Background. The relationships among the involvement of tumor at the final margins of resection, the presence of an extensive intraductal component (EIC), and the risk of local recurrence are important considerations in patients treated with conservative surgery and radiation therapy for early stage breast cancer but have not been defined adequately. Methods. Between 1982 and 1985, 885 patients were treated for clinical Stage I or II invasive breast cancer. The study population was limited to 181 patients with an infiltrating ductal carcinoma who received a radiation dose to the surgical site of 60 Gy or greater, whose final microscopic margins of resection were evaluable, and who had at least 5 years of follow‐up. A positive margin was defined as tumor present at the inked margin of resection, a close margin as tumor within 1 mm of the inked margin, and a negative margin as no tumor within 1 mm of the inked margin. A focally positive margin was defined as tumor at the margin in three or fewer low‐power fields. In 157 patients (87%), the tumor was evaluable for the presence or absence of an EIC. The median follow‐up was 86 months. Results. In 12 of 181 patients (7%), a recurrence developed at or near the primary site (true recurrence/marginal miss [TR/MM]) within 5 years. The 5‐year rate of TR/MM (with 95% confidence intervals) among patients with negative, close, focally positive, and more than focally positive margins was 0% (0‐4%), 4% (0‐20%), 6% (1‐17%) and 21% (10‐37%), respectively. Patients with positive margins also were more likely to have a distant failure within 5 years (14%, 8%, 25%, and 32% in the four groups, respectively). However, patients with positive margins more often had positive axillary lymph nodes than patients with negative or close margins (59% vs. 38%, P < 0.02). The 5‐year rate of TR/MM was 20% for patients with an EIC‐positive tumor and 7% for patients with an EIC‐negative tumor. However, among the 127 patients with an EIC‐negative tumor, the 5‐year rate of TR/MM was less than 10% in all margin groups. Among the 30 patients with an EIC‐positive tumor, the 5‐year rate of TR/MM was 0% when margins were negative or close but 50% when margins were more than focally positive. Conclusions. These results provide support for the use of breast‐conserving surgery and breast irradiation in all patients with uninvolved margins, whether the tumor is EIC‐positive or EIC‐negative. This study suggests that breast‐conserving therapy (including a radiation boost to the primary site) also may be a reasonable option for some patients with an EIC‐negative tumor and margin involvement.
Germ-line BRCA1 mutations can be present in young women with breast cancer who do not belong to families with multiple affected members. The specific BRCA1 mutation known as 185delAG is strongly associated with the onset of breast cancer in Jewish women before the age of 40.
The relative affinities of various cations for anionic sites in isolated, bacterial cell walls were assessed by means of a technique involving displacement of one cation by another. The affinity series determined was H+ greater than La3+ greater than Cd2+ greater than Sr2+ greater than Ca2+ greater than Mg2+ greater than K+ greater than Na+ greater than Li+. High affinity was correlated with low mobility of the bound ions in an electric field. The net cation-exchange capacities of walls isolated from a variety of bacteria were estimated by preparing the magnesium forms of the walls, washing them well with deionized water to remove supernumerary ions, and then completely displacing the magnesium with Na+ or H+. Total amounts of magnesium displaced varied from 73 mumol per gram dry weight, for walls of the teichoic acid-deficient 52A5 strain of Staphylococcus aureus to about 520 mumol per gram for Bacillus megaterium KM walls....
Summary Prophylactic mastectomy (PM) offers 90% or greater reduction in risk of breast cancer to women at increased hereditary risk. Nonetheless, acceptance in North America has been low (0–36%). Most women report reduced cancer worry post-operatively, but up to 25–50% of women electing surgery also report psychological distress and/or difficulty adapting following PM. Psychological consultation to aid decision-making and improve post-surgical coping isn’t routinely offered. This retrospective, cross-sectional study explored, quantitatively and qualitatively, interest in and acceptability of psychological consultation for issues related to PM among 108 women who had undergone or were considering surgery. Of the 71 women who had undergone PM, more than half felt pre-surgical psychological consultation was advisable and nearly 2/3 felt post-surgical psychological consultation would be helpful. All 37 women (100%) currently considering PM believed psychological consultation would aid decision-making and preparation for surgery. Narratives from the interviews illustrate the nature and intensity of the need for psychological support and describe preferences for the role of the psychologist. Suggestions are offered for the integration of psychological services for women deciding about or adapting to PM.
A case-control study of the associations of retinoids and specific carotenoids with breast cancer using concentrations of these nutrients in breast adipose tissue was conducted among women attending a breast clinic in the Boston area in 1989-1992. Breast adipose tissue was collected during breast biopsy. Cases (n = 46) were women whose biopsies revealed invasive or in situ breast cancer; control subjects (n = 63) were women whose biopsies revealed benign disease. We observed inverse associations between breast adipose concentrations of retinoids and carotenoids and risk of breast cancer, although not all were statistically significant. The multivariate-adjusted odds ratio comparing women above the median value of the control group for retinol with those below or equal to the median was 0.71 (95% CI: 0.26, 1.93; NS); corresponding odds ratios were 0.61 (95% CI: 0.23, 1.64; NS) for retinyl palmitate, 0.30 (95% CI: 0.11, 0.85) for beta-carotene, 0.32 (95% CI: 0.11, 0.94) for lycopene, and 0.68 (95% CI: 0.27, 1.73; NS) for lutein/zeaxanthin. There was a nonsignificant positive correlation (r = 0.23, P = 0.15) between breast adipose tissue concentrations of retinol and dietary intake of preformed vitamin A, including supplements measured by using a food-frequency questionnaire. No correlation was found between breast adipose concentrations of carotenoids and intake of dietary carotenoids. These data suggest that higher breast adipose concentrations of retinoids and some carotenoids may be associated with decreased risk of breast cancer and that further examination of these relations is warranted.
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