BACKGROUND: Through the International Male Breast Cancer Program, a prospective registry for male BC was created with the goals of evaluating 1) the clinical and biological features of this disease and 2) assessing feasibility of a prospective therapeutic clinical trial. METHODS: All men, with any stage histologically proven invasive breast cancer, age 3 18 years, and newly presenting at the participating institutions (within 3 months prior) were eligible. Patients were enrolled for 30 months after activation of the first center, through February 2017. Per the study design, if <100 men enrolled, the study would be considered a failure and therapeutic trials would not be pursued through this network. Epidemiologic data, staging, pathologic features, and BRCA status were collected. Treatment and outcome data collection is ongoing. Optional collection of FFPE tumor samples, blood, and QOL were performed in the US, the Netherlands, and Latin America. Clinical database lock for this report was May 30, 2017. We currently report patient and disease characteristics and will update with patterns of treatment for the presentation. Outcomes and biological samples will be analyzed in the future. RESULTS: 557 patients were enrolled: 75% in Europe, 20% in United States, 5% in other countries. 6.3% of patients had missing forms. Median age was 67 years (range 26-92). 93% were diagnosed 2010-2017. Among patients with complete data, 79% presented with a breast mass. 88% were M0 and 12% M1. Among M0 patients: 47%, 39%, 2%, and 11% had T1, T2, T3, and T4 disease respectively; 52% were N0. Overall, 98% had ER+ disease and 11% had HER2+ cancer. 14% had grade 1, 56% had grade 2, and 30% had grade 3 tumors. Among 112 men who underwent BRCA1 testing, 1 was positive. Among 118 men who had BRCA2 testing, 18 (15%) were positive. 21% of men had prior or concurrent malignancies, with the following most common sites: prostate, non-melanoma skin, colorectal, and melanoma. The prevalence of previously identified possible risk factors for male breast cancer were: overweight/obesity (72%), former/current smoker (51%), current alcohol 31 drink daily (41%), family history of breast cancer (35%), gynecomastia (16%), history radiation exposure (8%), use of anti-androgens (1%), and use of estrogens (1%). CONCLUSION: Through an international collaborative effort, we were able to prospectively accrue 557 patients to a male breast cancer registry. These results demonstrate feasibility of pursuing a therapeutic clinical trial in men with breast cancer. In addition, this study shows the relatively low uptake of BRCA testing, high rates of concurrent/prior malignancy, and the rates of potentially modifiable risk factors in this patient population. Funding from Breast Cancer Research Foundation, Susan G. Komen, Dutch Pink Ribbon Foundation, Swedish Breast Cancer Association (BRO) and EBCC Council. Citation Format: Giordano SH, Schröder CP, Poncet C, van Leeuwen-Stok E, Linderholm B, Abreu MH, Rubio I, Van Poznak C, Morganstern D, Cameron D, Vleugel MM, Smilde TJ, Bozovic-Spasojevic I, Korde L, Russell NS, den Hoed IDM, Honkoop AH, van der Velden AWG, van 't Riet M, Dijkstra N, Bogler O, Goulioti T, Hilsenbeck S, Ruddy KJ, Wolff A, van Deurzen CHM, Martens J, Bartlett JMS, Aalders K, Tryfonidis K, Cardoso F. Clinical and biological characterization of male breast cancer (BC) EORTC 10085/TBCRC 029/BOOG 2013-02/BIG 2-07: Baseline results from the prospective registry [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 P5-23-01.
Hyperuricemia is commonly found in the general population, with a prevalence of about 20 to 25% in adult men and slightly lower prevalence in pre-menopausal women. In both genders, incidence increases with age 1. The prevalence of chronic kidney disease (CKD) has been increasing in the past few years, with its morbidity and mortality not only related to the end-stage renal disease (ESRD), but also with cardiovascular disease. As such, every effort must be made to slow its progression. Emerging evidence suggests that the relationship between hyperuricemia and CKD is more than just a marker of renal dysfunction, playing a much more important role in its pathogenesis and progression, and cardiovascular morbidity-mortality as well. If that association proves to be true, the next question would be when to treat hyperuricemia, and which drugs should be used. Allopurinol has been used for a long time, but febuxostat has been showing growing evidence not only regarding the control of hyperuricemia, but also on slowing CKD progression. In this review, we will try to answer those questions, while describing the most recent evidence on hyperuricemia as a risk factor for CKD and its management in those patients. BIOLOGICAL BASES Uric Acid Homeostasis Uric acid (UA) is a compound endogenously produced by the purine metabolism. These purines, generated in the liver (either from dietary or from endogenous synthesis), are first metabolized into guanine and hypoxanthine, and then into xanthine, which is oxidized into UA by xanthine oxidase 2. Although the reason is not entirely understood, contrary to other mammals, hominids have lost the enzyme uricase, responsible for converting UA into a more soluble molecule 3,4. As such, UA is excreted unmetabolized, mainly by the kidney (about twothirds), and about one-third through the intestinal tract 5,6. Several genes encoding membrane transporters responsible for UA excretion have been identified, such as Abcg2 (ATP-binding cassette subfamily G membrane 2) in the enterocytes and proximal renal tubular epithelium; and others associated with UA reabsorption in the renal tubule, such as URAT1 (urate anion exchanger 1) and GLUT9 (glucose transporter type 9) 7. Physiological Functions UA has two main functions in the human body. The first is related to its role in the elimination of nitrogenous compounds, such as ammonia and urea. The second is derived from its potent antioxidant activity, which is so important that more than half of normal human's free-radical scavenging capacity in the serum is related to UA 8,9. This ability is of great importance to the microvascular endothelium, where UA prevents oxidative inactivation of endothelial enzymes, maintaining its ability to mediate vascular dilation in situations of oxidative stress 10. Apart from its beneficial biological effects, higher levels of UA have been linked to a higher risk of cardiovascular disease, with several studies describing it as an independent risk predictor of cardiovascular mortality 10,11. This duality has been named ...
Pituitary adenomas are often diagnosed as incidental findings on brain imaging. We present the case of a 52-year-old African American female patient with long standing depressed mood prior to the incidental finding of a pituitary adenoma. We explore the possibility of certain mood symptoms prompting an early diagnosis of pituitary adenoma.
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