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R Kåresen

Publications and source records attributed to R Kåresen.

At least 19 recordsLinked to original sources
PubMed2001

Mammography screening in Norway: results from the first screening round in four counties and cost-effectiveness of a modeled nationwide screening.

OBJECTIVE: To evaluate whether the results of the first screening round in the Norwegian Breast Cancer Screening Program predict future mortality reduction and to explore the cost-effectiveness of the program. METHODS: The results of surrogate measures were calculated and compared with the targets. A cost-effectiveness analysis was performed assuming a nationwide program starting in 1996 with an attendance rate of 80% and a mortality reduction of 30%. RESULTS: The attendance rate was 79.5% and the detection rate was 0.67%. The proportion of invasive tumors smaller than 15 mm was 53.1%, and 21.7% of the patients who underwent axillary surgery had lymphatic metastasis. The C/E ratios were found to be 3750 US dollars (USD) per year of life saved and 86,045 USD per life saved. CONCLUSION: The results of the first screening round will lead to a mortality reduction of at least 30%. The cost-effectiveness analysis shows that it is possible to run a highly cost-efficient screening program in Norway.

Aged↗
PubMed2000

[Psychological, social and economic situation of women surgically treated for cancer].

INTRODUCTION: As part of an international effort, a study of the psychosocial condition of women with cancer in Norway was performed in 1997. MATERIAL AND METHODS: 851 women with breast or gynaecological cancer in 27 Norwegian hospitals were asked to fill in a multi-choice questionnaire. RESULTS: 76% of the breast cancers were detected by the women themselves, 19% by mammography and 11% by clinical examination. Similar numbers for gynaecological cancer were 59% by the women and 41% by the doctors (13% screening smear). 25% of the women were informed about the cancer diagnosis by telephone and 9% by letter. 87% were satisfied with treatment and care, 7% dissatisfied. 62% were satisfied with the availability of doctors, 20% not. In 47% of the breast cases, therapy alternatives were discussed with the patients. In 23% of gynaecological, 50% of breast, and 72% of gynaecological cancer, patients had no wish to participate in the decision. 94 of a total of 850 patients (11%) experienced financial problems after the diagnosis had been established. More than 90% of the women had a better or unchanged relation to their partner, family and friends after treatment. However, 30% of the breast and 14% of the gynaecological cancer patients had problems with their body image, and 16% and 15% felt they were less sexually attractive. 89% felt their partner coped well with the situation, 9% had problems and only 2% lost their partner. 32% of the patients had used alternative medicine, 44% of those with recurrence and 28% under primary treatment. INTERPRETATION: Women operated for breast and gynaecological cancer face a variety of psychosocial and financial problems.

Body Image↗
PubMed2000

Genetic variants of CYP19 (aromatase) and breast cancer risk.

The effect of a SNP in exon 10 of CYP19 on tumor mRNA levels and splice variants were studied and correlated with clinical parameters and risk of breast cancer. In the vast majority of breast cancers, the estrogen levels modulate the tumor growth and depend on the activity of CYP19. Patients (n=481) and controls (n=236) were genotyped by T-tracks in a single sequencing reaction (SSR). The frequency of TT genotypes was significantly higher in patients versus controls (P=0.007) particularly among those with stage III and IV disease (P=0.004) and with tumors larger than 5 cm (P=0.001). A significant association between presence of the T allele and the level of aromatase mRNA in the tumors was observed (P=0.018), as well as with a switch from adipose promoter to ovary promoter (P=0. 004). Previously, we reported a rare polymorphic allele of CYP19 (repeat (TTTA)12) to be significantly more frequent in breast cancer patients than in controls. Here we describe another polymorphism, a C - T substitution in exon 10 of the CYP19 gene which is in strong linkage disequilibrium with the (TTTA)n polymorphism but with higher frequency of the variant allele. Our data suggest that the T-allele of the CYP19 gene is associated with a 'high activity' phenotype. Oncogene (2000) 19, 1329 - 1333.

3' Untranslated Regions↗
PubMed2000

[Diagnostic and therapeutic localized breast biopsy].

Preoperative localized mammary biopsy has been used as a diagnostic tool since before 1983 in the Breast Clinic, Ullevål Hospital. The great majority of procedures have been performed in the outpatient clinic with use of local anesthesia. Since 1988 all activity has been registered prospectively in a database. We discuss the use of the procedure and the results obtained during the period 1983-95. In the later part of the observed period, the use of the procedure as a diagnostic tool has been less frequent, but it has been increasingly used as a tool to identify the pathologic process when performing breast-conserving surgery. Surveillance of the malign-benign ratio is an important parameter in the quality assurance of the procedure. The malign-benign ratio has been greater than 0.3 during the period of observation. Continuous registration of procedure-related parameters is necessary for documentation of the results.

Biopsy, Needle↗
PubMed2000

Screening breast cancer patients for Norwegian ATM mutations.

483 Norwegian breast cancer patients were screened for six different ataxia telangiectasia mutated (ATM) mutations previously found to account for 83% of the disease alleles in Norwegian ataxia telangiectasia (AT) patients. Only one carrier was found. These results provide no evidence in favour of an excess risk of breast cancer associated with heterozygosity for classical AT mutations, but remain consistent with a maximum 2.4-fold increased risk.

Alleles↗
PubMed2000

Ductal carcinoma in situ of the breast--a review of diagnosis, treatment and outcome in a hospital-based Norwegian series.

Between 1980 and 1994, 71 women with histologically proven ductal carcinoma in situ (DCIS) were diagnosed at Ullevål Hospital; bilateral tumours were found in two patients. Surgical treatment was mastectomy (42 lesions) or local excision (31 lesions). Median follow-up time was 7.2 years. Ten patients experienced a local recurrence, seven of which were invasive carcinomas. The actuarial 5-year local recurrence rate was 22% after local excision. A multivariate analysis found that tumour size was the only factor that predicted local recurrence after local excision. An analysis of relative survival in a nation-wide material of 832 DCIS patients in the period 1980 to 1994 demonstrates that relative survival after a DCIS diagnosis is almost 100%, irrespective of surgical treatment of the initial lesion.

Adult↗
PubMed1999

[Cost-effectiveness of mammography screening in Norway].

Since January 1996, mammography screening every second year has been offered to women aged 50 to 69 in four counties in Norway. As an input to the evaluation of the programme, medical authorities commissioned an analysis of the cost-efficacy of screening. The results are presented in this paper. This study of the screening in the City of Oslo is based on registration of time used on various procedure, data for all procedure performed, and financial accounting data. The result have been recalculated for a simulated nation-wide project. Only costs up to the time of diagnosis (malignant/benign) have been included. The total cost of the Oslo programme 1996/97 was NOK 12.1 m (USD 1.6 m). Cost per women examined was NOK 395 and per cancer detected NOK 57,639. Cost per life saved was estimated at NOK 680,000, per year-of-life saved NOK 30,000. Based on accounting data only, comparisons could be made between counties. Costs in other counties were between 39 and 73% higher than in Oslo. Using an estimate of a 40% higher costs nation-wide, we find that the total cost of one year of nation-wide (population 4.5 m) screening would amount to NOK 83 m, cost per life saved to NOK 950,000, and per year-of-life saved to NOK 41,000. Estimated cost per life saved by traffic safety measures has been NOK 10 m. On this basis, mammography screening in Norway seems to be a highly cost-effective measure.

Breast Neoplasms↗
PubMed1999

[A prospective registration of diagnosis and treatment of breast tumors at the Ulleval hospital 1988-1995].

During the years 1988 to 1995, all diagnostic and therapeutic activities in the Breast Clinic, Ullevål Hospital, Oslo, Norway were registered prospectively. This paper presents the results from the registration. Of 4,436 new referrals, 1,169 had infiltrating mammary carcinoma and 63 ductal carcinoma in situ. 13.6% of those with breast carcinoma and 12.3% of those with benign breast disease had a first degree relative with breast cancer. The use of diagnostic biopsies for palpable and nonpalpable lesions decreased significantly through the period, from 155/112 in 1988 to 65/78 in 1995. For palpable lesions, the malign/benign ratio decreased from 0.82 in 1988 to 0.54 in 1995 while it improved from 0.43 to 0.88 for marked biopsies for nonpalpable lesions. Excluding those with mammographically and/or cytologically suspicious lesions from those who had a biopsy for a palpable lesion, we found that only seven out of 101 had cancer (ratio 0.07). Radical surgery was done in 790 cases with cytology as the only pre- and peroperative cancer verification. Three of them had a false positive cytology, as cancer was not found in the breast. One patient had metastasis later confirming that a cancer had been present; thus we had two false positive cytologies (2.5 per thousand). More than six axillary lymph nodes have to be examined in order to avoid false negative axillary status. In 1988 we had 41% with less than six nodes examined. This improved to 15% in 1995. Breast preserving therapy increased throughout the period from 4.1% in 1988 to 29.4% in 1995. Tumor size (pTI around 40%) and node positivity (35%) was fairly constant. In our opinion, a continuous prospective registration of the activity in a breast diagnostic centre is essential in order to improve and maintain service quality. The decision made by the Norwegian parliament in 1998 to introduce nation-wide mammography screening may be used to institute such continuous prospective registrations in all centres involved in the screening.

Breast Neoplasms↗
PubMed1999

[Follow-up of women surgically treated for breast cancer].

From May 1997, all breast cancer patients who had undergone ablatio were asked to contact their general practitioner for follow-up after six months. Evaluation of the method used was performed by means of a questionnaire sent to 148 women. At the same time report forms returned from the general practitioners were registered. 132 women returned the questionnaires (89%). Only seven women (5%) had not contacted their general practitioner. 117 women (89%) had been or were summoned to their general practitioner. This shows that general practitioners take responsibility for follow-up when the women get in touch. We received 52 (58%) report forms from the general practitioners. The reason for this low response rate among the general practitioners might be inadequate motivation.

Adult↗
PubMed1999

CYP17 and breast cancer risk: the polymorphism in the 5' flanking area of the gene does not influence binding to Sp-1.

The ability of a motif of the CYP17 5' untranslated region, created by a polymorphic T to C substitution, to bind to the human transcription factor Sp-1 was investigated. No binding of any of the polymorphic alleles was observed in electromobility shift assay. No other sequence within +1 to +100 of each of the CYP17 alleles formed complex with the Sp-1 or enhanced binding to the polymorphic CACC box. Genotyping of 510 breast cancer patients and 201 controls revealed no difference in genotype frequencies. Age at onset, tumor grade, lymph node status and distant metastases, stage, and estrogen and progesterone receptor status were not associated with the CYP17 genotype.

5' Untranslated Regions↗
PubMed1998

Increased sensitivity for detection of micrometastases in bone-marrow/peripheral-blood stem-cell products from breast-cancer patients by negative immunomagnetic separation.

Immunocytochemical detection (ICC) of isolated tumor cells in bone marrow (BM) is currently the most established method for monitoring early dissemination in epithelial cancer. However, the low sample size that can practically be analyzed restricts the sensitivity and reliability of the ICC method. To be able to analyze larger samples, a negative immunomagnetic separation (IMS) technique, utilising anti-CD45-conjugated Dynabeads, has been developed. Tumor-cell enrichment by depletion of CD45-expressing mononuclear cells (MNC) is followed by ICC for detection of the cytokeratin (CK)-positive (+) epithelial cells. In this study, bone-marrow samples (n = 165) and peripheral-blood-progenitor-cell (PBPC) apheresis products (n = 22) from breast-cancer patients were analyzed. The negative IMS analysis of 1 to 2 x 10(7) MNC was compared with ICC analysis of 2 x 10(6) unseparated MNC. Negative IMS resulted in 85% mean depletion of MNC. The results showed that 11.7% of the samples were positive by ICC analysis of unseparated MNC, as compared with 23.5% after negative IMS. In samples presenting > 10 CK+ cells, a 4-fold higher number of positive cells was detected by the negative IMS technique. Moreover, there was no evidence for general enrichment of false-positive cells. Altogether our results show that negative IMS is an efficient enrichment method for sensitive detection of CK+ cells in BM/PBPC products from breast-cancer patients. This opens the possibility for further characterization of micrometastatic tumor cells.

Bone Marrow Cells↗
PubMed1998

[Breast conserving surgery for breast cancer--local recurrence].

One of the disadvantages of breast conserving treatment compared with mastectomy is the higher rate of local recurrence. Even though a local recurrence has no influence on survival, it is a psychological trauma for the woman it affects. Breast conserving treatment has been practised at Ullevaal Hospital since 1986. This study is based on data from 216 consecutive cases of breast conserving surgery, from January 1986 to March 1996. Mean observation time was 29 months. Nine (4.2%) patients experienced a local recurrence. Age, histological grade, and the size of the tumor were identified as risk factors, whereas there was no correlation between histology, axillary node involvement, and surgical margins.

Adult↗
PubMed1998

E-cadherin and alpha-, beta-, and gamma-catenin protein expression in relation to metastasis in human breast carcinoma.

In the metastatic process, various cell-cell adhesion molecules seem to play an important role. E-cadherin, a transmembrane protein with an extracellular and an intracellular domain, is one of the key players involved in cell-cell adhesion. The function of E-cadherin in preventing metastasis in tumour development is believed to be dependent on intracellular catenins. In a previous study, the expression of E-cadherin was examined in a series of human breast carcinomas. In that study, down-regulation of E-cadherin failed to correlate with lymph node and/or distant metastasis. In the present study, the expression of alpha-, beta-, and gamma-catenins has been examined in a subset of the same tumours in order to evaluate their possible role in breast cancer metastasis. Tumour tissues from 90 primary breast carcinomas were immunostained for alpha-, beta-, and gamma-catenins. Reduced or absent immunoreactivity in the tumour tissue was seen in 63 (70.0 per cent) for alpha-catenin, in 50 (55.6 per cent) for beta-catenin, and in 50 (55.6 per cent) for gamma-catenin. Reduced expression of each of the catenins alone failed to correlate to metastasis. However, when all of the four proteins (E-cadherin, alpha-catenin, beta-catenin, and gamma-catenin) were analysed as one group, a significant association was seen between reduction in immunoreactivity of at least one of these four proteins and the presence of metastases. These results indicate that if one of these proteins is down-regulated, the function of the others in suppressing metastasis is altered. A significant association was seen between lobular invasive tumours and beta-catenin expression.

Adult↗
PubMed1998

Assessing estrogen and progesterone receptor status in fine needle aspirates from breast carcinomas. Results on six years of material and correlation with biochemical assay.

OBJECTIVE: To evaluate the usefulness of immunocytochemical staining on breast fine needle aspiration (FNA) cytology as a routine procedure for determination of estrogen (ER) and progesterone (PR) receptor status. STUDY DESIGN: FNA cytology material from 864 patients was immunostained for ER and PR using Abbott ER/PR-ICA kits. Percentage of stained nuclei, staining intensity and staining pattern was evaluated. In 259 cases comparison with biochemical assay was possible. RESULTS: Of the cases, 75.6% were ER positive and 65% PR positive, and 61.6% were both ER and PR positive. Approximately 4% of the smears were inconclusive because of scant cellularity. Concordance between the immunostaining and biochemical method was 84% for ER and 71% for PR. Kappa values were 0.61 and 0.4, respectively. Major discrepancies were found in 7.7% of the specimens. CONCLUSION: Inconclusive smears due to scant cellularity is a minor problem. Technical difficulties are few, and false negative and positive staining is rarely seen. The results are comparable to those from the biochemical method, and immunostaining of ER/PR on breast cancer FNA cytology smears is useful as a routine procedure for receptor determination.

Biopsy, Needle↗
PubMed1997

[Breast cancer].

Explore the source record for details and available documents.

Breast Neoplasms↗
PubMed1997

[Primary invasive breast cancer in Oslo 1980-89. A population based study of 1942 unselected patients treated by radical surgery].

A retrospective review is presented of 1,942 consecutive patients with histopathologically confirmed invasive breast cancer, who where treated radically in Oslo from 1980 to 1989, either at General Municipal Hospitals (MH) or at a national Comprehensive Cancer Center (CC). The treatment and outcome were related to accepted medical parameters and the responsible hospital category. The median number of axillary lymph nodes described at the MH was 8, compared to 14 at the CC. During the period 1984 to 1986, 62% of the patients had an estrogen receptor analysis (MH 60%, CC 85%). Of the patients with N > or = 4, 36% received adjuvant hormone treatment (MH 32%, CC 67%), whereas the comparable percentage of patients with pT3/pT4 was 53%. The five- and ten-year cancer-related survival rates were 83% and 71% respectively, with no difference between the MH and the CC. As nation-wide criteria for the management of breast cancer have been accepted, compliance and monitoring by surgeons, pathologists and oncologists is imperative as part of quality assurance.

Adult↗
PubMed1997

Interaction between bcl-2 and p21 (WAF1/CIP1) in breast carcinomas with wild-type p53.

The bcl-2 protein is found to be over-expressed in many types of human tumours and is a potent inhibitor of apoptosis. The exact mechanism by which bcl-2 prevents apoptosis and exercises its oncogenic effect is still unclear. Other studies on cell lines have reported that bcl-2 over-expression is related to suppression of p21 (WAF1/CIP). We have investigated the relationship between bcl-2 protein over-expression and expression of the p21 protein in a series of human breast carcinomas. Selected tumour samples from 100 breast-cancer patients (38 with abnormal p53 status, scored as protein accumulation and/or mutation, and 62 without detectable p53 alterations), were immunostained for bcl-2 protein, the p21 protein and the oestrogen-receptor (ER) protein. A highly significant association was found between reduced p21-protein expression and over-expression of bcl-2 in tumours with no detectable p53 alterations (p < 0.001). A significant association was seen between ER immunoreactivity and expression of the bcl-2 protein, as well as between bcl-2 protein expression and tumours of the higher differentiation grade (grade-2 tumours). No association was seen between bcl-2 over-expression and the presence of metastases. Our findings indicate that down-regulation of p21 may be a result of up-regulation of bcl-2 independent of p53.

Adult↗