Benign breast diseases

Discovery and characterization of prolactin neutralizing monoclonal antibodies for the treatment of female-prevalent pain disorders

Prolactin (PRL) has recently been demonstrated to elicit female-selective nociceptor sensitization and increase pain-like behaviors in female animals. Here we report the discovery and characterization of first-in-class, humanized PRL neutralizing monoclonal antibodies (PRL mAbs). We obtained two potent and selective PRL mAbs, PL 200,031 and PL 200,039. PL 200,031 was engineered as human IgG1 whereas PL 200,039 was reformatted as human IgG4. Both mAbs have sub-nanomolar affinity for human PRL (hPRL) and produce concentration-dependent and complete inhibition of hPRL signaling at the hPRL receptor (hPRLR). These two PRL mAbs are selective for hPRL as they do not inhibit other hPRLR agonists such as human growth hormone or placental lactogen. They also cross-react with non-human primate PRL but not with rodent PRL. Further, both mAbs show long clearance half-lives after intravenous administration in FcRn-humanized mice. Consistent with their isotypes, these mAbs only differ in binding affinities to Fcγ receptors, as expected by design. Finally, PL 200,019, the murine parental mAb of PL 200,031 and PL 200,039, fully blocked stress-induced and PRL-dependent pain behaviors in female PRL-humanized mice, thereby providing in vivo preclinical proof-of-efficacy for PRL mAbs in mechanisms relevant to pain in females.

Polycystic Ovary Syndrome and Fibrocystic Breast Disease: An Updated Review

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. There is no clear association between PCOS and benign breast disease (BBD). The latter is a frequent benign disorder, affecting women between 20 and 50 years of age. To date, the classification remains controversial, and the risk of developing breast cancer that is associated with these changes is different depending on the histopathological findings. The most frequent changes are breast cysts, which are noted in up to 50% of patients older than 30 years of age. This up-to-date review presents the relationship between PCOS and BBD. In conclusion, there is no clear association between benign breast disease and PCOS. Further studies on a large population with prospectively collected data using updated PCOS criteria are necessary.

Bucillamine-induced gigantomastia with galactorrhea and hyperprolactinaemia

Gigantomastia is characterised by excessive breast growth and can occur as a rare, drug-induced adverse event. D-penicillamine is the most frequent cause of drug-induced gigantomastia. Only one case of gigantomastia due to bucillamine, an analogue of D-penicillamine, has been reported so far. We herein report a case of bucillamine-induced gigantomastia presenting with acute enlargement of the bilateral breasts and accessory breast tissue in the axillae 7 months after the start of bucillamine therapy. Awareness about this rare adverse event is important since bucillamine is still widely used in Japan and Korea.

Positive association between progestins and the evolution of multiple fibroadenomas in 72 women

OBJECTIVE

Multiple fibroadenomas (MFA) of the breast is a rare benign disease, thus its natural history is poorly understood. The aim of our study was to describe the radiological evolution of MFA and to evaluate the influence of different factors on this evolution.

METHODS

This was a longitudinal cohort study. All patients included had two clinical and radiological assessments (breast ultrasound (US) and/or MRI) at least 5 years apart.

RESULTS

Seventy-two women were followed for 7.6 ± 2.1 years. The radiological evolution showed a decrease or stability in the number of fibroadenomas (FA) in 26/44 cases on the MRI and in 38/64 cases on the US. There was a decrease of size in 35/44 cases on the MRI and in 53/64 cases on the US. An increase in the number of FAs was found in 18/44 cases in the MRI and 26/64 cases in the US with, for the majority, a decrease of size (19/26 by MRI and 16/18 by MRI). Older age at the first FA (P < 0.0001) and at the diagnosis of MFA (P < 0.0001), pregnancy (P = 0.003) and progestin use (P < 0.001), particularly lynestrenol (P < 0.0001), had a beneficial effect on the evolution of MFA.

CONCLUSION

This is the first longitudinal study describing women with MFA. The radiological evolution of MFA seamed favorable and similar to that expected for a single FA. We identified factors influencing the evolution of the disease, including progestin treatments such as lynestrenol, which could have a beneficial effect. Our cohort should be followed further in order to expand our knowledge of MFA, especially concerning the risk of breast cancer.

Benign Breast Diseases: Evaluation and Management

Benign breast disease is a spectrum of common disorders. The majority of patients with a clinical breast lesion will have benign process. Management involves symptom control when present, pathologic-based and imaging-based evaluation to distinguish from a malignant process, and counseling for patients that have an increased breast cancer risk due to the benign disorder.

Minimally Invasive Breast Fibroadenoma Excision Using an Ultrasound-Guided Vacuum-Assisted Biopsy Device

Introduction We studied the extent to which an ultrasound-guided vacuum-assisted biopsy device ("hand-held Mammotome") could be used not only as a valuable tool for investigation of suspicious breast lesions, but also therapeutically for the complete removal of breast fibroadenomas. Materials and Methods 132 aspiration biopsies showing fibroadenoma on histology were collected retrospectively. We ascertained whether there were residual findings on breast ultrasound at a median follow-up of approx. 9 months following biopsy. A questionnaire was used to determine the complication rate, patient satisfaction and acceptance of the procedure. Results In this study complete fibroadenomectomy was achieved at aspiration biopsy in 76 % of cases (n = 132). Compared to fibroadenomas larger than 2.51 cm³ (59 %), those smaller than 2.5 cm³ were completely removed more often (87.6 %; p < 0.05). The procedure is associated with very little pain during and after biopsy and minimal haematoma development, both factors supporting a high rate of acceptance among patients. Conclusion Ultrasound-guided vacuum-assisted biopsy is safe and associated with very few complications. Its additional therapeutic potential is dependant on the size of the benign lesion as measured at initial ultrasound.

Effectiveness of Centchroman on Regression of Fibroadenosis and Mastalgia

INTRODUCTION

Fibroadenosis and mastalgia are common among the women in reproductive age group. Treatment for these conditions is not yet standardised. Most of the drugs used for fibroadenosis and mastalgia are expensive and have side effects.

AIM

To find out the efficacy of centchroman, a Selective Estrogens Receptor Modulator (SERM) on regression of fibroadenosis and mastalgia.

MATERIALS AND METHODS

Fifty one patients with mastalgia/fibroadenosis were treated with centchroman 30mg once daily on alternate days for a period of 3 months and followed up weekly for six months with Mastalgia chart and Visual Analog Scale (VAS) pain score.

RESULTS

Before starting treatment, four patients presented with pain score of 6 followed by, 37 patients with a score of 4 and 10 patients with a score of 2. All the patients were started on tab centchroman 30mg OD alternate days and were reviewed on weekly basis with Mastalgia chart and VAS pain score for three months. On fifth and sixth visit, 46 patients reported with pain score 0, one with pain score of 2 and four with pain score of 6. The efficacy of centchroman was found to be significant (p-value = 0.001). Three patients (5.9%) reported epigastric pain and ten patients (19.6%) reported menstrual delay. A total of 38 patients did not complain of any side effect.

CONCLUSION

Our study proves that centchroman is a safe and cost effective drug with significant efficacy on regression of fibroadenosis and mastalgia with minimal side effect.

Dietary patterns and benign breast diseases: a case-control study

Several studies have investigated the relation between benign breast diseases (BBD) and food intake. However, dietary patterns of these patients have not been taken into consideration up to now. The aim of this study is to determine the association between dietary patterns and BBD. In this case-control study, ninety-six patients with BBD and seventy controls were selected from women attending the Iranian Center for Breast Cancer affiliated with Academic Center for Education, Culture and Research. Demographic, physical activity and semi-quantitative FFQ were completed. The main dietary patterns were extracted by factor analysis. Two major dietary patterns emerged: Healthy dietary pattern including fish, poultry, eggs, low-fat dairy products, vegetables, legumes, nuts and seeds, whole grains, oil and mayonnaise, olives, fruits; and Unhealthy dietary pattern including red meats, organ and processed meats, high-fat dairy products, refined grains, sweets and desserts, animal and solid fats. After adjustment for age, BMI and energy intake, the participants in the highest tertile of Healthy dietary pattern (OR 0·44; 95 % CI 0·20, 0·99) were less likely to have BBD compared with those in the first tertile. After adjustment for other confounding variables, this relationship still remained close to significant level. However, higher consumption of Unhealthy dietary pattern was not associated with the risk of BBD. In conclusion, Healthy dietary pattern might be inversely associated with the risk of BBD; however, this result should be interpreted with caution. Future studies are needed to confirm our findings.

Profile of Breast Diseases in Post Pubertal Women Assessed By Clinical Breast Examination - A Community Based Study in Rural Pondicherry

INTRODUCTION

Breast diseases in women, whether benign or malignant, are very commonly encountered. Benign diseases are under reported and cancer is one of the leading causes of mortality in women. This study was undertaken with an aim to study the profile of various breast disease in the community.

MATERIALS AND METHODS

In this observational study all the post pubertal women residing in the selected village (n=1000) were included. The study was done from September 2013 to August 2015. A thorough history taking was done with the help of a predesigned proforma followed by a clinical breast examination and further investigation at our hospital if necessary.

RESULTS

It was found in this study that mastalgia, both cyclical and non-cyclical as well as lumps were a common finding in the general population. Significant proportions of women were found to be in the peri-menopausal age group. Median age of menarche was 13 years; menopause was 45 years. The average age at first childbirth was 21 years with 1 year being the median duration of breast-feeding. A total of 128 women (1 in 8) had positive symptomatology with 94 (1 in 11) of them having a breast disease on examination. One was diagnosed with breast cancer. The prevalence of cyclical mastalgia was 1 in 11, non-cyclical mastalgia 1 in 34, fibroadenosis 1 in 23 and fibroadenoma 1 in 100. The awareness regarding risk factors and the availability of screening program was very poor. The average age of presentation of mastalgia was 34 years; fibroadenosis was 35 years and fibroadenoma 29 years. None of the women interacted with or had consulted a practitioner regarding mastalgia as it was not perceived to be a sign of malignancy and did not cause any significant discomfort.

CONCLUSION

It was thus concluded from this study that benign breast diseases are a common occurrence in the general population. Breast cancer continues to be diagnosed only at later stages owing to lack of awareness and inadequately structured screening program. The concept of self-breast examination seems to be poorly understood. CBE is more fruitful with subsequent radiological and histopathological investigation, if warranted.

The prolactin receptor as a therapeutic target in human diseases: browsing new potential indications

INTRODUCTION

Prolactin (PRL) signaling has emerged as a relevant target in breast and prostate cancers. This has encouraged various laboratories to develop compounds targeting the PRL receptor (PRLR). As the latter is widely distributed, it is timely to address whether other conditions could also benefit from such inhibitors.

AREAS COVERED

The authors briefly overview the two classes of PRLR blockers, which involve: i) PRL-core based analogs that have been validated as competitive antagonists in various preclinical models, and ii) anti-PRLR neutralizing antibodies that are currently in clinical Phase I for advanced breast and prostate cancers. The main purpose of this review is to discuss the multiple organs/diseases that may be considered as potential targets/indications for such inhibitors. This is done in light of reports suggesting that PRLR expression/signaling is increased in disease, and/or that systemic or locally elevated PRL levels correlate with (or promote) organ pathogenesis.

EXPERT OPINION

The two immediate challenges in the field are i) to provide the scientific community with potent anti-prolactin receptor antibodies to map prolactin receptor expression in target organs, and ii) to take advantage of the availability of functionally validated PRLR blockers to establish the relevance of these potential indications in humans.

Expression of aldehyde dehydrogenase after neoadjuvant chemotherapy is associated with expression of hypoxia-inducible factors 1 and 2 alpha and predicts prognosis in locally advanced breast cancer

OBJECTIVE

To analyze the expression of hypoxia-inducible factors (hypoxia-inducible factor 1A and hypoxia-inducible factor 2A) and aldehyde dehydrogenase proteins in patients with locally advanced breast carcinoma who were subjected to neoadjuvant chemotherapy.

METHODS

We included 90 patients with histologically confirmed stage II and III breast carcinoma who were treated with neoadjuvant chemotherapy between 2000 and 2005. Immunohistochemistry for aldehyde dehydrogenase, hypoxia-inducible factor 1A, and hypoxia-inducible factor 2A was performed before and after neoadjuvant chemotherapy. We analyzed the influence of clinical and pathological features on clinical and pathological response, disease-free survival, and overall survival.

RESULTS

An objective clinical response to neoadjuvant chemotherapy was observed in 80% of patients, with 12% showing a complete pathological response. Among all clinical and pathological parameters, only the expression of hypoxia-inducible factor 1A was associated with a pathological response. A positive association was found between expression of aldehyde dehydrogenase and that of hypoxia-inducible factor 1A before and after chemotherapy. Aldehyde dehydrogenase expression was associated with expression of hypoxia inducible-factor 2A in tumors after neoadjuvant treatment. In a univariate analysis, prognosis was influenced by age, pathological response, metastasis to axillary lymph nodes after neoadjuvant chemotherapy, overexpression of hypoxia-inducible factor 2, and the presence of aldehyde dehydrogenase-positive cells within the primary tumor after neoadjuvant chemotherapy. In a multivariate analysis, only age and the presence of aldehyde dehydrogenase-positive cells after chemotherapy were associated with reduced overall survival.

CONCLUSION

The presence of aldehyde dehydrogenase-positive cells within the residual tumor after neoadjuvant chemotherapy is associated with an increase in the expression of hypoxia-inducible factor 2A and with poor prognosis in patients with locally advanced breast cancer.

MspA1 polymorphism of the CYP17 gene in breast cysts

OBJECTIVE

To study the prevalence of breast cysts in several age groups of the general female population and their association with the MspAI polymorphism of the gene CYP17.

RESULTS

In 204 ultrasound tests, cysts were present in 22% of the studied population. The epidemiological-clinical profile of these women was Caucasian, aged 41-50 years, regular menstrual cycles, multiparous and complaining of mastalgia. The genetic distribution of polymorphisms of the gene displayed Hardy-Weinberg equilibrium and the wild homozygous phenotype was observed in 36.4% of the case group and in 37.6% of the control groups; the heterozygous phenotype was observed in 50% of the study group and 46.3% of control group and a mutated homozygous phenotype was seen in 13.6% of the study group and 16.1% of the controls. There was no statistically significant difference between the groups (p = 0.92).

CONCLUSION

The prevalence and most of the epidemiological profile of breast cysts were in agreement with the literature. There was no statistically significant difference among the genotypic groups (wild homozygous, heterozygous and mutated homozygous), despite a slightly increased frequency of the mutated genotype in the control group. This difference indicates a trend of the MspAI polymorphism of the gene CYP17 to act as a protective factor against the development of breast cysts.

The dyslexia candidate gene DYX1C1 is a potential marker of poor survival in breast cancer

Background

The dyslexia candidate gene, DYX1C1, shown to regulate and interact with estrogen receptors and involved in the regulation of neuronal migration, has recently been proposed as a putative cancer biomarker. This study was undertaken to assess the prognostic value and therapy-predictive potential of DYX1C1 mRNA and protein expression in breast cancer.

Methods

DYX1C1 mRNA expression was assessed at the mRNA level in three independent population-derived patient cohorts. An association to estrogen/progesterone receptor status, Elston grade, gene expression subtype and lymph node status was analyzed within these cohorts. DYX1C1 protein expression was examined using immunohistochemistry in cancer and normal breast tissue. The statistical analyses were performed using the non-parametric Wilcoxon rank-sum test, ANOVA, Fisher's exact test and a multivariate proportional hazard (Cox) model.

Results

DYX1C1 mRNA is significantly more highly expressed in tumors that have been classified as estrogen receptor α and progesterone receptor-positive. The expression of DYX1C1 among the molecular subtypes shows the lowest median expression within the basal type tumors, which are considered to have the worst prognosis. The expression of DYX1C1 is significantly lower in tumors graded as Elston grade 3 compared with grades 1 and 2. DYX1C1 protein is expressed in 88% of tumors and in all 10 normal breast tissues examined. Positive protein expression was significantly correlated to overall survival (Hazard ratio 3.44 [CI 1.84-6.42]) of the patients but not to any of the variables linked with mRNA expression.

Conclusion

We show that the expression of DYX1C1 in breast cancer is associated with several clinicopathological parameters and that loss of DYX1C1 correlates with a more aggressive disease, in turn indicating that DYX1C1 is a potential prognostic biomarker in breast cancer.

Label-free discrimination of normal and fibroadenomal breast tissues using second harmonic generation imaging

Early detection of fibroadenoma (FA) is critical for preventing subsequent breast cancer. In this work, we show that label-free second harmonic generation (SHG) imaging is feasible and effective in quantitatively differentiating the fibroadenomal tissue from normal breast tissue. With the advent of the clinical portability of miniature SHG microscopy, we believe that the technique has great potential in offering a noninvasive in vivo imaging tool for early detection of FA and monitoring the treatment responses of FA in clinics.

Prolactin serum levels and breast cancer: relationships with risk factors and tumour characteristics among pre- and postmenopausal women in a population-based case-control study from Poland

Background:

Previous prospective studies have found an association between prolactin (PRL) levels and increased risk of breast cancer. Using data from a population-based breast cancer case–control study conducted in two cities in Poland (2000–2003), we examined the association of PRL levels with breast cancer risk factors among controls and with tumour characteristics among the cases.

Methods:

We analysed PRL serum levels among 773 controls without breast cancer matched on age and residence to 776 invasive breast cancer cases with available pretreatment serum. Tumours were centrally reviewed and prepared as tissue microarrays for immunohistochemical analysis. Breast cancer risk factors, assessed by interview, were related to serum PRL levels among controls using analysis of variance. Mean serum PRL levels by tumour characteristics are reported. These associations also were evaluated using polytomous logistic regression.

Results:

Prolactin levels were associated with nulliparity in premenopausal (P=0.05) but not in postmenopausal women. Associations in postmenopausal women included an inverse association with increasing body mass index (P=0.0008) and direct association with use of recent/current hormone therapy (P=0.0006). In case-only analyses, higher PRL levels were more strongly associated with lobular compared with ductal carcinoma among postmenopausal women (P=0.02). Levels were not different by tumour size, grade, node involvement or oestrogen receptor, progesterone receptor, or human epidermal growth factor receptor 2 status.

Conclusions:

Our analysis demonstrates that PRL levels are higher among premenopausal nulliparous as compared with parous women. Among postmenopausal women, levels were higher among hormone users and lower among obese women. These results may have value in understanding the mechanisms underlying several breast cancer risk factor associations.

Promoter methylation and the detection of breast cancer

Mammographic screening has been shown to reduce breast cancer mortality in women over the age of 50 years, and to a lesser extent in younger women. The sensitivity of mammography, however, is reduced in some groups of women. There remains a need for a minimally invasive, cost-effective procedure that could be used along side mammography to improve screening sensitivity. Silencing of tumor suppressor genes through promoter hypermethylation is known to be a frequent and early event in carcinogenesis. Further, changes in methylation patterns observed in tumors are also detectable in the circulation of women with breast cancer. This makes these alterations candidate markers for early tumor detection. In this paper, we review the current literature on promoter hypermethylation changes and breast cancer and discuss issues that remain to be addressed in order for the potential of these markers to augment the sensitivity of screening mammography. In general, studies in well-defined populations, including appropriate controls and larger numbers are needed. Further, focus on the optimization of methods of methylation detection in small amounts of DNA is needed.

Differential expression of follistatin and FLRG in human breast proliferative disorders

Background

Activins are growth factors acting on cell growth and differentiation. Activins are expressed in high grade breast tumors and they display an antiproliferative effect inducing G0/G1 cell cycle arrest in breast cancer cell lines. Follistatin and follistatin- related gene (FLRG) bind and neutralize activins. In order to establish if these activin binding proteins are involved in breast tumor progression, the present study evaluated follistatin and FLRG pattern of mRNA and protein expression in normal human breast tissue and in different breast proliferative diseases.

Methods

Paraffin embedded specimens of normal breast (NB - n = 8); florid hyperplasia without atypia (FH - n = 17); fibroadenoma (FIB - n = 17); ductal carcinoma in situ (DCIS - n = 10) and infiltrating ductal carcinoma (IDC - n = 15) were processed for follistatin and FLRG immunohistochemistry and in situ hybridization. The area and intensity of chromogen epithelial and stromal staining were analyzed semi-quantitatively.

Results

Follistatin and FLRG were expressed both in normal tissue and in all the breast diseases investigated. Follistatin staining was detected in the epithelial cytoplasm and nucleus in normal, benign and malignant breast tissue, with a stronger staining intensity in the peri-alveolar stromal cells of FIB at both mRNA and protein levels. Conversely, FLRG area and intensity of mRNA and protein staining were higher both in the cytoplasm and in the nucleus of IDC epithelial cells when compared to NB, while no significant changes in the stromal intensity were observed in all the proliferative diseases analyzed.

Conclusion

The present findings suggest a role for follistatin in breast benign disease, particularly in FIB, where its expression was increased in stromal cells. The up regulation of FLRG in IDC suggests a role for this protein in the progression of breast malignancy. As activin displays an anti-proliferative effect in human mammary cells, the present findings indicate that an increased FST and FLRG expression in breast proliferative diseases might counteract the anti-proliferative effects of activin in human breast cancer.

Progesterone receptors A and B and estrogen receptor alpha expression in normal breast tissue and fibroadenomas

Fibroadenomas are the most common benign breast tumors, occurring mainly in young women. Their responses to the hormonal environment are similar to those of normal breast tissue, which suggests that steroid receptors may play a role in tumor development. We evaluated the gene and protein expression of progesterone receptors A and B (PRA and PRB) and the protein expression of estrogen receptor alpha (ER-alpha) in fibroadenoma samples, comparing with adjacent normal breast tissue, from 11 premenopausal women. Progesterone and estradiol levels were determined. No alterations in the PRs gene and protein expression and the ER-alpha protein expression were observed between the follicular and luteal phases, in normal breast versus fibroadenomas. Protein levels of PRA and PRB were higher in fibroadenomas compared to normal breast tissue (P = 0.038 and P = 0.031), while the PRs mRNA levels were similar in both tissues (P = 0.721 and P = 0.139). There were no differences in ER-alpha protein expression between normal breast tissue and fibroadenomas (P = 0.508). The PRA:PRB ratio was similar in the tissues, and also showed a strong correlation in both (r = 0.964, P = 0.0001). Our data suggest a role of PRs in the growth and development of fibroadenomas, although without alterations of the PRA:PRB ratio in these tumors. The absence of alterations in ER-alpha protein levels could be a characteristic behavior of fibroadenomas, unlike breast cancer.

Gene and protein expression of p53 and p21 in fibroadenomas and adjacent normal mammary tissue

The aim of this study was to compare p53 and p21 mRNA, and proteins levels between fibroadenomas and adjacent normal mammary tissue of women in reproductive age. A transversal study was performed. Fourteen patients who attended the Breast Service of the Hospital de Clínicas de Porto Alegre were assessed and submitted to surgical resection of fibroadenomas. Fragments of the central area of the fibroadenoma and adjacent normal mammary tissue were obtained. mRNA expression for genes p53 and p21 was evaluated by RT-PCR, and protein expression by the western blot. Paired analyses showed higher gene expression of p53 (P = 0.017) and p21 (P = 0.003), and a higher protein expression of p53 (P = 0.001) in fibroadenomas as compared to normal breast tissue. p21 protein expression was not different (P = 0.97) between the fibroadenoma and the adjacent normal mammary tissue samples. These results suggest the participation of p53 in the formation of fibroadenomas. The role of p21 in fibroadenomas remains to be defined.

Identification of a gain-of-function mutation of the prolactin receptor in women with benign breast tumors

There is currently no known genetic disease linked to prolactin (Prl) or its receptor (PrlR) in humans. Given the essential role of this hormonal system in breast physiology, we reasoned that genetic anomalies of Prl/PrlR genes may be related to the occurrence of breast diseases with high proliferative potential. Multiple fibroadenomas (MFA) are benign breast tumors which appear most frequently in young women, including at puberty, when Prl has well-recognized proliferative actions on the breast. In a prospective study involving 74 MFA patients and 170 control subjects, we identified four patients harboring a heterozygous single nucleotide polymorphism in exon 6 of the PrlR gene, encoding Ile(146)-->Leu substitution in its extracellular domain. This sole substitution was sufficient to confer constitutive activity to the receptor variant (PrlR(I146L)), as assessed in three reconstituted cell models (Ba/F3, HEK293 and MCF-7 cells) by Prl-independent (i) PrlR tyrosine phosphorylation, (ii) activation of signal transducer and activator of transcription 5 (STAT5) signaling, (iii) transcriptional activity toward a Prl-responsive reporter gene, and (iv) cell proliferation and protection from cell death. Constitutive activity of PrlR(I146L) in the breast sample from a patient was supported by increased STAT5 signaling. This is a unique description of a functional mutation of the PrlR associated with a human disease. Hallmarks of constitutive activity were all reversed by a specific PrlR antagonist, which opens potential therapeutic approaches for MFA, or any other disease that could be associated with this mutation in future.

Breast disease: benign and malignant

Breast diseases, both benign and malignant, are common. Typically, young women present with more benign pathologies; however, breast malignancies can occur in young women, especially in those harboring mutations in the BRCA genes, other inherited genetic syndromes associated with increased risk of breast cancer, or familial predisposition for breast cancer. In all women aged 40 and over presenting with abnormalities of the breast, a primary breast cancer should be ruled out because it is the leading cancer among women in developed countries.

D. Apresentação das lesões mamárias císticas à ultra-sonografia utilizando a elastografia

OBJETIVO: Demonstrar a apresentação mais freqüente das lesões mamárias císticas utilizando a elastografia e discutir a sua aplicabilidade. MATERIAIS E MÉTODOS: A casuística compôs-se de 150 pacientes encaminhadas para realização de biópsia mamária percutânea com 175 lesões. Foram excluídas as lesões com diagnóstico histológico de lesões sólidas (153 lesões) e incluídas as lesões com características císticas à histologia (22 lesões), incluindo cistos complicados, lesões papilíferas, lesões inflamatórias, hiperplasia de células colunares típica e ectasia ductal. Estas lesões foram classificadas de forma retrospectiva por meio da elastografia, conforme escores criados pelos autores, variando de 1 a 4. RESULTADOS: Das 22 lesões encaminhadas, 13 (59%) correspondiam a cistos, uma (4,6%) a ectasia ductal, duas (9,2%) a lesões inflamatórias, cinco (22,6%) a lesões papilíferas e uma (4,6%) a hiperplasia de células colunares. Foram encontrados 17 escores 2, quatro escores 3, um escore 4 e nenhum escore 1, com especificidade de 95%. CONCLUSÃO: As lesões císticas mamárias têm diferentes apresentações à elastografia, conforme o resultado histológico, sendo este um método útil para a sua diferenciação e de fácil aplicabilidade na clínica diária.

History of benign breast disease and risk of breast cancer among women in China: a case-control study

BACKGROUND

Data from the Shanghai Breast Cancer Study were analyzed to evaluate the relationship between benign breast disease (BBD) and breast cancer among Chinese women with a self-report of physician-diagnosed BBD.

METHODS

Study participants consisted of 3,452 breast cancer cases and 3,474 population controls recruited by the Shanghai Breast Cancer Study. In-person interviews were conducted to collect information on demographics and suspected risk factors for breast cancer, including a detailed history of BBD. Unconditional logistic regression was used to derive adjusted odds ratios (OR(adj)) and 95% confidence intervals (CI) for the association between self-reported BBD and breast cancer.

RESULTS

Women with breast cancer were significantly more likely to have a self-reported history of BBD including lobular proliferation (OR(adj) = 1.6; 95% CI 1.4-1.8), fibroadenoma (OR(adj) = 1.9; 95% CI 1.6-2.3), and other BBD (OR(adj) = 1.6; 95% CI 1.3-2.1). Breast cancer risk was lower for surgically treated fibroadenoma as compared to non-surgically treated and higher for other BBDs that were surgically treated versus non-surgically treated.

CONCLUSIONS

Our results suggest that personal history of BBD is associated with an increased risk of future breast cancer among women in China. Surgical intervention for fibroadenoma may reduce the risk.

Plasma isoflavones and fibrocystic breast conditions and breast cancer among women in Shanghai, China

BACKGROUND

Proliferative benign breast conditions are associated with elevated risk of breast cancer, whereas nonproliferative conditions are not strongly associated with risk. Factors acting before onset of hyperplasia might be associated with both benign conditions and breast cancer, whereas those on the proliferative disease-to-cancer pathway would be associated only with cancer. Soy isoflavone exposure may influence breast cancer risk, but little is known of its association with benign conditions.

MATERIALS AND METHODS

We examined possible relationships between plasma genistein and daidzein concentrations and risk of breast disease in women, in a breast self-examination trial in Shanghai, China, diagnosed with breast cancer (n = 196) or a benign breast condition (n = 304), and 1,002 age-matched controls with no known breast disease. Benign conditions were classified as nonproliferative (n = 131) or proliferative with or without atypia (n = 173).

RESULTS

Isoflavone concentrations were inversely associated with risk of nonproliferative and proliferative benign fibrocystic conditions, as well as with breast cancer, both with and without concomitant proliferative changes in ipsilateral noncancerous mammary epithelium (P(trend) < 0.01 for all comparisons with controls). Women in the highest quartile of plasma genistein (>76.95 ng/mL) were less likely to have breast cancer (odds ratio, 0.26; 95% confidence interval, 0.13-0.50) or benign conditions (odds ratio, 0.40; 95% confidence interval, 0.23-0.70) compared with women in the lowest quartile (<9.42 ng/mL). Observed risks for breast cancer with and without surrounding proliferative changes were not different, respectively, from observed risks for benign proliferative and nonproliferative conditions alone.

CONCLUSION

Isoflavone exposure was inversely associated with fibrocystic breast conditions and breast cancer, and the results suggest that effects on cancer risk occur early in carcinogenesis.

Radiological features of breast benign lesions in patients with hyperprolactinemia

Background: The study was conducted to determine whether prolactin (PRL) influences radiological features of benign breast lesions. Methods: During the 4-year period, we observed 50 patients with nipple discharge: 23 with normal serum prolactin levels (group 1) and 27 with hyperprolactinemia (group 2a before hyperprolactinemia treatment and group 2b after hyperprolactinemia treatment). Patients observed during this study underwent breast ultrasonography (US) and mammography. Radiological findings in group 1, group 2a and group 2b were compared. Results: The most frequent radiological findings in group 2a were dilated lactiferous ducts and cystic lesions with statistical significances p<0.001 and p<0.01 in comparison to other radiological findings. In group 1 significantly less presence of dilated lactiferous ducts was observed (p<0.05) and proportional lower frequency of solid lumps compared to group 2a. Our results showed significantly lower incidence (p<0.001) of dilated lactiferous ducts, after hyperprolactinemia treatment (group 2b). In group 2b less presence of solid lumps and enlarged axillary lymph nodes is also observed in comparison to group 2a. Frequency of cystic lesions significantly decreased (p<0.05) and pseudocysts completely withdrew in patients with normalized serum prolactin levels. Conclusion: Prolactin significantly influences radiological presentation of benign breast diseases. Treatment of hyperprolactinemia results in withdrawal of mammary duct ectasia, pseudocystic formations, cystic lesions and solid lumps. Breast ultra-sonography and mammography should be considered as routine diagnostic procedures in patients with hyperprolactinemia.