Breast cancer in the contralateral breast: incidence and histopathology after unilateral radical treatment of the first breast cancer.

The objective of the study was to assess the 10-year cumulative risk and clinical risk factors for the development of a contralateral cancer and to compare the tumours histopathologically. Among 1980 consecutive radically treated breast carcinoma patients a separate malignant breast tumour was diagnosed in 90 and 74 could be histopathologically compared with the primary tumour. The 10-year cumulative risk was 6.5% (95% CI: 5-8%). There was no difference in 10-year cumulative risk in developing a second breast tumour comparing premenopausal (7.1%) with postmenopausal women (6.1%). The cumulative risk among premenopausal tamoxifen-treated women (19.3%) or among patients with relapse (13.8%) was significantly increased as compared to similar patients without tamoxifen or without relapse. Sixty-six percent of the tumours displayed different histopathology. Morphologically similar and different tumours developed almost equally among patients with synchronous tumours and in those with or without relapse. We conclude that a radically treated breast cancer patient has a 10-year cumulative risk of 6.5% to develop a new malignant breast tumour. In premenopausal women the tumour-protective effect of two years tamoxifen application seems questionable. Histopathological comparison of the bilateral breast tumours enables discrimination of bilateral breast tumours as two primaries in 2/3 of the patients with morphologically different tumours.

Hormone receptor measurements and survival in 1335 consecutive patients with primary invasive breast carcinoma.

The distribution of estrogen and progesterone receptors (ER, PR) was assessed in the primary tumour in 1335 of 2704 (49%) consecutive new breast carcinoma patients (HORMREC). In a subgroup of 757 radically treated patients without systemic adjuvant treatment (RADOP) the relation of the ER and PR content to relapse and survival was evaluated. Three levels were defined for ER: ER-: <10 fmol/mg protein, ER+: moderate ER content >/= 10-99 fmol/mg protein, and high ER content >/= 100 fmol/mg protein. In 1288 patients of the HORMREC group who were evaluable for ER, 1061 (82%) had ER+ tumours, 685 (65%) of moderate content and 376 (35%) of high content, respectively. Among 917 patients, evaluable for PR, 723 (79%) tumours were PR+ (>/= 20 fmol/mg protein), of them 352 (49%) with a moderate content (>/= 20-99 fmol/mg protein) and 371 (51%) with a high content ( >/= 100 fmol/mg protein). The median ER content was significantly increased among the post-menopausal women as compared to the premenopausal women, whereas the median PR content showed no such differences. For the RADOP patients, no correlation between ER status and the first site of relapse was seen, whereas PR+ tumours tended to relapse more often locally than PR- tumours. In the univariate analysis the five-and 10-year tumour-related survival rates for all patients were not correlated with ER or PR positivity. One subgroup of patients with favourable outcome was identified on the basis of hormone receptors: Premenopausal women with tumours of moderately elevated ER content. In the multivariate analysis tumour size and axillary node status were the only independent predictors of survival. Measurements of hormone receptor status give weak prognostic information in radically treated patients with breast cancer as long as no adjuvant systemic treatment is applied. As todays' adjuvant treatment is based on the knowledge of hormone receptor status of the primary tumour, this information should be obtained routinely.

Prognosis of radically operated breast carcinoma patients. A retrospective study of 167 consecutive patients with emphasis on histopathological grading, reproducibility and mean nuclear area.

A retrospective study of 167 consecutive radically treated breast cancer patients with histopathologically confirmed ductal carcinoma is presented. The aim was to establish the prognostic significance and reproducibility of histopathological grading done independently by two pathologists. Further-more, the value of measurements of mean nuclear area (MNA) in the primary tumour was assessed. The two pathologists reviewed the same histological sections using a three-point scoring system based on tubular structures, number of mitoses and nuclear pleomorphism. Grading was identical for 70% of the tumours (Kappa value 0.51). With increasing MNA, the fraction of poorly differentiated tumours increased. In the univariate analysis, tumour-related survival was significantly related to histopathological grading when G3 tumours were compared to G1/G2 tumours (p < 0.05). In the multivariate analysis, tumour size (pT category), lymph-node status and grading were the only significant factors influencing patient outcome (p < 0.05). MNA had no significant prognostic value. A combination of tumour size and histopathological grading identifies a group of node-negative patients (pT2 G2/G3) who may have a less favourable prognosis and for whom adjuvant treatment may be beneficial.

Hospital-related differences in breast cancer management. Analysis of an unselected population-based series of 1353 radically operated patients.

A retrospective review is presented of 1353 consecutive patients with histopathologically confirmed invasive breast carcinoma treated radically with curative intent during the decade 1980-89. None had received adjuvant systemic therapy with hormones or prolonged chemotherapy. The distribution of lymph-node negative (N-) and lymph-node positive (N+) patients was 75% and 25%, respectively. The treatment and outcome were analysed as regards conventional prognostic parameters, in particular considering the axillary lymph-node status and the responsible hospital category (General Municipal Hospitals (MH)) versus Comprehensive Cancer Center (CC)). The most striking difference was detected as regards the number of examined lymph nodes. The median number of nodes described at the MH was 7, as compared to 14 at the CC (p < 0.001). In patients with pT1 tumours the highest rate of lymph-node positivity was observed when 10 or more axillary nodes were removed. Adjuvant radiotherapy reduced the loco-regional recurrence rate in the N-patients, whereas only the regional recurrences were reduced among the N+ patients. The five- and 10-year tumor-related survival rates were 86% and 76%, respectively, with no difference between the MH and the CC. As life-prolonging adjuvant hormone therapy and chemotherapy is now available for patients with axillary lymph node metastases, it is important that patients with breast cancer are operated adequately with the aim to remove at least 10 axillary lymph nodes. A thorough examination of the axillary content should be performed by the pathologist, and the number of resected lymph nodes and metastases should be reported. The establishment of nation-wide standard criteria for the management of breast cancer is recommended.

Analysis of adjuvant treatment in postmenopausal patients with stage II invasive breast carcinoma--a pattern of care study and quality assurance of 431 consecutive patients in Oslo 1980-1989.

A retrospective study of consecutive radically operated stage II postmenopausal breast carcinoma patients diagnosed in Oslo 1980-1989 is presented. The primary aim was to analyse to which extent the increasing knowledge of the new life-prolonging treatment with adjuvant tamoxifen influenced the clinical routine, and how the national recommendations were followed up. Secondary, the concomitant use of estrogen receptor (ER) analysis during the decade was to be assessed. Eligible were 150 patients without adjuvant treatment, 123 patients with radiotherapy alone, and 158 patients who had received systemic adjuvant hormone therapy. The percentage of patients without any adjuvant treatment decreased from 43% (1980 1983) to 29% (1987 1989) together with decreasing use of radiotherapy. Adjuvant tamoxifen treatment increased from 18% to 51%. In 1989, the year after publication of national recommendations of adjuvant tamoxifen treatment in stage II patients, 43% of the patients who were candidates for adjuvant tamoxifen failed to receive the therapy. Only 58% of all stage II patients had an ER analysis in the study period. The low compliance to a scientifically proven and publicly recommended adjuvant treatment of patients with stage II breast carcinoma is disappointing, as is the low performance of ER determination. To reduce the delay of implementation of new treatment modalities in the management of breast carcinoma a strict quality assurance program is needed.

[Primary invasive breast cancer in Oslo 1980-89. A population based study of 1942 unselected patients treated by radical surgery]. / Primaer invasiv cancer mammae i Oslo 1980-89. Populasjonsbasert studie av 1,942 uselekterte, radikalopererte brystkreftpasienter.

A retrospective review is presented of 1,942 consecutive patients with histopathologically confirmed invasive breast cancer, who where treated radically in Oslo from 1980 to 1989, either at General Municipal Hospitals (MH) or at a national Comprehensive Cancer Center (CC). The treatment and outcome were related to accepted medical parameters and the responsible hospital category. The median number of axillary lymph nodes described at the MH was 8, compared to 14 at the CC. During the period 1984 to 1986, 62% of the patients had an estrogen receptor analysis (MH 60%, CC 85%). Of the patients with N > or = 4, 36% received adjuvant hormone treatment (MH 32%, CC 67%), whereas the comparable percentage of patients with pT3/pT4 was 53%. The five- and ten-year cancer-related survival rates were 83% and 71% respectively, with no difference between the MH and the CC. As nation-wide criteria for the management of breast cancer have been accepted, compliance and monitoring by surgeons, pathologists and oncologists is imperative as part of quality assurance.

Primary invasive breast carcinoma in Oslo 1980-1989. Incidence and delay.

A retrospective review was performed on 2704 consecutive patients in Oslo in whom histologically or cytologically confirmed primary invasive breast carcinoma had been diagnosed between 1980 and 1989. The age-adjusted incidence rates were significantly higher in the city of Oslo compared with those of the whole country and remained unchanged during the study period. The percentage of patients who could be treated radically remained unchanged. Among the patients with radical treatment the distribution of pT category and stage was similar during the first and last years. The median delay (from onset of symptoms to start of treatment) of two months remained unchanged during the decade and was not related to patient's age, histological grade or tumour localization in the quadrants of the breast. With increasing duration of delay the number of patients not suitable for radical treatment increased. When considering all 2704 patients, the radicality of treatment, the patient's age and delay were correlated with tumour-specific survival and remained independent factors of tumour-specific survival in the multivariate analysis. The unchanged distribution of pT category and stage in the radically treated patients during the decade surveyed is most probably related to the lack of screening mammography in Norway.

Carcinoma of the renal pelvis. Experience of 80 cases.

The clinical course and association with other urothelial carcinomas was studied in 80 patients with carcinoma of the renal pelvis. At the time of diagnosis macroscopic haematuria was the most common symptom. Urography and retrograde pyelography gave the most accurate diagnoses. Sixty-eight patients (85%) had transitional cell carcinomas, 39 had a history of another urothelial carcinoma either before or after the diagnosis of the renal tumour, usually in the urinary bladder. A previous urothelial carcinoma together with a small renal tumour were predictive of the subsequent development of another urothelial tumour. Regular cystoscopy is recommended during follow-up because of the short observed interval between the development of carcinoma of the renal pelvis and a subsequent urothelial malignancy. The overall five-year survival was 20%. Survival did not depend on the operation, but was significantly related to the extent of locoregional or distant metastases at the time of diagnosis. Patients with such renal tumours that were preceded by or associated with other urothelial carcinomas had a more favourable median survival (42 months) than patients whose renal tumour was their first urothelial carcinoma (19 months).

Cardiac arrhythmias in patients with small cell lung cancer and cardiac disease before, during and after doxorubicin administration. An evaluation of acute cardiotoxicity by continuous 24-hour Holter monitoring.

Cardiac arrhythmias have been reported during doxorubicin infusion. The aim of the present study was to investigate the prevalence of arrhythmias and elucidate whether previous cardiac disease might increase the probability of treatment-related ectopic activity. In 18 patients with small cell lung cancer, 11 with concomitant heart disease, electrocardiogram (ECG) was continuously registered by a portable tape recorder 24 h before, during and 24 h after doxorubicin infusion (Holter monitoring). The only significant finding was an increased number of bigeminal ventricular extrasystoles after doxorubicin infusion. A trend of increased number of ventricular extrasystoles was also observed. The study suggests that pretreatment arrhythmias do not dispose for increased cardiac irritability and that bolus injections of doxorubicin do not seriously influence the ectopic activity in patients with and without heart disease.

Phase II study of carboplatin in locally advanced and metastatic transitional cell carcinoma of the urinary bladder.

Twenty-five previously untreated patients with measurable locally advanced and/or metastatic transitional cell carcinoma of the urinary bladder were included in a phase II study with carboplatin. Bolus injections were administered in 2 courses every 4 weeks at an initial dose of 400 to 450 mg/m2 with the option of increasing the dose to 450 to 500 mg/m2 in individual patients during the second cycle, depending on haematological toxicity. Two patients had a complete response (CR), 13 showed no change (NC) and 9 had progression of disease (PD), including 4 early progressions. There was no delay in treatment because of myelosuppression. Thrombocytopenia led to a reduction in drug dosage. No reduction in renal function was observed. Increased dosage did not increase the response rate. This study indicated the low effectiveness of single agent carboplatin in transitional cell carcinoma of the urinary bladder.