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Biomedical subjects

J L Hayward

Publications and source records attributed to J L Hayward.

At least 73 records · Page 4Linked to original sources
PubMed1984

Serum carcinoembryonic antigen in the diagnosis and prognosis of women with breast cancer.

Serum carcinoembryonic antigen (CEA) has been measured in 628 patients before and 577 patients after treatment for breast cancer. These came from an unselected sequence of 730 women, subsequently diagnosed as having stage I or II breast cancer, referred to Guy's Hospital over a period of nearly 5 yr. CEA was also measured in serum from 238 ostensibly healthy volunteers and 65 women with benign breast disease. CEA measurements were of no diagnostic value. There were more patients with breast cancer with values in excess of 10 ng/ml measured preoperatively (7%) or after mastectomy (5%) than in controls (3%), but the difference is of marginal significance. High levels of CEA were not consistently associated with pathological stage or histological grade. Mastectomy was not associated with any significant change in the distribution of CEA levels. Patients with stage II disease and pre-operative CEA levels over 10 ng/ml has a faster recurrence rate than those with levels of less than 2.5 ng/ml. High levels were also associated with reduced survival. However, such patients comprised about 5% of women presenting with early breast cancer, so that the use of CEA measurements for prognosis is of limited value.

Adolescent↗
PubMed1984

Plasma retinol, beta-carotene and vitamin E levels in relation to the future risk of breast cancer.

In a prospective study of 5,004 women in Guernsey, plasma samples were collected and stored. Retinol, beta-carotene and vitamin E levels were later measured in the samples from 39 women who subsequently developed breast cancer and from 78 controls who did not develop cancer. Plasma retinol levels were not related to the risk of breast cancer, mean levels among cases and controls being 485 micrograms l-1 and 479 micrograms l-1 respectively. Plasma vitamin E levels showed a clear association, low levels being associated with a significantly higher risk of cancer. The mean vitamin E levels among cases and controls were 4.7 mg l-1 and 6.0 mg l-1 respectively (P less than 0.025), and the risk of breast cancer in women with vitamin E levels in the lowest quintile was about 5-times higher than the risk for women with levels in the highest quintile (P less than 0.01). beta-carotene levels showed a tendency to be lower in women who developed cancer than in controls (36 micrograms l-1 among cases compared with 50 micrograms l-1 among controls) but the difference was not statistically significant.

Adult↗
PubMed1984

A new combined approach to the conservative treatment of early breast cancer.

A combined surgical and radiotherapeutic technique is described that aims to: (1) achieve permanent local control of disease; (2) give full information on the histology and biochemistry of the tumor; (3) detail axillary node status; and (4) be compatible with adjuvant endocrine therapy or chemotherapy. This treatment is accomplished with minimal cosmetic defect and, in the majority of patients, with almost total conservation of the breast form. The surgical procedures are carried out during one hospital admission and performed with one anesthetic. No prosthetic replacement or augmentation of the breast is involved.

Breast Neoplasms↗
PubMed1984

Norethisterone acetate in the treatment of advanced breast cancer.

One hundred and twenty-five patients with progressive advanced carcinoma of the breast were treated with norethisterone acetate 20 mg tds orally after prior hormonal treatment or chemotherapy. Ninety-nine patients are evaluable for response. Sixteen patients (16%) achieved a partial response (median duration 4.5 months), 26 (26%) had stable disease (median duration 3 months) and 57 (58%) developed progressive disease on treatment. Patients who responded to norethisterone acetate had more often responded to prior hormonal or ablative treatment (56% vs 25%) and had received less prior treatment than those who did not respond (p less than 0.05). There was no statistically significant correlation between response and age, menopausal status, disease-free interval, stage at diagnosis, or distribution of disease. Side effects led to cessation of therapy in nine patients (9%).

Bone Neoplasms↗
PubMed1983

A prospective study of urinary androgen levels and ovarian cancer.

The three major urinary androgen metabolites, dehydroepiandrosterone (DHEA), androsterone (ANDRO), and aetiocholanolone (AETIO) were measured in 1,484 volunteer women between 29 and 60 years of age on the island of Guernsey from 1962-1967. Twelve of these women subsequently developed ovarian cancer after a median interval of 130 months and a minimum interval of 19 months. All three androgen levels in these women were lower than those in controls matched for age and menopausal status. The results were most striking for DHEA, where half of the cases were below the 27th percentile of their matched controls (p = 0.007, two-sided). The results for ANDRO were of marginal significance (p = 0.06), and those for AETIO were not significant (p = 0.33).

Adult↗
PubMed1983

Control of pleural effusions in patients with breast cancer. A randomized trial.

In a controlled randomized trial, 46 patients with pleural effusions secondary to breast cancer were treated at first diagnosis with either intracavitary mustine or talc, to determine which agent produced the more effective pleurodesis. Of the 37 evaluable patients, control of the effusion was achieved in 9/17 (56%) of those treated with mustine and 18/20 (90%) of the talc group (P less than 0.025). This suggests that early treatment with intracavitary talc can effectively palliate this complication of breast cancer.

Breast Neoplasms↗
PubMed1983

Controlled trial of adjuvant chemotherapy with melphalan for breast cancer.

370 patients who had carcinoma of the breast with involved axillary lymph-nodes were randomised after total mastectomy and axillary clearance to receive either no additional treatment or melphalan 6 mg/m2 daily for 5 days every 6 weeks for sixteen cycles. There was a trend towards longer relapse-free survival (RFS) in patients treated with melphalan, but this was not significant either in the whole series or in sub-groups according to menopausal status or extent of nodal involvement. In patients receiving melphalan RFS was not significantly affected by either the occurrence of amenorrhoea or the dosage of melphalan received. Overall survival did not differ significantly between the two groups. The results of this trial suggest that there is no place for the use of melphalan as adjuvant therapy in the management of early breast cancer.

Adult↗
PubMed1983

Sequential bone scans and chest radiographs in the postoperative management of early breast cancer.

A total of 241 patients with early breast cancer had serial bone scans and chest radiographs during the first two years of follow-up after primary treatment. Each patient had had a modified radical mastectomy and been found to have involved axillary nodes. They were part of a prospective randomized trial testing the use of L-phenylalanine mustard L-PAM as adjuvant chemotherapy. During the two years, these patients had a total of 832 serial bone scans and 1091 serial chest radiographs. Twenty-five patients (10.4 per cent) had bone metastases detected on sequential scanning, only 13 of whom, however, were asymptomatic at the time of the positive scan. Twelve (5 per cent) patients were found to have pulmonary metastases on routine sequential chest radiography of whom only 8 were asymptomatic at the time of the positive chest radiograph. It is concluded from this study that, apart from their usefulness in the monitoring of clinical trials, serial bone scans and chest radiographs cannot be recommended routinely in the follow-up of asymptomatic patients because of the low yield and high cost involved.

Adult↗
PubMed1983

Pathology of primary tumors and axillary lymph nodes in British and Japanese women with breast cancer.

Histopathologic features of the primary tumor and axillary lymph nodes from 97 consecutive patients with breast cancer from Japan were compared with those from 164 patients from England. Between the two groups, there were statistically significant differences in the morphology of the primary tumors regarding nuclear grade and patterns of tumor infiltration. In axillary lymph nodes, sinus histiocytosis was much more common in Japanese cases than in British cases, and was related to a diminished frequency of axillary node metastases. Germinal centers were also more common in the nodes of Japanese patients and were similarly associated with diminished frequency of metastases.

Axilla↗
PubMed1983

Thyroid function in early breast cancer.

Serum 'free thyroxine' was measured as a thyroid function index (TFI) in 238 women with early breast cancer and 107 normal controls. The mean TFI was significantly lower in the cases compared with controls. The TFI was not related to pathological stage but correlated with histological grade, with the highest values found in well-differentiated (grade I) and the lowest in anaplastic tumours (grade III). A similar result was obtained with the urinary and androsterone:aetiocholanolone (5 alpha:5 beta) ratio in that the ratio was significantly lower in patients with grade III than in those with grade I tumours. These results indicate that thyroid hormones may be involved in tumour cell differentiation. Patients with low 5 alpha/5 beta ratios had significantly faster recurrence rates than those with high ratios. A similar trend was found for the TFI. The TFI decreases after mastectomy and at 12 months after operation is still below the pre-operative basal level.

Adult↗
PubMed1983

Steroid receptors and prognosis in operable (stage I and II) breast cancer.

Four hundred and forty-seven women with operable (TNM stage I or II) breast cancer in whom oestrogen receptors (ER), progesterone receptors (PgR) or both receptors had been assayed were studied. Receptor status was independent of axillary nodal status, but infiltrating duct carcinomas that were ER-, PgR- or ER-PgR- were more likely to be anaplastic (P less than 0.001). Four hundred patients with follow-up and uniform treatment were analysed for post-operative disease-free interval (DFI) and survival. No significant difference in DFI existed between patients with ER+ and ER- tumours or PgR+ and PgR- tumours, although there was a trend for longer DFI for ER+ and PgR+. DFI was longer in patients with better-differentiated (grade 1 and 2) tumours than with anaplastic (grade 3) tumours. In patients with ER+ tumours, those with grade 1 and 2 tumours had a longer DFI than those with grade 3 tumours (P less than 0.005). Survival was significantly longer in patients with ER+ tumours compared to those with ER- tumours (P less than 0.001), but there was no such association between tumour PgR and survival. Survival of patients with ER+PgR+ tumours was significantly longer than those with ER-PgR- tumours (P less than 0.025) and, in patients with no evidence of axillary nodal involvement, significantly longer than those with ER+PgR- tumours. Survival in patients with nodal involvement was influenced by histological grade, being longer in those with grade 1 or 2 tumours compared to those with grade 3 tumours. For ER+ tumours, survival was longer in patients with grade 1 or 2 than with grade 3 tumours. These results suggest that steroid receptors significantly affect survival but not DFI. This effect is most closely related to ER content, with relatively little additional information accruing from analysis of PgR. Histological grade influences both DFI and survival, and analysis of both grade and ER content may give a more accurate indication of prognosis in operable breast cancer.

Axilla↗
PubMed1983

Breast parenchymal patterns in women with bilateral primary breast cancer.

Mammograms were obtained from 44 women aged over 30 years with bilateral primary breast cancer, 60 women with unilateral breast cancer, matched for age and menopausal status with the bilateral cases, and 937 normal women, again all aged over 30 years. The mammograms were classified according to Wolfe's criteria. Both groups of cancer patients were found to have a significantly (p less than 0.05) greater proportion of pre-menopausal women with the DY type of breast parenchymal pattern compared with the normal pre-menopausal women. No association was found between the P2 mammographic pattern and breast cancer. The study failed to show any difference in the distribution of mammographic risk categories in women with bilateral disease and those with unilateral cancers only.

Adult↗
PubMed1983

Distribution of 17 beta-estradiol in the sera of normal British and Japanese women.

Normal Japanese women had significantly more of their blood 17 beta-estradiol (E2) bound to sex hormone-binding globulin (SHBG) (53%) than British women (30%) and conversely less bound to albumin. While the proportion of SHBG-bound E2 increased with SHBG capacity and while binding fell as weight increased, the differences between the races do not appear to be explicable in terms of SHBG capacity or weight. At a given SHBG capacity, the Japanese women had more E2 bound to the protein than the British women. Where weights in the 2 populations overlapped, the Japanese women still had more of their E2 bound to SHBG than did the British women. Our results suggested that the affinity of albumin for E2 is lower in Japanese women.

Adult↗
PubMed1982

Serum concentrations of total and non-protein-bound oestradiol in patients with breast cancer and in normal controls.

In premenopausal women with breast cancer, total serum oestradiol (E2) concentrations are normal but nonprotein-bound E2 concentration are significantly raised. This is not due to low sex-hormone-binding-globulin (SHBG) binding capacities which are within the normal range and is unlikely to be due to the small but significant decrease in albumin concentrations. In post-menopausal patients, both total and non-protein-bound E2 are significantly raised: this may be explained partially by lower SHBG binding capacities. In patients and controls there is a highly significant correlation between non-protein-bound E2 and SHBG but, for a given SHBG binding capacity, the patients have more non-bound E2 than controls. It is concluded that the breast in women with breast cancer may be exposed to elevated levels of biologically active E2 although the reasons for this remain obscure.

Adult↗
PubMed1982

The pattern of metastatic disease in patients with pleural effusions secondary to breast cancer.

The pattern of pleural metastases in women with effusions secondary to breast cancer was evaluated by thoracoscopy in a series of 46 patients with previously untreated effusions. Metastases involving the visceral pleural were seen in 59 per cent of patients whereas parietal deposits were found in only 15 per cent. No tumour deposits were seen in 26 per cent of cases. No patients had both visceral and parietal tumour secondaries. Patients within each of these groups showed differences in rates of positive effusion cytology, chest wall recurrence and previous evidence of recurrent breast cancer.

Breast Neoplasms↗