Increasing overweight in Greenland: social, demographic, dietary and other life-style factors.

OBJECTIVES: In several Arctic countries, weight gain is very evident among the local populations and the percentages of overweight and obese persons are increasing rapidly. Since the development of overweight among the Arctic populations seems to coincide with the westernization of their diet and other life-style factors, it is tempting to hypothesize that the transition to carbohydrate- and fat-rich western food causes the weight gain. The high relative content of (n-3) fatty acids in traditional foods presumably provides some protection against cardiovascular diseases, type 2 diabetes and various other diseases of affluent industrialized societies. In the present study, we have investigated the recent weight gain in Greenland and have tried to relate it to social factors, present dietary habits and other life-styles. STUDY DESIGN: The cross-sectional study, which was part of the Arctic Monitoring and Assess Programme, included 410 men and women (18-49 years) from 5 districts in Greenland. It was based upon questionnaires including a dietary survey, anthropometric measurements and blood lipid analyses. RESULTS: Obesity (Body Mass Index (BMI) > 30 kg/m2, corresponding to about 19% of the participants) increased with age, was most prevalent among higher household economic levels, and correlated with neither local, nor imported food intake. CONCLUSION: Overweight was not found to be correlated with either western, or traditional food composition. Obesity had adverse effects on several health indicators, serum triglyceride, HDL and the cardiovascular risk index, (Chol-HDL)/HDL and TG/HDL, counteracting the positive effects of (n-3) fatty acids and should be considered as a serious health risk for the Greenlandic population.

The importance of diet on exposure to and effects of persistent organic pollutants on human health in the Arctic.

AIM: To describe the importance of diet on exposure to and possible health effects of persistent organic pollutants (POPs) in the Arctic. METHODS: The study is based on a literature review. RESULTS: Minor decreases in POPs and minor increases in Hg levels in Arctic populations in Greenland, Eastern Russia, Western Alaska and Eastern Canada are likely to occur by the year 2010 and major decreases in both POPs and Hg levels in these same populations by 2030. Levels of POPs and metals in populations in the Faeroe Islands and the Scandinavian countries are already reasonably low and are only likely to decline marginally by 2030. Estimating the effects on the basis of current knowledge is difficult, but the combination of improved methodology and selection of risk groups will be a progressive step in the process. Any strategies based on traditional food substitution should ensure that the value of the dietary components is sustained. CONCLUSIONS: To improve our understanding of the health effects associated with exposure to contaminants in the Arctic, we recommend that circumpolar epidemiological studies should be implemented on a larger scale. MeHg- and POPs-related effects are still the key issues. However, the role of newly discovered contaminants, such as PBDEs (polybrominated diphenyl ethers) and PCNs (polychlorinated naphthalenes), should be investigated. For exposure assessment, mixtures and nutritional interactions should be considered in epidemiological studies. Epidemiological studies on nutritional benefits of traditional foods should be incorporated in risk-assessment profiles. We need a more nuanced view on human dietary exposure to xenobiotics. Risk should not be evaluated alone, but seen in relation to benefits from specific diets. It is essential that countries ratify and implement multinational environmental agreements.

High human plasma levels of organochlorine compounds in Greenland. Regional differences and lifestyle effects.

INTRODUCTION: The purpose of the study has been to analyse data, collected for surveillance purposes under the Human Health Programme of AMAP (Arctic Monitoring and Assessment Programme, in Greenland, regarding geographical differences and lifestyle versus pollution load from persistent organic pollutants (POP), and to make possible exposure assessments. It comprises a regional study from six districts and an ongoing study of pregnant women and infants. METHODOLOGY: Biostatistical analyses of data collected in Greenland from 61 men and 10 women from six different districts (1997-98) and from 110 mother-infant pairs in the Disko Bay area (1996-97) and 223 mother-infant pairs (1994-96). The data consisted of questionnaire answers and bloodsamples from men, women, and newborn infants (cord blood) analysed for fatty acids, selenium and 26 POPs including 14 PCB-congeners and four toxaphenes. RESULTS: Strong regional differences were found, related to different intakes of marine food with very high PCB-loads among men from the East coast. The various POP-plasma levels were mutually correlated and strong correlations were found between POP-plasma concentrations in mothers and new-born, R > 0.9, p < 0.0001. Among the pregnant women 95% surpassed the Canadian concern level for PCB, and 60% of the men from Scoresbysund surpassed the action level. The association between reported monthly food frequency and POPs was relatively weak, but the POPs were strongly correlated with plasma and erythrocyte n-3/n-6 fatty acid ratios as biomarkers of marine food intake. Multiple regression analysis showed highly significant positive correlation between smoking, and POP-plasma levels, after correction for age, alcohol intake, marine food, plasma lipids and n-3/n-6 fatty acid ratios. CONCLUSION: As the most important determinants of high POP-plasma levels in Greenlanders we propose: age, high plasma n-3 fatty acids (marine food), East coast region, and being a smoker.

High blood levels of persistent organic pollutants are statistically correlated with smoking.

Persistent Organic Pollutants (11 pesticides and 14 PCB-congeners), and heavy metals (Cd, Cu, Hg, Pb, Se, and Zn) were determined in 175 pregnant women and 160 newborn infants (umbilical cord blood) from Disko Bay, Greenland, 1994-96. Among these, 135 women filled out questionnaires about drinking, smoking and intake of traditional Inuit food. Multiple linear regression analyses showed highly significant positive associations between the mothers' smoking status (never, previous, present) and plasma concentrations of all the studied organic pollutants both in maternal blood and umbilical cord blood. Traditional food and not the tobacco is known to be the source of the contaminants. But smoking may influence the enzymatic turnover of toxic substances.

Stereotactic core breast biopsy of a minimal carcinoma complicated by a large hematoma: a management dilemma.

Stereotactic core biopsy of a 4-5-mm, suspicious mammographic lesion was complicated by substantial hematoma formation in a patient with subsequently diagnosed factor XI deficiency. As a result, the small infiltrating ductal carcinoma could no longer be identified at mammography to allow accurate needle localization for lumpectomy. Sufficient resorption of the hematoma at 3 months permitted successful needle localization and lumpectomy. In these cases, expectant management may obviate extensive surgery.

[Painful menstruation and low intake of n-3 fatty acids]. / Menstruationssmerter og lavt indtag af n-3-fedtsyrer.

Menstrual pain, dysmenorrhea, which is known to be prostaglandin mediated, can possibly be influenced by the dietary ratio of omega-3 and omega-6 polyunsaturated fatty acids. The prostaglandins derived from marine omega-3 fatty acids are normally less aggressive and therefore expected to be associated with milder menstrual symptoms. This hypothesis was surveyed in an epidemiological study in Danish women based upon self administered questionnaires concerning menstrual history, present symptoms, general health, socio-economic factors, and general dietary habits. Two prospective four-day dietary records were used to estimate average daily nutrient intake. The subjects were recruited by advertising, they were 20-45 years of age, not pregnant, and did not use oral contraceptives. No correlations were found between socioeconomic or anthropometric data and menstrual problems. However, certain dietary habits e.g. low intakes of animal and fish products, and low intakes of specific nutrients (omega-3 PUFA, B12 and omega-3/omega-6 ratio) were correlated with menstrual pain. The other nutrients in the diet were not significantly related to menstrual pain. The results were highly significant and mutually consistent and supported the hypothesis that a higher intake of marine, omega-3 fatty acids correlate with milder menstrual symptoms.

Menstrual pain in Danish women correlated with low n-3 polyunsaturated fatty acid intake.

OBJECTIVES: The hypothesis tested was that menstrual discomfort, e.g. dysmenorrhoea, known to be prostaglandin-mediated, can be influenced by the dietary ratio of n-3 and n-6 polyunsaturated fatty acids. The prostaglandins derived from marine n-3 fatty acids are normally less aggressive and therefore expected to be associated with milder symptoms. DESIGN: The question was surveyed in an epidemiological study based upon self-administered questionnaires concerning menstrual history, present symptoms, general health, socioeconomic factors, and general dietary habits. Two (prospective) 4-day dietary records were used to estimate average daily nutrient intake. SUBJECTS: The subjects were recruited by advertising (about 220 volunteered); 181 healthy Danish women were selected, aged 20-45 years; they were not pregnant and did not use oral contraceptives. RESULTS: No correlations were found between socioeconomic or anthropometric data and menstrual problems. On the contrary certain dietary habits, e.g. low intake of animal and fish products, and intakes of specific nutrients, were correlated with menstrual pain. The average dietary n-3/n-6 ratio of women with menstrual pain was 0.24. It was significantly higher among those with low intake of B12 coincident with low intake of n-3 (0.42, P < 0.001) (chi-square), with low n-3 intake coincident with low n-3/n-6 ratio (0.42, P < 0.005), and finally with low intake of B12 coincident with low n-3/n-6 ratio (0.47, P < 0.001). CONCLUSION: The results were highly significant and mutually consistent and supported the hypothesis that a higher intake of marine n-3 fatty acids correlates with milder menstrual symptoms.

Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed?

PURPOSE: To determine the optimum number of specimens to obtain at stereotaxic core breast biopsy. MATERIALS AND METHODS: Stereotaxic biopsies were performed in 145 mammographically evident lesions by using a dedicated table with patients in the prone position. Samples were obtained with an automated gun and a 14-gauge needle. Indications for biopsy were calcifications (n = 53) and masses (n = 92). Three to 11 (mean, 5.4) core biopsy specimens were obtained per lesion and were analyzed separately. RESULTS: Diagnostic material was obtained in the first specimen in 102 (70%) of the 145 lesions. Obtaining two, three, four, five, and six core specimens yielded a diagnosis in 117 (81%), 129 (89%), 132 (91%), 137 (94%), and 140 (97%) of the 145 lesions, respectively. Obtaining five specimens yielded a diagnosis in 46 (87%) of the 53 calcifications and 91 (99%) of the 92 masses. Obtaining six specimens resulted in a diagnosis in 49 (92%) lesions evident as calcifications but did not improve the yield on masses. CONCLUSION: Stereotaxic 14-gauge core biopsy achieved a 99% diagnostic yield with five specimens for masses. Additional specimens may be necessary to diagnose some calcified lesions.

Non-Hodgkin lymphoma of the breast: imaging characteristics and correlation with histopathologic findings.

PURPOSE: To determine the imaging characteristics of non-Hodgkin lymphoma (NHL) of the breast and correlate these findings with histopathologic subtype. MATERIALS AND METHODS: The authors retrospectively reviewed records in 32 cases of histologically proved NHL in 29 women. Mammography was performed before biopsy in all cases, and breast sonography was performed before biopsy in eight. RESULTS: Mammary NHL was primary in 21 of the 32 cases (66%) and secondary in 11 (34%). Mammography revealed a solitary, uncalcified mass in 22 cases (69%), multiple masses in three (9%), and diffuse increased opacity with skin thickening in three (9%). Four cases (13%) had normal findings. Seven of the eight sonograms revealed masses, which were solitary in five and multiple in two. Histologic examination showed diffuse NHL in 26 cases (81%) and follicular NHL in six (19%). No mammographic or sonographic features were identified that helped distinguish primary from secondary disease or follicular from diffuse NHL. CONCLUSION: Although the imaging characteristics may suggest the possibility of breast NHL, none of the findings are pathognomonic. The imaging pattern of mammary NHL is unrelated to its histopathologic subtype.

Imaging of pregnancy-associated breast cancer.

PURPOSE: To assess the use of mammography in diagnosis of pregnancy-associated breast cancer (PABC). MATERIALS AND METHODS: A retrospective review of medical records between 1973 and 1993 was performed in 85 women with breast cancer diagnosed during pregnancy or within 1 year after pregnancy. In 21 of these women, mammography was performed before biopsy; the mammographic findings in this study group, which had 23 cases of invasive carcinoma, were reviewed for signs of malignancy. Breast sonography was performed in six cases in five women; sonographic findings were also reviewed. RESULTS: Mammographic findings were present in 18 of 23 cases (78%), including mass (n = 13) (nine cases with calcification), suspicious calcifications (n = 4), and diffusely increased parenchymal density (n = 1). Breast sonography revealed focal solid mass in six of six cases. Axillary lymph node metastases occurred in 15 of 23 cases (65%). Although symptoms occurred before or during pregnancy in 12 cases (52%), PABC was diagnosed after pregnancy in 19 cases (83%). CONCLUSION: PABC is often advanced at diagnosis and associated with poor prognosis. Breast imaging studies usually demonstrate focal findings due to clinically evident PABC.

Inflammatory breast carcinoma: mammographic findings.

PURPOSE: To identify and quantitate mammographic characteristics of inflammatory carcinoma (IC). MATERIALS AND METHODS: A retrospective analysis was made of the clinical and mammographic findings in 22 women (aged 31-66 years [mean, 51 years]) with IC, who were seen between 1980 and 1990 at the authors' institution. RESULTS: A palpable mass was present in 17 of the 22 women (77%); skin thickening, axillary adenopathy, nipple inversion, and erythema were common findings. At mammography, the findings in one woman with dense breasts were negative. A primary tumor, evident on the basis of a mass and/or malignant-type calcifications, was seen in all other cases. Skin thickening was present in 15 women, stromal coarsening in 11, diffusely increased breast density in nine, and axillary adenopathy in five. CONCLUSION: IC has a mammographic pattern of inflammatory changes: skin thickening and stromal coarsening and/or diffusely increased breast density, associated with evidence of a primary tumor mass and/or calcifications. In this series, inflammatory changes without an associated mass and/or malignant-type calcifications were not seen in women with IC.

Radiography of microcalcifications in stereotaxic mammary core biopsy specimens.

PURPOSE: To describe the technique of specimen radiography in stereotaxically guided core biopsies and evaluate its role in detection and diagnosis of microcalcifications in breast tissue. MATERIALS AND METHODS: Specimens from 361 stereotaxic breast core biopsies of 72 nonpalpable lesions with mammographic evidence of microcalcifications were obtained from 65 patients. Specimens were placed in saline on microscope slides and radiographed. RESULTS: Microcalcifications were detected radiographically in 146 of 361 (40%) cores. If calcifications were present on specimen radiographs, histologic detection of these calcifications was made in 114 of 146 (78%) specimens, and diagnosis was made in 118 of 146 (81%). If calcifications were not present on specimen radiographs, histologic detection was obtained in 27 of 215 (13%) specimens and specific diagnosis in 81 of 215 (38%). CONCLUSION: Specimen radiography should be routinely performed in stereotaxic core biopsies of breast microcalcifications to ensure appropriate tissue has been obtained and to direct pathologic diagnosis of the tissue specimens.

Use of digital mammography in needle localization procedures.

OBJECTIVE: With digital technology, images can be displayed rapidly and manipulated. This study was undertaken to assess the duration and accuracy of needle localizations performed with digital vs film-screen technology. These two technologies also were compared with respect to radiation doses and ability to image a standard phantom. SUBJECTS AND METHODS: A prototype digital mammographic system with both a 512 x 512 matrix and a 1024 x 1024 matrix was evaluated by using the American College of Radiology mammography accreditation phantom, and these results were compared with testing done on commercially available, dedicated, analog mammography equipment. Duration, accuracy of needle placement, and number of exposures needed to perform localization were recorded for 157 consecutive needle localizations done with digital technology, and these results were compared with data collected from 103 needle localizations done with film-screen technology. Another 33 localizations attempted with digital imaging were aborted because of technical factors. Average glandular doses were calculated for those women who had a compressed breast thickness of 4-5 cm. RESULTS: The time to complete needle localization was reduced by almost 50%, from 20 to 11 min, when digital technology was used. Because of the small (5 x 5 cm) field of view of the digital system, an additional mammogram obtained at the onset of the procedure was found to be helpful in localization, but otherwise the number of images was the same regardless of imaging receptor. Mean glandular dose was reduced by about 50% with digital imaging from 0.219 to 0.120 cGy. In those 17% (33/190) of needle localizations that could not be completed with digital imaging, failure was due to a variety of factors. Despite improved detectability of fibrils, specks, and masses on digital images, digital systems did not show some fine calcifications or soft-tissue masses during needle localizations. Difficulty in imaging lesions near the chest wall or in the axilla and the small field of view also caused procedures attempted with digital imaging to be aborted and completed with film-screen systems. CONCLUSION: The time to complete needle localization was reduced by 50%, with a similar reduction in patients' radiation dose, when digital mammography was used. These findings should be applicable to stereotaxic procedures done with digital mammography. Factors limiting the use of digital mammography equipment included inability to image some fine calcifications and some masses, difficulty in imaging near the chest wall and in the axilla, and a small field of view.

Microcalcifications on postoperative mammograms as an indicator of adequacy of tumor excision.

Mammograms, including microfocus spot magnification views, were obtained before reexcision of the tumor-ectomy site in 43 women with breast carcinoma. These studies were prospectively evaluated by radiologists experienced in breast imaging. All women had mammographically evident microcalcifications associated with their original tumors. In all, tumor was at or near the margin of resection or the status of margins was unknown, necessitating reexcision of the tumorectomy site. Of 29 women with residual microcalifications, 20 had residual tumor. The positive predictive value of residual microcalcifications was 0.69. The positive predictive value was greatest (0.90) in women with ductal carcinoma in situ, when more than five microcalifications were present. Residual microcalifications not due to carcinoma were secondary to sclerosing adenosis, fat necrosis, and foreign body granuloma. Of the 13 cases in which no residual calcifications were left after tumorectomy, residual tumor was found in four. The negative predictive value of the absence of calcifications for total excision of tumor was 0.64 for all tumor types and was 1.0 for the noncomedo subtype of ductal carcinoma in situ.

Screening mammography: value in women 35-39 years old.

OBJECTIVE: The value of screening mammography for detecting early breast cancer in younger women is not widely recognized. We review the results of screening mammography and of breast biopsies performed on the basis of mammographic findings in women 35-39 years old to determine the detection rate for breast cancer and the stage of breast cancers detected at mammographic screening in this age group. MATERIALS AND METHODS: Computer-tabulated results of mammography in women 35-39 years old who participated in a mobile mammographic screening program during the 36-month period from January 1989 to December 1991 were retrospectively reviewed with a standardized data collection form. Pathology reports from biopsies recommended on the basis of screening mammograms or follow-up examinations (coned views/sonograms) also were reviewed. Data were compared with results of mammographic screenings and pathologic findings at biopsy in women 40-49 years old who participated in this screening program during the same period. RESULTS: A total of 5105 screening mammograms were obtained in women 35-39 years old. Of these, 4654 (91%) showed no abnormalities. Biopsy was recommended in 36 (< 1%). Eight biopsies showed carcinoma, intraductal in five and stage I infiltrating ductal in three. Mammograms showed calcifications in all cancers detected; two infiltrating cancers also had an associated mass. The number of breast cancers detected was 1.6 per 1000 screenings, comparable to our rate of 1.4 cancers per 1000 screenings in women 40-49 years old. Because the number of cancers detected was small, the 95% confidence interval for the ratio of detection rates was wide, ranging from 2.56:1 to 1:2.29. CONCLUSION: Early stage tumors in women 35-39 years old can be detected on mammograms. The breast cancer detection rate in women 35-39 years old was comparable to that for women in their forties in our population; however, our data do not exclude a more than twofold difference in detection rates between these two groups. These data should be considered in determining the value of mammographic screening in women 35-39 years old.

Mammographic findings in men with breast cancer.

OBJECTIVE: Our objective was to identify the mammographic findings of breast cancer in men. MATERIALS AND METHODS: The mammograms of 23 men with proved breast cancer (mean age, 63 years; range, 44-86 years) were retrospectively reviewed. Medical histories included gynecomastia in five, prior cancer in three, and radiation exposure in two. The most common signs were a mass in 13 and bloody nipple discharge in eight. RESULTS: Carcinoma was evident mammographically as an uncalcified mass in 17 patients (74%) and as a mass with microcalcifications in two patients (9%). Three tumors were not evident on mammograms, including one that was obscured by gynecomastia. Tumors were largely subareolar (14/17, 82%), and all were ductal cancers, including six pure intraductal carcinomas. CONCLUSION: Mammograms of men with breast cancer usually show an uncalcified subareolar mass, which may mimic or be obscured by gynecomastia. If calcifications are present, they may not have a pattern usually associated with malignancy.

Primary adrenocortical carcinoma: CT evaluation with clinical correlation.

Clinical histories and CT findings were reviewed in 38 patients with primary adrenocortical carcinomas. The primary tumors exhibited central areas of low attenuation representing tumor necrosis (n = 26), irregular contrast enhancement (n = 16), detectable calcification (n = 9), and a thin, capsulelike rim surrounding the tumor (n = 7). Tumors metastasized to liver (n = 9), lung (n = 5), and lymph nodes (n = 5). In eight of nine cases of liver metastasis the primary tumor arose in the left adrenal gland. Evidence of endocrinopathy was present in each of nine patients with lesions 6 cm or less in diameter, but in only two of seven adults with lesions exceeding 15 cm in diameter. We conclude that, contrary to established concepts, adrenocortical carcinoma may present as a smooth, homogeneous, functioning mass 6 cm or less in diameter on CT.