Family history, oral contraceptive usage, and breast cancer.

When breast cancer patients were grouped according to their family history of breast cancer striking differences were found in age distribution. Thus, the proportion of cases less than 45 years of age was grandmother greater than aunt greater than mother greater than FH-negative greater than sister. A similar FH-related sequence was observed in regard to current OC usage among breast cancer patients less than 45 years of age. It also appeared that current oral contraceptive (OC) usage increased the risk of invasive breast cancer among grandmother- or aunt-positive women while decreasing the risk among FH-negative women. There are important practical and conceptual reasons for further studies of the influence of interactions between age, OC usage and family history on the stepwise development of breast cancer.

Screening for occult lung cancer.

A pilot screening program for the early detection of lung cancer was carried out in Saskatchewan in 1968 using chest roentgenography and cytologic examination of sputum samples. The yield from 23 000 men aged 40 years and over was only 10 cases. Nine of the men had advanced disease. One had occult lung cancer. A period of 31 months elapsed between the discovery of malignant cells in this patient's sputum and roentgenographic localization of the tumour. Following pneumonectomy he has survived with no discernible residual or metastatic tumour for 12 years. The morphologic changes in the resected lung provided a basis for discussing the preclinical phase of squamous cancer of the lung, the treatment of occult cancer and multicentric primary pulmonary tumours. The survey would have been more successful with a narrower target group and more frequent examination.

Malignant tumors of the small intestine.

Primary malignant tumors of the small intestine are uncommon. The average annual incidence rate over a period of 30 years in Saskatchewan was 0.7 and 0.6 per 100,000 for male and females, respectively. The 209 patients who comprise the series represent 1.6% of the total number who had gastrointestinal cancers over the same period. The distribution of the tumors by site and histologic type is described. Both carcinoid and adenocarcinomatous tumors of the small intestine are associated with a high incidence of primary malignant neoplasms in other sites (17.0 and 20.3%, respectively). One patient with Peutz-Jeghers syndrome is of interest because of the malignant change which occurred in more than one of the small bowel polyps and because of consequent liver metastases. The reason for the poor prognosis in noncarcinoid small bowel malignant neoplasms is probably due to late diagnosis. The five-year disease-free survival in these tumors was 22.5%. Malignant carcinoids had a better overall five-year survival rate of 64%. For those confined to the bowel wall, the five-year survival rate was 73%, compared to 59% for those extending to nodes or metastasizing to distant organs.

Parity as a prognostic factor in young breast cancer patients.

Data were analyzed concerning 219 female breast cancer patients less than 36 years of age who were diagnosed and treated in the Province of Saskatchewan, Canada, during 1946-72. Pathology slides were available for review on 171 of these patients, and invasive breast cancer could be confirmed in 136. Nulliparous patients had more favorable age-adjusted survival rates than parous patients for the total patient group and for those patients whose tumor was verified to be invasive cancer on pathologic review. Adjustment for potential confounding factors indicated that differences in survival among parity groups could be explained to a substantial degree by differences in distribution over node status and the nuclear grade of the primary tumor. Because these factors relate to the biologic behavior of breast cancer and because the distributions of these factors were significantly associated with the parity categories utilized in the analysis, the data provide some evidence that parity influences the behavior of breast cancer in young women.

Intrastage prognostic heterogeneity: implications for adjuvant chemotherapy of breast cancer.

The precise role of the use of adjuvant chemotherapy in the treatment of primary breast cancer has been questioned by some clinicians. One of the most important questions regarding the use of adjuvant chemotherapy is the identification of appropriate patients to receive it. The presence of positive axillary nodes has been the determining factor for the evaluation of chemotherapy in clinical trials. The possibility that other factors should be considered in deciding on the routine use of chemotherapy is discussed here on the basis of data from breast cancer patients diagnosed in the Province of Saskatchewan, Canada, none of whom received chemotherapy as part of their primary treatment. The data illustrate the prognostic heterogeneity that exists among patients with negative axillary nodes and among patients with positive axillary nodes. The implications of such heterogeneity include the possibilities that some patients may not benefit from adjunctive chemotherapy and that some may actually be harmed by it. Specific procedures are described for the analysis of existing clinical trial data to determine whether there is any evidence that some patients may not have benefited from adjunctive chemotherapy. Additional clinical trials would have to be done to substantiate such observations.

Family history and oral contraceptives: unique relationships in breast cancer patients.

The relative frequency of a history of breast cancer among specific blood relatives was determined for breast cancer patients according to their prior use of oral contraceptives (OC). These data were compared with those derived from patients having various types of noninvasive breast lesions and from control women. It was found that a history of breast cancer among grandmothers or aunts was significantly more frequent among breast cancer patients who had used OC for one or more years continuously than among OC-negative breast cancer patients, and among patients with noninvasive breast lesions and control women, regardless of OC usage. Breast cancer patients whose grandmothers or aunts had breast cancer used OC significantly more frequently than did family history (FH)-negative breast cancer patients and breast cancer patients having a history of breast cancer limited to relatives other than grandmothers and aunts (mothers, sisters, cousins). It appears that the family history is a significant covariable in the relationship between OC usage and breast cancer. There is a need for specific studies to test the possibilities that OC usage increases the risk of breast cancer among women whose grandmothers or aunts had breast cancer, and reduces the risk of breast cancer in FH-negative women.

Prognosis in breast cancer utilizing histologic characteristics of the primary tumor.

A study was made of the inter-relationships and prognostic significance of structural characteristics found in primary breast cancers and their associated axillary lymph nodes. The prognostically favorable characteristics included the following. For the primary tumor: nuclear differentiation of the cancer cells, diffuse lymphoid cell infiltrations (LI) and perivenous lymphoid cell infiltrations (PVI). For the axillary lymph nodes: sinus histiocytosis (SH). Perivenous lymphoid cell infiltrations (PVI) in the primary tumor are found to be as important a prognostic factor as SH in the axillary lymph nodes; these two characteristics are found to be positively associated. Evaluation of the nuclear grade (NG), LI, and PVI in the primary tumor allows for the definition of association with cancer cells having a low (anaplastic) nuclear grade, and to be positively associated with follicular hyperplasia (FH) in the lymph nodes. We also found a positive association between the cellular responses to areas of in situ carcinoma and the cellular responses to accompanying invasive breast breast cancer tissue. They also provide a prognostic system for classifying breast cancer patients on the basis of the microscopic characteristics of the primary tumor and surrounding breast tissue. The latter system should be of value in comparing the therapeutic benefits of various treatments.