In 141 mastectomy specimens, performed for invasive or noninvasive carcinomas, histopathologic study was performed to assess the extent of nipple‐areola involvement by the tumor. In this study, patients were excluded if (1) the tumor was located beneath the areola; and (2) nipple and/or areola abnormalities were clinically present. Tumor involvement of the nipple and/or areola was found in 44 of 141 specimens (31%), with intraductal growth in 36 (82%) of 44, stromal invasion in 3 (7%), and ductal and stromal invasion in 5 (11%). Analysis of nipple‐areolar involvement with consideration of the different variables indicates that it occurred in association with tumor size, tumor‐areola distance, and histologic type. Such information provides clinically relevant guidelines in decision making for limited breast surgery.
A controlled cooperative study was carried out to assess the value of modified radical mastectomy for patients with stage II breast cancer. The data was analyzed from 11 institutions in the Shikoku District participating in a prospective clinical trial in which patients were randomly assigned either to a modified radical mastectomy group or an extended radical mastectomy group. These two groups of patients were similar to each other in terms of such background factors as age distribution, menopausal status, TNM classification, tumor size, location of the primary tumor, axillary nodal involvement, histological type, and estrogen receptor status. The median follow-up times in the modified and extended radical mastectomy groups were 4.7 and 4.5 years, respectively. The cumulative curves indicated no difference between the two groups in either disease-free survival or overall survival. The survival rates were classified according to the presence or absence of axillary nodal metastases. However, no significant difference was found between the two groups. These findings thus suggest that the routine removal of the grossly uninvolved major pectoral muscle and parasternal lymph nodes is not necessary in patients with stage II breast cancer.
Mass screening for breast cancer using physical examination alone has been carried out since 1983 in Zentsuji, Kagawa Prefecture, Japan. Over a 7-year period, breast cancer was detected in 11 of a total 8,271 examinees, the detection rate being high at 0.13%. The detected cases included a few early-staged breast cancers, suggesting that mass screenings are of slight efficacy. Seven cases of interval cancer were found by breast self-examination after the mass screenings, supporting the value of breast self-examination. A relatively large number of interval breast cancers was detected in 1985 and 1986, when the rates of required further examination remained under 1%. The sensitivity and specificity of this screening were 61.1% and 94.5%, respectively, indicating a low sensitivity. These results suggest that the qualitative diagnoses made from the first screening by physical examination alone were often revealed to be false negatives. Therefore, the existing diagnosis should be employed in the first screenings. It is recommended that mammography be introduced to detect breast tumors which are nonpalpable or undetectable by physical examination alone.
Tamoxifen was administered over a period of 4 weeks to 19 female Sprague-Dawley rats bearing 20 DMBA-induced mammary tumors. Consequently, 13 tumors (65.0 per cent) regressed and showed a reduction in their estradiol receptor (ER) and progesterone receptor (PgR) concentrations. In spite of subsequent treatment given to the rats bearing the regressed tumors, 6 new tumors occurred. The ER and PgR concentrations of these tumors were lower than those of the tumors before tamoxifen therapy, and histochemical study showed these tumors to be composed mostly of ER-negative cells. These results suggest that: (a) the hormone dependency of breast cancer is reduced by tamoxifen therapy; (b) breast cancers recurring during tamoxifen therapy show reduced hormone dependency.
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