Sweet Corn Sentinel Monitoring for Lepidopteran Field-Evolved Resistance to Bt Toxins

As part of an insect resistance management plan to preserve Bt transgenic technology, annual monitoring of target pests is mandated to detect susceptibility changes to Bt toxins. Currently Helicoverpa zea (Boddie) monitoring involves investigating unexpected injury in Bt crop fields and collecting larvae from non-Bt host plants for laboratory diet bioassays to determine mortality responses to diagnostic concentrations of Bt toxins. To date, this monitoring approach has not detected any significant change from the known range of baseline susceptibility to Bt toxins, yet practical field-evolved resistance in H. zea populations and numerous occurrences of unexpected injury occur in Bt crops. In this study, we implemented a network of 73 sentinel sweet corn trials, spanning 16 U.S. states and 4 Canadian provinces, for monitoring changes in H. zea susceptibility to Cry and Vip3A toxins by measuring differences in ear damage and larval infestations between isogenic pairs of non-Bt and Bt hybrids over three years. This approach can monitor susceptibility changes and regional differences in other ear-feeding lepidopteran pests. Temporal changes in the field efficacy of each toxin were evidenced by comparing our current results with earlier published studies, including baseline data for each Bt trait when first commercialized. Changes in amount of ear damage showed significant increases in H. zea resistance to Cry toxins and possibly lower susceptibility to Vip3a. Our findings demonstrate that the sentinel plot approach as an in-field screen can effectively monitor phenotypic resistance and document field-evolved resistance in target pest populations, improving resistance monitoring for Bt crops.

Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program

Background

Male breast cancer (BC) is rare, managed by extrapolation from female BC. The International Male BC Program aims to better characterize and manage this disease. We report the results of part I, a retrospective joint analysis of cases diagnosed during a 20-year period.

Methods

Patients with follow-up and tumor samples, treated between 1990 and 2010, in 93 centers/9 countries. Samples were centrally analyzed in three laboratories (the United Kingdom, the Netherlands and the United States).

Results

Of 1822 patients enrolled, 1483 were analyzed; 63.5% were diagnosed between 2001 and 2010, 57 (5.1%) had metastatic disease (M1). Median age at diagnosis: 68.4 years. Of 1054 M0 cases, 56.2% were node-negative (N0) and 48.5% had T1 tumors; 4% had breast conserving surgery (BCS), 18% sentinel lymph-node biopsy; half received adjuvant radiotherapy; 29.8% (neo)adjuvant chemotherapy and 76.8% adjuvant endocrine therapy (ET), mostly tamoxifen (88.4%). Per central pathology, for M0 tumors: 84.8% ductal invasive carcinomas, 51.5% grade 2; 99.3% estrogen receptor (ER)-positive; 81.9% progesterone receptor (PR)-positive; 96.9% androgen receptor (AR)-positive [ER, PR or AR Allred score ≥3]; 61.1% Ki67 expression low (<14% positive cells); using immunohistochemistry (IHC) surrogates, 41.9% were Luminal-A-like, 48.6% Luminal-B-like/HER-2-negative, 8.7% HER-2-positive, 0.3% triple negative. Median follow-up: 8.2 years (0.0-23.8) for all, 7.2 years (0.0-23.2), for M0, 2.6 years (0.0-12.7) for M1 patients. A significant improvement over time was observed in age-corrected BC mortality. BC-specific-mortality was higher for men younger than 50 years. Better overall (OS) and recurrence-free survival (RFS) were observed for highly ER+ (P = 0.001), highly PR+ (P = 0.002), highly AR+ disease (P = 0.019). There was no association between OS/RFS and HER-2 status, Ki67, IHC subtypes nor grade.

Conclusions

Male BC is usually ER, PR and AR-positive, Luminal B-like/HER2-negative. Of note, 56% patients had T1 tumors but only 4% had BCS. ER was highly positive in >90% of cases but only 77% received adjuvant ET. ER, PR and AR were associated with OS and RFS, whereas grade, Ki67 and IHC surrogates were not. Significant improvement in survival over time was observed.

Abstract P6-19-01: Evaluation of multiple transcriptomic gene risk signatures in male breast cancer

Introduction: Male breast cancer (MBC) is a rare disease accounting for less than 1% of all breast cancers (BC) and 1% of all cancers in males. The clinical management is largely extrapolated from female BC. Several multigene assays are increasingly used to guide clinical treatment decisions in female BC, however there is little data on the utility of these tests in MBC.

Methods: Here we present the gene expression results of 380 M0, ER+ve, HER2-ve MBCs enrolled in the Part 1 (retrospective joint analysis) International Male Breast Cancer Program of 1483 patients diagnosed between 1990-2010 (Cardoso et al. Annals of Oncology, 2018). Using a custom Nanostring™ panel comprised of the genes from the commercial risk tests Prosigna®, OncotypeDx® and Mammaprint®, risk scores and intrinsic subtyping data were generated to recapitulate the commercial tests as described by Bayani and Yao et al (npjBreast Cancer, 2017). Survival outcomes by risk classification were analyzed using Cox models with time-dependent covariates when the proportional hazard assumption was not met and adjusted for clinical and treatment variables.

Results: Prosigna-like risk scores identified 99 (26.1%) as low-risk, 159 (41.8%) as intermediate-risk, and 122 (32.1%) as high-risk. Using the TAILORx cut-off (25) for OncotypeDx-like risk of recurrence scoring, 158 (41.6%) were identified as low-risk, while 222 (58.4%) were identified as high-risk. MammaPrint-like results identified 175 (46.1%) as low-risk and 205 (53.9%) as high-risk. Overall, patients classified as high-risk had higher grade, more nodal involvement, larger tumors, and more frequently treated with chemotherapy than low-risk patients. Survival analyses demonstrated clear clinical utility for each test, showing patients at high-risk with poor relapse-free survival (RFS) as compared to patients classified as low-risk: Prosigna-like RFS at 3-years (HR=2.20, 95% CI, 1.28-3.80); Oncotype-like RFS at 3-years (HR=1.92, 95% CI, 1.17-3.17); MammaPrint-like RFS (HR=1.51, 95% CI, 1.00-2.27); with similar findings for distant relapse-free survival (DRFS) and overall survival (OS). Across outcomes and all gene signatures, patients with concordant Low/Low risk classification had better prognosis than those with concordant High/High risk classification. PAM50 intrinsic subtyping identified 147 (38.7%) as Luminal A, 57 (15.0%) as Luminal B, 80 (21.1%) as Her2-enriched and 96 (25.3%) as Basal-like; showing overall 34.5% concordance to clinic-pathological subtyping by central pathology (95% CI, 29.7%-39.5%). Comparison between the tests in the MBC cohort and a comparable cohort of female BC from the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial processed in the same way will be presented.

Conclusion: Common transcriptomic assays designed to assess residual risk, validated in female BC, provide similar information in male BC patients. Not surprisingly, disagreement between test results at the individual patient level was observed. To our knowledge, this is the largest study of MBC assayed to generate risk scores of the current commercial BC tests to demonstrate their clinical utility and their differences and similarity to female BC.

This work has been funded by the Breast Cancer Research Foundation (BCRF).

Citation Format: Bayani J, Poncet C, Yao CQ, Crozier C, Anouk N, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Dal Lago L, Fraser J, Hilbers FH, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Van Den Weyngaert D, van Deurzen C, van Leeuwen-Stok E, Vermeij J, Winer E, Boutros PC, Giordano SH, Cardoso F, Bartlett JM. Evaluation of multiple transcriptomic gene risk signatures in male 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 P6-19-01.

Abstract P4-08-06: Impact of molecular subtypes on long-term outcomes in triple-negative breast cancer (TNBC) patients treated with adjuvant AC chemotherapy on SWOG S9313

Introduction: TNBC is heterogeneous disease with several molecularly defined subtypes (Lehman et al), each of which may be predictive of response to chemotherapy. TNBC molecular subtypes are associated with varied pathological responses to neoadjuvant chemotherapy. However, subtype specific long-term outcomes for TNBC patients treated with uniform adjuvant chemotherapy are not known.

Aims: To characterize long-term outcomes of TNBC molecular subtypes (TNBCtypes) in patients treated with adjuvant doxorubicin (A) and cyclophosphamide (C) on S9313

Methods: SWOG 9313 accrued 3,125 women with early stage breast cancer to two alternative dose schedules of AC with no difference in outcomes between the two arms (J Clin Oncol 2007). From this trial we identified 425 (14%) patients with centrally determined TNBC for whom tissue was available. Microarray profiling was performed on genomic RNA extracted from pre-treatment FFPE tissue. A 101-gene expression model which has shown to reproduce the classification provided by the original 2188-gene algorithm (Ring et al) was applied to the microarray profiling to generate the following TNBCtypes–Basal-Like 1 (BL1), Basal-Like 2 (BL2), Mesenchymal (M), mesenchymal stem–like (MSL), and luminal androgen receptor (LAR). Immunomodulatory +/- (IM) status was assigned independent of the subtypes. Sequencing of BRCA1/2 from tumor DNA was also performed. The subtypes were tested for prognostic effect on DFS and OS using Cox regression model with adjustment for nodal status.

Results: For 425 TNBC patients, the median age was 45 years, 33% were node-positive and 10-year DFS and OS = 66.3% and 74.1%, respectively. A total of 381/424 (89.7%) cases could be classified into TNBCtypes with distribution as follows: BL1=24%, BL2=8%, M=24%, MSL=11%, LAR=9%, unclassified (UNL) =24%. No association between TNBCtypes and race or nodal status was noted. Compared to other subtypes LAR subtype was associated with older age at diagnosis (median age 53 vs 45, p&lt;0.001). Overall 24% of samples were IM+ and 25% demonstrated deleterious tBRCA1/2 mutation. DFS, tBRCA1/2 mutation and IM+ status distribution across different subtypes are provided in the table. All subtypes except for LAR demonstrated a drop in hazard function for recurrence after 5 years.

 5 year DFS (%)10 year DFS (%)DFS HR (95% CI), p valueDeleterious tBRCA1/2 mutationIM+ statusBL184.5%77.5%141%60%BL281.3%70.5%1.59 (0.81-3.13) p = 0.1816%12%M69.2%61.2%2.06 (1.25-3.40) p = 0.00528%0%MSL54.8%50.0%2.38 (1.33-4.28) p = 0.00418%7%LAR74.3%53.8%2.24 (1.22-4.14) p = 0.0112%8%UNL76.4%71.8%1.36 (0.80-2.33) p = 0.2620%30%

Conclusions: In the presence of adjuvant AC, TNBC molecular subtypes have varied prognosis, with BL1 subtype demonstrating the best prognosis and MSL and LAR subtypes demonstrating the worst prognosis. LAR subtype is associated with older age at diagnosis and continued elevated hazard function for recurrence after year 5. tBRCA1/2 mutations are distributed across all subtypes with the highest prevalence in BL1 and M subtypes. IM+ status was infrequently noted in non-BL1 subtypes. These findings underscore TNBC heterogeneity and the need to account for this heterogeneity in prospective clinical trials.

Citation Format: Sharma P, Barlow WB, Hout DR, Seitz RS, Bailey DB, Godwin AK, Pathak H, Timms KM, Solimeno C, Linden HM, Porter P, Tripathy D, Hortobagyi GN, Thompson A, Pusztai L, Hayes DF. Impact of molecular subtypes on long-term outcomes in triple-negative breast cancer (TNBC) patients treated with adjuvant AC chemotherapy on SWOG S9313 [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 P4-08-06.

Abstract PD7-12: Molecular subtyping of male breast cancer by the International male breast cancer program (IMBC): EORTC 10085/TBCRC 0-29/BIG 2-07/NABCG/BOOG 2009-04

Introduction. Male breast cancer (male BC) is a rare disease for which disease management is extrapolated from females. IMBC, an international consortium, which previously reported on clinico-pathological aspects, now reports on molecular subgroups revealed by RNA sequencing and their relation to patient outcome.

Methods. Tumor samples from the retrospective MALE BC registry diagnosed between 1990-2010 and with pathology and outcome data (relapse-free- (RFS) and overall survival (OS)) were included (n=699). To allow the discovery of prognostic features, we selected, stratified for known risk factors (TN stage, grade, age at diagnose and adjuvant endocrine treatment), from the cohort 152 cases with poor (RFS &lt;= 4 yrs) and good outcome (RFS &gt; 7yrs) evenly distributed. Here, we report RNA sequencing results of the first 73 cases, 38 with poor and 35 with good outcome. RNA sequencing reads were used to generate gene expression values and to report transcripts carrying driver mutations. Unsupervised clustering identified subgroups and within subgroups differentially expressed genes were identified. The reported prognostic male BC subgroups M1 and M2 (Johansson BCR 2012(14):R31) were also annotated. All identified subgroups were related to outcome using logistic regression (p-value using Wald test).

Results. Unsupervised clustering revealed 2 main subgroups of which group 1 was enriched for expression of ER target genes, WNT3 and genes from amplicons known for female BC, e.g. 19p13 (CCNE1), 8q24 (MYC), and 11q13 (CCND1). The biology of the smaller group 2 was less defined but TGFβ2 expression was high as were various kallikreins (KLK) including interestingly KLK3 (prostate specific antigen). Other known amplified regions [(8p11 (FGFR1), 20q13 (ZNF217) and 12q15 (MDM2)] and mutated transcripts [PIK3CA (H1047R/L/Q; E542K, E545K, N345K; 16% of cases), TP53 and SF3B1 (K700E) (2% of cases)] were identified. Profound tumor infiltrate gene expression was present in 5% of cases and one third of cases expressed proliferation markers. Except for TP53, none of these latter characteristics were unevenly distributed among the 2 main subgroups. ER and AR were highly correlated, particularly in group 1. The two main groups could be further subdivided. Group 1 comprised 3 subgroups of which subgroup 1a expressed TFF1/3 and NAT1, well-known ER targets, while subgroups 1b and 1c expressed other ER targets,respectively BEX1 and PITX1. HOXC cluster expression differentiated subgroup 1b from 1a and 1c. None of these intrinsic subgroups were, however, related to RFS. The previously reported M2 subgroup, which largely segregated with subclusters 1a and 1b, was associated with a better RFS than the M1 subgroup (OR=2.9; 95%CI 1.1-7.5; p-value=0.03).

Conclusions. 1) Intrinsic subtypes of male BC were revealed and their subgrouping is defined by ER associated subsets of genes. 2) The association of the reported M2 subgroup of male BC with longer RFS was validated; 3) Currently identified biological characteristics of male BC may improve future treatments. The full report on 152 cases including a comparison to female BC will be presented at the conference.

This research was funded by Breast Cancer Research Foundation

Citation Format: Martens JWM, Sieuwerts A, Ponchet C, Smid M, de Weerd V, Slaets L, Piper T, van Deurzen CHM, Schroder CP, Stangle C, Kloosterman W, van Leeuwen-Stok E, Nilsson C, Vermeij J, Peeters S, Goulioti T, Nowaczyk M, Aebi S, Rubio IT, Kelly C, Bayani J, Porter P, Murray M, Hudis C, Middleton L, Korde L, Ruddy K, Winer E, Bogler O, van den Weyngaert D, dal Lago L, Fraser J, Benstead K, van Asperen C, Linderholm B, Hedenfalk I, Tryfonidis K, Giordano S, Bartlett J, Cardoso F. Molecular subtyping of male breast cancer by the International male breast cancer program (IMBC): EORTC 10085/TBCRC 0-29/BIG 2-07/NABCG/BOOG 2009-04 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-12.

Abstract PD8-02: Tumor subtype and survival differences between Hispanic and non-Hispanic white breast cancer patients in the California cancer registry

Background: Prior studies show that Hispanic breast cancer patients are more likely than non-Hispanic white (NHW) women to be diagnosed with triple negative tumors but data on other subtypes are limited. Published data on survival differences between Hispanics and NHW breast cancer patients are inconsistent and vary depending on the covariates included in the multivariate models. We assessed differences in the distribution of the major tumor subtypes of breast cancer, as well as subtype-specific survival, between Hispanic and NHW patients according to nativity, and age and stage at diagnosis.

Methods: We used data from the population-based California Cancer Registry to include female invasive breast cancer cases diagnosed between 2004 and 2013 with follow-up through December 31, 2013, resulting in 90,236 total cases (69,693 NHW and 20,543 Hispanics). Tumor subtypes were classified into four categories: hormone receptor positive and HER2 negative (HR+/HER-), HR+/HER2+, HR-/HER2+, and triple negative (HR-/HER2-). Logistic regression was used to estimate differences in distribution of subtype between Hispanic and NHW women. Cox proportional hazard models were used to estimate differences in survival for Hispanics and NHWs by subtype, adjusting for clinical and sociodemographic characteristics.

Results: Compared to NHW patients, Hispanic women were more likely to be diagnosed with tumors that were HR+/HER2+ (OR=1.22; 95% CI, 1.16-1.29), HR-/HER2+ (OR=1.37; 95% CI, 1.29-1.47), and triple negative (OR=1.27; 95% CI, 1.21-1.34) than HR+/HER2-. Foreign-born Hispanics had a higher odds of having HER2+ than HR+/HER2- tumors compared to NHW women (OR=1.29 for HR+/HER2+ and OR=1.50 for HR-/HER2+); these differences were less pronounced among U.S.-born Hispanics (OR=1.04 for HR+/HER2+ and OR=1.16; 95% CI, 1.06-1.26 for HR-/HER2+). In age-adjusted models, Hispanic women had higher breast cancer mortality than NHW women (HR=1.23; 95% CI, 1.17-1.30), which was consistent across all tumor subtypes. However, the mortality differences disappeared after adjustment for clinical, sociodemographic characteristics, and marital status.

Conclusions: Hispanic women were more likely than NHWs to be diagnosed with triple negative breast cancer as well as tumors overexpressing HER2 than HR+/HER2- tumors. This pattern held true when stratified by nativity, although higher ORs for HER2+ tumors among foreign-born than U.S.-born Hispanic women were observed. Within each subtype, Hispanics had 20%-30% higher mortality than NHW, which appeared to be explained by a combination of sociodemographic and clinical factors.

Citation Format: Martinez ME, Cress R, Gomez S, Rodriguez D, Cook LS, Schwab R, Nodora JN, Porter P, Li C. Tumor subtype and survival differences between Hispanic and non-Hispanic white breast cancer patients in the California cancer registry [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 PD8-02.

Seasonal population dynamics of the potato psyllid (Hemiptera: Triozidae) and its associated pathogen "Candidatus Liberibacter solanacearum" in potatoes in the southern great plains of North America

The potato psyllid, Bactericera cockerelli (Sulc) (Hemiptera: Triozidae), and its associated pathogen "Candidatus Liberibacter solanacearum" (Ca. L. solanacearum), the putative causal agent of zebra chip (ZC) disease in potatoes (Solanum tuberosum L.), were sampled in commercial potato fields and untreated control plots for 3 yr in multiple locations in Texas, Kansas, Nebraska, and Colorado. Populations of the potato psyllid varied across years and across potato growing regions. However, the percentage of potato psyllids infected with Ca. L. solanacearum although variable across years, was consistently highest in the Lower Rio Grande Valley of Texas (LRGV), the reported overwintering location for this pest. The numbers of Ca. L. solanacearum-infected psyllids collected on field traps and large nymphs counted on leaf samples were both positively correlated with the final percentage of ZC in tubers. In the LRGV, where vector and disease pressure is the highest, population levels of immature life stages of the psyllid and percentage of ZC differed greatly between commercial and untreated fields. These results show that the pest management program that was used can be effective at controlling development of the psyllid and ultimately reducing the incidence of ZC.

Prediction of late recurrences by breast cancer index in the NCIC CTG MA.17 cohort

2

Background: The MA.17 trial demonstrated that extended adjuvant endocrine therapy with letrozole after 5-y of tamoxifen markedly reduced the risk of recurrence in women with ER+ early stage breast cancer. This trial provides an opportunity to assess the ability of biomarkers to predict late recurrences in ER+ breast cancer. The Breast Cancer Index (BCI), a continuous risk index based on the combination of HOXB13:IL17BR (H:I) and the molecular grade index (MGI), estimates the individual risk of recurrence in ER+ breast cancer patients. In this study, the prognostic utility of BCI to predict late recurrences was examined.

Methods: FFPE tumor blocks were collected from patients who experienced a breast cancer recurrence up to unblinding of MA.17. Controls were matched 2:1 for age, tumor size, nodal status and prior chemotherapy, and were disease free for longer than cases. All cases were reviewed for standard histopathology and evaluated using the real-time RT-PCR BCI assay.

Results: Patient characteristics for the case-control study were similar to that from the overall study. Characteristics for cases (N=83) and controls (N=166) were not significantly different except for treatment. A higher percentage of controls compared to cases tended to be categorized as low risk by BCI (58% vs 43%), while a lower percentage of controls than cases tended to be categorized as high risk by BCI (34% vs 24%). In univariate analysis, treatment, BCI, H:I and HOXB13, but not tumor grade or MGI, were significant predictors of late recurrence. After adjusting for standard variables (age, tumor grade and treatment), BCI (OR 2.37; P=0.03), H:I (OR 2.55; P=0.04) and HOXB13 (OR 1.35; P=0.02) remained significant predictors of recurrence. HOXB13 expression at diagnosis predicted patient benefit from extended endocrine therapy with letrozole.

Conclusions: In this case-controlled study, the data demonstrate that BCI is a significant predictor of late recurrences in ER+ patients following 5-y of tamoxifen. The prognostic performance of BCI to predict late recurrences was largely dependent on HOXB13 expression. The integration of H:I and MGI within BCI provides prognostic utility for both early and late recurrences.

Abstract P3-10-26: Quantitative Protein and Gene Expression Biomarkers of Tamoxifen and Letrozole Recurrence in the NCIC CTG MA.17 Cohort

Background: The MA.17 study showed that extended adjuvant endocrine therapy with letrozole (LET) after completing 5 years of tamoxifen (TAM) markedly reduced the risk of recurrence in women with ER+ early stage breast cancer and improved overall survival in women presenting with node +ve disease. The HOXB 13:IL17BR gene expression ratio (signature) has been shown to predict outcome in breast cancer patients treated with adjuvant tamoxifen monotherapy and provides additional information beyond that from known positive (ER and PR) and negative (Her-1 and Her-2) predictors of responsiveness to tamoxifen in node-ve women. We report a case control evaluation of the Breast Cancer Index (BCI; bioTheranostics, Inc.), which combines the HOXB13 and IL17BR twogene and the molecular grade index (MGI) gene expression signatures, with respect to distinguishing which patients are at risk of late recurrences and who would respond to extended endocrine therapy with LET. The prognostic and predictive utility of quantitative immunofluorescence of ER, PR, Her-2, tumor aromatase, COX-2, GATA3 and Nat1 in the TAM-PLACEBO and the TAM-LET cohorts will also be evaluated and compared to results derived by standard immunohistochemistry. Methods: FFPE tumor blocks were collected from patients who experienced a breast cancer recurrence up to unblinding of MA.17. Controls were matched 2:1 for age, tumor size, lymph node status, and prior chemotherapy, and were all disease free for longer than cases. All cases were reviewed for standard histopathology by two independent pathologists. RNA was extracted, amplified, converted to cDNA and subjected to RT-PCR with primers and probes to HOXB13, IL17BR, BUB1A, CENPA, NEK2, RACGAP1 and RRM2. ER, PR HER1, HER2, COX2, Aromatase, GATA3 and NAT1 will be analyzed by routine IHC techniques and by immunoflourescent Automated Quantitative Analysis (AQuA).

Results: 105 cases and 210 matched controls are available for evaluation. All sections are under review and tissue microarrays have been performed on all cases and controls. Detailed results on the BCI and ER, PR, Her-2 will be available at the SABCS.

Discussion: MA.17 has shown that extended adjuvant endocrine therapy after tamoxifen is effective at preventing disease recurrence given for an additional 5 years. Numerous clinical trials are exploring whether extending AIs will show this benefit, and there is an increasing need to improve the therapeutic index by distinguishing those at risk from those who are not. It is also important to determine which patients will benefit from the therapy and which will recur without benefit. The latter patients could be triaged to clinical trials of novel therapies to overcome endocrine resistance. This study will help to define these issues and pave the way for more effective selection of specific patients for adjuvant endocrine strategies.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-10-26.

Frequency of resistance to Bacillus thuringiensis toxin Cry1Ab in southern United States Corn Belt population of European corn borer (Lepidoptera: Crambidae)

The high-dose refuge resistance management strategy is the main approach used to delay resistance in targeted pests to Bacillus thuringiensis (Bt) toxins in transgenic crops. We used an F2 screen to test a critical assumption of the high-dose refuge strategy, which is that resistance allele (R) frequencies are initially rare (<10(-3)) in Ostrinia nubilalis (Hübner) (Lepidoptera: Crambidae) from the southern Corn Belt. We expanded the methodological scope of the F2 screen so that both males and females may be used to initiate a screen and determined how the results from both sexes may be combined. In total, 62 female and 131 male O. nubilalis lines from Kansas and 39 female and four male lines from Texas were screened. No major resistance alleles were found and estimated R frequency for the southern Corn Belt was updated to between 0 and 0.0044 with 95% credibility. The experiment-wise detection probability was 98.7%. These results suggest the frequency of resistance alleles is low enough that the high-dose refuge resistance management strategy may be effective for delaying resistance evolution in O. nubilalis to Bt corn in the southern Corn Belt.

Cyclin E expression in breast cancer: predicting germline BRCA1 mutations, prognosis and response to treatment

BACKGROUND

Elevated levels of the cell cycle protein cyclin E, and low levels of its inhibitor, p27(Kip1), have been associated with a poor prognosis following breast cancer. Some studies have found that germline mutations in the breast cancer susceptibility gene, BRCA1, are also associated with an inferior survival rate. The relationship between cyclin E/p27(Kip1) levels, BRCA1 status and outcome has not been studied in detail.

PATIENTS AND METHODS

We analyzed a historical cohort of 288 Ashkenazi Jewish women who were diagnosed with breast cancer between 1980 and 1995 and were previously tested for BRCA1/2 mutations. Protein levels of cyclin E and p27(Kip1) were assessed by immunohistochemistry. Breast cancer-specific survival (BCSS) was the main outcome measured.

RESULTS

The median follow-up was 8 years. Thirty tumors carried germline BRCA1 mutations. These tumors were more likely to have high cyclin E protein levels [odds ratio (OR) 9.5; P <0.001] and low p27(Kip1) protein levels (OR 2.8; P=0.03) than tumors from patients without BRCA1/2 mutations. High cyclin E expression level was the strongest predictor of BRCA1 germline mutations (multivariate OR 4.7; P=0.004). On univariate analysis, high cyclin E protein levels [relative risk (RR) 2.6; P <0.001] and low p27(Kip1) protein levels (RR 2.3; P=0.006) were significant prognostic factors for a poorer BCSS. In Cox multivariate models, high cyclin E levels remained an independent indicator of poor outcome only in the subgroup of patients who did not receive chemotherapy (P=0.002).

CONCLUSIONS

In this ethnically restricted cohort, a high level of cyclin E is a characteristic of BRCA1-related breast cancer, and is a marker of poor prognosis following breast cancer, particularly in the absence of adjuvant chemotherapy.

Total hip arthroplasty using the Wroblewski golf ball cup inserted through the posterior approach

The Wroblewski golf ball acetabular cup was introduced by surgeons using the trochanteric osteotomy approach for revision total hip replacement (THR) in order to reduce the rate of dislocation. We have routinely used the Ogee long posterior wall (Ogee LPW) and the Wroblewski angle bore cups in THR. Although the new Wroblewski golf ball cup performed well there was a significant early rate of dislocation of 20%. Our rate of dislocation over a period of ten years using the Ogee LPW and Wroblewski angle bore cups had been 0.52%. We present our findings and an investigation as to why the new cup has such a high rate of dislocation when used with the posterior approach. We show that a relatively small change in the design of the acetabular component resulted in significant adverse clinical results.

Field trial of diatomaceous earth in cotton gin trash against the larger black flour beetle, Cynaeus angustus (Coleoptera: Tenebrionidae)

The larger black flour beetle, Cynaeus angustus (LeConte) (Coleoptera: Tenebrionidae), is an agricultural and home nuisance pest in North America. In the Southern High Plains of Texas, the larger black flour beetle is associated with cotton gin trash, by-products of cotton ginning that are field stored in large piles for economic reasons. Larger black flour beetle overwinter in gin trash piles but may disperse by the millions in summer and autumn, entering houses as far as 2 km away where they cause distress to homeowners. Because > 1.2 billion kg of gin trash is produced annually in Texas alone, the potential consequences of the larger black flour beetle are enormous. We conducted a field experiment that evaluated the efficacy of diatomaceous earth (DE) on the abundance of the larger black flour beetle in gin trash. There were no significant differences in numbers of larger black flour beetle among treatments and controls (mean number of adults summed over time: controls = 115.41, layered treatment = 87.60, top and bottom treatment = 96.50, bottom treatment = 115.16). There were sufficient numbers of beetles in treated piles to still pose a potential home nuisance problem, likely because the moisture content of field-stored gin trash is too high for DE to work effectively. Therefore, treating cotton gin trash with diatomaceous earth will probably be unable to prevent home infestations of larger black flour beetle. Location within a gin trash pile and season influenced pest numbers, which has implications for long-term field storage of cotton gin trash.

Frequency of alleles conferring resistance to Bt maize in French and US corn belt populations of the European corn borer, Ostrinia nubilalis

Farmers, industry, governments and environmental groups agree that it would be useful to manage transgenic crops producing insecticidal proteins to delay the evolution of resistance in target pests. The main strategy proposed for delaying resistance to Bacillus thuringiensis ( Bt) toxins in transgenic crops is the high-dose/refuge strategy. This strategy is based on the unverified assumption that resistance alleles are initially rare (<10(-3)). We used an F(2) screen on >1,200 isofemale lines of Ostrinia nubilalis Hübner (Lepidoptera: Crambidae) collected in France and the US corn belt during 1999-2001. In none of the isofemale lines did we detect alleles conferring resistance to Bt maize producing the Cry1Ab toxin. A Bayesian analysis of the data indicates that the frequency of resistance alleles in France was <9.20 x 10(-4) with 95% probability, and a detection probability of >80%. In the northern US corn belt, the frequency of resistance to Bt maize was <4.23 x 10(-4) with 95% probability, and a detection probability of >90%. Only 95 lines have been screened from the southern US corn belt, so these data are still inconclusive. These results suggest that resistance is probably rare enough in France and the northern US corn belt for the high-dose plus refuge strategy to delay resistance to Bt maize.

Modeling the development of resistance by stalk-boring lepidopteran insects (Crambidae) in areas with transgenic corn and frequent insecticide use

We simulated the population dynamics and population genetics of two bivoltine species of corn borers, the European corn borer, Ostrinia nubilalis (Hübner), and the southwestern corn borer, Diatraea grandiosella Dyar, in a hypothetical region of irrigated transgenic and nontransgenic corn where insecticide was applied only to the nontransgenic refuge crop. Over the 100-yr time horizon, resistance developed quickly in both species and to both transgenic corn and the insecticide when the allele for resistance to the respective toxin was dominant. When the allele for transgenic resistance was not dominant and the refuge location was constant over the time horizon, spraying the refuge to control southwestern corn borer had no effect on how quickly resistance to the transgenic corn developed. In contrast, the European corn borer developed resistance to transgenic corn much sooner when the refuge was sprayed once per year, and the time to 3% resistance allele frequency decreased as efficacy of the insecticide increased. Only when the refuge was treated less than once every 5 yr (10 generations) did the frequency of application decline enough to permit resistance management for the European corn borer to approximate the effectiveness of an unsprayed refuge. A consistently sprayed refuge <40% of the corn acreage was an inadequate resistance management strategy for the European corn borer even when a low efficacy insecticide (70% mortality) was used. When assumptions about European corn borer adult behavior were changed and the adults behaved similarly to adult southwestern corn borer, the development of resistance to the transgenic crop was slowed significantly.

The influence of age on outcome after operation for the carpal tunnel syndrome

Decompression of the carpal tunnel is a common surgical procedure. Although the incidence of the carpal tunnel syndrome increases with age, there is no clear information available on the outcome of surgery in relation to age. We studied prospectively 87 consecutive patients who underwent decompression, using a validated self-administered questionnaire, and found that improvement in symptoms and function decreased with increasing age. This was most marked in patients over the age of sixty years.

The influence of age on outcome after operation for the carpal tunnel syndrome. A prospective study

Decompression of the carpal tunnel is a common surgical procedure. Although the incidence of the carpal tunnel syndrome increases with age, there is no clear information available on the outcome of surgery in relation to age. We studied prospectively 87 consecutive patients who underwent decompression, using a validated self-administered questionnaire, and found that improvement in symptoms and function decreased with increasing age. This was most marked in patients over the age of sixty years.

High-quality RNA and DNA from flow cytometrically sorted human epithelial cells and tissues

Microarray technologies have made possible comprehensive analyses of nucleic acid sequence and expression. However, the technology to obtain efficiently high-quality RNA and DNA suitable for array analysis from purified populations of neoplastic cells from human tissues has not been well addressed. Microdissection can enrich for populations of cells present in various tumor tissues, but it is not easily automated or performed rapidly, and there are tissues in which cells of interest cannot be readily isolated based on morphologic criteria alone. Here we describe a protocol for efficient RNA and DNA isolation from flow cytometrically purified whole epithelial cells from primary tissue. The aqueous reagent, RNAlater, which preserves RNA, allows immunolabeling and purification of whole epithelial cells by flow sorting without special instrument preparation to reduce RNase activity. We used real-time PCR to determine RNA quality afterflow sorting. High-quality RNA and DNA suitable for expression and genotype analysis can be readily obtained from flow cytometrically purified populations of neoplastic cells from human tissues.

Concepts and data model for a co-operative neurovascular database

BACKGROUND

Problems of clinical management of neurovascular diseases are very complex. This is caused by the chronic character of the diseases, a long history of symptoms and diverse treatments. If patients are to benefit from treatment, then treatment decisions have to rely on reliable and accurate knowledge of the natural history of the disease and the various treatments.

METHODS

Recent developments in statistical methodology and experience from electronic patient records are used to establish an information infrastructure based on a centralized register.

RESULTS

A protocol to collect data on neurovascular diseases with technical as well as logistical aspects of implementing a database for neurovascular diseases are described. The database is designed as a co-operative tool of audit and research available to co-operating centres.

CONCLUSION

When a database is linked to a systematic patient follow-up, it can be used to study prognosis. Careful analysis of patient outcome is valuable for decision-making.

Associated Cerebral And Spinal AVM in Infant and Adult. Report of Two Cases Treated by Endovascular Approach

SUMMARY

We report two cases of a rare association of brain and spinal arteriovenous malformation (AVM) in an infant and in an adult. Both patients were embolised with glue with good clinical and morphological results. The first patient is an infant with a suspected family history of Rendu Osler Weber disease with multiple AVMs : two hemispheric cerebellar lesions (one of them revealed by a ventricular haemorrhage) and one cervical spinal cord AVM (SCAVM). The associated SCAVM fortuitously bled one month after treatment of the symptomatic cerebellar AV shunt. In the adult case, the management first involved a symptomatic SCAVM with favourable outcome; the cerebral AVM bled secondarily and was then excluded by endovascular approach.

Human papillomavirus and long-term oral contraceptive use increase the risk of adenocarcinoma in situ of the cervix

We examined United States Surveillance, Epidemiology, and End Results incidence data and conducted a population-based case-control study to examine the role of human papillomavirus (HPV) and oral contraceptive (OC) use in the etiology of adenocarcinoma in situ of the cervix (ACIS). One hundred and fifty women diagnosed with ACIS and 651 randomly selected control women completed in-person interviews. The presence of HPV DNA in archival ACIS specimens was determined by E6 and L1 consensus PCR. Serum samples from case and control subjects were collected at interview, and antibodies to HPV-16 L1 and HPV-18 L1 were detected by virus-like particle capture assays. The overall prevalence of HPV DNA was 86.6%, with 39.0% positive for HPV-16 DNA, 52.4% positive for HPV-18 DNA, and 13.4% positive for more than one HPV type. The age-adjusted relative risk of ACIS associated with HPV-18 seropositivity was 3.3 (95% confidence interval 2.2-4.9). No increased risk was associated with antibodies to HPV-16 L1. Among women born after 1945, the relative risk increased with duration of OC use, with the highest risk for 12 or more years of use (odds ratio, 5.5; 95% confidence interval, 2.1-14.6) relative to nonusers. The detection of HPV DNA in 86.6% of ACIS and the strong association of ACIS with HPV-18 L1 seropositivity underscore the importance of HPV, particularly HPV-18, in the etiology of ACIS. In addition, long-term OC use may contribute to the pathogenesis of these tumors in some women.

Human papillomavirus 16 and 18 L1 serology compared across anogenital cancer sites

Human papillomavirus (HPV) DNA has been detected in the great majority of cancers of the uterine cervix and anus, whereas the association of HPV DNA with cancer at other anogenital sites has produced less consistent results. This study was designed to compare HPV exposure among anogenital cancer cases and matched controls. Cases (1782) of anogenital cancer diagnosed in the Seattle area from 1978 to 1998 were identified and interviewed. Their responses were compared with those of 2383 age- and sex-matched controls. Blood was drawn at interview from both cases and controls and tested for antibodies to HPV-16 and HPV-18. Tissue blocks were tested for HPV DNA for 649 cases. Serum antibodies to HPV-16 were associated with in situ and invasive cancer at all sites among men and women with the exception of in situ penile cancer. Anti-HPV-18 antibodies were associated with cancers at all sites among women. The increased risk of cancer associated with HPV-16 seropositivity ranged from odds ratio = 1.8 (95% confidence interval, 1.4-2.5) for adenocarcinoma of the cervix to odds ratio = 5.9 (95% confidence interval, 3.4-10.3) for anal cancer in men. Associations between seroprevalence and cancers were stronger when analyses were restricted to HPV-16- or HPV-18 DNA-positive cases. HPV DNA was detected in >80% of cancers from all sites tested. HPV-16 DNA was the type most frequently detected at all sites (range, 40.9-82.2%). HPV-18 DNA was detected in 44.7% of adenocarcinomas of the cervix but detected much less often (2.6-18.1%) at other sites. These findings support an important role for HPV infection in anogenital cancer at all sites. Differences in the proportion of seropositives among HPV-16 DNA-positive cases by site suggest either that the immune response varies by site or that cancer development may lead to changes in antibody responses in a site-specific fashion.

Changing incidence rate of invasive lobular breast carcinoma among older women

BACKGROUND

In 1998, an unusually large number of invasive lobular breast carcinoma cases were seen at the University of Washington. The purpose of this study was to assess whether the incidence rate of invasive lobular carcinoma has been increasing disproportionately compared with the incidence rate of invasive ductal carcinoma.

METHODS

Age specific and age-adjusted breast carcinoma incidence rates from 1977-1995 were obtained from the nine population-based cancer registries that participate in the Surveillance, Epidemiology, and End Results (SEER) program. Three histologic groupings were used: lobular, ductal, and all invasive breast carcinomas. Overall incidence rates for each grouping, as well as for each stage (local, regional, and distant), were obtained.

RESULTS

The rate of incidence of lobular carcinoma increased steadily from 1977-1995 in women age >/= 50 years whereas it remained stable in women age < 50 years. Alternatively, the rate of incidence of ductal carcinoma increased steadily from 1977-1987, but from 1987-1995 it remained relatively constant across all age groups.

CONCLUSIONS

The incidence rates of invasive lobular breast carcinomas increased steadily since 1977 whereas the incidence rates of invasive ductal carcinoma have plateaued since 1987. This rise occurred specifically among women age >/= 50 years and may be related to postmenopausal status. Further epidemiologic, clinical, and laboratory research is required to assess what factors are contributing to this trend.

Enterobacter agglomerans spondylodiscitis: a possible, unrecognized complication of tetracycline therapy

STUDY DESIGN

This case report describes infection in a lumbar disc in a healthy young man with an organism of low pathogenicity. The patient was taking a prolonged course of antibiotics at the time the infection occurred.

OBJECTIVE

To describe this unique case of infective spondylodiscitis.

SUMMARY OF BACKGROUND DATA

To the authors' knowledge, spinal infection with Enterobacter agglomeranshas never been reported. This organism is a transient gut colonizer, and may have established itself secondary to the patient's prolonged ingestion of tetracycline for acne.

METHODS

This 22-year-old farmer had spontaneous lumbar back pain. Radiologic investigations showed an abnormality in the L4-L5 disc region, and together with other investigations, were suggestive of infection. The diagnosis was confirmed by surgical aspiration.

RESULTS

Antibiotic therapy was administered, and the patient made a complete recovery. Follow-up radiographs showed a complete loss of the L4-L5 disc space with only minimal bone destruction.

CONCLUSION

A unique cause of infective lumbar discitis is presented. Several features of this case are unusual. The magnetic resonance findings were not readily diagnostic. The cultured organism is usually nonpathogenic. The infection may have been secondary to prolonged tetracycline therapy.

Primary lymphoma of the bladder treated successfully with mitozantrone gel

We describe a young man who presented with a short history of painless haematuria. Subsequent investigations and biopsy of lesions found in his bladder at cystoscopy confirmed the diagnosis of primary lymphoma of the bladder. Computed tomography studies confirmed the disease was localised to his bladder. Unfortunately, the tumour was not eradicated by radiotherapy. However, it was successfully treated with intravesical mitozantrone given in a novel gel formation. Three years after diagnosis the patient remains well with no evidence of recurrence.

Variation in mammographic breast density by time in menstrual cycle among women aged 40-49 years

BACKGROUND

Mammography is less effective for women aged 40-49 years than for older women, which has led to a call for research to improve the performance of screening mammography for younger women. One factor that may influence the performance of mammography is breast density. Younger women have greater mammographic breast density on average, and increased breast density increases the likelihood of false-negative and false-positive mammograms. We investigated whether breast density varies according to time in a woman's menstrual cycle.

METHODS

Premenopausal women aged 40-49 years who were not on exogenous hormones and who had a screening mammogram at a large health maintenance organization during 1996 were studied (n = 2591). Time in the menstrual cycle was based on the woman's self-reported last menstrual bleeding and usual cycle length.

RESULTS

A smaller proportion of women had "extremely dense" breasts during the follicular phase of their menstrual cycle (24% for week 1 and 23% for week 2) than during the luteal phase (28% for both weeks 3 and 4) (two-sided P = .04 for the difference in breast density between the phases, adjusted for body mass index). The relationship was stronger for women whose body mass index was less than or equal to the median (two-sided P<.01), the group who have the greatest breast density.

CONCLUSIONS/IMPLICATIONS

These findings are consistent with previous evidence suggesting that scheduling a woman's mammogram during the follicular phase (first and second week) of her menstrual cycle instead of during the luteal phase (third and fourth week) may improve the accuracy of mammography for premenopausal women in their forties. Breast tissue is less radiographically dense in the follicular phase than in the luteal phase.

Decreased epinephrine responses to hypoglycemia during sleep

BACKGROUND

In patients with type I diabetes mellitus, hypoglycemia occurs commonly during sleep and is frequently asymptomatic. This raises the question of whether sleep is associated with reduced counterregulatory-hormone responses to hypoglycemia.

METHODS

We studied the counterregulatory-hormone responses to insulin-induced hypoglycemia in eight adolescent patients with type I diabetes and six age-matched normal subjects when they were awake during the day, asleep at night, and awake at night. In each study, the plasma glucose concentration was stabilized for 60 minutes at approximately 100 mg per deciliter (5.6 mmol per liter) and then reduced to 50 mg per deciliter (2.8 mmol per liter) and maintained at that concentration for 40 minutes. Plasma free insulin, epinephrine, norepinephrine, cortisol, and growth hormone were measured frequently during each study. Sleep was monitored by polysomnography.

RESULTS

The plasma glucose and free insulin concentrations were similar in both groups during all studies. During the studies when the subjects were asleep, no one was awakened during the hypoglycemic phase, but during the final 30 minutes of the studies when the subjects were awake both the patients with diabetes and the normal subjects had symptoms of hypoglycemia. In the patients with diabetes, plasma epinephrine responses to hypoglycemia were blunted when they were asleep (mean [+/-SE] peak plasma epinephrine concentration, 70+/-14 pg per milliliter [382+/-76 pmol per liter]; P=0.3 for the comparison with base line), as compared with when they were awake during the day or night (238+/-39 pg per milliliter [1299+/-213 pmol per liter] P=0.004 for the comparison with base line, and 296+/-60 pg per milliliter [1616+/-327 pmol per liter], P=0.004, respectively). The patients' plasma norepinephrine responses were also reduced during sleep, whereas their plasma cortisol concentrations did not increase and their plasma growth hormone concentrations increased slightly. The patterns of counterregulatory-hormone responses in the normal subjects were similar.

CONCLUSIONS

Sleep impairs counterregulatory-hormone responses to hypoglycemia in patients with diabetes and normal subjects.

Effect of implant dose/volume and surgical resection on survival in a rat glioma brachytherapy model: implications for brain tumor therapy

OBJECTIVE

This study sought to investigate the effects of implant dose/volume and surgical resection on survival in a rat glioma brachytherapy model. Two doses were investigated to determine a suitable therapeutic range.

METHODS

We performed two experiments. Three treatment groups and one control group of male F-344 rats bearing 9L brain tumors 12 days after tumor inoculation were used in the first experiment. Day 12 tumors were an average of 4 to 6 mm in diameter. Animals treated with brachytherapy received a tumor dose of 80 Gy delivered to a 5.5-mm-radius volume. Total macroscopic tumor removal was achieved by microsurgical techniques. A subsequent experiment compared the survival of tumor-burdened rats treated with an implant dose of 60 Gy delivered to a 5.5-mm-radius volume with a control group.

RESULTS

Surgery alone produced an increased life span of 28.6% over control animals treated with sham surgery and dummy seed implants, a statistically significant increase in survival (P = 0.0023, log-rank test). Brachytherapy alone produced the most significant increase in survival over control animals (P = 0.0001, log-rank test; median survival not attained with an implant dose of 80 Gy delivered to a 5.5-mm-radius volume; and P = 0.0001, increased life span 121% with an implant dose of 60 Gy delivered to a 5.5-mm-radius volume). This was not improved by the addition of surgical tumor removal.

CONCLUSION

We have demonstrated a relationship between implant dose/volume and survival of tumor-burdened rats in this model that is not improved by the addition of tumor removal. Implications for brain tumor brachytherapy are discussed.

Effects of age on perinatal substance abuse among whites and African Americans

This descriptive study assessed age effects on perinatal use of alcohol, marijuana, and cocaine among African-American and white women. Data were derived from the California Perinatal Exposure Study, relying on a statistical probability sample n = 29,494) of women who underwent anonymous urine toxicology screening in birthing hospitals. The central hypothesis was that there would be no difference in age effects on drug use among white and African-American women. Marital status and payment source were used as risk factors in order to create detailed age-risk profiles for both racial-ethnic groups. Logistic regression analyses were used and findings indicated that cocaine use peaked in early adulthood for whites and in mid-adulthood for African-Americans who had higher prevalence levels with the same or fewer risk factors as whites. Over one third of African-American women in their mid-thirties who were not married and who had publicly assisted births tested positive for cocaine. In contrast, high risk whites had higher marijuana prevalence levels than African-American women, and prevalence increased with age. Alcohol prevalence increased with age for African-American and white women who were publicly assisted, but decreased with age for all others. Findings for alcohol and marijuana generally followed the same risk-adjusted patterns for African American and white women but with different prevalence levels; however, cocaine use had a unique pattern with higher prevalence among African-American women in mid-adulthood regardless of risk level.

Randomized trial of breast self-examination in Shanghai: methodology and preliminary results

BACKGROUND

The efficacy of breast self-examination in helping to reduce mortality from breast cancer has not been rigorously demonstrated.

PURPOSE

To assess efficacy, a large, randomized trial was initiated in Shanghai, China.

METHODS

From October 1989 to October 1991, 267040 current and retired female employees associated with 520 factories in the Shanghai Textile Industry Bureau were randomly assigned on the basis of factory to either a self-examination instruction group (133375 women) or a control group (133665 women). The women were born within the period from 1925 through 1958. Women in the instruction group were given intensive training in breast self-examination, including the use of silicone breast models and personalized instruction, plus two subsequent reinforcement sessions and multiple reminders to practice the technique. Women in the control group were asked to attend training sessions on the prevention of low back pain. All women have been followed for the development of breast diseases and for death from breast cancer.

RESULTS

A high level of participation during the first 4-5 years of the trial was documented among women in the instruction group. Randomly sampled women in this group demonstrated greater proficiency in detecting lumps in breast models than did randomly sampled women in the control group. Approximately equal numbers of breast cancers were detected in the two groups (331 in the instruction group and 322 in the control group) through 1994, which is the last year for which case-finding efforts have been completed. The breast cancers detected in the instruction group were not diagnosed at an appreciably earlier stage or smaller size than those in the control group. More benign breast lesions were detected in the instruction group than in the control group (1457 versus 623, respectively), suggesting a higher index of suspicion for women who received training. Cumulative breast cancer mortality rates through 5 years from entry into the study were nearly equivalent for the two groups.

CONCLUSIONS

Breast self-examination has not led to a reduction in mortality from breast cancer in this study cohort in the first several years since the trial began. A shift toward the diagnosis of disease at a less advanced stage in women given instruction has also not been demonstrated. Longer follow-up of participants in this trial is required before final assessment can be made of the efficacy of breast self-examination.

IMPLICATIONS

At this time, there is insufficient evidence to recommend for or against the teaching of breast self-examination.

Prenatal substance abuse in California: findings from the Perinatal Substance Exposure Study

This article reports the overall statewide findings of an epidemiological study that included 29,494 pregnant women who had been admitted for delivery in more than 200 hospitals in California and who were tested for alcohol and other drugs via blind urine toxicology screens. Results were matched to demographic data. The article includes analysis and discussion of four major variables: race/ethnic group differences, acculturation, source of payment for birth, and prenatal care status. Regional results are also discussed. The authors emphasize the high rate of alcohol use and self-reported tobacco use in comparison to relatively low rates of illicit drug use. Alcohol use rates were fairly stable, while use of illicit drugs and tobacco tended to vary according to social and demographic variables. The findings establish the need for both broad-based and targeted prevention and intervention programs to better disseminate the risks involved in drinking alcohol, smoking tobacco, and using drugs during pregnancy.

Gene mapping of familial autosomal dominant dilated cardiomyopathy to chromosome 10q21-23

Dilated cardiomyopathy (DCM) is the most common form of primary myocardial disorder, accounting for 60% of all cardiomyopathies. In 20-30% of cases, familial inheritance can be demonstrated; an autosomal dominant transmission is the usual type of inheritance pattern identified. Previously, genetic heterogeneity was demonstrated in familial autosomal dominant dilated cardiomyopathy (FDCM). Gene localization to chromosome 1 (1p1-1q1 and 1q32), chromosome 3 (3p25-3p22), and chromosome 9 (9q13-9q22) has recently been identified. We report one family with 26 members (12 affected) with familial autosomal dominant dilated cardiomyopathy in which linkage to chromosome 10 at the 10q21-q23 locus is identified. Using short tandem repeat polymorphism (STR) markers with heterozygosity > 70%, 169 markers (50% of the genome) were used before linkage was found to markers D10S605 and D10S201 with a pairwise LOD score = 3.91, theta = 0, penetrance = 100% for both markers. Linkage to 1p1-1q1, 1q32, 3p25-3p22, and 9q13-9q22 was excluded. We conclude that a new locus for pure autosomal dominant FDCM exists, and that this gene is localized to a 9 cM region of 10q21-10q23. The search for the disease causing gene and the responsible mutation(s) is ongoing.

A syndrome of multiorgan hyperplasia with features of gigantism, tumorigenesis, and female sterility in p27(Kip1)-deficient mice

SUMMARY

Targeted disruption of the murine p27(Kip1) gene caused a gene dose-dependent increase in animal size without other gross morphologic abnormalities. All tissues were enlarged and contained more cells, although endocrine abnormalities were not evident. Thymic hyperplasia was associated with increased T lymphocyte proliferation, and T cells showed enhanced IL-2 responsiveness in vitro. Thus, p27 deficiency may cause a cell-autonomous defect resulting in enhanced proliferation in response to mitogens. In the spleen, the absence of p27 selectively enhanced proliferation of hematopoietic progenitor cells. p27 deletion, like deletion of the Rb gene, uniquely caused neoplastic growth of the pituitary pars intermedia, suggesting that p27 and Rb function in the same regulatory pathway. The absence of p27 also caused an ovulatory defect and female sterility. Maturation of secondary ovarian follicles into corpora lutea, which express high levels of p27, was markedly impaired.

Thrombospondin-1, an inhibitor of angiogenesis, is regulated by progesterone in the human endometrium

Thrombospondin-1 (TSP1), a multifunctional extracellular matrix glycoprotein, has been shown to suppress the angiogenic response in vivo and in vitro. We hypothesized that TSP1 might play a role in the inhibition of capillary morphogenesis during the endometrial cycle and examined its expression in 46 human endometrial specimens. Our results show that the expression of TSP1 in the endometrium is (a) cycle-dependent, (b) associated with periods of low capillary growth, and (c) regulated by progesterone. TSP1 protein was identified in the basement membrane of capillaries of the functional endometrium during the secretory phase. Abundant expression of TSP1 mRNA in the secretory phase was also detected by in situ hybridization, in contrast to the low levels seen in the proliferative phase. These findings were confirmed by Northern analysis of proliferative and secretory endometrium. Transcripts for TSP1 were observed predominantly in stromal cells, but signal was also detected in some endothelial and smooth muscle cells. Since the proliferation of endometrial tissue is regulated by steroid hormones, we tested the effects of estrogen and progesterone on TSP1 expression by stromal cells isolated from human endometrium. We found that levels of TSP1 mRNA and protein were increased after incubation with progesterone. Maximal stimulation of mRNA was observed after 8 h of treatment with 10-50 microM progesterone, and the effect was suppressed by the progesterone antagonist RU-486. Induction by progesterone was cell-specific and equivalent to the stimulation mediated by PDGF. Finally, the levels of TSP1 present in progesterone-stimulated cultures were sufficient to inhibit the migration of endothelial cells in vitro; this effect was nullified by anti-TSP antibodies. We therefore propose that the production of TSP1 at later stages of the endometrial cycle is linked to the inhibition of vessel formation and that TSP1 expression is progesterone-dependent in this tissue.