Suspected Breast Cancer Research Articles

Value of needle biopsy in outpatient diagnosis of breast cancer.

Outpatient needle biopsy of suspected breast cancers has been performed on 151 patients. Of 135 who were ultimately diagnosed as having a malignant tumor, 107 were correctly diagnosed on the initial needle biopsy, a success rate of 79%. The procedure is well tolerated by most patients and enables family support during a very stressful period. Furthermore, outpatient histopathologic confirmation of cancer allows adequate preoperative investigation and more efficient use of operating theater time.

Psychiatric problems in the first year after mastectomy.

The psychiatric morbidity associated with mastectomy was assessed in 75 women by following them up from the time they presented with suspected breast cancer to one year after the operation. Fifty women with benign breast disease served as controls. Throughout the follow-up period the incidence of psychiatric problems was higher among the women who had undergone mastectomy. One year after surgery 19 (25%) of these women compared with only 5 (10%) of the controls needed treatment for anxiety or depression or both, and 16 (33%) compared with 3 (8%) respectively had moderate or severe sexual difficulties. Altogether 29 patients in the mastectomy group (39%) and six of the controls (12%) had serious anxiety, depression, or sexual difficulties. Of the eight women in the mastectomy group who sought help for their problems, only two felt that the help given had been appropriate. The inability to recognise and treat these emotional disturbances is a common and serious problem. Monitoring by specially trained nurses and social workers might help to identify them earlier and even reduce them.

Immune competence in breast cancer ? Relationship of pretreatment immunologic tests to diagnosis and tumor stage

The immune competence of a group of 276 patients with suspected breast cancer has been assessed using a spectrum of tests: the peripheral lymphocyte count, serum immunoglobulin levels, lymphocyte response to phytohemagglutinin (PHA), Mantoux test, and dinitrochlorobenzene (DNCB) skin test. All tests were completed prior to any form of treatment as the initial part of an ongoing, long-term assessment which will ultimately relate immune competence to prognosis. 225 patients with breast cancer were allocated into stages based on their TNM status. The remaining 51 patients proved to have benign breast disease and made up the control group. In analysis, control patients were compared with “early” breast cancer patients, while the effect of advancing disease was assessed by betweenstage comparisons in the cancer group. There were no significant differences between “early” breast cancer and control patients or between cancer stages in peripheral lymphocyte count, serum immunoglobulin levels, lymphocyte response to PHA, or Mantoux responses. Age was found to have a crucial effect on some of these parameters and some apparent differences between the various groups lost significance after appropriate allowances were made for age. Important differences seen with the DNCB test persisted after allowing for age effects. Responses to DNCB were significantly depressed in patients with “early” breast cancer compared to controls. Patients with disseminated cancer showed greater depression than early breast cancer patients, but surprisingly, patients with locally advanced tumors had good responses to DNCB. Possible reasons for the paradoxical preservation of DNCB reactivity in patients with locally advanced cancer are discussed. The DNCB test is the most discriminating of the five tests of immune function studied.

Preoperative bone scans. Use in women with early breast cancer.

Strontium nitrate Sr 87m bone scans were made preoperatively in a group of women with suspected breast cancer, 35 of whom subsequently underwent radical mastectomy. In 3 of the 35 (9%), the scans were abnormal despite the absence of clinical or roentgenographic evidence of metastatic disease. All three patients has extensive axillary lymph node involvement by tumor, and went on to have additional bone metastases, from which one died. Roentgenograms failed to detect the metastases in all three. Occult bone metastases account in part for the failure of radical mastectomy to cure some patients with breast cancer. It is recommended that all candidates for radical mastectomy have a preoperative bone scan.

Preoperative Bone Scans

Strontium nitrate Sr 87m bone scans were made preoperatively in a group of women with suspected breast cancer, 35 of whom subsequently underwent radical mastectomy. In 3 of the 35 (9%), the scans were abnormal despite the absence of clinical or roentgenographic evidence of metastatic disease. All three patients has extensive axillary lymph node involvement by tumor, and went on to have additional bone metastases, from which one died. Roentgenograms failed to detect the metastases in all three. Occult bone metastases account in part for the failure of radical mastectomy to cure some patients with breast cancer. It is recommended that all candidates for radical mastectomy have a preoperative bone scan.

Uptake of 206 Bi citrate in carcinoma of the breast.

Eighteen patients with suspected breast cancer were given 206Bi citrate 12 hours before breast biopsy. 206Bi activity was measured in pathological and normal breast tissue removed at surgery and in the blood. Four of 5 malignant tumors showed substantially higher 206Bi activity than the surrounding normal breast tissue or blood, and the mean tumor uptake was significantly higher than that of the nonmalignant tissue.

Thermography in detection of early breast cancer.

Thermography has been regarded chiefly as an adjunct to physical examination and mammography in suspected breast cancers. the possibility that elevated skin temperatures of themselves may have significance has been regarded with little enthusiasm or frank skepticism. Four cancers that came to biopsy solely on the basis of elevated skin temperatures are presented. in each case, physical examination and mammographic studies were negative or equivocal. All four cancers were Stage I, with no axillary lymph node metastasis. the reports of other thermographers, who have found breast cancers entirely on the basis of elevated skin temperatures, are cited.

Breast Cancer and Progestogens

To the Editor:— In the issue of Sept 25 (201:1058, 1967), Dr. Anna Southam answered question about administration of estrogens to women with suspected breast cancer. She stated that a synthetic progestogen which is commercially available in the United States is effective in relieving the symptoms of chronic cystic mastitis, but for some reason she refrained from being specific about which of the available progestogens she uses for this purpose. Most of the marketed products are combined with estrogen. I would also like to call attention to the statement by Francis Moore (New Eng J Med277:295, 1967) that progestogens stimulate breast cancer metastases as do estrogens. Dr. Moore et al refer to study which reported stimulation of breast cancer by medroxyprogesterone acetate (Provera) which would militate against confident use of progestogens in those same patients in whom estrogen was felt to be contraindicated.