Abstract P2-14-24: Argon scalpel in the surgical treatment of breast cancer

Summary: Surgery is a key part of the treatment of breast cancer. The adoption of electric scalpel began to be used in breast surgeries in 1970 and this equipment uses high frequency electric current to create the following effects: cutting, coagulation or mixing of the two. Data show a decrease in the intraoperative bleeding, however, can also increase complications, such as seroma and thermal lesions in the surgical flaps. A new technique that could be used is the coagulation with argon plasma which is a method of non-contact thermal hemostasis.

Objectives: to compare the electric scalpel with the scalpel by coagulation with argon plasma about aspects surgical and pathological.

Methods: this is a prospective cohort study in which 60 patients with breast cancer were selected at the Discipline of Breast Diseases of the Department of Gynecology of the Federal University of São Paulo (UNIFESP) at any clinical stage where the surgical treatment was indicated, from March 2014 to August 2014. The patients were consecutively selected and randomized into two groups: electric scalpel surgery (ES) and argon plasma coagulation surgery (APC). Inclusion criteria were: 18 to 90 years old patients with breast cancer at any clinical stage where surgical (conservative or radical) treatment was indicated. Intraoperative bleeding was assessed by measuring the weights of the compresses. The patients who underwent surgery were evaluated at 7, 14 and 30 postoperative days. In these returns, the appearance of the surgical wound, the presence and amount of seroma (in mL), hematoma or infection were analyzed. Surgical site infection was considered when there was erythema, increased local or systemic temperature, pain, suture dehiscence or presence of purulent exudate. The surgical specimen was studied in the Department of Pathological Anatomy of UNIFESP. The pathological analysis as recommended by the WHO and particular evaluations were carried out in order to observe the extent and degree of the thermal effect produced in surgical specimens by the two hemostatic techniques (ES and APC).

Results: The mean age of the patients was 56.0 years for the ES group and 54.9 for the APC. There was no significant difference between the groups regarding intraoperative bleeding. However, a statistically significant difference was observed when the days with drain were compared in the postoperative period, with a mean of 10.1 days for the SE group and 7.1 days for the APC group. The study demonstrated that the APC group had a significant greater thermal effect on the margins of the surgical specimen.

Table 1.Thermal effect on the margins of the surgical specimens by study group (p=0.032)Thermic EffectEletric N (%)Argon N (%)Total N (%)Absent7 (23.3)0 (0)7 (11.7)G110 (33.3)12 (40.0)22 (36.4)G211 (36.7)13 (43.3)24 (40.0)G32 (6.7)5 (16.7)7 (11.7)

Conclusions: the use of argon scalpel, when compared to the electric scalpel, allowed hemostasis to be performed adequately without altering the rates of bleeding, surgical time and postoperative complications, and reduced the number of days with the drain. The thermal effect on the surgical specimen was significant greater with the argon scalpel.

Citation Format: Giordano R, Bromberg S, Elias S, Nazário A, Waitzberg A, Sá R, Facina G. Argon scalpel in the surgical treatment of breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-24.

Abstract P2-12-03: Prospective study of acupuncture in the rehabilitation of women undergoing surgical treatment of breast cancer in relation to the strength and quality of life

Objective: To investigate the benefits of acupuncture in relation to the shoulder muscle strength and quality of life in women undergoing surgical treatment for breast cancer.

Methods: Women with breast cancer, aged 18 years or more, with pain level ≥ 3 in the Visual Analog Scale in shoulder girdle or upper limb three months after surgery, were included in this prospective study. The patients were randomly divided into two groups and received weekly treatment for 10 sessions. Kinesiotherapy group (G1): treated with pre-defined standard kinesiotherapy, lasting 30 minutes. Group Acupuncture + Kinesiotherapy (G2): treated with the same Kinesiotherapy group protocol followed by another 30 minutes of acupuncture using pre-defined points. Acupuncture points used were as follows: CV 3, SP 9, ST 36, KD 7, LV 3, GB 21, LI 15, SJ 14, LU 5, LI 4, ST 38 and BL 60. Patients were evaluated at baseline, after five weeks and at the end of 10 weeks. Parameters studied were: clinical profile and socio-demographic data, muscle strength and quality of life.

Results: 48 patients completed treatment, 24 in each group. Regarding shoulder muscle strength, all movements showed improvement and there was no statistical difference between groups. However, when analyzing intragroup changes, improvement of flexion and internal rotation were observed in G1 and increase of all movements were found in G2. Concerning EORTC, there was statistically significant difference between groups of pain symptom in the 5th session, with better score in patients of G2 in relation to G1. About EORTC intragroups results, G1 showed improvement in physical function, pain and insomnia; and G2 in performance roles, fatigue and pain.

Conclusion: According to this prospective study, kinesiotherapy and acupuncture had a positive effect on the shoulder muscle strength and quality of life of patients.

Keywords: 1. Breast cancer. 2. Rehabilitation. 3. Acupuncture. 4. Muscle Strength. 5. Quality of life.

Citation Format: Giron PS, Haddad CA, Rizzi SL, Pinheiro TL, Luz RP, Nazário AP, Facina G. Prospective study of acupuncture in the rehabilitation of women undergoing surgical treatment of breast cancer in relation to the strength and quality of life [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-12-03.

Abstract P3-09-13: Assessment of muscle strenght and range of motion of shoulder women undergoing surgery for breast cancer

Background: Surgery for breast cancer can cause various deficiencies in upper limb and the surgery type can influence, normally the radical surgeries are more harmful. The presence of pain, reduced range of motion and decrease of muscle strength of the upper limb in the early postoperative period are some of the major deficiencies of these patients. The aim of this study was to evaluate muscle strength and range of motion of the shoulder in patients undergoing partial or total mastectomy to treat breast cancer preoperatively, 7 and 30 days after surgery.

Methods: We included patients with breast cancer and surgical indication in a prospective study in the Gynecological Department of Sao Paulo Federal University, Brazil. Exclusion criteria were previous breast surgeries, immediate reconstruction, bilateral surgery, orthopedic diseases in the shoulder and neurological diseases. A total of 114 women were evaluated preoperatively (Pre), seven (PO7) and thirty days (PO30) after surgery, being 70 partial mastectomies (P) and 44 total mastectomies (T). For the assessment of muscle strength, it was used a Hand Held Dynamometer, model 01163 from Lafayette Instrument Company®, using the peak force in kilogram. It was calibrated to isometric contraction for five seconds. Each movement was measured twice and the average was used for the final rating. To measure the range of motion in degrees was used a goniometer. For both assessments cited the movements were: flexion, extension, adduction, abduction, internal and external rotation of the shoulder.

Results: We used the test with two-factor ANOVA and multiple comparisons with the Tukey's test to analyze the results. In the assessment of muscle strength, every movement had a statistically significant difference between the periods Pre, PO7 and PO30 (p < 0.001). Thereby, a reduction of strength in PO7 improvement in PO30, but did not reach the initial period of Pre. The internal rotation, beyond the difference between the periods, showed a difference in muscle strength between the types of surgery (p = 0.005) being greater reduction in group T, on PO7 and PO30. In evaluating range of motion of shoulder, extension and internal rotation showed no statistical differences for periods or for the surgical groups. The flexion, abduction and adduction had statistical differences between the three periods (p < 0.001) and also between surgical types, always with smaller values of range of movements in group T compared to P (flexion p = 0.013; abduction p < 0.001 and adduction p < 0.001). However, the adduction in partial mastectomies had returned its values to the Pre period on PO30 (p < 0.001). And finally the external rotation showed difference only between the periods pre and post-surgery (p < 0.001), but not between PO7 and PO30.

Conclusion: Surgery for breast cancer causes reduction in muscle strength of the shoulder that does not return after 30 days of surgery in both surgical types (P and T). It also reduces the range of motion of this joint in flexion, abduction, adduction and external rotation, with deficits of partial always lower than the total mastectomy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-13.

Abstract P6-08-03: Incidence of winged scapula after breast cancer surgery with axillary dissection - Preliminary results

Background: The axillary dissection during breast cancer surgery can cause a condition known as Winged Scapula. This condition, which may affect shoulder mobility, occurs when an injury to the long thoracic nerve weakens the serratus anterior muscle. Therefore, we conducted this study to determine the incidence of Winged Scapula and its impact on shoulder mobility.

Method: We included patients with breast cancer and surgical indication for axillary dissection in a prospective study in the Gynecological Department of São Paulo Federal University. We excluded women with pre-surgery winged scapula, neurological diseases, orthopedic shoulder problems, comprehension difficulties and those undergoing autologous tissue reconstructions. We physically evaluated 84 patients before the surgery and again fifteen days after. We used the Hoppenfeld test (present or absent) to assess Winged Scapula incidence, the lateral scapular slide test (asymmetry - yes or no) to assess scapular position, and the 4-type method to assess scapular dyskinesia. In addition, we used a goniometer for flexion, extension, adduction and abduction to measure shoulder range of motion (ROM). Finally, patients indicated their level of pain using a scale from 0 to 10.

Results: The McNemar test was used to statistically analyze the incidence of Winged Scapula and scapular asymmetry. Winged Scapula incidence was 7.1% with a 95% confidence interval ranging from 1.6% to 12.6% (p = 0.041). The lateral scapular slide test showed no statistical significance, which means the surgery did not cause scapular asymmetry. Scapular dyskinesia was analyzed through the Wilcoxon Signed Rank Test. There was no statistically significant evidence that surgery caused scapular dyskinesia (p = 0.904). We used the Paired T-Test to compare pre and post-operative shoulder ROM and pain. Flexion, adduction and abduction shoulder ROM presented a statistically significant reduction (p = 0.000). Respectively, the mean reductions were 34.19o (SD = 27.34), 6.6o (SD = 11.04) and 37.23o (SD = 33.09). Extension was the only movement without a significant change in range (p = 0.0156). Reported pain increased significantly after surgery (p = 0.003), from 1.476 (SD = 3.024) to 2.702 (SD = 2.853). A two-way Analysis of Variance (ANOVA) compared the ROM of the patients with Winged Scapula to those without. In ANOVA, a p > 0.05 indicates that there is no statistically significant difference in the way both groups vary. In this analysis both groups showed the same patter over time in all movements; flexion (p = 0.242), extension (p = 0.187), adduction (p = 0.096) and abduction (p = 0.793). Therefore, patients with Winged Scapula showed the same pattern of ROM reduction as patients without.

Conclusion: We found that the axillary dissection during breast cancer surgery caused Winged Scapula 7.1% of the time, and that there was no relationship between the surgery and scapular asymmetry and dyskinesia. Furthermore, this surgical procedure also reduced shoulder ROM (flexion, adduction and abduction) and increased pain fifteen days after surgery. Finally, we could find no evidence that Winged Scapula led to a smaller shoulder ROM in recent post-operative physical analysis.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-03.

Abstract P3-09-12: Effects of acupuncture on rehabilitation after breast cancer surgery - Preliminary results

Background: The increased incidence of breast cancer and successful treatment result in greater survival of these patients and consequently a greater number of survivors. These patients may have chronic condition of pain in the shoulder and upper limb, including cervical and thoracic spine. This paper seeks, through acupuncture, a new approach in the rehabilitation of these patients.

Method: This study was conducted in the Gynecological Department of São Paulo Federal University. The study included women who underwent surgical treatment of breast cancer, radical or conservative, and present pain in the region of the shoulder and upper limb, including cervical and thoracic spine after three months of surgery. Patients older than 18 years and pain level ≥ 3 on the Visual Analog Scale (VAS). We excluded patients with bilateral breast surgery, metastatic disease, vascular disorders and tactile sensitivity, with diabetes mellitus type I and II uncompensated and education level less than four years.

The patients were randomly divided into two groups, with 15 patients per group who were treated weekly for 10 weeks, one group treated with kinesiotherapy standard, pre-defined, based on stretching the neck muscles, scapular exercises and upper limb strength lasting 30 minutes and the other group was performed the same protocol described above kinesiotherapy followed by another 30 minutes of Acupuncture using pre-defined points.

Acupuncture points used were as follows: CV 3, SP 9, ST 36, KD 7, LV 3 - edema and treat gynecological disorders; VB 21, LI 15, TH 14, LU 5, LI 4, ST 38 and UB 60 - treat pain and difficulty of movement in the upper limb.

Patients were evaluated at baseline, after five weeks and at the end of 10 weeks. We used the Visual Analog Scale (VAS) for pain intensity ratings and the DASH questionnaire (Disabilities of the Arm, Shoulder and Hand Questionnaire) assessing functional capacity in diseases of the upper limb, measuring the skills to do certain activities as well as the symptoms.

Results: The ANOVA test was used for statistical analysis of pain relief by VAS scale in both groups. Both groups had significant improvement with p> 0.001 and no difference between groups, with p = 0.756. The same analysis of variance was used in the DASH questionnaire, with similar results, both groups improved significantly with p> 0.001 and no difference between groups with p = 0.200. In multiple comparisons all reviews are different from each other showing a gradual improvement.

Conclusion: We found that both types of treatment (kinesiotherapy or kinesiotherapy and acupuncture) are effective, and the evolution of the two groups was the same with a gradual improvement.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-12.

Analysis of human mammary fibroadenoma by Ki-67 index in the follicular and luteal phases of menstrual cycle

OBJECTIVES

Fibroadenoma is the most common benign mammary condition among women aged 35 or younger. Expression of Ki-67 antigen has been used to compare proliferative activity of mammary fibroadenoma epithelium in the follicular and luteal phases of the menstrual cycle.

MATERIALS AND METHODS

Ninety eumenorrheic women were selected for tumour excision; they were assigned to either of the two groups, according to their phase of menstrual cycle. At the end of the study, 75 patients with 87 masses were evaluated by epithelial cell Ki-67 expression, blind (no information given concerning group to which any lesion belonged).

RESULTS

Both groups were found to be homogeneous relative to age, menarche, body mass index, previous gestation, parity, breastfeeding, number of fibroadenomas, family history of breast cancer and tabagism. Median tumour size was 2.0 cm and no relationship between proliferative activity and nodule diameter was observed. No typical pattern was observed in the expression of Ki-67 in distinct nodules of the same patient. Average values for expression of Ki-67 (per 1000 epithelial cells) in follicular and luteal phases were 27.88 and 37.88, respectively (P = 0.116).

CONCLUSION

Our findings revealed that proliferative activities in the mammary fibroadenoma epithelium did not present a statistically significant difference in the follicular and luteal phases. The present study contributes to clarifying that fibroadenoma is a neoplasm and does not undergo any change in the proliferative activity during the menstrual cycle.

Evaluation of CD83 antigen in the normal mammary epithelium and fibroadenoma human

Abstract #2038

Background: The immune response initiation requests the capture and the presentation of the antigens to the specific lymphocytes. The cells that has this capacity are denominated antigen-presenting cells, and the dendritic cell (DC) is the one that has larger specialization degree for these functions. The DC maturation it is considered essential for the beginning of the immune response. The CD83 antigen is a co-stimulator, member of the immunoglobulin superfamily with 45Kd, and your expression is an important marker of the maturation of DC.
 Objectives: To analyze the CD83 antigen expression in the human's breast fibroadenoma and in the adjacent breast tissue and to identify the clinical features that can influence this expression.
 Material and Methods: It is a retrospective study where 29 histopathologic materials of breast fibroadenomas and the adjacent breast tissue, of 28 women in reproductive age, were analyzed. The immunohistochemistry method was used for analysis of the CD83 antigen expression and, subsequently, the cells were counted by light microscopy. A thousand epithelium cells of each case were analyzed (five hundred of the fibroadenoma and five hundred of the adjacent breast tissue) for statistical calculation of the expression or not of the antigen reaction in the cells. We used parametric test (t-Student) for statistical analysis of the results.
 Results: The CD83 antigen expression positive in the fibroadenoma's cells (365.52 ± 133.13) in relation to the adjacent breast tissue's cells (189.59 ± 140.75) was statistically greater (p <0.001). Several clinical features were analyzed, however, only parity showed influence in the expression of the CD83 antigen in the adjacent mammary tissues, and the positive expression was more evident in nulliparous women (p=0.042).
 
 Conclusion: The CD83 antigen expression was statistically greater in the breast fibroadenoma's cells, when compared with the one of the adjacent breast tissue. No clinical variable influenced CD83 expression in the breast's fibroadenoma, however, it was significantly greater in the adjacent normal breast tissue of nulliparous women.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2038.

The effect of raloxifene on vascular endothelial growth factor expression in breast carcinomas of postmenopausal women

Abstract #1031

Background: To evaluate the effect of raloxifene on vascular endothelial growth factor (VEGF) expression in breast carcinomas of postmenopausal women. Materials and Methods: Sixteen postmenopausal patients with operable stage II, estrogen receptor-positive, infiltrating ductal breast carcinoma were treated with raloxifene at the dose of 60 mg/day for a period of 28 days prior to definitive surgery. Tumor size varied from 3 to 5 cm (mean 3.7 cm) and the mean age of patients was 61.8 years (range 49-72 years). Tumor samples were obtained by incisional biopsy at the time of diagnosis and again at the time of definitive surgical treatment. VEGF expression was obtained by immunohistochemistry (primary anti-VEGF monoclonal antibody, IgG, C-1, sc-7269, 200 mg/ml, Santa Cruz Biotechnology, Santa Cruz, USA). Evaluation of VEGF expression was assessed semiquantitatively based on the fraction of stained tumor cells and on the intensity of staining. McNemar's test of symmetry was used to evaluate agreement between the positive or negative classification of VEGF expression prior to and following raloxifene treatment (p<0.05). Results: Fourteen of the 16 patients (88%) were classified as positive for VEGF expression prior to raloxifene treatment, while only 5 (31%) were classified as positive following treatment (p<0.007) (see Figure 1 and Table 1).[figure1] 
 
 Discussion: The results of the present study show that raloxifene reduced VEGF expression in breast cancer in postmenopausal women, thus suggesting that the drug may reduce neovascularization and the growth of estrogen receptor-positive breast tumors and reinforcing the argument for its possible use both in chemoprevention and in the treatment of breast cancer.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1031.

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Association of estrogen receptor gene alpha polymorphisms with postmenopausal mammary density

Abstract #5003

Background: With the human genome studies, knowledge about polymorphisms started raising interest in a variety of fields and, in medicine, the evidence of direct action of polymorphisms on the arising and progression of diseases, disclosing the possibility of using them as disease predisposition markers. Substitutions, insertions or deletions which are transmitted through generations and reach frequencies equal or superior to 1% in the population are named polymorphisms. Knowing that the mammographic pattern is a multifactorial character, the objectives of this study were to evaluate a possible association of clinical characteristics and polymorphisms HaeIII, MspI and XbaI of the estrogen receptor gene alpha with postmenopausal mammary density. Materials and Methods: A prospective evaluation was made of 120 women who were not hormone therapy users and had no clinically or mammographically identified breast lesions. All of them underwent bilateral mammography, and the radiological density was determined by three independent observers, with two subjective evaluations based on the ACR-BIRADS® classification of mammographic patterns, 2003, and one computerized evaluation – the grey-scale histogram tool of the Adobe Photoshop® 7.0 software. Peripheral blood samples were obtained for DNA extraction, performed according to the GFX® Kit protocol from Amersham-Pharmacia. After DNA extraction, PCR-RFLP (Polymerase Chain Reaction - Restriction Fragment Length Polymorphism) was carried out for an analysis of the polymorphisms present in intron 1 (HaeIII and XbaI) and in exon 1 (MspI) of the estrogen receptor gene. Results: There was a high degree of concordance among the observers in the determination of mammary density (Kappa, Pearson and Spearman - p<0.001). The associations of clinical characteristics with mammary density were: age (p=0.04), body mass index (p<0.0001), age at menarche (p=0.02), age at menopause (p=0.120), age at first delivery (p=0.120), parity (p=0.09). The relation between the allele distribution of the polymorphisms and the density was: XbaI (p=0.02), HaeIII (p=0.65), and MspI (p=0.65). Conclusion: Polymorphism XbaI and the clinical factors age, menarche and body mass index showed to be associated with postmenopausal mammary density.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5003.

Prevalence of fibroadenomas in kidney-transplanted patients using cyclosporine A

Abstract #6078

Background: Fibroadenoma is the commonest benign tumor of female breast, classified as fibroepithelial neoplasia. It is frequent during reproductive years mainly in the 2nd and 3rd decades of life, coinciding with follicular maturation and steroidogenesis. With the beginning of the era of transplants the use of cyclosporine A was accepted by the medical community as potential lymphocyte T suppressant. In 1980 the first report on multiple breast fibroadenomas in renal transplant patients taking cyclosporine A was published. The imaging standard of fibroadenomas also seems to differ from usually found in asymptomatic patients: diameters are notably larger, lower longitudinal / anteroposterior diameter ratio and are more hyperechogenic.
 Objetive: To define the prevalence of breast fibroadenomas in kidney-transplanted patients taking cyclosporine A.
 Materials and Methods: Prevalence of breast fibroadenomas was determined in three groups of patients: 50 women with renal transplant taking cyclosporine A (Group 1); 51 women with renal transplant not taking cyclosporine A (Group 2) and 181 women without renal transplant (Control Group). Evaluation was performed by anamnesis, physical examination and breast ultrasonography. In the case of clinical or imaging suspicion of fibroadenoma, the diagnosis was confirmed by core needle biopsy or lumpectomy.
 Results: The groups were homogeneous regarding age, menstrual status and former breast cancer family history. Fourteen percent fibroadenomas were found in the renal transplant patient group taking cyclosporine A versus 2.0% in the renal transplant patient group not taking cyclosporine A, and 2.8% in the control group. Prevalence of breast fibroadenomas in renal transplant patients taking cyclosporine A was significantly higher than in those not taking the drug and than in the control group (p=0.001). Frequency of fibroadenomas of the control group and renal transplant patients not taking cyclosporine was similar (p=0.073). Multiplicity, bilaterality and greater nodule dimensions were observed more in renal transplant patients taking cyclosporine A, but there was no statistical significance among the groups.
 
 Conclusion: Breast fibroadenomas are more prevalent in the renal transplant patients taking cyclosporine A.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6078.

Bcl-2 oncogene expression in estrogen receptor-positive and negative breast carcinoma

PURPOSE

The aim of this study was to evaluate Bcl-2 oncogene expression in estrogen receptor (ER)-positive and negative breast carcinomas.

METHODS

A study involving 72 cases of infiltrating ductal carcinoma of the breast in postmenopausal women divided into two groups: Group A (ER positive, n=37) and Group B (ER negative, n=35). Immunohistochemical analysis of bcl-2 expression was carried out semiquantitatively based on the percentage of stained tumoral cells and the intensity of staining. The chi-square test was used in the statistical analysis of the data and significance was established at p < 0.05.

RESULTS

Bcl-2 oncogene expression was statistically greater in tumors of Group A (59.5%) compared to those of Group B (8.6%), (p < 0.001).

CONCLUSION

Bcl-2 had a significantly greater expression in the ER-positive breast tumors compared to ER-negative tumors.

Effects of low dose tamoxifen on normal breast tissue from premenopausal women

The aim of this study was to determine the effects of low doses of tamoxifen (5 and 10mg/day) for 50 days compared with the standard dose (20 mg/day) on breast biomarkers measured in normal breast tissue from premenopausal patients. A randomised double-blind study was performed using tissue from 56 premenopausal women with a diagnosis of fibroadenoma of the breast. Excisional biopsy was performed on the 50th day of therapy. Normal breast tissue samples were collected during surgery. The patients were divided in groups: A (placebo, n=11); group B (5 mg, n=16), group C (10 mg, n=14) and group D (20 mg, n=15). In this cross-sectional study, differences in the expression of Oestrogen Receptor alpha (ERalpha), Progesterone Receptor (PR), Ki-67, apoptotic bodies and mitotic index between the different groups after treatment can be seen on the normal breast tissue. We believe that a lower dose of tamoxifen could reduce the side-effects associated with treatment without affecting its chemopreventive activity in the breast.

Estrogenic activity of tamoxifen on normal mammary parenchyma in the luteal phase of the menstrual cycle

OBJECTIVES

Tamoxifen, an anti-estrogenic drug used in the adjuvant treatment of breast cancer, deserves more investigation for the determination of its efficacy as a prophylactic agent against breast cancer in high risk women. Thus, the action of tamoxifen on the human mammary gland was studied by measuring the number of lysosomes in normal mammary epithelium during the administration of tamoxifen.

METHODS

Tamoxifen was administered only during the luteal phase of the menstrual cycle to avoid interference with corpus luteum formation. A fragment of breast tissue adjacent to a fibroadenoma was obtained during surgery from 35 premenopausal women aged 15 to 37 years who had been eumenorrheic for at least 6 months; 18 of these patients were treated with tamoxifen and 17 were used as controls. Lysosome counts were performed under the light microscope on slides submitted to the acid phosphatase cytochemical technique and the data were analyzed statistically by the Mann-Whitney test.

RESULTS

The fragments from the group treated with tamoxifen showed a significant decrease in lysosome numbers.

CONCLUSIONS

Tamoxifen administered after ovulation significantly decreases the number of lysosomes in the cells of normal mammary epithelium, demonstrating the antiestrogenic effect of the drug on this target tissue.