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Query: UMLS:C0006142 (breast cancer)
 160,383 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with breast cancer have been classified as having slow, intermediate, or rapid rates of disease progression through the use of a clinical index, which depends on data from the patient's history. Patients without evidence of adverse progression of disease who waited 4 months or more between their first symptom and treatment were classified as slow; those waiting less than 4 months, intermediate. Patients with evidence of adverse progression were classified as rapid. We evaluated the 616 patients who had no evidence of distant disease at the time of treatment from an inception cohort of 685 patients to assess the correlation between the slow, intermediate, and rapid strata and the disease-free interval. Ten percent were in TNM stage I, 63% in TNM stage II, and 26% in TNM stage III. Among the 43% (266/616) of patients who developed recurrent disease, the median disease-free interval was longest in the slow stratum (33.6 months) and shortest in the rapid stratum (19.5 months). The difference in the 10-year disease-free survival rates in the three strata was significant (chi 2 = 26.4; p less than 0.001). The findings were similar when prognosis was assessed within the TNM stage or nodal groups. For example, in the rapid stratum, node-negative and node-positive patients had almost identical disease-free intervals. The independence of the contribution of the rate of disease progression strata to predicting disease-free survival was confirmed through the Cox analysis. If breast cancer did recur, the manifestation occurred sooner in patients who were demarcated as rapid by the clinical index. Thus the index estimates the aggressiveness of residual disease when it is present.
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PMID:Rate of progression in breast cancer and the disease-free interval. 398 15

The reported incidence of local recurrence after mastectomy for locally advanced breast cancer (TNM Stage III and IV) is between 30% and 50%. The purpose of this study was to evaluate the effect of radiation therapy (XRT) followed by total mastectomy on the incidence of local recurrence in patients with locally advanced breast cancer. Fifty-three patients who presented with locally advanced breast cancer, without distant metastases, were treated with XRT (4500-5000 R) to the breast, chest wall, and regional lymph nodes. Five weeks after completion of XRT, total mastectomy was performed. There were no operative deaths. The complications that occurred in 22 patients after surgery were flap necrosis, wound infection, and seroma. Patients have been followed from 3 to 134 months. Twenty-five patients are alive (3-134 months), 12 free of disease; 28 patients have died with distant metastases (6-67 months). Isolated local recurrence occurred in only two patients. Four patients had local and distant recurrence (total local recurrence is 6/53). The remaining patients all developed distant metastases. We have devised a treatment strategy which significantly decreases the incidence of local recurrence in patients with locally advanced breast cancer. However, the rapid appearance of distant metastases emphasizes the need for systemically active therapy in patients with locally advanced breast cancer.
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PMID:Surgical adjuvant treatment of locally advanced breast cancer. 399 34

Reduced cellular immune response is well documented in patients with advanced breast cancer. To investigate immunocompetence at the time of diagnosis, 104 patients with breast cancer staged according to the TNM classification were studied preoperatively and compared with 95 age matched healthy women. Tests of blood mononuclear leukocytes included lymphocyte and monocyte counts, determination of rosette forming T (SER +) and B (MER +) lymphocytes, T lymphocyte subsets defined with monoclonal antibodies (Leu-1, Leu-2a, Leu-3a) and with lectin fractionation (soybean agglutinin, SBA), lymphocyte transformation tests with PHA and ConA and colony formation of T cells in agar (TL-CFC). Two age groups (A: 30-50, B: 51-70 years) and the different tumor stages (I-IV) were analyzed. Patients and controls did not differ in absolute numbers of lymphocytes, T and B cells. In patients of group B the absolute number of monocytes was slightly increased in stages II and III and significantly in stage IV (p less than 0.025). Similarly, the lymphocyte response to PHA was significantly reduced in stage IV group B only (p less than 0.05). ConA induced lymphocyte proliferation and TL-CFC capacity were not different in patients and controls. In the small number of patients and age matched controls, in whom T lymphocyte subsets were determined, the relative numbers of T cells with helper or suppressor phenotype as defined with Leu-3a, Leu-2a, or SBA were similar. In conclusion, in breast cancer, at the time of diagnosis, blood T lymphocyte populations and functions are not altered except in elderly patients with disseminated disease. The monocytosis and reduced PHA responsiveness observed in the latter group may be related phenomena.
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PMID:[Intact cellular immune response in patients with locally metastasizing breast carcinoma at the time of diagnosis]. 622 73

Four hundred and forty-seven women with operable (TNM stage I or II) breast cancer in whom oestrogen receptors (ER), progesterone receptors (PgR) or both receptors had been assayed were studied. Receptor status was independent of axillary nodal status, but infiltrating duct carcinomas that were ER-, PgR- or ER-PgR- were more likely to be anaplastic (P less than 0.001). Four hundred patients with follow-up and uniform treatment were analysed for post-operative disease-free interval (DFI) and survival. No significant difference in DFI existed between patients with ER+ and ER- tumours or PgR+ and PgR- tumours, although there was a trend for longer DFI for ER+ and PgR+. DFI was longer in patients with better-differentiated (grade 1 and 2) tumours than with anaplastic (grade 3) tumours. In patients with ER+ tumours, those with grade 1 and 2 tumours had a longer DFI than those with grade 3 tumours (P less than 0.005). Survival was significantly longer in patients with ER+ tumours compared to those with ER- tumours (P less than 0.001), but there was no such association between tumour PgR and survival. Survival of patients with ER+PgR+ tumours was significantly longer than those with ER-PgR- tumours (P less than 0.025) and, in patients with no evidence of axillary nodal involvement, significantly longer than those with ER+PgR- tumours. Survival in patients with nodal involvement was influenced by histological grade, being longer in those with grade 1 or 2 tumours compared to those with grade 3 tumours. For ER+ tumours, survival was longer in patients with grade 1 or 2 than with grade 3 tumours. These results suggest that steroid receptors significantly affect survival but not DFI. This effect is most closely related to ER content, with relatively little additional information accruing from analysis of PgR. Histological grade influences both DFI and survival, and analysis of both grade and ER content may give a more accurate indication of prognosis in operable breast cancer.
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PMID:Steroid receptors and prognosis in operable (stage I and II) breast cancer. 631 42

Peripheral blood lymphocytes from female patients with early breast cancer were examined before surgery for their ability to develop a primary antibody response in vitro against sheep red blood cells in soft agar cultures containing autologous plasma. After 6 days incubation, foci of proliferating hemolysin-forming cells surrounded by a lytic area were detected on the surface of the plates and counted with a dissection microscope; this response was antigen-dependent and antigen-specific. We applied this assay to a group of women suffering from early breast cancer and devoid of distant metastases. From our data, it appears that if all the patients are grouped together, cancer-bearing women produce somewhat fewer (P less than 0.05) haemolytic foci than healthy controls. However, division of the cancer patients into two subgroups, according to the TNM pretreatment clinical classification of regional lymph nodes, generated an interesting finding: N1 patients (N1b or N1a) produced definitely fewer foci than N0 patients, and the difference was highly statistically significant (P less than 0.001). The depression of anti sheep red blood cell antibody production observed in N1 patients was unrelated to the presence or absence of metastatic growth in their regional lymph nodes.
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PMID:Antibody production in cultured blood lymphocytes from breast cancer patients. 635 85

Surveys of surgical practice in the United States during the last 2 decades have documented a gradual retreat from the standard radical mastectomy for treatment of early breast cancer. During this time, clinical trials have tested traditional principles of cancer surgery, and permitted conclusions to be made regarding treatment alternatives. Modified mastectomy (total mastectomy plus axillary dissection) has proved equal to radical mastectomy in terms of survival, disease-free survival, and local tumor control in a randomized trial confined to TNM clinical Stage I and II cases. This study showed that routine removal of grossly uninvolved pectoral muscles (and apical axillary nodes) is not necessary in early cases, a result which failed to support the principle of en bloc dissection. Trials addressed to the practice of prophylactic regional node dissections have indicated that node dissections are useful for reducing regional tumor recurrence, for providing prognostic information, and for establishing the need for adjuvant treatment, but they do not improve overall survival. Metastases in lymph nodes appear to be a sign, rather than a source, of tumor dissemination. Furthermore, a recent trial indicates that routine removal of the breast may not be necessary in early cases. High-dose irradiation of the breast (after wide excision of the primary and axillary dissection) in TNM clinical Stage I cases provided local tumor control and survival comparable to that of radical mastectomy. Trials of breast preservation not yet complete address more advanced stages (TNM I and II), and the question of whether irradiation is necessary in all cases. On the basis of completed studies, it appears that TNM clinical State I and II cancers can be appropriately treated with modified mastectomy; Stage I cancers can be treated equally well with irradiation of the breast after quadrantectomy and removal of axillary lymph nodes.
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PMID:Surgical clinical trials. 636 22

In order to improve the long-term cosmetic results following the radical irradiation of primary breast cancer at Mount Vernon Hospital, dosage was reduced in the early 1970s. The clinical impression that local recurrence had become more frequent at the reduced dose level led to an early review of the results. This report details the results in 159 patients who formed the two largest groups of patients treated between 1968 and 1980. Sixty-five patients were treated between 1968 and 1973, using 6500 cGy to the whole breast in 25 daily fractions over 5 weeks, with alternate breast fields treated each day. Forty-two of these patients were with TNM stage I and II disease [TNM Classification of Malignant Tumours, Geneva, UICC, 1978] and had 5-yr actuarial survival and local recurrence figures of 59 and 10% respectively. The corresponding figures in 52 patients with stage I and II disease treated between 1974 and 1980 with 5500 cGy to the whole breast in 25 daily fractions over 5 weeks with both breast fields treated each day were 79 and 26.6%. In spite of the small numbers involved and the bias in favour of the latter group of patients, who had a greater proportion of T1,N0 lesions, the difference in local recurrence rate in favour of the former group (who received 6500 cGy) almost reached statistical significance at the 0.05 level. A difference was also observed when the two subgroups of stage I and II patients who had had their primaries excised prior to irradiation were compared. The 23 patients with TNM stage IIIa and b disease treated with 6500 cGy between 1968 and 1973 had similar local recurrence (49.7% at 18 months) and survival experience (32.5% at 5 yr) to the 42 similarly staged patients treated with 5500 cGy between 1974 and 1980 (48 and 36.4% respectively). It is possible that the addition of combination cytotoxic therapy to the primary management in 12 patients with stage IIIb disease in the latter group favourably influenced the local control data obtained. Cosmetic results were substantially better in the groups receiving 5500 cGy, with approximately 20% developing disfiguring retraction and skin changes. In contrast, these sequelae were almost inevitable in the patients who received 6500 cGy.
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PMID:Recent experience in the radical irradiation of primary breast cancer at Mount Vernon Hospital. 642 88

The survival of the patients with breast cancer depends on many factors. The TNM system, which is the most widely used prognostic system takes into account only the size, and the local extension of the tumor, and presence or not of axillary or supraclavicular lymph nodes. The axillary nodes involvement is the single precise prognostic variable. However, other valuable and important factors are to be considered. As a matter of fact, the growth rate of the tumors, their estrogen and progesterone receptor status, and their histopathological grade may reflect with a better accuracy the tumor biology, and should be integrated among the variables to study before the choice of an adjuvant treatment.
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PMID:[Evaluation of prognostic factors in breast cancer]. 649 47

Breast cancer presenting in 32 Nigerian women 30 years of age or younger was studied; 32 other premenopausal women matched in TNM stage of disease served as controls. More than 80% of both groups presented with advanced breast carcinoma; 18.7% of the study group patients were pregnant or lactating. Management consisted of some form of surgery and chemotherapy (methotrexate, cyclophosphamide, 5-fluorouracil and prednisolone for both groups). Two year survival for the study group (25%) was lower than that of the control group (37.5%). Breast cancer in this age group is a problem which needs further documentation in Africa. Earlier diagnosis, and a more aggressive combined modality therapy are needed to improve the prognosis.
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PMID:Breast carcinoma in young Nigerian women. 650 4

Calcitonin seasonal (circannual) variations in apparently healthy women and in women suffering from breast cancer in different evolutive-TNM-stage, were studied. Annual values are higher in patients with breast cancer, but there is no correlation with metastases. A significant calcitonin circannual rhythm with acrophase in winter was detectable in controls but not in breast cancer patients. The circannual rhythm obliteration could be a predictive signal of disease and not only metastatic disease.
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PMID:Calcitonin in a chronoepidemiologic perspective. 652 20


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