Breast Cancer Screening of 51,170 Women

PURPOSE: The purpose of this study was to evaluate the efficacy of annual breast screening, which includes a mammography and a clinical physical examination. METHODS: From April 1995 to March 2000, we performed 51,170 annual clinical examinations and mammographies on 26,354 women, who wanted to undergo breast screening, at the breast center. Ninety-five breast cancers were detected during screening, and of these, only 76 breast cancers were operated on. The result were compared with 650 symptomatic breast cancers from the outpatient department (OPD). RESULTS: Of the 51,170 cases screened, the recall rate for further examination was 9.9% (n=5,066), and the biopsy rate was 2.1% (n=1,096). Ninety-five breast cancers were detected; a detection rate of 0.19%. Fourteen breast cancers were detected after more than 2 screening rounds. On the analysis of the medical audit data based on the screening mammographies, the positive predictive value, confirmed when a biopsy from a surgical consultation was recommended (PPV), was 8.6%. Further, 41 cases involving tumors found at stage 0 or I (54%). There were 25 cases of axillary lymph node metastasis (32.9%). These results were compatible with the ideal rates for medical audits, except for PPV and axillary lymph node metastases. The pathologic stages of the screened group were: 0, 22.4%; I, 31.6%; II, 40.8%; III, 5.2%, whereas those of the OPD group were 0, 3.4%; I, 27.4%; II, 52.8%; III, 15.5%, and IV, 0.8%. Early breast cancers were detected more frequently through screening than by the OPD (P<0.05). Breast conservation surgery was carried out on 32.9% (25 cases) from the screened group, but only 12.8% (83 cases) from the OPD group (P<0.05). CONCLUSION: Our breast cancer screening was properly performed. Further, these findings indicate that breast cancer screening using a clinical examination and a mammography is very effective in the early detection of breast cancer.

Nitric Oxide Synthase (NOS) Expression in Breast Cancer

PURPOSE: NO, a diatomic free radical, plays a diverse physiological and pathophysiological roles in the vascular, neuronal and immune systems. It is produced by nitric oxide synthase (NOS) which consists of three different isoforms. In this study we investigated NOS expression in 84 human breast carcinomas and its associations to other clinicopathological factors. METHODS: The immunohistochemical staining for NOS expression in 84 human breast carcinomas were performed and their medical records were reviewed retrospectively. RESULTS: iNOS expression in tumor cells was observed in 48.2% and eNOS expression was detected in 51.9%. iNOS expression in tumor cells has positive correlation with eNOS expression in tumor and is associated with iNOS expression in stroma and endothelial cells. Although iNOS expression in tumor cells has negative correlation with tumor size (P=0.047) and lymph node metastasis (P=0.002), it has no effects on 5 year overall and disease free survivals. iNOS expression in stroma also has negative correlation with tumor size (P=0.016) and nuclear grade (P=0.025). No significant correlation between eNOS expression and clinicopathological factors was observed but eNOS expression in tumor cells contributed to worse 5 year overall survivals (92.1% vs 77.0%) in marginal significance (P=0.053). CONCLUSION: These data suggest that iNOS expression in tumor may have an inhibitory effect in tumor growth and lymph node metastasis. These results may be further investigated.

Interval Breast Cancers: Comparisons with Screen Detected Cancers

PURPOSE: Although the screening with a mammography has been shown to reduce breast cancer mortality, it has limitations relating to its sensitivity and efficacy. Interval cancers are those that become symptomatic, and are detected between screening examinations. The success of a screening program in reducing the rate of mortality due to breast cancer relies on keeping the number of interval cancers at a minimum. This study was performed to review the mammographic features of interval cancers, and to compare their clinicopathological factors with those cancers detected by screening. METHODS: Of the 881 women who had operations for breast cancer performed between 1995 and 1999, we retrospectively analyzed the medical records and mammograms of 57 who received at least a mammogram before the diagnosis of their breast cancer. These patients were divided into an interval cancer group, who had symptoms, and a screen detected cancer group, who had not. The factors compared included the clinical, radiographic, histopathological, and immunohistochemical features. RESULTS: Interval cancers were more likely to have masses, than microcalcifications, in their mammographic features, and were more likely to be invasive and at a higher stage according to their histopathological features. The false negative rate was 48% for the screen detected cancers, and 35% for the interval cancers (P=0.414). HRT users had the higher false negative rate of 51.6% than the 26.9% for the nonuser (P=0.103). CONCLUSION: The interval cancers were found to be different from the screen detected cancers in terms of their radiological and pathological features. The standardization of screen interval, and additional magnification mammography, or ultrasonography may contribute to reduce false negative rates of mammography.

Microvessel Density and Expression of p53 Protein in Skin Carcinoma: basal and squamous cell carcinoma

Basal cell carcinoma(BCC) and squamous cell carcinoma (SCC) are very prevalent neoplasms of the human skin. Ultraviolet radiation in sunlight is a well-established mutagen of the p53 gene and is one of basal cell carcinoma and squamous cell carcinoma. The newly-formed vascular network is important for neoplasms to grow beyond a size of about 1 mm2. Recent reports have suggested the hypothesis that a mutant p53 protein is closely related with capillary density. Immumohistochemistry for p53 protein and CD34 was performed in 20 cases of BCCs and 14 SCCs to evaluated the relationship between p53 protein and capillary density. The results were as follows:1. The microvessels stained by CD34 were mainly located in the interface of tumor cells and stroma. 2. There was no difference in the microvessel density according to the histologic types and age of the patients, but a higher microvessel density was noted in male patients. 3. The aggressive BCCs and the less-differentiated SCCs showed higher p53 immunostaining. 4. The mean microvessel density of cases showing strong positive immunostaining of the p53 gene(54.73+/-17.75) was higher than that of others(39.75+/-18.30). These results suggested that p53 protein expression and microvessel density are not related to the histologic types and age of the patients, but that differentiation and biologic behavior such as the infiltrating property of tumors and the microvessel density are closely related to p53 protein expression.