Predictors of Self-Reported Family Health History of Breast Cancer

The objective of this study was to identify predictors of self-reported family health history of breast cancer in an ethnically diverse population of women participating in a breast cancer screening program. Participants completed a self-administered questionnaire about their demography, health, breast health and family health history of breast cancer. The association between family health history of breast cancer and categorical variables were analyzed using the T test, chi square, and multi-nominal logistic regression. Those who were least likely to report a family history of cancer were African Americans (p = 0.02), and immigrant women from South America (p < 0.001) and Africa (p = 0.04). However, 34.4 % reported having a second-degree maternal relative with breast cancer compared to 6.9 % who reported having a second degree paternal relative with breast cancer. Therefore, there is a need to increase efforts to educate families about the importance of collecting and sharing one's family health history.

Functionally active estrogen receptor isoform profiles in the breast tumors of African American women are different from the profiles in breast tumors of Caucasian women

BACKGROUND

Several cancer surveys have shown that African-American women (AAW) develop highly aggressive breast tumors and experience about three times higher mortality rates compared with other populations. Generally, breast tumors in AAW are poorly differentiated or undifferentiated and exhibit increased frequency of nuclear atypia, higher mitotic activity, higher S-phase fraction, and tumor necrosis. The molecular factors responsible for these tumor characteristics are mostly unknown.

METHODS

To explore whether the aggressive tumor biology observed in AAW is related to distinct alterations in estrogen receptor (ER) isoforms, the relative expression levels of four functionally active ER isoform mRNAs, ERalpha wild type, ERbeta wild type, ERalpha exon 3delta, and ERalpha exon 5delta, were measured by reverse transcriptase-polymerase chain reaction analysis in 18 immunohistochemically ERalpha positive tumors and in 6 ERalpha negative tumors and their matched normal tissues.

RESULTS

In the tumors of AAW, the protective ERbeta isoform was decreased significantly compared with matched normal tissues (paired t test; n = 24 patients; P = 0.0018). In addition, both the constitutively active ERalpha exon 5delta and the dominant negative ERalpha exon 3delta mRNA levels were elevated in tumor tissues compared with matched normal tissues (paired t tests; n = 24 patients; P = 0.0002 and P = 0.024, respectively).

CONCLUSIONS

The data presented here show for the first time that functionally active ER isoform profiles in the breast tumors of AAW are different from those in Caucasian women. The tumors in AAW are characterized by decreased levels of the protective ERbeta isoform and elevated levels of the constitutively active ERalpha exon 5delta isoform. Variations in estrogen-mediated signaling because of the alterations in these two ER isoforms may account in part for differences in tumor biology between AAW and Caucasian women.

Management of intractable pain in cancer patients by implantable morphine infusion systems

Ten patients underwent implantation of intrathecal morphine catheters with subcutaneous implantation of morphine Infusaid pumps for the treatment of intractable pain of malignant origin from May 1984 to October 1985. All patients exhibited a good initial response to intrathecal morphine and developed some degree of tolerance. All patients with bony metastasis and/or lumbarsacral plexopathy developed rapid tolerance.Depressive illness was noted in all patients undergoing a psychiatric evaluation prior to institution of morphine infusion therapy. Seventy percent of patients treated could be treated on an outpatient basis after pump implantation.Complications included a pump pocket infection requiring the removal of the implanted system. There was no pump failure, respiratory depression, urinary retention, or mortality related to the use of the morphine infusion system. It is recommended that intrathecal morphine infusion be instituted when narcotics have been identified as necessary for pain relief, before the development of significant systemic tolerance.

The first simultaneous intraoperative hyperthermia and radiotherapy procedure: dog experiment and technique

The Department of Radiation Therapy of Howard University Hospital was the first to revive (1976) the use of intraoperative radiotherapy, or direct view irradiation, using electron beam (IORTe(-)) in the United States. Since that time, this pioneering effort has gained both national and international acceptance. Now, many leading centers employ this investigational treatment modality. Recently, a new mode of cancer therapy has been gaining acceptance, namely hyperthermia (the treatment of cancer by heat). Hyperthermia has been shown, both experimentally and clinically, to improve the rate of local control (thermal enchancement ratio [TER]) when combined with radiation therapy in the treatment of cancer. Maximal TER has been observed with simultaneous or immediate application of radiation and hyperthermia for both tumor and normal tissues. Therefore, to achieve maximum therapeutic gain, selective, intraoperative, simultaneous heating and irradiation of the tumor with mechanical retraction of the normal and sensitive structures from the treatment field seems a promising alternative.There have been no published reports, to the authors' knowledge, on the combination of simultaneous IORTe(-) with intraoperative hyperthermia (IOHT). To employ this combination in human subjects, several questions must be answered first using animal models, including the technical and practical feasibility, the toxicity and morbidity, as well as the pathologic changes that may arise. The technical aspects of the first animal case, using a mongrel dog, applying simultaneous IORTe(-) and IOHT are presented.

Malignant melanoma of the skin of the nose

Seventeen patients with cutaneous melanomas of the nose were treated at the M. D. Anderson Hospital during the years 1944-1978. The local recurrence rate was 6 per cent. The two-year survival rate was 82 per cent; the five-year survival rate, 29 per cent; the ten-year survival rate, 12 per cent. Only 20 per cent of the patients developed histologically positive lymph nodes, and all died of the disease. Wide local excision with skin grafting is the treatment of choice, with a modified neck dissection and/or superficial parotidectomy reserved for subsequent nodal metastasis.