Montclair Breast Center

Breast Cancer; Studies from M. Hino and co-researchers in the area of breast cancer published

26 August 2008

2008 AUG 26 - (NewsRx.com) -- According to recent research from Tokyo, Japan, "This study was undertaken to assess the feasibility of performing a sentinel lymph node biopsy (SLNB) for a patient with operable breast cancer after undergoing neoadjuvant chemotherapy (NAC). Between January 2002 and December 2003, women with primary breast cancer who had a breast tumor measuring larger than 3 cm in unilateral diameter were eligible for NAC."

"All patients who had completed NAC underwent lymphatic mapping with labeled Tc-99m phytate on the day before surgery. Sentinel lymph node biopsy followed by a full axillary lymph node (AXLN) dissection (ALND) was performed in all patients. Sentinel lymph nodes (SLN) were sent for a frozen-section examination. The rate of SLN identification was 71%. Both the sensitivity and negative predictive value of SLNB were 100%. The false negative rate was 0%. When candidates for SLNB were restricted to patients with a breast tumor measuring less than 3 cm and clinically negative nodes after NAC, the rate of SLN identification increased to 93% from 71% while still maintaining the 0% false negative rate," wrote M. Hino and colleagues.

The researchers concluded: "Sentinel lymph node biopsy after NAC is therefore considered to be a feasible and accurate method to predict the AXLN status in patients who have a breast tumor measuring less than 3 cm in unilateral diameter and a clinically negative AXLN status at the time of surgery after NAC."

Hino and colleagues published their study in Surgery Today (Sentinel lymph node biopsy after neoadjuvant chemotherapy in a patient with operable breast cancer. Surgery Today, 2008;38(7):585-591).

For additional information, contact M. Hino, Ebara Hospital, Tokyo Metropolitan Health & Med Treatment Corp., Dept. of Surgery, 4-5-10 Higashiyukigaya, Tokyo 1450065, Japan.

Publisher contact information for the journal Surgery Today is: Springer, 233 Spring St., New York, NY 10013, USA.
This article was prepared by Cancer Weekly editors from staff and other reports.

Breast Cancer; Findings from University of California advance knowledge in breast cancer

19 August 2008

2008 AUG 19 - (NewsRx.com) -- "Sentinel lymph node biopsy (SLNB) has largely replaced axillary dissection (ALND) for axillary staging in early breast cancer. However, intense pathologic evaluation is not routinely available intraoperatively; therefore, patients with SLN metastasis may require a second surgery for completion ALND," scientists in the United States report.

"We hypothesized that a single-section approach (by either frozen section [FS] or touch preparation analysis [TPA]) could be accurate for intraoperative SLN evaluation. We performed a prospective, blinded study of patients undergoing SLNB for breast cancer from September 2004 to July 2006. SLNs were bivalved along the long axis, underwent FS and TPA of the facing halves, followed by routine sentinel node processing (serial sectioning with hematoxylin/eosin staining). A single pathologist reviewed all study slides and was blinded to the permanent section interpretation. We analyzed 233 nodes from 118 patients. Overall, 21% of patients (N = 25) had SLN metastasis by serial-section histopathology. Single-section FS and TPA had similar sensitivities (0.67 and 0.66, P = .82) and specificities (0.995 and 0.995, P = 1.0) for detection of SLN metastasis, yielding equivalent accuracies (95%). All micrometastases (< 2 mm; N = 4) were missed by both techniques. False positives were rare-only one in each group (2% overall). Single-section TPA and FS have similar accuracies and can be safely used to identify the majority of patients with SLN metastasis, sparing these patients a delayed ALND," wrote K.A. Vanderveen and colleagues, University of California.

The researchers concluded: "False-negative results from TPA or FS occur in patients with micrometastatic disease, for which the role of completion ALND remains controversial."

Vanderveen and colleagues published their study in Annals of Surgical Oncology (A prospective, blinded trial of touch prep analysis versus frozen section for intraoperative evaluation of sentinel lymph nodes in breast cancer. Annals of Surgical Oncology, 2008;15(7):2006-2011).

For additional information, contact R.J. Bold, University of California, Dept. of Surgery, Medical Center, Sacramento, CA 95817, USA.

The publisher's contact information for the journal Annals of Surgical Oncology is: Springer, 233 Spring St., New York, NY 10013, USA.

Breast Cancer; Findings in breast cancer reported from R. Craneokada and co-researchers

19 August 2008

2008 AUG 19 - (NewsRx.com) -- "Postoperative changes after axillary lymph node surgery may significantly alter breast cancer survivors' (BCS) quality of life. Although sentinel lymph node biopsy (SLNB) has less immediate morbidity than axillary lymph node dissection (ALND), its long-term impact on shoulder abduction, arm swelling, and neurosensory changes has not been evaluated," researchers in the United States report.

"The purpose of this study was to compare long-term morbidity after SLNB or ALND and breast-conservation surgery. Female BCS who remained free of disease at least 3 years after ALND or SLNB for Stage I-III unilateral breast cancer completed a symptom questionnaire and a brief neurosensory physical examination of the upper arm and axilla (range of motion, arm circumference, and sensation to light touch with cotton and needle). The mean age of the 187 participating BCS was 62 years. At a mean follow-up of 6.6 years after ALND and 4.9 years after SLNB, most BCS had full abduction; only 10 cases (8 ALND, 2 SLNB) had a 2 cm proximal and/or distal circumference difference on the ipsilateral side compared with the contralateral side. ALND was associated with a significantly greater likelihood of subjective arm numbness (P < .001), chest or axillary numbness (P < .001), arm or hand swelling (P < .001), and objective neurosensory changes in the posterior axilla, medial and distal upper arm (P < .001). Operative procedure was the only significant predictor of neurosensory changes (P < .001)," wrote R. Craneokada and colleagues.

The researchers concluded: "SLNB is associated with significantly less subjective and objective long-term morbidity than ALND."

Craneokada and colleagues published their study in Annals of Surgical Oncology (Long-term morbidity of sentinel node biopsy versus complete axillary dissection for unilateral breast cancer. Annals of Surgical Oncology, 2008;15(7):1996-2005).

For additional information, contact R. Craneokada, St. Johns Health Center, John Wayne Cancer Institute, Dept. of Surgery Oncology, Santa Monica, CA, USA.

Publisher contact information for the journal Annals of Surgical Oncology is: Springer, 233 Spring St., New York, NY 10013, USA.

Breast Cancer; New breast cancer research has been reported by A. Kovacs et al

19 August 2008

2008 AUG 19 - (NewsRx.com) -- "In the treatment of early stage breast cancer breast conserving surgery (BCS) followed by whole breast irradiation (WBI) is a standard method. The impact of the tumor bed boost following WBI is well-defined, but there are various delivery methods," scientists writing in the journal Pathology & Oncology Research report.

"In this study the electron and the photon boost techniques were compared. For 78 early stage breast cancer patients both CT based 3D conformal photon boost and electron boost plans were created. For dosimetric comparison coverage index (CI), external volume index (EI) and conformality index (COIN) were studied. Lung volume receiving a dose of 2 Gy was also reviewed. Seventy-eight patients with 156 plans were compared. The mean tumor bed volume was measured as 61.39 cm(3) the mean tumor bed-skin distance was 3.13 cm. In the case of CI and COIN significant differences were found in favor of the photon boost. In the comparison of EI no significant difference was detected between the two techniques. The mean lung volume receiving 2 Gy were 42.3 and 168.35 cm(3), for photons and electrons respectively," wrote A. Kovacs and colleagues.

The researchers concluded: "In the adjuvant treatment of early stage breast cancer WBI followed by conformal photon boost showed to be superior to electron boost in focus of the COIN and CI."

Kovacs and colleagues published their study in Pathology & Oncology Research (Comparison of photon with electron boost in treatment of early stage breast cancer. Pathology & Oncology Research, 2008;14(2):193-197).

Additional information can be obtained by contacting A. Horvath, Debrecen University Medical, Dept. of Radiotherapy, Medical & Health Science Center, Nagyerdei Krt 98, H-4012 Debrecen, Hungary.

The publisher of the journal Pathology & Oncology Research can be contacted at: Springer, Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands.

Breast Cancer; Research from J. Fodor and co-authors reveals new findings on breast cancer

19 August 2008

2008 AUG 19 - (NewsRx.com) -- "Between 1983 and 1987, 1309 women with stage I or II breast cancer underwent mastectomy (n = 894) or conservative surgery (CS, n = 415). Of these patients, 124 developed an isolated local recurrence (ILR): chest wall, 56 and in-breast, 68," researchers in Budapest, Hungary report.

"The 10-year actuarial rate of cause-specific survival after treatment for ILR was 52%. On multivariate analysis three independent prognostic factors for the risk of death after ILR were identified: operability of recurrence (operable vs. inoperable, relative risk [RR]: 5.9), age at initial diagnosis (> 40 vs. <= 40 years, RR: 2.2) and time to ILR (> 24 vs. <= 24 months, RR: 2). Initial lymph node stage (negative vs. positive) showed borderline significance (p = 0.06), and type of initial surgery (CS vs. mastectomy) and recurrent tumor grade (1-2 vs. 3) were not independent predictors of survival. In the mastectomy group, single surgical scar recurrence with initial node negative stage predicted good prognosis, and the 10-year survival was 85%. In the CS group, the 10-year survival rate was 88% with new primary tumor and 54% with true recurrence (p = 0.01), and the type of salvage surgery (mastectomy vs. repeat complete excision) had no significant impact on survival (p = 0.2). The majority (n = 44) of CS patients developed <= 2 cm in-breast recurrence, and the 10-year survival was 81 % after both salvage excision (n = 28) and mastectomy (n = 16). The identified unfavorable prognostic factors are pointers of the forthcoming systemic progression," wrote J. Fodor and colleagues.

The researchers concluded: "Patients with <= 2 cm in-breast recurrence might receive a second CS."

Fodor and colleagues published their study in Breast (Prognosis of patients with local recurrence after mastectomy or conservative surgery for early-stage invasive breast cancer. Breast, 2008;17(3):302-308).

For additional information, contact J. Fodor, National Institute Oncology, Dept. of Radiotherapy, POB 21, Rath Gy U 7-9, H-1525 Budapest, Hungary.

Publisher contact information for the journal Breast is: Churchill Livingstone, Journal Production Dept., Robert Stevenson House, 1-3 Baxters Place, Leith Walk, Edinburgh EH1 3AF, Midlothian, Scotland.

Breast Cancer; Researchers from University of Nottingham describe findings in breast cancer

19 August 2008

(NewsRx.com) -- " The three strongest prognostic determinants in operable breast cancer used in routine clinical practice are lymph node (LN) stage, primary tumor size, and histologic grade. However, grade is not included in the recent revision of the TNM staging system of breast cancer as its value is questioned in certain settings," investigators in Nottingham, the United Kingdom report.

"Materials and Methods This study is based on a large and well-characterized consecutive series of operable breast cancer (2,219 cases), treated according to standard protocols in a single institution, with a long-term follow-up (median, 111 months) to assess the prognostic value of routine assessment of histologic grade using Nottingham histologic grading system. Histologic grade is strongly associated with both breast cancer-specific survival (BCSS) and disease-free survival (DFS) in the whole series as well as in different subgroups based on tumor size (pT1a, pT1b, pT1c, and pT2) and LN stages (pN0 and pN1 and pN2). Differences in survival were also noted between different individual grades (1, 2, and 3). Multivariate analyses showed that histologic grade is an independent predictor of both BCSS and DFS in operable breast cancer as a whole as well as in all studied subgroups," wrote E.A. Rakha and colleagues, University of Nottingham.

The researchers concluded: " Histologic grade, as assessed by the Nottingham grading system, provides a strong predictor of outcome in patients with invasive breast cancer and should be incorporated in breast cancer staging systems."

Rakha and colleagues published their study in the Journal of Clinical Oncology (Prognostic significance of Nottingham histologic grade in invasive breast carcinoma. Journal of Clinical Oncology, 2008;26(19):3153-3158).

For additional information, contact E.A. Rakha, University of Nottingham, Nottingham City Hospital NHS Trust, Dept. of Histopathol, Hucknall Rd., Nottingham NG5 1PB, UK.

The publisher of the Journal of Clinical Oncology can be contacted at: American Society Clinical Oncology, 2318 Mill Road, Ste. 800, Alexandria, VA 22314, USA.

Breast Cancer; Studies from Georgetown University have provided new data on breast cancer

26 August 2008

2008 AUG 26 - (NewsRx.com) -- According to a study from the United States, "Mammographic density is a risk factor for breast cancer. Mammographic density and breast magnetic resonance imaging (MRI) volume (MRIV) assess the amount of fibroglandular tissue in the breast."

"Mammographic density and MRIV can be modulated with hormonal interventions, suggesting that these imaging modalities may be useful as surrogate end-point biomarkers for breast cancer chemoprevention trials. We evaluated the effect of raloxifene on mammographic density and MRIV in premenopausal women at increased risk for breast cancer. Mammograms and MRI were obtained at baseline and after 1 and 2 years of 60 mg raloxifene by mouth daily for 27 premenopausal women. Mammographic percent dense area was calculated using a semiquantitative thresholding technique. T-1-weighted spoiled gradient-echo MRI with fat suppression was used to determine breast MRIV using a semiautomatic method. Mean change in mammographic density and median change in MRIV were assessed by the Wilcoxon signed-rank test. No significant change in mammographic density was seen after treatment with raloxifene. Mean change after 1 year was 1% [95% confidence interval (95% CI), -3 to +5] and after 2 years was 1% (95% CI, -2 to +5). MRIV decreased on raloxifene. Median relative change in MRIV after 1 year was -17% (95% Cl, -28 to -9; P 0.0017) and after 2 years was -16% (95% CI, -31 to -4; P 0.0004). In high-risk premenopausal women, mammographic density did not change on raloxifene, whereas MRIV significantly declined," wrote J. Engwong and colleagues, Georgetown University.

The researchers concluded: "Our findings suggest that MRIV is a promising surrogate biomarker in premenopausal women at increased risk for breast cancer and should be investigated further in breast cancer prevention trials."
Engwong and colleagues published the results of their research in Cancer Epidemiology Biomarkers & Prevention (Effect of raloxifene on mammographic density and breast magnetic resonance imaging in premenopausal women at increased risk for breast cancer. Cancer Epidemiology Biomarkers & Prevention, 2008;17(7):1696-1701).
For additional information, contact J. Engwong, Georgetown University, Vincent T Lombardi Cancer Research Center, 2nd Floor, 3800 Reservoir Rd. NW, Washington, DC 20007, USA.

The publisher of the journal Cancer Epidemiology Biomarkers & Prevention can be contacted at: American Association Cancer Research, 615 Chestnut St., 17TH Floor, Philadelphia, PA 19106-4404, USA.

Cancer; Reports from University of California highlight recent research in cancer

26 August 2008

(NewsRx.com) -- According to a study from the United States, "Breast density, the radiographically opaque fraction of the breast in a mammogram, is one of the strongest biomarkers of breast cancer risk. However, younger populations do not typically have mammograms due to radiation concerns."

"This study explored a commercially available dual-energy X-ray absorptiometer (DXA) system as a low-dose method to measure breast fibroglandular density in adolescent girls. Eighteen girls (13-14 years old) indicated their breast development according to Tanner and underwent three dedicated DXA scans, two of their left and one of their right breasts. Total projected breast area was manually delineated on each image and percent fibroglandular volume density (%FGV), absolute fibroglandular volume (FGV), total breast area, and volume were computed. It was possible to image breasts representing all five Tanner stages; %FGV ranged from 31.9% to 92.2% with a mean of 71.1 +/- 14.8%, whereas FGV ranged from 80 to 270 cm(3) with a mean of 168 +/- 54 cm(3). Left and right breast %FGV were highly correlated (r(p) = 0.97, P< 0.0001) and of the same magnitude (P = 0.18). However, left total volume and FGV were larger than the right by 38 cm(3) (P = 0.04) and 19 cm(3) (p = 0.02), respectively. Total volume and FGV increased by Tanner stage, whereas %FGV did not. Our method had excellent precision for %FGV and moderate precision for FGV (root mean square SDs of 2.4% and 16.6 cm(3))," wrote J.A. Shepherd and colleagues, University of California.

The researchers concluded: "These pilot data indicate that dedicated DXA breast scans may be useful in studies exploring breast density in girls."

Shepherd and colleagues published their study in Cancer Epidemiology Biomarkers & Prevention (Breast density assessment in adolescent girls using dual-energy X-ray absorptiometry: A feasibility study. Cancer Epidemiology Biomarkers & Prevention, 2008;17(7):1709-1713).

For more information, contact J.A. Shepherd, University of California, Dept. of Radiol, Musuloskeletal & Quantitat Imaging Research Group, Box 0946, San Francisco, CA 94143, USA.

Publisher contact information for the journal Cancer Epidemiology Biomarkers & Prevention is: American Association Cancer Research, 615 Chestnut St., 17TH Floor, Philadelphia, PA 19106-4404, USA.

This article was prepared by Cancer Weekly editors from staff and other reports.

Breast Cancer; New breast cancer study results from University of Texas, M. D. Anderson Cancer Center described

15 July 2008

(NewsRx.com) -- A new study, 'Inflammatory breast cancer: PET/CT, MRI, mammography, and sonography findings,' is now available. In this recent article published in the journal Breast Cancer Research and Treatment, scientists in the United States conducted a study "To describe the role of Positron Emission Tomography/Computed Tomography (PET/CT), Magnetic Resonance Imaging (MRI), sonography, and mammography in patients with inflammatory breast cancer (IBC). Patients who had been newly diagnosed with IBC and who had undergone mammography, sonography, MRI, PET/CT, or a combination of these were included in this study."

"The visibility of breast parenchymal lesion (BPLs), skin abnormalities, regional (axillary, supraclavicular, or internal mammary) nodal disease, and distant metastatic disease was documented with the imaging techniques. Eighty patients (median age, 51 years, [range, 25-78 years]) were included in this study: 75 (94%) had undergone mammography, 76 (95%) sonography, 33 (41%) MRI, and 24 (30%) PET/CT. A primary BPL was found in 60 patients (80%) on mammography (mass or calcifications), 72 (95%) on sonography (mass or architectural distortion), 23 (96%) on PET/CT (hypermetabolic BPL), and 33 (100%) on MRI (enhancing BPL). Regional axillary nodal disease was found in 74 patients (93%) by histologic or cytologic examination, in 71 patients (93%) on sonography, in 21 (88%) on PET/CT, in 29 (88%) on MRI, and in 34 (45%) on mammography. Distant metastases in the bone, liver, and contralateral lymph nodes were diagnosed in nine patients (38%) on PET/CT. MRI was the most accurate imaging technique in detecting a primary BPL in IBC patients. Sonography can be useful in diagnosing regional nodal disease," wrote W.T. Yang and colleagues, University of Texas, M. D. Anderson Cancer Center.

The researchers concluded: "PET/CT provides additional information on distant metastasis, and it should be considered in the initial staging of IBC."

Yang and colleagues published their study in Breast Cancer Research and Treatment (Inflammatory breast cancer: PET/CT, MRI, mammography, and sonography findings. Breast Cancer Research and Treatment, 2008;109(3):417-26).
Additional information can be obtained by contacting W.T. Yang, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030 USA.

The publisher of the journal Breast Cancer Research and Treatment can be contacted at: Kluwer Academic Publ, Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands.

Breast Cancer Therapy; Study results from Dana-Farber Cancer Institute, Department of Radiation Oncology provide new insights into breast cancer therapy

4 March 2008

(c) Copyright 2008 Cancer Weekly via NewsRx.com
2008 MAR 4 - (NewsRx.com) -- A report, 'Partial breast irradiation versus whole breast radiotherapy for early-stage breast cancer: a decision analysis,' is newly published data in International Journal of Radiation, Oncology, Biology, Physics (see also Breast Cancer Therapy). In this recently published article, scientists in the United States conducted a study "To compare the quality-adjusted life expectancy between women treated with partial breast irradiation (PBI) vs. whole breast radiotherapy (WBRT) for estrogen receptor-positive early-stage breast cancer. We developed a Markov model to describe health states in the 15 years after radiotherapy for estrogen receptor-positive early-stage breast cancer."

"Breast cancer recurrences were separated into local recurrences and elsewhere failures. Ipsilateral breast tumor recurrence (IBTR) risk was extracted from the Oxford overview, and rates and utilities were adapted from the literature. We studied two cohorts of women (aged 40 and 55 years), both of whom received adjuvant tamoxifen. Assuming a no evidence of disease (NED)-PBI utility of 0.93, quality-adjusted life expectancy after PBI (and WBRT) was 12.61 (12.57) and 12.10 (12.06) years for 40-year-old and 55-year-old women, respectively. The NED-PBI utility thresholds for preferring PBI over WBRT were 0.923 and 0.921 for 40-year-old and 55-year-old women, respectively, both slightly greater than the NED-WBRT utility. Outcomes were sensitive to the utility of NED-PBI, the PBI hazard ratio for local recurrence, the baseline IBTR risk, and the percentage of IBTRs that were local. Overall the degree of superiority of PBI over WBRT was greater for 55-year-old women than for 40-year-old women. For most utility values of the NED-PBI health state, PBI was the preferred treatment modality," wrote D.J. Sher and colleagues, Dana-Farber Cancer Institute, Department of Radiation Oncology.

The researchers concluded: "This result was highly sensitive to patient preferences and was also dependent on patient age, PBI efficacy, IBTR risk, and the fraction of IBTRs that were local."

Sher and colleagues published their study in International Journal of Radiation, Oncology, Biology, Physics (Partial breast irradiation versus whole breast radiotherapy for early-stage breast cancer: a decision analysis. International Journal of Radiation, Oncology, Biology, Physics, 2008;70(2):469-76).

For more information, contact D.J. Sher, Dana-Farber Cancer Institute, Dept. of Radiation Oncology, Boston, MA 02115 USA..

Publisher contact information for the International Journal of Radiation, Oncology, Biology, Physics is: Elsevier Science Inc., 360 Park Avenue South, New York, NY 10010-1710, USA.

Breast Cancer; New breast cancer findings from Johns Hopkins University, U.S., described

22 May 2007
Cancer Weekly
(c) Copyright 2007 Cancer Weekly via NewsRx.com

2007 MAY 22 - ( NewsRx.com) -- New findings reported from Johns Hopkins University, U.S., describe advances in breast cancer.

Study 1: Current study results from the report, "Sulforaphane induces cell type-specific apoptosis in human breast cancer cell lines," have been published. According to a study from the United States, "Sulforaphane, an isothiocyanate found in cruciferous vegetables, has been shown to induce phase 2 detoxication enzymes and inhibit the growth of chemically induced mammary tumors in rats, although the exact mechanisms of action of sulforaphane are not understood. In this study, we evaluated the effects of sulforaphane on cell growth and death in several human breast cancer cell lines and examined the hypothesis that sulforaphane acts as a histone deacetylase (HDAC) inhibitor in these cell lines."

"Sulforaphane treatment inhibited cell growth, induced a G(2)-M cell cycle block, increased expression of cyclin B1, and induced oligonucleosomal DNA fragmentation in the four human breast cancer cell lines examined, MDA-MB-231, MDA-MB-468, MCF-7, and T47D cells. Activation of apoptosis by sulforaphane in MDA-MB-231 cells seemed to be initiated through induction of Fas ligand, which resulted in activation of caspase-8, caspase-3, and poly(ADP-ribose) polymerase, whereas apoptosis in the other breast cancer cell lines was initiated by decreased Bcl-2 expression, release of cytochrome c into the cytosol, activation of caspase-9 and caspase-3, but not caspase-8, and poly(ADP-ribose) polymerase cleavage. Sulforaphane inhibited HDAC activity and decreased the expression of estrogen receptor-alpha, epidermal growth factor receptor, and human epidermal growth factor receptor-2 in each cell line, although no change in the acetylation of H3 or H4 was seen. These data suggest that sulforaphane inhibits cell growth, activates apoptosis, inhibits HDAC activity, and decreases the expression of key proteins involved in breast cancer proliferation in human breast cancer cells," wrote A. Pledgie-Tracy and colleagues, Johns Hopkins University, Sidney Kimmel Cancer Center.

The researchers concluded: "These results support testing sulforaphane in vivo and warrant future studies examining the clinical potential of sulforaphane in human breast cancer."

Pledgie-Tracy and colleagues published the results of their research in Molecular Cancer Therapeutics (Sulforaphane induces cell type-specific apoptosis in human breast cancer cell lines. Molecular Cancer Therapeutics, 2007;6(3):1013-21).

For additional information, contact A. Pledgie-Tracy, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 1550 Orleans Street, Baltimore, MD 21231 USA.

Study 2: Breast cancer evaluation by FDG-PET/CT is preferable to PET or CT alone.

"We retrospectively reviewed FDG-PET/CT images in patients with breast cancer to determine whether PET/CT improved the level of diagnostic confidence as compared with PET and to compare PET/CT and CT findings at the location of suspected malignancies. The study included 75 patients with known breast cancer. The initial PET/CT study for each patient was retrospectively reviewed to determine whether improved diagnostic confidence (IDC) regarding lesion localization and characterization was observed with PET/CT as compared with PET alone," investigators in the United States reported.

"PET/CT and CT findings were compared regarding lesion characterization and staging in 69 of the 75 patients, and in the case of discordant findings, comparison with histological or informative follow-up results was also performed," explained M. Tatsumi and colleagues, Johns Hopkins Medical Institute. "Fifty of the 75 patients exhibited increased FDG uptake in a total of 95 regions. In the comparison of PET/CT and PET, PET/CT resulted in IDC in 30 (60%) of these 50 patients and in 52 (55%) of the 95 regions.

"In the comparison between PET/CT and CT in 69 patients, PET/CT demonstrated a significantly better accuracy than CT (p<.05). PET/CT showed definitely positive findings in 60 regions with malignancies, among which CT exhibited positive findings in 43 (72%). PET/CT and CT accurately staged 59 (86%) and 53 (77%) of the 69 patients, respectively. PET/CT added incremental diagnostic confidence to PET in more than 50% of patients and regions with increased FDG uptake. PET/CT accurately detected more regions with malignancies than did CT."

The researchers concluded, "This initial evaluation suggests that PET/CT is preferable to PET or CT in the diagnosis of breast cancer."

Tatsumi and colleagues published their study in European Journal of Nuclear Medicine and Molecular Imaging (Initial experience with FDG-PET/CT in the evaluation of breast cancer. Eur J Nucl Med Mol Imaging, 2006;33(3):254-262).

For additional information, contact R.L. Wahl, Johns Hopkins Medical Institute, Dept. Radiol, Division Nuclear Med, 601 N Caroline St., Rm 3223A, Baltimore, MD 21287, USA.

Study 3: Breast cancer prevention claims associated with high soy consumption may be premature Researchers in the United States note, "High intake of soy foods has been proposed to contribute to the low breast cancer risk in Asian countries. However, results of epidemiologic studies of this association are highly variable, and experimental data suggest that soy constituents can be estrogenic and potentially risk enhancing."

"Thus, rigorous evaluation of available epidemiologic data is necessary before appropriate recommendations can be made, especially for women at high risk of breast cancer or those who have survived the disease," said B.J. Trock and colleagues of Johns Hopkins University. "We performed a meta-analysis of 18 epidemiologic studies (12 case-control and six cohort or nested case-control) published from 1978 through 2004 that examined soy exposure and breast cancer risk. Pooled relative risk estimates were based on either the original soy exposure measure defined in each study or on an estimate of daily soy protein intake."

"Risk estimates, levels and measures of soy exposure, and control for confounding factors varied considerably across studies," noted the investigators. "In a pooled analysis, among all women, high soy intake was modestly associated with reduced breast cancer risk (odds ratio [OR] =0.86, 95% confidence interval [CI] =0.75 to 0.99); the association was not statistically significant among women in Asian countries (OR=0.89, 95% CI=0.71 to 1.12)."

They continued, "Among the 10 studies that stratified by menopausal status the inverse association between soy exposure and breast cancer risk was somewhat stronger in premenopausal women (OR=0.70,95% CI=0.58 to 0.85) than in postmenopausal women (OR=0.77, 95% CI=0.60 to 0.98); however, eight studies did not provide menopause-specific results, six of which did not support an association. When exposure was analyzed by soy protein intake in grams per day, a statistically significant association with breast cancer risk was seen only among premenopausal women (OR=0.94, 95% CI=0.92 to 0.97)."

"Soy intake may be associated with a small reduction in breast cancer risk," the scientists concluded. "However, this result should be interpreted with caution due to potential exposure misclassification, confounding, and lack of a dose response. Given these caveats and results of some experimental studies that suggest adverse effects from soy constituents, recommendations for high-dose isoflavone supplementation to prevent breast cancer or prevent its recurrence are premature."

Trock and colleagues published their study in the Journal of the National Cancer Institute (Meta-analysis of soy intake and breast cancer risk. J Natl Cancer Inst, 2006;98(7):459-471).

For additional information, contact B.J. Trock, Johns Hopkins School of Medicine, Department of Urology, 600 N. Wolfe Street, 149 Jefferson Building, Baltimore, MD 21287, USA. btrock@jhmi.edu.

Keywords: Baltimore, Maryland, United States, Breast Cancer, Breast Carcinoma, Breast Cancer Risk Factor, Soy, Soy Intake, Isoflavones, Cancer Prevention, Women's Health.