Relationship between breast arterial calcification and coronary artery disease by invasive coronary angiography in postmenopausal women.

PURPOSE: To evaluate the relationship between the presence of BAC and coronary artery disease (CAD) by invasive coronary angiography (ICA) in postmenopausal women. METHODS: In this cross-sectional study, postmenopausal women (age ≥ 45 years) with history of CAD, who underwent both ICA and digitized mammography, within six months of each other, were enrolled. Women who underwent prior percutaneous coronary intervention, or exhibited grade D breast density (BI-RADS®) or breast cancer upon mammography were excluded. Digital mammograms were identified in the electronic medical record system and reviewed for the presence of BAC, without knowledge of the ICA results by two experienced physicians. The ICA results were obtained from the electronic medical record, and categorized as follows: 1-single-vessel disease; 2-two-vessel disease; and 3-multivessel disease (≥3vessels). For statistical analysis Student t test, Gamma distribution, Chi-square test and logistic regression (odds ratio,OR) were used. RESULTS: Of the 183 postmenopausal women evaluated, 39 (21.3 %) had BAC. Women with BAC were older and had a longer time since menopause when compared to women without BAC (68.2 ± 9.6 × 59.6 ± 10.0 years of age and 19 ± 10.1 × 13.5 ± 8.2 years, respectively) (p < 0.0.0001). Among the clinical and cardiovascular characteristics evaluated, only the incidence of smoking was higher in women with BAC (p = 0.007). There was no difference in the number of affected vessels upon ICA in women with or without BAC (p = 0.683). In multivariate analysis, after adjustment for age, time since menopause and smoking, the presence of BAC was not associated with a significant risk of observing a greater number of affected vessels upon ICA (OR1.07; 95 %CI 0.41-2.76, p = 0.609). CONCLUSIONS: The presence of BAC was not associated with the severity of CAD in postmenopausal women.

Low pretreatment serum concentration of vitamin D at breast cancer diagnosis in postmenopausal women.

OBJECTIVE: The aim of the study was to evaluate the rate of and risk factors for low pretreatment vitamin D (VitD) levels in postmenopausal breast cancer (BC) women, compared with postmenopausal women without BC. METHODS: A cross-sectional clinical study was conducted to compare 209 women with BC (case group) to 418 women without BC (control group), age range: 45 to 75 years. The case group consisted of women diagnosed with BC, amenorrhea ≥12 months, aged ≥45 years, without use of medication or clinical conditions that might interfere with VitD levels. The control group consisted of women with amenorrhea ≥12 months, aged ≥45 years, without BC. The groups were matched for age and time since menopause, at a case: control ratio of 1:2. Serum 25-hydroxyvitamin-D [25(OH)D] concentration was measured in all women 10 to 20 days after BC diagnosis and before the proposed treatment. Serum levels ≥30 ng/mL were defined as sufficient. The Student's t test or gamma distribution, χ test, and logistic regression (odds ratio, OR) were used for statistical analysis. RESULTS: The BC group had a higher body mass index (BMI) and higher percentage of obesity than the control group (57.4% vs 40.2%, P < 0.0001). In addition, rates of insufficient (20-29 ng/mL) and deficient (<20 ng/mL) 25(OH)D levels were higher in BC patients than in controls (55.6% vs 49.3%, P = 0.039 and 26.2% vs 20.3%, P = 0.018), respectively. In risk analysis (adjusted for age, time since menopause, and BMI), BC patients had a 1.5-fold higher risk of developing low VitD levels (OR = 1.52, 95% CI, 1.04-2.22, P = 0.029) than women without BC. CONCLUSIONS: Postmenopausal women had an increased risk of VitD deficiency at the time of BC diagnosis, associated with a higher rate of obesity, than women of the same age group without cancer.

Vitamin D deficiency is associated with poor breast cancer prognostic features in postmenopausal women.

This study aimed to evaluate the association between pretreatment vitamin D (VD) deficiency with breast cancer prognostic features in Brazilian postmenopausal women. An analytical cross sectional study was conducted with 192 women, aged 45-75 years, attended at University Hospital. Women with recent diagnosis of breast cancer, in amenorrhea >12months and age ≥45 years, without medication use or clinical conditions that interfere with VD values were included. Clinical and anthropometric data were collected. Serum level of 25 hydroxyvitamin D [25(OH)D] was measured in all patients until 20days after breast cancer diagnosis, and was classified as normal (≥30ng/mL), insufficiency (20-29ng/mL) and deficiency (<20ng/mL). Data on breast cancer (histopathological type, grade, tumor stage, lymph node status), hormone status (estrogen receptor, ER, progesterone receptor, PR), human epidermal growth factor receptor type 2 (HER2) and epithelial proliferative activity (Ki-67) were collected. For statistical analysis, the t-student test, the Gamma Distribution (asymmetric variables), the chi-square test and the logistic regression (OR-odds ratio) were used. The median 25(OH)D level was 25.8ng/mL (range 12.0-59.2ng/mL). Sufficient vitamin D levels were detected in 65 patients (33.9%), whereas insufficient levels in 92 patients (47.9%), and deficient levels in 35 patients (18.2%). Participants with insufficient and deficient 25(OH)D levels had a higher proportion of tumors with a high grade and locally advanced and metastatic disease, more positive lymph node, a lower proportion of ER, PR positives tumors and higher Ki-67(p<0.05). Patients with normal vitamin D had a higher frequency of luminal A (47.7%) and luminal B (32.2%) tumors when compared to patients with vitamin D insufficiency or deficiency. Furthermore, all cases of triple negative were detected in women with low VD levels. Multivariate analysis, after adjusting for age, time since menopause and BMI, showed that insufficient and deficient level of vitamin D were significantly associated with negative estrogen receptor (OR 3.77 CI 95% 1.76-8.09 and OR 3.99 CI 95% 1.83-8.68), high Ki-67 (OR 2.50, CI 95% 1.35-4.63, and OR 2.62, CI 95% 1.40-4.98), and positive axillary lymph node status (OR 1.59, CI 95% 1.03-2.33, and OR 1.58, CI 95% 1.02-2.92) respectively. In Brazilian postmenopausal women with breast cancer, there was an association between vitamin D insufficiency or deficiency and tumors with worse prognostic features. Low vitamin D levels were shown to be a risk factor for ER negative tumors, with positive axilla and a higher rate of cell proliferation.

Accuracy of (99m)Tc-sestamibi scintimammography for breast cancer diagnosis.

Scintimammography using (99m)Tc-sestamibi is a noninvasive and painless diagnostic imaging method that is used to detect breast cancer when mammography is inconclusive. Because of the advantages of labeling with (99m)Tc-sestamibi and its high efficiency in detecting carcinomas, it is the most widespread agent for this purpose. Its accumulation in the tumor has multifactorial causes and does not depend on the presence of architectural distortion or local or diffuse density variation in the breast. The objective of this study was to evaluate the accuracy of scintimammography for detecting breast cancer. One hundred and fifty-seven patients presenting 158 palpable and non-palpable breast nodules were evaluated. Three patients were male and 154 were female, aged between 14 and 81 years. All patients underwent scintimammography, and the nodule was subjected to cytological or histological study, i.e., the gold standard for diagnosing cancer. One hundred and eleven malignant and 47 benign nodules were detected, with predominance of ductal carcinomas (n=94) and fibroadenoma/fibrocystic condition (n=11/n=11), respectively. The mean size was 3.11 cm (7-10 cm) among the malignant nodules and 2.07 cm among the benign nodules (0.5-10 cm). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 89, 89, 95, 78 and 89%, respectively. Analysis on the histological types showed that the technique was more effective on tumors that were more aggressive, such as ductal carcinoma. In this study, (99m)Tc-sestamibi scintimammography was shown to be an important tool for diagnosing breast cancer when mammography was inconclusive.