Thyroid hormones and breast cancer association according to menopausal status and body mass index.

BACKGROUND: Thyroxine (T4) has been positively associated with tumor cell proliferation, while the effect of triiodothyronine (T3) on cell proliferation has not been well-established because it differs according to the type of cell line used. In Mexico, it has been reported that 14.5% of adult women have some type of thyroid dysfunction and abnormalities in thyroid function tests have been observed in a variety of non-thyroidal illnesses, including breast cancer (BC). These abnormalities might change with body mass index (BMI) because thyroid hormones are involved in the regulation of various metabolic pathways and probably by menopausal status because obesity has been negatively associated with BC in premenopausal women and has been positively associated with BC in postmenopausal women. METHODS: To assess the association between serum thyroid hormone concentration (T4 and T3) and BC and the influence of obesity as an effect modifier of this relationship in premenopausal and postmenopausal women, we measured serum thyroid hormone and thyroid antibody levels in 682 patients with incident breast cancer (cases) and 731 controls, who participated in a population-based case-control study performed from 2004 to 2007 in three states of Mexico. We tested the association of total T4 (TT4) and total T3 (TT3) stratifying by menopausal status and body mass index (BMI), and adjusted for other health and demographic risk factors using logistic regressions models. RESULTS: Higher serum total T4 (TT4) concentrations were associated with BC in both premenopausal (odds ratio (OR) per standard deviation = 5.98, 95% CI 3.01-11.90) and postmenopausal women (OR per standard deviation = 2.81, 95% CI 2.17-3.65). In premenopausal women, the effect of TT4 decreased as BMI increased while the opposite was observed in postmenopausal women. The significance of the effect modification was marginal (p = 0.059) in postmenopausal women and was not significant in premenopausal women (p = 0.22). Lower TT3 concentrations were associated with BC in both premenopausal and postmenopausal women and no effect modification was observed. CONCLUSIONS: There is a strong association between BC and serum concentrations of TT3 and TT4; this needs to be further investigated to understand why it happens and how important it is to consider these alterations in treatment.

[Comparative study of clinical and pathological features of breast cancer in women with 40 years old and younger vs 70 years old and older]. / Comparación de las características de pacientes de 40 o menos y 70 años o más de edad con carcinoma mamario.

BACKGROUND: Invasive breast cancer is the most common neoplasia in women attended at IMSS health system since 2004. OBJECTIVE: To compare clinical and radiological characteristics on initial appraisal, as well as surgical treatment, pathological features and adjuvant treatment in women with primary breast cancer of 40 years old and younger vs 70 years old and older. MATERIAL AND METHOD: Clinical, radiological and pathological data of 150 patients with breast cancer treated at Hospital de ginecoobstetricia Luis Castelazo Ayala, from January 2003 to June 2006 were collected, and after divided in two groups: 1) patients with 40 years old and younger (n = 50), and 2) patients with 70 years old and older (n = 100). RESULTS: Tumoral size and radiological characteristics were similar in both groups. Group 1 and group 2 had 22 and 13%, respectively, of family history of breast cancer. Fine needle biopsy has positive predictive value of 50% for group 1, and 36% for group 2. Conservative surgery was less common at group 2. Most frequent histological type in both groups was infiltrating ductal carcinoma, followed by infiltrating lobular carcinoma, most common in older women (19 vs 12%), and we found more well differentiated ductal carcinomas in the group of 70 years old and older (12 vs 4%). Seventy-six percent of group 1 and 75% of group 2 were classified as early stage breast cancer (stages I and II). Cytotoxic therapy was offered mostly to group 1, 92 vs 35%. Radiotherapy (80 vs 59%), and hormonal therapy was given only to 56% of group 1 vs 80% of group 2. CONCLUSIONS: Clinical and staging features were similar in both groups. Family history was more influential to group 1. Fine needle biopsy has a low positive predictive value for diagnostic. Well-differentiated carcinomas were higher in patients of group 2, and group 1 had more high-grade carcinomas. There was a trend to perform more conservative surgery at group 1, as well as they underwent more adjuvant chemotherapy and radiotherapy. Use of hormonal therapy was more common at group 2.

[Identification of surgical margins by intraoperative mammography of quadrantectomys specimens for breast cancer and histopathological comparison]. / Identificación de los márgenes quirúrgicos mediante mastografía transoperatoria de cuadrantectomías por cáncer de mama y comparación histopatológica.

BACKGROUND: Wide surgical margins are prognostic indicators to prevent recurrences after conservative surgery in breast cancer; type of surgery and histopathological analysis are key factors too. OBJECTIVES: To evaluate tumoral size and surgical margins of quadrantectomy specimens utilizing mammography and histopathology, and decide if mammography of quadrantectomy specimens are useful for close margins prediction. MATERIALS AND METHODS: Prospective, observational and descriptive study based on the findings of specimen projections of two mammography quadrantectomies, and histopathological data. Ten patients with breast cancer were evaluated from May to November 2006. Surgical margins of quadrantectomys were marked with radiopaque material. RESULTS: Tumoral size was similar in mammography and histopathological analysis of quadrantectomys, however there was a tendency to report a larger size in mammography. With mammography only one case was reported as close superficial margin, the rest of patients has adequate margins (1 cm or higer). Five cases were close by histopathology (3 in the deep margin, one superior and one more in the superior and inferior margins), and five had adequate margins. Four additional surgical procedures where practiced (3 re-excisions and one mastectomy), in one of them additional surgery was unnecessary. CONCLUSIONS: Mammography evaluation was useful to identify peripheral margins (superior, inferior medial and lateral) as well as tumoral size, but useless to identify close borders (deep and superficial areas). It is necessary to evaluate more cases to improve this technique and to establish a common language between specialists.

Carcinoma ductal in situ (intraductal) de la glándula mamaria. Análisis histológico, biológico, terapéutico y pronóstico de 52 casos / Ductal carcinoma in situ (intraductal) of the mammary gland. Histological, biological, therapeutic and prognosis analysis in 52 cases

Durante un periodo de cinco años fueron diagnosticados y tratados 52 casos de carcinoma ductal in situ. La edad promedio de las pacientes fue de 54.7 años, existía antecedente familiar de carcinoma mamario en 11.4 por ciento y nuliparidad o paridad tardía en el 19.2 por ciento. Once casos (21.2 por ciento) se asociaron a otro carcinoma mamario, ya fuese sincrónica o metacrónicamente. El 81 por ciento tenían tumor palpable; el tamaño promedio fue de 3.1 cm. El subtipo histológico más frecuente fue el comedocarcinoma (42 por ciento), seguido del sólido (23 por ciento) y del cribiforme (21 por ciento). Veinte pacientes fueron tratados con mastectomía radical modificada y cinco con mastectomía total; en estos casos no hubo recurrencia locorregional. Doce mujeres fueron tratadas con cuadrantectomía más radioterapia y hubo un caso (8.3 por ciento) recurrente. También hubo recurrencia en el 40 por ciento los casos tratados con resección amplia más radioterapia y en 40 por ciento de los manejados sólo con extirpación del tumor. Los factores que mostraron una mayor asociación con las recurrencias fueron: subtipo comedocarcinoma, grado nuclear 3, índice de necrosis (+++). cuando el procedimiento quirúrgico fue amplio (cuadrantectomía), se registraron menos recurrencias en las mujeres tratadas conservadoramente. La radioterapia posoperatoria se asoció a menor índice de recurrencias. Factores como tamaño tumoral, relación mama/tumor, localización del tumor, número de lesiones, estado de los bordes posresección y antecedente de radioterapia previa son todos los factores a tomarse en cuenta para decidir si el caso deberá ser tratado conservadoramente o con mastectomía

Tumor desmoide: análisis clínico, terapéutico y pronóstico de 20 casos / Desmoid tumor: clinical, therapeutical and prognostic analysis of twenty cases

El tumor desmoide se origina en las fascias o aponeurosis musculares. Es una neoplasia poco frecuente y está incluida en el grupo de las fibromatosis. aunque se describe como un tumor benigno, su tendencia a la recurrencia y su poder de invasión local han hecho que algunos autores lo consideren un sarcoma de bajo grado de malignidad. Presentamos una revisión de 20 casos atendidos en el Servicio de Oncología del Hospital General de México. Se hace énfasis en la localización del tumor, tamaño, estructuras involucradas, cuadro clínico, las diversas modalidades de tratamiento y en la evolución