A case-control study has been carried out among women attending a screening service in Palermo (Sicily) from 1974 through 1983 to ascertain the distribution of the most frequently investigated risk factors for breast cancer in a southern European population. Information has been obtained from the archives of the screening service. The analysis was separately conducted for pre- and post-menopausal cases and non-cases. Risk factors for pre-menopausal women are: nulliparity (nulliparous versus parous: OR 2.17, 95% CI 1.41-3.32); age at first birth (25-29 versus less than 20: OR 2.16, 95% CI 1.17-4.00); interval between menarche and first birth (greater than 20 years versus less than 6: OR 5.34, 95% CI 2.08-13.66); number of births (greater than 4 versus 1-2: OR 1.98, 95% CI 1.10-3.50). Risk factors for post-menopausal women are: nulliparity (nulliparous versus parous: OR 2.18, 95% CI 1.59-2.99); age at first birth (greater than 29 versus less than 20: OR 1.84, 95% CI 1.13-2.99); interval between menarche and first birth (16-20 years versus less than 6: OR 2.15, 95% CI 1.20-3.85). Age at menarche, age at menopause, breast feeding and family history were not found to be risk factors for breast cancer in the investigated population. The existence of influencing differences between northern and southern populations has been postulated.

This article reports on a consecutive series of 3627 breast cancer (BC) patients undergoing preoperative staging by chest x-ray (CXR), bone x-ray (BXR) or bone scintigraphy (BS), and liver ecography (LE) or liver scintigraphy (LS). The detection rate (DR) of preclinical asymptomatic distant metastases depended on the T and N category (TNM classification system), and was very low (CXR: 0.30%, BXR: 0.64%, BS: 0.90%, LE: 0.24%, LS: 0.23%). The sensitivity, determined after a 6-month follow-up, was below 0.50% for all tests. The highest value (0.48%) was recorded for BS, which also had the lowest specificity (0.95%). The entire preoperative staging policy using the studied tests seems questionable due to poor sensitivity and an extremely low DR of distant metastases.

We briefly review some biochemical aspects of benign breast disease (BBD), mainly focusing on free and conjugate estrogen content of breast cyst fluid (BCF), also in relation to cyst type. Evidence is reported that high K(+)-type I-cysts clearly associate with low Cl- levels and accumulate significantly higher quantities of dehydroepiandrosterone sulfate (DHAS) and estrone-3-sulfate (E1S). In spite of the limited number of cases, both increasing DHAS and E1S levels correlate with the increment of K+ to Na+ ratio. A positive correlation was also found between DHAS and E1S. Using electrochemical detection (ECD) on-line to high performance liquid chromatography (HPLC) in the reverse phase mode, we also studied the free estrogen profile. We observed that in type I BCF there are significantly increased amounts of free estrone (E1). The E1S to E1 ratio was significantly different in the two cyst subpopulations; again, a positive correlation was found between free and sulfated E1 (r = 0.820, p less than 10(-6). This last, together with other experimental observations, allows us to hypothesize that in BCF a main pathway of steroids should be E1S----E1. Besides, high specific activity of sulfatase, as well as beta-glucuronidase enzymes, has been demonstrated for BBD. Preliminary information is also reported concerning the BCF pattern of free estrogens, including the highly polar ones, i.e., catecholestrogens (CCE) and the parent methoxy (MeO) conjugates, which represent, in BCF, a predominant portion of all free estrogens. Both CCE levels and ratios appear unevenly distributed in the two different cyst types. In addition, some BCFs show very high concentrations of 16 alpha-OH-E1. Further studies are needed to answer the main question: whether estrogen patterns could represent additive parameters to further categorize breast cystic disease (BCD) or whether they are of minor interest to determine patients' risk of developing breast cancer.

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