Breast cancer in northern Alberta: pilot study in computerized registration.

Analysis of data from 643 breast cancer patients seen between 1971 and 1973 in northern Alberta was undertaken as a preliminary study leading towards a comprehensive breast registry. Age at first treatment and menopausal status were found to be related significantly to the clinical stage of the disease. Other data reported included age at menarche, lymph node involvement and methods of primary treatment. A decline in use of the radical mastectomy was noted. The comprehensive breast registry, which will be used to identify high-risk groups, assess treatment modalities, test hypotheses and generate ideas, has a high probability of success because of compulsory registration of new cases of breast cancer in Alberta and collection of data by the same four individuals.     

Reproductive events and family history as risk factors for breast cancer in northern Alberta.

Reproductive events and family history as risk factors for breast cancer in northern Alberta were investigated with the use of data from a computerized population-based registry. Women aged 30 to 79 years attending diagnostic breast clinics at the Cross Cancer Institute from 1971 through 1975 constituted the two study groups; 1232 women had diagnosed breast cancer (malignant disease group) and 602 women were clinically free of all types of breast disease (control group). An increased relative risk of breast cancer was found in women with a family history of breast cancer, those who gave birth to their first term infant at age 30 years or older, those in whom more than 15 years elapsed between menarche and that birth, and those with a late natural menopause. There was a decreased risk, relative to nulliparity, in the postmenopausal women who first gave birth to a term infant 5 years or less after menarche. Artificial menopause (bilateral oophorectomy), parity and age at menarche had no apparent effect on the risk. The pattern of risk factors in northern Alberta differed from that reported for other geographic areas, including other provinces of Canada, thus emphasizing the need for local studies in the planning of screening programs.     

Survival rates among patients with cancer in Alberta in 1974-78.

We calculated 5-year crude and relative survival rates, by age and sex, for patients in Alberta in whom cancer was diagnosed between 1974 and 1978. Cancers with low overall 5-year relative survival rates (less than 35%) included stomach cancer, cancer of the pancreas, lung cancer, brain cancer, multiple myeloma and myeloid leukemia. Cancers with high overall 5-year relative survival rates (more than 70%) included melanoma, breast cancer, cancer of the uterus, cancer of the bladder and Hodgkin''s disease. Five-year relative survival rates were generally lower in the highest age group (75 years or more). A strong inverse relation between age and survival was noted for brain cancer, non-Hodgkin''s lymphoma, Hodgkin''s disease and myeloid leukemia.     

Accuracy and completeness of the New Zealand Cancer Registry for staging of invasive breast cancer

PurposePopulation based cancer registries are an invaluable resource for monitoring incidence and mortality for many types of cancer. Research and healthcare decisions based on cancer registry data rely on the case completeness and accuracy of recorded data. This study was aimed at assessing completeness and accuracy of breast cancer staging data in the New Zealand Cancer Registry (NZCR) against a regional breast cancer register.MethodologyData from 2562 women diagnosed with invasive primary breast cancer between 1999 and 2011 included in the Waikato Breast Cancer Register (WBCR) were used to audit data held on the same individuals by the NZCR. WBCR data were treated as the benchmark.ResultsOf 2562 cancers, 315(12.3%) were unstaged in the NZCR. For cancers with a known stage in the NZCR, staging accuracy was 94.4%. Lower staging accuracies of 74% and 84% were noted for metastatic and locally invasive (involving skin or chest wall) cancers, respectively, compared with localized (97%) and lymph node positive (94%) cancers. Older age (>80 years), not undergoing therapeutic surgery and higher comorbidity score were significantly (p < 0.01) associated with unstaged cancer. The high proportion of unstaged cancer in the NZCR was noted to have led to an underestimation of the true incidence of metastatic breast cancer by 21%. Underestimation of metastatic cancer was greater for Māori (29.5%) than for NZ European (20.6%) women. Overall 5-year survival rate for unstaged cancer (NZCR) was 55.9%, which was worse than the 5-year survival rate for regional (77.3%), but better than metastatic (12.9%) disease.ConclusionsUnstaged cancer and accuracy of cancer staging in the NZCR are major sources of bias for the NZCR based research. Improving completeness and accuracy of staging data and increasing the rate of TNM cancer stage recording are identified as priorities for strengthening the usefulness of the NZCR.     

35 岁以下年轻乳腺癌患者的临床特征及预后因素分析

目的:探讨年轻乳腺癌患者的临床病理特点及影响其预后的相关因素。方法:选取潍坊市人民医院2005年11月至2011年11月收治的年龄不高于35岁的137例年轻乳腺癌患者的临床资料,其中共有116例入组,初步分析年轻乳腺癌患者的临床病理特征及对预后产生的影响。结果:116例患者中位随访时间为46.0个月。3年OS和PFS为94.6%和79.1%。单因素、多因素分析结果显示淋巴结转移情况和Ki67水平与预后的显著相关(P0.05),淋巴结转数目、Ki67水平与预后呈负相关。结论:年轻乳腺癌患者的生物学行为、病理及预后较为特殊。淋巴结转移情况、Ki67水平是影响预后的关键因素。     

Retrospective study of reasons for improved survival in patients with breast cancer in east Anglia: earlier diagnosis or better treatment.

OBJECTIVES: To investigate the recent fall in mortality from breast cancer in England and Wales, and to determine the relative contributions of improvements in treatment and earlier detection of tumours. DESIGN: Retrospective study of all women with breast cancer registered by the East Anglian cancer registry and diagnosed between 1982 and 1989. SUBJECTS: 3965 patients diagnosed 1982-5 compared with 4665 patients diagnosed 1986-9, in three age groups 0-49, 50-64, > or = 65 years, with information on stage at diagnosis and survival. MAIN OUTCOME MEASURES: Three year relative survival rates by time period, age group, and stage; relative hazard ratios for each time period and age group derived from Cox''s proportional hazards model, adjusted for single year of age and stage. RESULTS: Survival improved in the later time period, although there was little stage specific improvement. The proportion of early stage tumours increased especially in the 50-64 year age group, and adjustment for stage accounted for over half of the improvement in survival in women aged under 65 years. CONCLUSION: Over half of the drop in mortality in women aged under 65 years seems to be attributable to earlier detection of tumours, which has been observed since the mid-1980s. This could have resulted from an increase in breast awareness predating the start of the breast screening programme.     

Pregnancy-Associated Breast Cancer in Taiwanese Women: Potential Treatment Delay and Impact on Survival

This study investigated the clinicopathologic characteristics and survival of women diagnosed with pregnancy-associated breast cancer (PABC) in Taiwan. PABC is defined as breast cancer diagnosed during pregnancy or within 1 year after obstetric delivery. Our sample of PABC patients (N = 26) included all patients diagnosed at a major medical center in northern Taiwan from 1984 through 2009. Among these patients, 15 were diagnosed during pregnancy and 11 were diagnosed within 1 year after delivery. The comparison group included 104 patients within the same age range as the PABC patients and diagnosed with breast cancer not associated with pregnancy from 2004 through 2009 at the same hospital. Patients'' initiating treatment delayed, 5-year and 10-year overall survival were delineated by stratified Kaplan-Meier estimates. Patients'' characteristics were associated with initiating treatment delayed was evaluated with multivariate proportional hazards modeling. Antepartum PABC patients were younger and had longer time between diagnosis and treatment initiation than postpartum PABC patients. The predictor of treatment delayed was including birth parity, cancer stage, and pregnancy. The PABC group had larger tumors, more advanced cancer stage, and tumors with less progesterone receptor than the comparison group. The antepartum PABC patients had higher mortality than postpartum PABC and comparison groups within 5 years after diagnosis. Based on these results, we confirmed that pregnant women with breast cancer were more likely to delay treatment. Therefore, we recommend that breast cancer screening should be integrated into the prenatal and postnatal routine visits for early detection of the women''s breast problems.     

La laparotomie dans la maladie de Hodgkin: signification de l'atteinte de la rate.

We retrospectively reviewed 224 cases of Hodgkin''s disease, in 120 of which staging laparotomy was performed. The surgical findings in cases of clinical stage I or II disease with supradiaphragmatic presentation or clinical stage III disease did not influence the treatment plans. Of the 64 patients with positive results of laparotomy (splenic or lymph node involvement or both) 51 had splenic involvement; their 5-year survival rate, 57%, was similar to that of the patients with clinical or pathological stage III disease - 58% and 54% respectively. At laparotomy 11 patients with pathological stage III disease were found to have isolated splenic involvement; their 5-year survival rate, 64%, was not appreciably different from that of the patients with clinical stage II disease, 70%; both groups were treated with radiotherapy only. From this study we can conclude that splenic involvement in Hodgkin''s disease has no deleterious effect on survival and that splenic irradiation seems to be as effective as splenectomy in controlling the disease.     

Patients with Nipple-Areola Paget’s Disease and Underlying Invasive Breast Carcinoma Have Very Poor Survival: A Matched Cohort Study

Paget’s disease (PD) of the breast is a rare disease. The survival rate of PD was reported to depend on the characteristics of the underlying carcinoma. This study aimed to investigate the characteristics and survival rate of PD patients with underlying invasive breast carcinoma (IBC). Fifty-two patients were diagnosed with PD and an associated IBC from 2001 to 2005 in Fudan University Shanghai Cancer Center. Twenty-four (46.2%) had no clinical manifestation of PD and were diagnosed unexpectedly by a histologic examination. The 52 patients were all recruited in this study as the PD group. They tended to have greater chances of lymph node involvement (53.8% vs. 35.7%), lower hormone receptor expression (34.6% vs. 69.7%), higher human epidermal growth factor receptor 2 (HER2) expression (76.9% vs. 21.3%), and worse survival (5-year relapse-free survival (RFS) 52.2% vs. 86.7%, P<0.01; breast cancer-specific overall survival (OS) 62.1% vs. 91.8%, P<0.01) when compared with patients diagnosed with IBC. A matched study was then performed to investigate whether the poor survival of patients in the PD group was due to the unfavorable prognosis of the underlying IBC. One hundred and fifty-six (3∶1 ratio of controls to PD patients) patients diagnosed with IBC only were recruited into the matched group. The match was conducted according to four variables: dimension of IBC, lymph node status, hormone receptor status and HER2 status. The 5-year RFS (52.2% vs. 81.4%, P<0.01) and OS (62.1% vs. 85.9%, P<0.01) were both lower for patients in the PD group than those in the matched group. Patients with PD and underlying IBC had poor survival. Their survival was worse than that of patients with IBC of similar stage and characteristics. For patients with no clinical PD manifestation who were histologically diagnosed as PD, survival might be worse compared to patients with clinically diagnosed PD.     

乳腺癌中α- 晶状体B 链蛋白表达的临床病理研究

目的:探讨α-晶状体蛋白B链(Alpha-crystallin B chain,CRYAB)在乳腺癌中表达的临床病理学意义。方法:收集乳腺癌病例及相应的临床资料包括随访资料,应用IHC染色方法检测CRYAB在乳腺良性病变(BBD)、无淋巴结转移乳腺癌(NMBC)、有淋巴结转移乳腺癌(MBC)及配对淋巴结转移灶(PMLN)中的表达,分析CRYAB表达与乳腺癌临床病理指标(患者年龄、肿块大小、淋巴结转移情况、临床分期、组织学分型和分级、雌孕激素受体和c-cerb B2表达情况、绝经情况)间及生存状态的关系。结果:CRYAB在对照组BBD组、NMBC组、MBC组、PMLN组的阳性表达率分别为97.9%(46/47)、44.6%(37/83)、13.1%(14/107)、10.8%(11/107),其中BBD组和NMBC组,BBD组、NMBC组分别与MBC组、PMLN组均存在显著性差异。CRYAB表达与淋巴结转移(P0.001)、临床分期(P=0.001)、组织学分级(P=0.037)和雌孕激素受体表达情况(P0.001)有显著相关,无淋巴结转移组的阳性表达率显著高于有淋巴结转移组,临床晚期的阳性表达率低于临床早期,雌孕激素受体阳性病例的阳性表达率显著低于雌孕激素受体阴性病例。生存分析结果显示CRYAB阳性表达的患者生存期比CRYAB阴性表达的患者生存期更长(p=0.037)。结论:CRYAB与乳腺癌的转移、临床分期、生存状态、雌孕激素受体表达有关。     

Factors influencing the survival of patients with cancer of the prostate.

During the period 1969 through 1973, 777 new cases of cancer of the prostate in northern Alberta men were registered with the Alberta Cancer Registry. The overall survival rate after 5 years was 41.2%. As expected, the rates were higher for those aged less than 65 years than for those who were older at the time of diagnosis and higher for those without metastases than for those with metastases at that time. Urban residents had a higher survival rate than rural residents (45.3% v. 38.0%), and the survival ratio of the former, 1.31, was significant. Information on occupation, smoking and the interval between appearance of the first symptom and diagnosis was not always available. However, the differentials observed suggest that those in a professional occupation and nonsmokers live longer after the diagnosis of cancer of the prostate but that the interval before diagnosis does not affect the length of survival.     

Luminal A型和Luminal B型乳腺癌患者的腋窝淋巴结转移发生率及预后的比较研究

目的:对比Luminal A型和Luminal B型乳腺癌患者的腋窝淋巴结转移发生率及预后情况。方法:回顾性分析我院从2011年5月~2014年12月收治的乳腺癌患者180例作为研究对象。将其按照临床病理类型的差异分成Luminal A型组84例与Luminal B型组96例。比较两组临床病理特征、腋窝淋巴结转移发生率、5年复发率与生存率,比较两组患者超声学特征。结果:Luminal A型组年龄>50岁、肿瘤大小≤2 cm、组织分级Ⅰ级人数占比均高于Luminal B型组(P<0.05)。Luminal A型组腋窝淋巴结转移发生率为13.10%(11/84),显著低于Luminal B型组的39.58%(38/96)(P<0.05)。Luminal A型组和Luminal B型组患者的5年复发转移率对比差异无统计学意义(P>0.05),Luminal A型组5年生存率为86.90%(73/84),高于Luminal B型组的73.96%(71/96)(P<0.05)。Luminal A型组边界清晰、无钙化人数占比均高于Luminal B型组,而Alder为Ⅲ级人数占比低于Luminal B型组(P<0.05)。结论:Luminal A型乳腺癌患者的腋窝淋巴结转移发生率低于Luminal B型乳腺癌患者,且两者的临床病理和超声学特征存在一定的差异,Luminal A型乳腺癌患者的预后优于Luminal B型。     

Impact of comorbidity on survival by tumour location: Breast,colorectal and lung cancer (2000–2014)

BackgroundTo assess the impact of comorbidity, measured by the Charlson Comorbidity Index (CCI), on survival in breast, colorectal and lung cancer.MethodsWe identified 3455 breast cancer, 3336 colorectal cancer and 2654 lung cancer patients through the Hospital del Mar cancer registry. The prevalence of comorbidities according to the CCI was calculated. Kaplan-Meier curves and the log-rank test were used to compare survival curves for each cancer location. Cox regression was used to calculate survival hazard ratios and 1-, 3- and 5-year mortality rate ratios adjusted by age, sex, CCI, place of first consultation, stage, treatment and period of diagnosis.ResultsThe overall unadjusted 5-year follow-up survival proportion was 82.6% for breast cancer, 55.7% for colorectal cancer, and 16.3% for lung cancer. Overall survival was associated with CCI ≥ 3 in breast cancer (HR: 2.33 95%CI: 1.76–3.08), colorectal cancer (HR: 1.39; 95%CI: 1.13–1.70) and lung cancer (HR: 1.22; 95%CI: 1.06–1.40). In breast cancer, the higher the CCI, the higher the adjusted mortality rate ratio and differences were greater in 5-year than in 1-year follow-up survival.ConclusionsComorbidity is a significant predictor of overall survival in cancer patients; however, it has a stronger impact on survival in breast cancer than in colorectal and lung cancer.     

Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland.

OBJECTIVE--To compare survival outcome for patients with breast cancer cared for by specialist and non-specialist surgeons in a geographically defined area. DESIGN--Retrospective study of all female patients aged under 75 years in the area treated between 1980 and June 1988 (before breast screening began). Patients were identified from the cancer registry and from pathology records of all hospitals in the area. Specialist surgeons were identified by one author. All other surgeons caring for patients from the area were considered non-specialists. SETTING--A geographically defined population in urban west of Scotland. SUBJECTS--3786 patients with histologically verified breast cancer operated on between 1 January 1980 and 30 June 1988 and followed to 31 December 1993. MAIN OUTCOME MEASURES--Five and 10 year survival rates for specialists and non-specialists; relative hazard ratios derived from Cox''s proportional hazards model adjusted for prognostic factors--age, socioeconomic status, tumour size, and nodal involvement. RESULTS--The five year survival rate was 9% higher and the 10 year survival 8% higher for patients cared for by specialist surgeons. A reduction in risk of dying of 16% (95% confidence interval 6% to 25%) was found after adjustment for age, tumour size, socioeconomic status, and nodal involvement. The benefit of specialist care was apparent for all age groups, for small and large tumours, and for tumours that did and did not affect the nodes and was consistent across all socioeconomic categories. CONCLUSIONS--Survival differences of the magnitude demonstrated have implications for the provision of services for the treatment of women with breast cancer. There is a need to improve equity in the treatment of breast cancer.     

乳腺癌患者的临床特征及其辅助治疗的影响因素分析

目的:探讨乳腺癌患者的临床病理特点及其辅助治疗的影响因素。方法:选取2009年1月~2012年2月我院收治的114例60岁以上的乳腺癌患者,按照年龄将其分为60~69岁组以及70岁以上组,对两组患者的临床特点、病例特点以及辅助治疗的模式进行对比分析。结果:两组患者在合并疾病、癌肿大小、病理学类型、受累淋巴结、以及雌孕激素受体阳性率、表皮生长因子2过度表达、肿瘤抑制基因P53阳性率以及Ki-67增殖指数等方面相比较,差异均无统计学意义(P0.05)。两组患者的手术治疗方式以及术后辅助化疗情况相比较,差异有统计学意义(P0.05)。多因素Logistic回归分析发现,年龄、淋巴结受累情况以及雌激素受体是否阳性成为术后辅助化疗主要考虑的因素。随诊2年,60~69岁组与70岁以上组患者的2年无复发生存率分别为88.89%(64/72)、92.86%(39/42),两组相比较,差异无统计学意义(P0.05)。结论:70岁以上的乳腺癌患者的临床特点与60~69岁的患者相比较无明显差异,目前,临床治疗采取的方法有所不同,但均能够达到较好的效果。年龄、淋巴结受累情况以及雌激素受体是否阳性成为医生考虑术后辅助化疗方案的主要因素。     

Time since childbirth and prognosis in primary breast cancer: population based study.

OBJECTIVE: To investigate whether time since birth of last child was of prognostic importance in women with primary breast cancer. DESIGN: Retrospective cohort study based on a population based database of breast cancer diagnoses with detailed information on tumour characteristics, treatment regimens, reproductive factors, and vital status. SETTING: Denmark. SUBJECTS: 5652 women with primary breast cancer aged 45 years or less at the time of diagnosis. MAIN OUTCOME MEASURES: 5 and 10 year survival; relative risk of dying. RESULTS: Women diagnosed in the first 2 years after last childbirth had a crude 5 year survival of 58.7% and 10 year survival of 46.1% compared with 78.4% and 66.0% for women whose last childbirth was more than 2 years before their diagnosis. After adjustment for age, reproductive factors, and stage of disease (tumour size, axillary nodal status, and histological grading), a diagnosis sooner than 2 years since last childbirth was significantly associated with a poor survival (relative risk 1.58, 95% confidence interval 1.24 to 2.02) compared with women who gave birth more than 5 years previously. Further analyses showed that the effect was not modified by age at diagnosis, tumour size, and nodal status. CONCLUSIONS: A diagnosis of breast cancer less than 2 years after having given birth is associated with a particularly poor survival irrespective of the stage of disease at debut. Therefore, a recent pregnancy should be regarded as a negative prognostic factor and should be considered in counselling these patients and in the decisions regarding adjuvant treatment.     

Reduced clinicopathological influence of hormone-dependence on breast carcinomas in women older than 70 years

In order to evaluate the influence of hormone dependence on the features of infiltrating ductal carcinoma of the breast we have assayed the cytosolic levels of estrogen receptor (ER), progesterone receptor (PR), pS2 and cathepsin D in 53 women aged over 70 years and in 95 women aged between 55 and 70 years. Tumor size, axillary involvement, distant metastasis, histological grade, ploidy and S-phase were taken into account. Carcinomas of women aged over 70 did not show higher concentrations or higher positive results for ER and PR than those of women in the 55-70-year age group. In older patients, negativity for ER was associated only with higher S-phase fraction, while negativity for PR was not associated with any of the parameters analyzed. In the younger subgroup, negativity for ER was associated with larger tumor size, higher S-phase fraction, lymph node involvement, histological grade 3 and lower pS2 values. Negativity for PR was associated with the same parameters, as well as with a higher frequency of recurrence. Our results suggest a reduced influence of hormone dependence on the clinicopathological features of breast carcinomas in patients older than 70 years compared with women aged between 55 and 70 years.     

Bilateral breast cancer in northern Alberta: risk factors and survival patterns.

Of 2231 women with stage I, II or III breast cancer who were registered and seen between 1971 and 1979 and followed to the end of 1981, 48 (2.2%) had synchronous and 58 (2.6%) asynchronous bilateral breast cancer. The unadjusted incidence rate for a second breast cancer was 6.4/1000 breast-years at risk, compared with a rate of 0.70 for the risk of a first breast cancer in women. When calculated from the date of diagnosis of the first breast cancer the survival rate was better for the group with asynchronous disease than for the group with synchronous disease or for a group with unilateral disease, but when calculated from the date of diagnosis of the second cancer the rate was the same in all three groups. Comparison of known risk factors showed a significant association between the development of bilateral cancer and a later age at the birth of the first child and a longer interval between menarche and that birth. There was a trend towards greater age and more stage III cancer in the group with synchronous disease. There was no correlation between receiving radiotherapy for the first breast cancer and development of the second cancer. Annual mammography and clinical examination of asymptomatic women at a cancer centre resulted in the detection of a significantly higher proportion of minimal breast cancers in the second breast compared with the first. Such screening practices should be even more valuable in the earlier detection of unilateral breast cancer in asymptomatic women who have not had breast cancer.     

Natural history of coronary artery disease in relation to angiographic, hemodynamic and clinical factors

Studying the natural history of coronary artery disease could provide a frame of reference for prognosis and appraisal of treatment for patients having this disease. We studied a total of 465 consecutive patients with angiographically significant coronary artery disease, defined as greater than 50% stenosis in at least one principal artery, who were followed with medical treatment only from 1 to 7 years. Excluding patients with left main coronary disease, there were 73 deaths, of whom 63 were cardiac. The 5-year cumulative survival rates were 72% for the entire group, 87% for single vessel disease, 73% for double vessel disease and 51% for triple vessel disease. In single vessel disease, patients with left anterior descending artery involvement tended to have higher mortality. In double vessel disease, survival was worse with the combination of left anterior descending and right coronary artery involvements than the other 2 combinations. A history of myocardial infarction was not significantly different from angina in 5-year survival rate. Nevertheless, an abnormal Q-wave in ECG was associated with lower survival. History of hypertension and electrocardiographic left ventricular hypertrophy did not affect survival. While congestive heart failure, abnormal resting LVEDP and left ventricular asynergy were all associated with reduced survival. The left ventricular ejection fraction had highly prognostic value, only 42% of patients survived with ejection fraction less than 0.3 at the end of 5 years after angiography.