Predictive factors of upstaging DCIS to invasive carcinoma in BCT vs mastectomy.

BACKGROUND: Upstaging from DCIS to invasive ductal carcinoma varies widely from 0 to 59%. We aim to identify risk factors associated with upstaging in all DCIS patients and based on specific surgical intervention. METHODS: Patients with a pre-operative diagnosis of DCIS undergoing BCT or mastectomy were reviewed. Multivariable analysis was performed to identify risk factors for upstaging. RESULTS: In total, 623 patients had a preoperative diagnosis of DCIS. Upstaging occurred in 74 patients (12%) overall. There was no difference in upstaging rates between mastectomy and BCT (11% v 14% p = 0.27). Sentinel lymph node biopsy was positive in 4/212 patients (1%). Multivariable analysis revealed suspicion of microinvasion (OR 5.7 95%CI2.2-14.9), surgeon suspicion of invasive disease (OR 2.7, 95% CI 1.2-6.4) and larger size/multicentric/extensive tumor (OR 1.9 95% CI 1.1-3.4) increase risk of upstaging. CONCLUSIONS: Suspicion of microinvasion, surgeon suspicion, and tumor size can be used to help guide the use of sentinel lymph node biopsy. For patients without these high risk characteristics, it is hard to justify the use of concurrent SLN biopsy for patients who undergo BCT.

Comparison of risk factors for coronary heart disease among attenders and non-attenders at a screening programme.

Few objective comparative data are available from primary care on the prevalence of risk factors for coronary heart disease among those who do and do not attend screening programmes. This study set out to examine differences in risk factors between attenders and non-attenders at such a coronary heart disease screening programme. The 2402 patients in the age range 25-55 years who attended the original health check were examined by a practice nurse, and a questionnaire about health issues was completed. A one in 10 systematic sample of the 1398 patients who did not attend the original screening programme were approached and after considerable effort 98 were persuaded to attend for the same examination and questionnaire analysis. The 98 non-attenders were found to be older and to have a higher mean body mass index, mean cholesterol level, mean systolic blood pressure and mean diastolic blood pressure than the 2402 attenders. The non-attenders were more likely to be in the lower social classes, to have a personal or family history of coronary heart disease and to smoke than attenders. They were less likely to be highly educated and to have an unacceptably high level of alcohol consumption. The results of this study suggest that clinics that invite patients to attend are likely to attract those with lower risk factor profiles. For coronary heart disease prevention to be effective there is a need to cater for patients opportunistically.

Unusual paraneoplastic syndromes of breast carcinoma: a combination of cerebellar degeneration and Lambert-Eaton Myasthenic Syndrome.

INTRODUCTION: Paraneoplastic neurological disorders are rare complications of breast carcinoma. Lambert-Eaton Myasthenic Syndrome (LEMS) is most commonly associated with small cell lung cancer. However, a combination of LEMS and subacute cerebellar degeneration as paraneoplastic syndromes is extremely rare, and has never been described in association with breast cancer. CASE: We report for the first time an unusual association of LEMS and paraneoplastic subacute cerebellar degeneration with breast carcinoma. CONCLUSION: In patients with atypical LEMS, when there is no evidence of respiratory malignancy, breast cancer should be included in the differential diagnosis.

Thyroid hormone levels and cigarette smoking in baboons.

Using a primate animal model, two studies were undertaken to examine the effects of cigarette smoking on thyroid hormone levels. In study 1, mean total triiodothyronine (total T3) and mean total thyroxine (total T4) levels were measured in two groups of baboons (Papio cynocephalus) who were taught to smoke cigarettes using operant conditioning techniques. The smokers were divided into established and naive smokers according to pack-years of exposure. A control group of never-smoker baboons was included for comparison. Blood sampling was done after long-term cigarette consumption and again 1 week after cigarette deprivation. In the naive smoker group, mean total T3 concentrations were reduced below control group values (P less than 0.05). After cigarette deprivation for 1 week, mean total T3 values returned to normal. No significant differences in total T4 levels were observed in either group. In study 2, we assessed some other indices of thyroid function. The same groups of baboons were divided into good and poor smokers by plasma cotinine and blood carboxyhemoglobin (% COHb) levels during 28 weeks of cigarette smoking activity. Immediate fluctuations and reductions in total T3 levels were observed that were not accompanied by reductions in total T4. The animals were then cigarette deprived for 1 week and blood samples were obtained every other day during this period. Significant increases in total T3 concentrations were observed in poor smokers immediately after cessation. Both groups also exhibited significant reductions (P less than 0.05) in T3 uptake and free T4 index (FT4I) when compared to control group values. These data suggest that poor smokers are more susceptible to thyroid hormone level shifts than more established smokers, since the established smokers become habituated to the compounds contained in cigarette smoke through repeated exposure.