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PubMed2003

Breast diseases in the Northern region of Saudi Arabia.

OBJECTIVE: The incidence and pattern of breast diseases varies within countries. There is virtually no information on breast diseases found in the Northern region, Kingdom of Saudi Arabia (KSA). This study hopes to provide data in this area. METHODS: We reviewed the histological and clinical records of 708 patients who presented to General Surgery in Prince Abdul-Rahman Al-Sudairy Central Hospital, Sakaka, Al-Jouf, KSA, with breast complaints over an 8-year period (June 1994 and June 2002). Breast findings were categorized in terms of benign, inflammatory, malignant, congenital and functional. Benign diseases were also evaluated in terms of their proliferative status and cancer risk. RESULTS: The findings in order were benign breast disease in 245 (48.9%) were most common, inflammatory disease, 213 (42.5%), and finally cancer of the breast in 43 (8.6%). Fibroadenoma was the most common benign disease. Twenty-seven (5.4%) of benign breast disease were lesions with a cancer relative risk ranging from 1.6-4.4. Breast abscess was the most common inflammatory disease. Ductal carcinoma was the most common breast cancer. Breast cancer was bulky and presented late in mostly premenopausal women. CONCLUSION: Breast diseases are common among our patients. Although benign disease is the most common, some patients have lesions that have a small but definite cancer risk. Of concern is the pattern of advanced breast cancer, which presents mostly in young premenopausal women. A concerted educational program is needed to acquaint the patients with the significance of breast masses.

Adolescent↗

PubMed1995

Thyroid hormones in fibrocystic breast disease.

This study was undertaken to evaluate the role of thyroid hormones in fibrocystic breast disease. The concentrations of thyroid-stimulating hormone (TSH), thyroxine (T4), free T4 and free triiodothyronine (T3) were determined in serum of 50 women with fibrocystic breast disease without macrocysts (cysts of over 3 mm diameter) and in the serum and breast cyst fluid (BCF) of 60 women with fibrocystic breast disease and macrocysts. Possible relationships between thyroid hormones and estradiol, dehydroepiandrosterone sulfate, testosterone, progesterone and 17-hydroxyprogesterone in the BCF also were analyzed. Serum thyroid hormone levels did not differ between the two groups. Free T3 levels were higher in BCF than in serum (p < 0.001), whereas T4, free T4 and TSH concentrations were lower in BCF as compared to serum (p < 0.001). Cysts were divided according to their K+/Na+ ratio because a ratio above 3 represents a predictor of malignant transformation. Free T3 concentrations were higher in BCF than in serum, in both low K+/Na+ cysts and in cysts with a K+/Na+ ratio above 3; those cysts with a high K+/Na+ ratio had the highest free T3 concentration. Free T3 in cysts correlated positively to the K+/Na+ ratio (r = 0.831; p < 0.001). Multiple linear regression analysis demonstrated that the concentration of free T3 in BCF was predicted statistically by the positive regression coefficient for the estradiol concentration. No candidate variable was included in the model to predict concentrations of TSH, free T4 or T4 in BCF. These data suggest an important role of free T3 in the physiology of fibrocystic breast disease.

17-alpha-Hydroxyprogesterone↗

PubMed1990

Education on breast disease in an obstetrics and gynecology training program: a multidisciplinary approach.

Breast cancer affects one in ten women during their lifetime. Recognizing the importance of early detection in the prognosis of this condition, the American Board of Obstetrics and Gynecology has stated guidelines encouraging breast disease education in obstetrics and gynecology training programs. To fulfill this academic responsibility, we have organized a multidisciplinary Breast Disease Detection and Treatment Clinic where patients with abnormal mammograms or any breast-related complaints are evaluated and managed. In cooperation with the radiology department and general surgery service, a mammogram review conference has been instituted. Abnormal mammograms are reviewed with a radiologist. Our activities have been coordinated such that a general surgery staff member and resident are present during the breast clinic hours to review mammograms and to examine the patients with the gynecologist, providing immediate consultation. Needle aspiration of breast cysts, repeat imaging studies, and general surgery referrals for breast biopsies are performed as indicated. The patient receives integrated care of her breast problem in one visit, and our residents gain the experience of diagnosing and managing breast problems which, before establishment of this clinic, were referred to the general surgery department. This multidisciplinary approach developed in our institution helps us provide the most efficient care to our patients, while providing our residents with integrated teaching and training concerning the diagnosis and management of breast disease.

Ambulatory Care Facilities↗

PubMed1987

Steroid receptors in benign breast disease, gross cystic disease and fibroadenoma.

The benign breast pathology embraces a wide variety of anatomo-clinical-pathological conditions producing confusion in nomenclature. The Authors collected three different types of BBP and investigated the hormonal receptor status for each. The following concentrations of ERc were found: 1-6 fmol/mg in BBD; less than 2 fmol/mg in GCD; 12-18 fmol/mg in the cytoplasm and 29-37.5 fmol/mg in the nucleus in FA. In FA, PgR was found in concentrations of 43.5-50 fmol/mg in the cytoplasm and 0.2-10 fmol/mg in the nucleus. Even if we consider these three histo-pathological entities (BBD, GCD, FA) separately, no correlation can be seen between the presence of receptors and benign breast disease. The only observation we can make is that the fibroadenomas contain more easily identifiable receptor concentrations than BBD and GCD.

Adenofibroma↗

PubMed2004

Abnormal uterine bleeding as a presentation of metastatic breast disease in a patient with advanced breast cancer on tamoxifen therapy.

INTRODUCTION: Extra pelvic tumours rarely metastasise to the female genital tract. Typically it is the ovaries that are involved and the primary tumours include the breast and the gastrointestinal tract. Metastatic disease involving the uterus is rare. CASE REPORT: A case of metastatic breast carcinoma involving both the uterine corpus and cervix is described. The patient was known to have advanced breast carcinoma and was on tamoxifen therapy when she presented with postmenopausal bleeding. Histological assessment of the hysterectomy specimen including immunohistochemistry staining confirmed the breast carcinoma as the primary. CONCLUSION: Unusual uterine bleeding in a patient with breast cancer, should alert the gynaecologist to the possibility of metastatic breast disease regardless of tamoxifen treatment.

Aged↗

PubMed1995

Benign breast disease: absence of genetic alterations at several loci implicated in breast cancer malignancy.

Benign breast disease (BBD) is a heterogeneous group of benign breast problems that has been associated with breast cancer risk by several investigators. Genetic alterations have been described in breast carcinomas under the headings of loss of heterozygosity (1p, 3p, 7q, 11p, 17p, 17 and 18q), mutations (p53, c-H-ras-1), and/or gene amplifications (c-myc, int-2/FGF3, and c-erbB-2/neu). In an attempt to determine whether these genetic alterations might also be involved in the development of BBD, we have analyzed such alterations in 50 BBD lesions. The histological types of samples studied were: 37 fibroadenomas; 8 benign phyllode tumors; and 5 fibrocytic diseases. Cellular DNA was extracted from tissues and from corresponding blood leukocytes according to standard techniques, digested with appropriate restriction endonucleases, and analyzed by Southern blot. The following are informative cases found in a total number of patients analyzed for each locus: 13 of 26 for L-myc (1p); 9 of 23 for THRB (3p); 11 of 29 for met (7q); 27 of 50 for c-H-ras-1 (11p); 3 of 13 for TP53 (17p); 14 of 50 for D17S30 (17p); 20 of 33 for D17S4 (17q); and 13 of 33 for D18S5 (18q). No loss of heterozygosity was detected at any of the examined loci. Alternatively, none of the 50 BBD cases displayed an amplification of the three genes tested (c-myc, int-2/FGF3, and c-erbB-2/neu). Our results show that molecular alterations, which are more frequently involved in malignant breast carcinomas, do not occur in BBD lesions. These results indicate that these molecular alterations could constitute late events in the pathogenesis of breast carcinomas.

Adolescent↗

PubMed1985

An assessment of ultrasound mammography as an additional investigation for the diagnosis of breast disease.

X-ray mammography was performed on 446 patients with suspected breast disease and 23 breast carcinomas were detected of 26 (sensitivity: 88.5%) that were ultimately diagnosed in the 12-24 months' period following examination. Ultrasound mammography was used as an additional procedure in 183 patients because the radiographic findings were considered to be indeterminate and it detected an additional two carcinomas, to give an overall sensitivity of 96%. X-ray mammography identified 40 benign lesions and subsequent ultrasound mammography characterised 38 of these as being either cystic or solid. Ultrasound also detected an additional 32 benign lesions (28 cysts and 4 fibroadenomas) which had not been evident on X-ray mammography. It is concluded that ultrasound mammography is a useful complementary procedure for those patients who have radiodense breasts or indeterminate radiographic findings on X-ray mammography.

Adenofibroma↗

PubMed1993

Breast cancer risk associated with proliferative breast disease and atypical hyperplasia.

BACKGROUND: Women with proliferative breast disease (PD) have been observed to have an increased risk of breast cancer. The authors evaluated the effect of PD on breast cancer risk in a case-control study among participants of the Breast Cancer Detection Demonstration Project (BCDDP). METHODS: More than 280,000 women were screened in the BCDDP at 29 centers. Study subjects were selected from BCDDP participants who underwent biopsy that revealed benign breast tissue. There were five BCDDP centers for which histologic slides were available on more than 85% of the benign biopsy specimens. Case patients for this study were the 95 women from these five centers who had breast cancer develop during follow-up. Two matched control patients who did not have breast cancer develop were selected for each case. The biopsy slides were reviewed by two pathologists who were blinded with regard to cancer outcome. RESULTS: Women with atypical hyperplasia (AH) had 4.3 times the breast cancer risk of women without PD (95% confidence interval [CI], 1.7-11). In women with PD lacking AH, the relative risk was 1.3 (95% CI, 0.77-2.2). A family history of breast cancer (FH) increased breast cancer risk 2.4 times (95% CI, 1.4-4.3). The joint occurrence of FH and AH had a strong synergistic effect on breast cancer risk. CONCLUSIONS: AH is a reliable marker of increased breast cancer risk among women undergoing breast biopsy.

Adult↗

PubMed1984

Risk factors for pathologically confirmed benign breast disease.

Between November 1981 and March 1983, data were collected to evaluate risk factors for benign breast lesions in a case-control study based on 288 women with histologically proven benign breast disease, admitted for biopsy to the Tumor Institute of Milan, and 285 age-matched controls. Questions were asked about menstrual and reproductive characteristics, marital status, education, history of various diseases, and lifetime use of oral contraceptives and other hormonal treatments. Nulliparity or low parity, late age at first birth, and late menopause were associated with an increased risk of benign breast disease. The elevated risk associated with late age at first birth was not accounted for by parity. Early age at menarche was associated with an increased risk, but the estimate was not statistically significant. The data do not suggest that the use of oral contraceptives or other female hormones (such as estrogen replacement therapy) is related to the risk of benign breast disease. Risk was apparently lower, however, among current and long-term oral contraceptive users. There was no evidence of a trend with reference to body mass index. The present data indicate a substantial agreement between the risk factors for (pathologically confirmed) benign and malignant breast disease, not only directly, by showing a relationship with parity, age at first birth, and age at menopause, but also indirectly, by failing to produce evidence that greater weight or the use of oral contraceptives has a protective effect.

Adolescent↗

PubMed1998

Trichomoniasis of the breast diseased by fibrocystic mastopathy: pathogenic rather than saprophytic relationship (Trichomonas in fibrocystic mastopathy process).

Because of the striking similarity between histopathological pictures of chronic trichomonal cervicitis uteri, the tissue reaction after subcutaneous inoculation of Trichomonas culture in experimental animals and female breast diseased by fibrocystic mastopathy, the detection of Trichomonads was undertaken in surgically removed diseased breast parts. In 12 FCM patients, subjected to segmental breast resection, the imprint smears were prepared from dissected specimens and after supravital staining immediately examined by light microscopy. The mucous content from dilated ducts was inoculated in the culture media. The dissected tissues have been further histologically analysed by standard method. In nine out of 12 examined FCM cases the direct microscopy revealed aflagellary, pseudocystic, leucocytoid form of Trichomonads. The cultures were positive in 4 cases: in 3 patients Trichomonas tenax was identified and in the last one T vaginalis. Histopathological findings in all 12 examined cases have shown the changes characteristic for FCM. On the basis of the accumulated knowledge about pathogenic capacity of Trichomonads, it can be with great certainty claimed that these protozoa, even in their pseudocystic form are able to cause the all appearances characteristic for FCM. This first report about Trichomonas infection in the middle of FCM process gives the unexpected hope in solving of its etiology and new insight into antitrichomonal host reaction which is frequently associated with epithelial dysplasia and unrarely with precancerous lesions as earlier observed in cervix uteri.

Female↗

PubMed2003

Adolescent diet and incidence of proliferative benign breast disease.

Studies of adult diet and risk of breast cancer have yielded mainly null results, but this does not rule out a possible impact of adolescent diet. This study examined associations between components of adolescent diet and risk of proliferative benign breast disease (BBD), a marker for breast cancer. The study population consisted of 29494 women in the Nurses' Health Study II who completed a questionnaire on adolescent diet in 1998 and who were 33-53 years of age at that time. A total of 470 new cases of proliferative BBD were identified between 1991 and 1997. Incidence rate ratios (RRs) and 95% confidence intervals (CIs) were calculated for quartiles of energy-adjusted intakes, using the lowest quartile of each as the reference group. Total fat intake during adolescence was unrelated to risk of proliferative BBD, although there were positive associations for intakes of animal fat and monounsaturated fat and an inverse association for intake of vegetable fat. For vitamin E intake, the multivariate RRs were 1.13, 0.88, and 0.79 (95% CI, 0.61-1.04) for women in the second, third, and highest quartiles, respectively (P for trend = 0.05). The multivariate RRs were 0.94, 0.99, and 0.75 (95% CI, 0.57-0.98) for women in increasing quartiles of fiber intake (P for trend = 0.05). Vegetable fat, vitamin E, and fiber intakes during adolescence were inversely associated with risk of proliferative BBD in this population. Confirmation of these associations may suggest a means for prevention of breast cancer.

Adolescent↗

PubMed1999

Consistency achieved by 23 European pathologists from 12 countries in diagnosing breast disease and reporting prognostic features of carcinomas. European Commission Working Group on Breast Screening Pathology.

A detailed analysis of the consistency with which pathologists from 12 different European countries diagnose and classify breast disease was undertaken as part of the quality assurance programme of the European Breast Screening Pilot Network funded by the Europe against Cancer Programme. Altogether 107 cases were examined by 23 pathologists in 4 rounds. Kappa statistics for major diagnostic categories were: benign (not otherwise specified) 0.74, atypical ductal hyperplasia (ADH) 0.27, ductal carcinoma in situ (DCIS) 0.87 and invasive carcinoma 0.94. ADH was the majority diagnosis in only 2 cases but was diagnosed by at least 2 participants in another 14, in 9 of which the majority diagnosis was benign (explaining the relatively low kappa for this category). DCIS in 4 (all low nuclear grade) and invasive carcinoma (a solitary 1-mm focus) in 1. The histological features of these cases were extremely variable; although one feature that nearly all shared was the presence of cells with small, uniform, hyperchromatic nuclei and a high nucleo-cytoplasmic ratio. The majority diagnosis was DCIS in 33 cases; kappa for classifying by nuclear grade was 0.38 using three categories and 0.46 when only two (high and other) were used. When ADH was included with low nuclear grade DCIS there was only a slight improvement in kappa. Size measurement of DCIS was less consistent than that of invasive carcinoma. The majority diagnosis was invasive carcinoma in 57 cases, the size of the majority being 100% in 49. The remainder were either special subtypes (adenoid cystic, tubular, colloid, secretory, ductal/medullary) or possible microinvasive carcinomas. Subtyping was most consistent for mucinous (kappa, 0.92) and least consistent for medullary carcinomas (kappa, 0.56). Consistency of grading using the Nottingham method was moderate (kappa=0.53) and consistency of diagnosing vascular invasion, fair (kappa=0.38). There was no tendency for consistency to improve from one round to the next, suggesting that further improvements are unlikely without changes in guidelines or methodology.

Breast Diseases↗

PubMed1999

Benign breast disease.

The author presents an overview of benign breast disease. History, epidemiology, risk factors, hormonal influence, and clinical features are discussed. Appropriate treatment for mastalgia, diffuse nodularity, mastitis, and dominant lumps is presented. The importance of patient education, clinical breast examination, mammography, and patient reassurance is stressed. Benign breast disease in men is also discussed.

Breast Diseases↗

PubMed1984

Oral contraceptive use and fibrocystic breast disease among pre- and postmenopausal women.

The association between use of oral contraceptives and fibrocystic breast disease was assessed among women aged 20-74 years in a hospital-based case-control study conducted between November 1979 and November 1981 in Connecticut. The study groups comprised 633 women with biopsy-proven fibrocystic breast disease and 1,062 controls who had been admitted, as inpatients or outpatients, to general surgical services. For the premenopausal women, there was no evidence that long-term use of oral contraceptives was associated with a decreased frequency of fibrocystic breast disease among either current or past users. For the postmenopausal women, previous oral contraceptive exposure was associated with an increased occurrence of cystic disease. These findings contradict previous investigations reporting a negative association between oral contraceptive use and the development of fibrocystic breast disease.

Adult↗

PubMed1988

A nationwide study of breast disease.

Records of histopathology from the 3734 Jewish women having breast biopsy and/or operations in all Israeli hospitals during the year from July 1979 to June 1980 were reviewed. Approximately 28.5% of these women were diagnosed as having breast cancer and 71.5% as having benign breast disease: 48.5% had benign proliferative mastopathy (BPM), 16.6% had fibroadenoma (FA) without coexistent BPM, and 6.4% had other benign breast conditions. The age-specific incidence rate was 66 in 100,000 for breast cancer and 165.2 in 100,000 for benign breast disease. Native European or American women and native Israeli women had significantly higher age standardized incidence rates of both breast cancer and BPM, but not of FA, as compared to African/Asian-born women (P less than 0.01). Age-related ratios between invasive to precursor breast lesions were similar in all ethnic groups. The data suggest that breast cancer and benign proliferative mastopathy may have a common etiologic component.

Adult↗

PubMed1996

Streamlining breast disease management.

New technology has been developed for performing percutaneous (non-surgical) breast biopsy and tracking the outcome of breast disease patients. The procedure, mammotomy, takes a biopsy of breast tissue lesions quickly during the same office visit at which the screening mammography discovers an abnormality. Because the procedure is non-invasive, it bypasses the extra time and expense of open surgical biopsies. In conjunction with mammotomy, Breast Cancer Manager (BCM) software is intended to streamline breast care data management. These technologies provide the cornerstone of a comprehensive breast health plan that can streamline patient care across specialties. This plan uses an organ-based, multispecialty coalition of practitioners related to the diagnosis and treatment of breast disease. The BCM software provides a central, complete record of all care given to a patient from the first screening mammogram through surgery and adjuvant therapy. All practitioners will have access to its information and at the same time be able to add to it, making it the repository of patient and practice data for management analysis and outcomes reporting. This article looks at the treatment paradigm of breast disease and details the potential cost savings made possible by mammotomy and the BCM software.

Biopsy, Needle↗

PubMed1992

Hormones and growth factors in nipple aspirates from normal women and benign breast disease patients.

Several reports have indicated that the breast fluid obtained by nipple aspiration provides valuable biological material for inclusion in studies of breast cancer biochemical epidemiology. Breast fluids contain a variety of hormones and growth factors, often at concentrations considerably higher than those in the corresponding serum. Aspirates from benign breast disease patients have very high levels of bioactive lactogenic hormones and, to a lesser extent, immunoassayable prolactin, compared with healthy controls. A growth hormone-like protein, recognized in a radioimmunoassay but not in a growth hormone-specific immunoradiometric assay, and lacking activity in the Nb2 cell bioassay, is usually present in fluids from Finnish (low breast cancer risk) but not American (high breast cancer risk) women. Epidermal growth factor and transforming growth factor-alpha are present in breast fluids, with preliminary indications that these functionally related polypeptides occur at relatively high concentrations in benign breast disease.

Adult↗

PubMed1975

Sex hormones in breast disease.

Serum concentrations of oestradiol 17beta and progesterone were measured daily throughout one menstrual cycle in 32 normal women, 32 women with benign disease of the breast and 10 women with cancer of the breast. In normal women concentrations varied with age. Women with cysts had concentrations of oestradiol 17beta which were significantly higher than normal. In women with cancer the concentrations of oestradiol 17beta and progesterone were significantly higher than normal, but the difference was very small and much larger numbers of patients need to be studied. Concentrations of oestradiol 17beta and progesterone in postmenopausal women were consistently very low.

Adult↗