[Recurrence after treatment of breast intraductal carcinoma]. / Les récidives après traitement des carcinomes intracanalaires du sein.

OBJECTIVE: To assess the risk of local recurrence of intraductal carcinoma of the breast with a large series and a review of literature. METHODS: We present a retrospective study of 331 cases treated for intraductal carcinoma of the breast. Only patients with at least 5 years follow-up were selected. We were specially interested in recurrence risk factors. In these patients with a long follow-up; pathology was reevaluated with new investigation technique. RESULTS: After a median follow-up of 109 months, 40 local recurrences were observed; these lesions were invasive in 23 cases. Only one patient had recurrence after mastectomy. For the others, they had lumpectomy associated with radiotherapy in 12 cases. Histologic features, grade and therapeutic options were evaluated as risk factors of local recurrence. CONCLUSION: Follow-up after lumpectomy for intraductal carcinoma was studied. The status of tumor margins was important; irradiation appeared useful, specially in case of high grade carcinoma but further large prospective randomized studies are needed. The use of prognostic index is interesting, but there are still unanswered questions.

pS2 protein: a marker improving prediction of response to neoadjuvant tamoxifen in post-menopausal breast cancer patients.

Tamoxifen as sole initial therapy is gaining importance in the management of post-menopausal breast cancer patients. Age oestrogen (ER) and progesterone (PR) receptor status are accurately considered to select patients for hormonal treatment. However, additional markers are needed. By immunohistochemistry (IHC), we studied tumour expression of ER, PR, pS2, c-erbB-2 and glutathione S-transferase pi (GST pi) on initial core biopsies of 208 post-menopausal patients with a non-metastatic invasive ductal carcinoma, treated by neoadjuvant tamoxifen therapy. A good response to tamoxifen was defined as tumoral regression > or = 50% (110 patients). Relationship between response and age, tumour size, T, N, histological grade, ER and PR contents evaluated by radioimmunoassay, ER, PR, pS2, c-erbB-2 and GST pi expression evaluated by IHC were studied. Univariate and multivariate analysis showed that tumoral regression was linked only to pS2 (P = 0.004) and ER (P = 0.018) IHC expression. According to the immunohistochemical profile, three groups could be defined: pS2- and ER-positive tumours, pS2- or ER-positive tumours and pS2- and ER-negative tumours with response rates of 60%, 45% and 8% respectively. Although prospective studies are needed to confirm these results, we conclude that pS2 and ER immunohistochemical status are useful tools for predicting tumour regression with neoadjuvant tamoxifen in post-menopausal breast carcinoma patients.

[Evaluation of a clinical course in an oncology department during the second cycle of medical education. A 12-year study by questionnaire among 321 students]. / Evaluation d'un stage hospitalier en cancérologie au cours du deuxième cycle des études médcales. Enquête par questionnaire chez 321 étudiants en 12 ans.

The comprehensive cancer center in the Southwest of France, Bergonié Institute hosts medical students in 4th-6th year of their studies, for 4-month courses. This course was evaluated at its end by a questionnaire, during two periods of 6 years: 1983-88. 161 students; 1990-95, 160 students. Due to the policy of the Bordeaux University, these students were significantly younger during the second period: 48.4% in 4th year vs 25.8% in the first period (P = 0.00024). The main reasons for choosing this hospital were to meet cancer patients (54.8%), to improve knowledge in oncology (49.7%) or to see a variety of diseases, unlike in other specialty services (20.8%). At the end of the course, the main investigation in oncology appeared to be pathology (40.8%), radiology (38.2%) or blood cell counts (14.5%). Their training was highly (2+) or very highly (3+) rated by 67.9% of the students in theoretical matters, by 66% in clinical practice and by 92.5% in behavior. The best-learned fields were relations with patients (67.4%), treatments (24.5%) and clinical examination (23.5%). Students declare to have been negatively impressed by failures and deaths (34.7%), patients in poor condition (24.7%) or treatments poorly tolerated or not efficient enough (12.2%). They declare to have been well impressed by cooperation of caregivers (26.5%), comprehensive care (22.7%), teachers' efforts (22.1%), patient-caregiver relations (21.%) and courageous patients (18.1%). Finally students' presence during consultation is useful to see outpatients in good condition or cured patients. Between the first and the second period, there is a significant decrease of clinical training and a trend in favor of improved treatment and better prognosis. Thus this hospital appears mainly useful for training in patient-doctor relations and in clinical practice in a variety of diseases. Efforts have to be made to further improve clinical training. Such an investigation should be pursued to check the students' training periodically. This will allow the adaptation and improvement of the teaching, in accordance with changes in patients' conditions and treatments.

Breast cancer and in vitro fertilization. About 32 cases.

Because of the increased risk of breast cancer for infertile nulliparous women, the suspected promoter role of estradiol in mammary carcinogenesis and the high frequency of ovulation inducer treatments, it was interesting to focus on the risk of breast cancer after such a treatment. We reviewed 32 cases during a retrospective survey in Assisted Reproductive Techniques (ART) centers in France. Because of the small sample size and the few cases published so far, no statistical study could be made. However, many observations may have gone unnoticed or were not published. Two hypotheses can be proposed: (1) the facilitating role of stimulation on potential infra-clinical or un-diagnosed cancers; (2) the initiation of new cancers. Consequently, we propose to establish a register for the follow-up of treated women to monitor the advent of new cancers and to increase the follow-up of patients with other associated risk factors.

Variation of hormonal receptor, pS2, c-erbB-2 and GSTpi contents in breast carcinomas under tamoxifen: a study of 74 cases.

Seventy-four post menopausal patients with primary non-metastatic invasive ductal carcinomas of the breast were first treated with tamoxifen alone (30 mg p.o. daily) for 5 months. To study changes induced by tamoxifen, core biopsies before treatment and surgical specimens after hormonal therapy were assayed by immunohistochemistry for oestrogen (ER) and progesterone receptors (PR), pS2, GSTpi and c-erbB2. After tamoxifen, ER and PR significantly decreased in 60 and 44 cases respectively, whereas 11 and 19 cases showed no variation and 2 and 11 cases showed an increase (P<10(-4)). GSTpi and pS2 showed a significant increase in 43 and 41 cases, a decrease in 2 and 21 cases and no variation in 29 and 12 cases (P<10(-4) and P=0.04 respectively). c-erbB-2 showed no significant variation under tamoxifen, increased in only three cases and decreased in 13 cases. No relation was found between these variations and efficiency of hormone therapy. Our results allow a better knowledge of protein expression modifications occurring in breast cancer cells under tamoxifen therapy. They are also more consistent with clone selection rather than with phenotype modification.

The prognostic value of c-erbB2 in primary breast carcinomas: a study on 942 cases.

To assess the practical prognostic value of c-erbB2, we performed a study on 942 invasive ductal carcinomas treated with primary surgery between 1980 and 1986 in our center. We evaluated its expression by immunohistochemistry in paraffin-embedded tissue using a polyclonal antipeptide antibody. Of 942 tumors, 229 (24%) showed a positive membrane staining. We observed a significant association between c-erbB2 and Scarff-Bloom-Richardson grading (p < 0.0001) and a negative correlation between c-erbB2 and both estrogen and progesterone receptors (p < 0.0001). In our analysis, with respect to overall survival (OS), relapse-free survival (RFS), and metastasis-free survival (MFS), c-erbB2 was statistically significant (p < or = 0.0001) for the whole group and the node-positive subgroup. In multivariate analysis, c-erbB2 appeared to be an independent variable for RFS and MFS in the node-negative group. However, in our hands, c-erbB2 had a poor prognostic value in comparison with the classical prognostic variables such as histological grade, nodal status (N), hormonal receptor status (estrogen and progesterone receptors), and tumor size, and it did not supersede the classical parameters.