Treating early breast cancer.
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Breast Neoplasms↗
Biomedical subjects
R E Mansel
Publications and source records attributed to R E Mansel.
Plasma fatty acid profiles in benign breast disorders.
Breast pain (mastalgia) and macroscopic breast cysts present commonly. Mastalgia may be improved by dietary manipulation to reduce saturated fat or supplement essential fatty acid intake. Fatty acid profiles were measured in women with mastalgia and breast cysts, before and during treatment with evening primrose oil, a rich source of essential fatty acids. The fatty acid profiles of both groups of patients were abnormal, with increased proportions of saturated fatty acids and reduced proportions of essential fatty acids. Treatment with evening primrose oil improved the fatty acid profiles towards normal, but this was not necessarily associated with a clinical response.
Breast Diseases↗
A case control study of factors associated with macroscopic breast cysts.
Women who have a breast cyst aspirated are at increased risk of developing breast cancer. We present an age-matched case control study comparing the reproductive characteristics of 352 women who had a breast cyst aspirated with a control group of 352 contemporaneous clinically normal women. Women with breast cysts were more likely to be nulliparous [odds ratio (OR) = 2.28, 95% confidence interval (CI) = 1.34-3.88] or have a late age at first live birth (chi 2 trend = 5.6, P less than 0.025), and a late menopause (chi 2 trend = 4.3, P less than 0.05). They were less likely to have ever used the oral contraceptive pill (OR = 0.38, 95% CI = 0.26-0.55) or to have used the pill for a short duration (chi 2 trend = 16.8, P less than 0.001), and were less likely to have had a hysterectomy (OR = 0.58, 95% CI = 0.36-0.93). They were more likely to wear a small bra (chi 2 trend = 18.6, P less than 0.001) and bra cup (chi 2 trend = 5.6, P less than 0.025). Nulliparity, late age at first live birth and late menopause are factors common to breast cancer risk.
Adult↗
Prolactin and total lactogenic hormone measured by microbioassay and immunoassay in breast cancer.
Basal prolactin (PRL) and total lactogenic hormone (TLH) levels were measured using a new microbioassay (BA) and conventional immunoradiometric assay (IRMA) in patients with breast cancer and compared to an age-matched control group. No significant differences were found using the IRMA, but BA lactogenic levels were significantly elevated in breast cancer patients compared controls, leading to a markedly elevated BA/IRMA ratio for both PRL (2.7 vs 1.4, P less than 0.0001) and TLH (2.8 vs 1.4, P less than 0.0001) which was greatest for postmenopausal women. Using the mean +2 standard deviations as the upper limit of normal, there was no significant difference between breast cancer patients and controls for IRMA, but BA and BA/IRMA PRL levels were elevated in 42% and 61% of the patients, respectively. There was a weak negative correlation of BA and IRMA PRL with age for normals (r = -0.53 for both) but no correlation was evident for breast cancer patients (r = 0.06 and -0.13, respectively) implying a sustained absolute and relative bioactive hyperprolactinaemia at all ages. These results show increased lactogenic bioactivity in breast cancer and suggest that different forms of bioactive prolactin undetected by IRMA (or enhancing serum factors) are present in the sera of these patients.
Adult↗
Bioactive and immunoactive prolactin levels after TRH-stimulation in the sera of normal women.
The availability of an improved microbioassay for lactogenic hormone measurement has enabled comparison of basal and dynamic prolactin bioactivity (BA) and immunoactivity (IRMA) in normal human serum. Serum from 16 normal females aged 22-74 years was assayed and revealed a mean BA/IRMA prolactin ratio of 1.6 for basal and 1.8 for peak TRH-stimulated levels. Basal prolactin levels in postmenopausal women measured by bioassay were lower than in premenopausal women showing a relative and absolute decrease in prolactin bioactivity with age, but there was no significant difference in dynamic levels. There was also no significant difference in BA or IRMA levels following the stress of venepuncture. These findings indicate that, as previously described for basal levels, there is a good correlation between dynamic prolactin bioactivity and immunoactivity in human serum.
Adult↗
Drug treatments for mastalgia: 17 years experience in the Cardiff Mastalgia Clinic.
Mastalgia commonly presents to medical practitioners. The majority of patients can be managed by exclusion of cancer and reassurance. In some the severity of pain affects the quality of life and drug treatment should be considered. Since its inception 324 patients with cyclical mastalgia and 90 with non-cyclical mastalgia have received a therapeutic trial of drug treatment in the Cardiff Mastalgia Clinic. Overall 92% of those with cyclical mastalgia and 64% with non-cyclical mastalgia obtained a clinically useful response to therapy. Danazol was the most effective drug, with bromocriptine and evening primrose oil having equivalent efficacy. Many fewer adverse events were complained of by patients treated with evening primrose oil than danazol or bromocriptine.
Anti-Inflammatory Agents, Non-Steroidal↗
Reproductive factors associated with mastalgia.
Mastalgia has been classified as an aberration of the normal, rather than a disease. We present an age-matched, case-control study which compares the reproductive factors of patients with severe cyclical and noncyclical mastalgia with control groups of women who presented to a breast clinic but in whom no clinical abnormality was found and who did not later develop breast disease. There were few statistically significant differences in reproductive factors between the cases and controls, which lends some support to the concept that mastalgia can be considered to be an aberration of the normal.
Breast↗
Pneumothorax: a complication of fine needle aspiration of the breast.
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Adult↗
Monoclonal antibody 323/A3: a marker for the presence of breast carcinoma.
The monoclonal antibody 323/A3 has been suggested as a marker of cancer risk in benign breast disease. Patients who have had both a benign biopsy and a later biopsy for breast carcinoma were studied. The staining patterns in the biopsies were analysed using a semi-quantitative recording system adapted from Mariani-Costantini et al. Immunohistochemical (IHC) staining was carried out on formalin fixed paraffin embedded tissue sections. In apocrine metaplasia the cytoplasm of benign tissue did not stain with 323/A3 whereas in the biopsies with associated breast cancer 5 of 7 biopsies stained, a statistically significant difference. A positive predictive value of 100% was noted for strong cytoplasmic staining to indicate the presence of carcinoma and this phenomenon may be useful as a means of demonstrating patients who have malignant breast disease in which a biopsy has inadequately sampled the breast tissue.
Adult↗
Axillary dissection in breast cancer.
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Axilla↗
The axilla: not a no-go zone.
Many surgeons, particularly in the UK, give inadequate primary treatment to patients with operable breast cancer. For spurious reasons they regard axillary clearance as unnecessarily extensive surgery and rely instead upon total mastectomy or tumour excision and node sampling, with or without postoperative radiotherapy. But it is now clear that relapse-free and overall survival can be improved by appropriate adjuvant therapy. Thus inadequate exploration of the axilla is doubly unjustified. Not only is there the obvious risk of failure to remove nodes that contain metastases--so that some patients are deprived of cure by primary treatment--but the extent of tumour spread will be inadequately assessed in many more patients, with the risk that they may not receive appropriate adjuvant treatment.
Axilla↗
Oestrogen-regulated 24-kDa protein--a marker for breast carcinoma in benign breast tissue.
A monoclonal antibody (mAb) raised to an oestrogen-induced protein (24-kDa protein) has been suggested as a marker of women at risk of developing breast cancer. Patients with benign breast biopsies who have not developed breast cancer (benign control groups) were compared to women who had malignant breast biopsies. The benign tissue components from each group were studied. Subsequently, women with benign breast biopsies who have not developed malignancy were compared to women with benign breast biopsies who later went on to develop breast cancer. The study was carried out on formalin-fixed paraffin-embedded tissue sections. Comparison between tissue from the benign control groups and from women with breast cancer demonstrated the cytoplasmic staining in apocrine metaplasia of benign controls to be more pronounced. No staining differences were apparent between benign biopsies of patients who have not developed breast cancer and benign biopsies of those who have. We conclude that diminished expression in apocrine metaplasia of mAb to 24-kDa protein may indicate the presence of breast cancer but we have been unable to establish the role of 24-kDa protein as a marker for cancer risk.
Adult↗
Traumatic rupture of the diaphragm: a difficult diagnosis.
Rupture of the diaphragm occurs in approximately 5 per cent of cases of severe blunt trauma to the trunk, and the mortality may be as high as 50 per cent. The diagnosis is important because of the high incidence of associated organ damage and complications of a missed injury. Successful diagnosis requires a high index of suspicion but can be made from the chest radiograph in 90 per cent of cases if visceral herniation has occurred. We present three cases of rupture of the diaphragm which highlight the frequent occurrence of a delayed or missed diagnosis.
Accidents, Traffic↗
Zinc alpha-2 glycoprotein levels in serum and breast fluids: a potential marker of apocrine activity.
Zinc alpha-2 glycoprotein (ZnGP) was measured in human breast microcysts, breast secretions, breast cyst fluid and serum. Detectable amounts of ZnGP were found in all fluids but the highest levels were found in microcysts. Apocrine macrocysts had a higher ZnGP level than flattened macrocysts. In both cysts and secretions levels of ZnGP correlated with those of dehydroepiandrosterone sulphate. Levels were significantly higher in cyst fluids from women who developed further cysts during follow-up compared with those in fluid from women who did not. Concentrations of ZnGP in serum from breast cancer patients were significantly higher than controls but not women with breast cysts. Women with node positive breast cancer had higher serum levels compared with those in node negative patients. Women with more advanced breast cancer had higher serum ZnGP levels than those with earlier disease. ZnGP is a serum and breast marker of apocrine activity and may prove to be a useful prognostic marker in breast cancer.
Apocrine Glands↗
Is there an increased risk of breast cancer in women who have had a breast cyst aspirated?
A consecutive series of 644 women who presented with breast nodularity between 1976 and 1982 have been followed up to determine their rate of subsequent breast cancer. Fifteen women have developed breast cancer, 14 of these were among 352 women with an aspirated cyst (relative risk 4.4). Women with multiple cysts had the highest risk and women with breast nodularity had no excess risk. Review of histology specimens from those women who had undergone biopsy showed an excess of florid epithelial hyperplasia in women who subsequently developed breast cancer and women with multiple aspirated cysts were more likely to have florid epithelial hyperplasia. Multiple cysts are clinical markers of histological breast proliferation and women who have had multiple breast cysts aspirated have an increased risk of breast cancer and should be advised to practice regular self examination.
Adult↗
Management of the painful and nodular breast.
Mild breast pain and nodularity are common and may be considered normal. Only when symptoms are severe enough to affect the patient's lifestyle should drug treatment be considered. Using danazol, bromocriptine or evening primrose oil a clinically useful improvement in pain can be anticipated in 77% of patients with cyclical mastalgia and 44% with non-cyclical mastalgia. Benign nodularity should not be biopsied surgically as it is unnecessary and makes subsequent assessment of the breast difficult.
Adult↗
Basal prolactin and total lactogenic hormone levels by microbioassay and immunoassay in normal human sera.
The availability of an improved microbioassay for prolactin measurement has enabled comparison of lactogenic hormone bioactivity and immunoreactivity in normal human serum. Serum was studied from 61 normal females and 15 normal males. The correlation of both assays was very close for all subjects with a mean ratio of bioassay to immunoassay of 1.5 (range 0.8-2.0) for prolactin and 1.4 (range 0.5-1.9) for total lactogenic hormone. There was no significant variation in prolactin or total lactogenic hormone values by microbioassay or immunoassay with sexual or menstrual status. Postmenopausal prolactin levels were lower by both assays compared with premenopausal values with a relative and absolute decrease in prolactin bioactivity with age. These findings indicate that there is a good correlation between prolactin bioactivity and immunoactivity in human serum.
Adult↗
Management of mammillary fistulae.
Mammillary fistulae develop between the lactiferous ducts of the breast and areolar skin. Over a 14-year period 41 fistulae were treated in 36 patients (34 women, 2 men). In 24 women at least one subareolar abscess (mean 2.5) had been incised and drained previously. Fourteen fistulae developed after discharge of an inflammatory mass and three after surgical biopsy. Twelve women underwent 13 fistulectomies, two of which required reoperation. The remaining 24 patients with complicated fistulae (n = 28) had previously undergone multiple surgical procedures; 12 patients had 13 fistulae treated by total duct excision and primary closure without antibiotic cover and six fistulae required reoperation. Fifteen fistulae in 12 women were treated by duct excision with either primary closure under antibiotic cover (n = 7) or packing with healing by granulation (n = 8) and only one recurred (P less than 0.05). Operations for mammillary fistulae should be treated as contaminated procedures. In simple cases where no previous surgery has taken place, fistulectomy is appropriate. In complicated cases, treatment should be duct excision with the wound either closed primarily under antibiotic cover or left open to heal by secondary intention.
Adolescent↗