 4.4 units/ml (mean +/- S.D., n = 97). The patients with primary and recurrent breast cancer had significantly higher levels of CA 15-3, their values being 23.1 +/- 59.6 (n = 47) and 127.6 +/- 179.7 (n = 32) units/ml, respectively. When the value of 20 units/ml was used as the cutoff for the normal value, the positive rates were 4%, 26% and 75% in normal women and breast cancer patients primary and recurrent, respectively. No increased levels were found in the sera of patients with benign breast diseases or with gastrointestinal, thyroid, lung and other cancers. The elevated levels of CA 15-3 decreased after successful therapy both in primary and recurrent breast cancer patients, while there was no change in nonresponders. The measurement of serum CA 15-3 would be useful for monitoring the therapy and for detection of the recurrence of breast cancer.

[ACTH dependent Cushing's syndrome with an empty sella turcica: report of three cases with emphasis on diagnostic value of selective venous sampling]

Three cases of ACTH dependent Cushing's syndrome are reported with emphasis on diagnostic value of selective venous sampling. Case 1. A 44-year-old female was admitted to our hospital with clinical diagnosis of Cushing's disease. Endocrinological examination revealed typical data of Cushing's disease. High resolution CT scan showed an empty sella turcica, and a chest film showed multi-cystic lesion in the left lower lung field. In the first trial of selective venous sampling, central to peripheral ACTH ratio (C/P ratio) was high at the superior vena cava. So, an ectopic ACTH producing lung tumor was strongly suspected. Further examinations for lung tumor were performed, and finally showed lung cryptococcosis. Therefore, selective venous sampling was performed again, and pituitary ACTH dependency was diagnosed. An eccentric pituitary microadenoma was successfully removed by transsphenoidal surgery. Case 2. A 54-year-old female was admitted to our hospital with clinical diagnosis of Cushing's disease. In the endocrinological examinations plasma ACTH was not respond to provocation of LVP or CRF. In selective venous sampling, C/P ratios of ACTH were not greater than 2.0 at any sampling site. Further examinations showed lung tumor in the lower lobe of left lung. This tumor was surgically proved to be an ectopic ACTH producing lung carcinoid. Case 3. A 24-year-old female was admitted to our hospital for the purpose of further examination of Cushing's disease. Three years previously exploratory transsphenoidal surgery demonstrated an empty sella without adenoma. She received postoperative radiation therapy with a dose of 5000 rad. Endocrinological examination showed typical data due to Cushing's disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[An analysis of treatments of recurrent breast cancer in relation to the lesion]

One hundred fifty-four patients being treated for recurrent breast cancer were studied for response rates and prognosis according to first recurrent lesions in radiation, chemotherapy, hormone therapy and combined therapy groups. It was important to consider the sites of the recurrent lesions in the treatments. Although there was no significant difference in prognosis among the first recurrent therapy groups, the overall cumulative five-year survival rate of the patients who responded (to the initial treatment) was significantly better than that of those who did not. As for the treatment of recurrent breast cancer, it is important to consider hormone receptor, lesion and age and to choose the effective mode of treatment for the first (recurrence of the) disease.