Patients with tumors that are ER-positive 1%-9% have clinical and pathologic characteristics different from those with tumors that are ER-positive ≥10%. Similar to patients with ER-negative tumors, those with ER-positive 1%-9% disease do not appear to benefit from endocrine therapy; further study of its clinical benefit in this group is warranted. Also, there is a need to better define which patients of this group belong to basal or luminal subtypes.

PurposeChemotherapies for breast cancer generally have strong cellular cytotoxicity and severe side effects. Thus, significant emphasis has been placed on combinations of naturally occurring chemopreventive agents. Silibinin is a major bioactive flavonolignan extracted from milk thistle with chemopreventive activity in various organs including the skin, prostate, and breast. However, the mechanism underlying the inhibitory action of silibinin in breast cancer has not been completely elucidated. Therefore, we investigated the effect of silibinin in MCF-7 human breast cancer cells and determined whether silibinin enhances ultraviolet (UV) B-induced apoptosis.MethodsThe effects of silibinin on MCF-7 cell viability were determined using the MTT assay. The effect of silibinin on PARP cleavage, as the hallmark of apoptotic cell death, and p53 protein expression in MCF-7 cells was analyzed using Western blot. The effect of silibinin on UVB-induced apoptosis in MCF-7 cells was analyzed by flow cytometry.ResultsA dose- and time-dependent reduction in viability was observed in MCF-7 cells treated with silibinin. Silibinin strongly induced apoptotic cell death in MCF-7 cells, and induction of apoptosis was associated with increased p53 expression. Moreover, silibinin enhanced UVB-induced apoptosis in MCF-7 cells.ConclusionSilibinin induced a loss of cell viability and apoptotic cell death in MCF-7 cells. Furthermore, the combination of silibinin and UVB resulted in an additive effect on apoptosis in MCF-7 cells. These results suggest that silibinin might be an important supplemental agent for treating patients with breast cancer.

PurposeThe aim of this study was to investigate the clinical outcome of additional breast lesions identified with breast magnetic resonance imaging (MRI) in breast cancer patients.MethodsA total of 153 patients who underwent breast MRI between July 2006 and March 2008 were retrospectively reviewed. Thirty-three patients (21.6&) were recommended for second-look ultrasound (US) for further characterization of additional lesions detected on breast MRI and these patients constituted our study population.ResultsAssessment for lesions detected on breast MRI consisted of the following: 25 benign lesions (73.5&), two indeterminate (5.9%), and seven malignant (20.6%) in 33 patients. Second-look US identified 12 additional lesions in 34 lesions (35.3%) and these lesions were confirmed by histological examination. Of the 12 lesions found in the 11 patients, six (50.0%) including one contralateral breast cancer were malignant. The surgical plan was altered in 18.2% (six of 33) of the patients. The use of breast MRI justified a change in treatment for four patients (66.7%) and caused two patients (33.3&) to undergo unwarranted additional surgical procedures.ConclusionBreast MRI identified additional multifocal or contralateral cancer which was not detected initially on conventional imaging in breast cancer patients. Breast MRI has become an indispensable modality in conjunction with conventional modalities for preoperative evaluation of patients with operable breast cancer.

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