Radial scars and complex sclerosing lesions on core needle biopsy of the breast: upgrade rates and long-term outcomes.

PURPOSE: Radial scars and complex sclerosing lesions of the breast are part of a group of "indeterminate" breast lesions, which are excised due to risk of coexistent carcinoma. The aim of this study was to assess rate of upgrade of these lesions to invasive and in situ carcinoma and to quantify the risk of development of subsequent cancer in women diagnosed with these lesions. METHODS: A retrospective review of a prospectively maintained breast screening database was performed. All patients with radial scar identified at either core biopsy or final excision biopsy between January 2006 and July 2012 were identified. Full pathological reports for both core biopsy and final excision biopsy were reviewed. Patient outcomes were followed for a mean of 117.1 months. RESULTS: Of 451 B3 biopsies performed at our screening unit, 95 (22%) were found to have a radial scar or complex sclerosing lesion (CSL) on core needle biopsy. Within this group, 77 had no atypia on CNB, with 7 (9%) upgraded to invasive/in situ carcinoma on final excision. Of nine with definite atypia on CNB, 3 (33%) were upgraded. In those patients without atypia or malignancy on final excision, 7.5% developed cancer during 10-year follow-up. CONCLUSION: Patients with radial scar with atypia have a higher risk of upgrade to malignancy. Further research is needed to identify which patients may safely avoid excision of radial scar. Patients with a diagnosis of radial scar on CNB are at increased subsequent risk of breast cancer and may benefit from additional screening.

Endocrine therapy adherence: a cross-sectional study of factors affecting adherence and discontinuation of therapy.

BACKGROUND/AIMS: Adjuvant endocrine therapy for at least 5 years improves oncological outcomes in oestrogen receptor-positive breast cancer. Adherence rates to prescribed endocrine therapy are low and the search for modifiable causes of this continues. The aim of this study was to assess adherence rates in an Irish cohort of breast cancer patients prescribed adjuvant endocrine therapy and to assess modifiable factors associated with suboptimal adherence. METHODS: A cross-sectional anonymous survey was performed on 261 patients currently prescribed endocrine therapy. Data were collected regarding demographics, treatment, social and emotional factors and medication side effects. Each patient completed a medication adherence score and provided information about discontinuation of therapy and reasons for same. RESULTS: Only 67.8 % of patients assessed demonstrated complete medication adherence on the medication adherence scale. Twenty-nine patients (10.9 %) permanently stopped taking their prescribed endocrine therapy. Suboptimal adherence was more likely in younger patients (p < 0.001), those in employment (p = 0.005), those who experienced side effects (p = 0.006), those who perceived themselves to have low levels of emotional support (p < 0.001) and those who use the internet to read about their illness (p = 0.003). CONCLUSIONS: Endocrine therapy adherence is suboptimal in almost one-third of patients in our cohort. Appropriate assessment and management of side effects and negative emotions, combined with direction of patients to accurate internet sources of information, could help improve endocrine therapy adherence in women with early-stage breast cancer.

Breast cancer information on the internet: analysis of accessibility and accuracy.

Studies show internet sourced information often has poor accuracy. However, it is rapidly becoming a major source of patient information. Our aim was to assess accuracy of breast cancer-related information on the internet. The top five breast cancer-related search terms were identified using the commercial program "Wordtracker". These terms were searched using the search-engine "Google" and the top 100 webpages per topic analysed for applicability and accuracy of information. Overall 500 webpages were analysed. 42% were inapplicable to the question asked. Applicable accuracy rates were variable amongst the five terms: "breast cancer symptoms" 84%, "breast cancer care" 87%, "breast cancer stage" 88%, "breast cancer survival" 91% and "breast cancer signs" 78%. Educational websites were more likely to be accurate(p < 0.001) and interest group administered websites less likely to be accurate(p = 0.018) than other websites. Finding accurate breast cancer information on the internet is difficult due to large numbers of inapplicable unregulated websites preferentially returned via search engines.

Fine mapping of ZNF804A and genome-wide significant evidence for its involvement in schizophrenia and bipolar disorder.

A recent genome-wide association study (GWAS) reported evidence for association between rs1344706 within ZNF804A (encoding zinc-finger protein 804A) and schizophrenia (P=1.61 × 10(-7)), and stronger evidence when the phenotype was broadened to include bipolar disorder (P=9.96 × 10(-9)). In this study we provide additional evidence for association through meta-analysis of a larger data set (schizophrenia/schizoaffective disorder N=18 945, schizophrenia plus bipolar disorder N=21 274 and controls N=38 675). We also sought to better localize the association signal using a combination of de novo polymorphism discovery in exons, pooled de novo polymorphism discovery spanning the genomic sequence of the locus and high-density linkage disequilibrium (LD) mapping. The meta-analysis provided evidence for association between rs1344706 that surpasses widely accepted benchmarks of significance by several orders of magnitude for both schizophrenia (P=2.5 × 10(-11), odds ratio (OR) 1.10, 95% confidence interval 1.07-1.14) and schizophrenia and bipolar disorder combined (P=4.1 × 10(-13), OR 1.11, 95% confidence interval 1.07-1.14). After de novo polymorphism discovery and detailed association analysis, rs1344706 remained the most strongly associated marker in the gene. The allelic association at the ZNF804A locus is now one of the most compelling in schizophrenia to date, and supports the accumulating data suggesting overlapping genetic risk between schizophrenia and bipolar disorder.

Routine calcium measurement is not necessary after most thyroid surgeries: a prospective clinical study.

OBJECTIVES: Calcium levels are often measured to diagnose postoperative hypocalcaemia following thyroidectomy. The aims of this study were to (i) prospectively determine the incidence of symptomatic and biochemical hypocalcaemia following thyroidectomy, (ii) to identify if any associations exist between hypocalcaemia, type of surgery, histological diagnosis, specimen size/weight and the presence of histological parathyroid tissue and (iii) to evaluate the necessity of routine measurement of calcium levels following all thyroidectomies. DESIGN: Prospective clinical study. SETTINGS: University teaching hospital. PARTICIPANTS: Eighty-six patients presenting consecutively for thyroid surgery. OUTCOME MEASURES: Type of surgery, indications, perioperative calcium levels, symptoms of hypocalcaemia and histology were documented. RESULTS: Fifty-four patients underwent thyroid lobectomy and isthmusectomy, 19 underwent total and 13 completion thyroidectomy. Significantly, no patient undergoing thyroid lobectomy developed hypocalcaemia versus 26% of total thyroidectomies (P=0.001) and 23% of completion thyroidectomies (P=0.006). All eight patients with hypocalcaemia required treatment. Seven were initially identified clinically. Logistic regression analysis revealed that operation type was the only independent risk factor for developing hypocalcaemia (P=0.021). CONCLUSIONS: No patient developed hypocalcaemia following thyroid lobectomy and isthmusectomy. Considering the majority (63%) of thyroid surgeries were lobectomies, most patients tested appear low risk for hypocalcaemia. Definitive prediction of hypocalcaemia postoperatively remains a challenge. However, our results suggest that analysing calcium levels routinely following thyroid lobectomy is unwarranted.

Analysis of 10 independent samples provides evidence for association between schizophrenia and a SNP flanking fibroblast growth factor receptor 2.

We and others have previously reported linkage to schizophrenia on chromosome 10q25-q26 but, to date, a susceptibility gene in the region has not been identified. We examined data from 3606 single-nucleotide polymorphisms (SNPs) mapping to 10q25-q26 that had been typed in a genome-wide association study (GWAS) of schizophrenia (479 UK cases/2937 controls). SNPs with P<0.01 (n=40) were genotyped in an additional 163 UK cases and those markers that remained nominally significant at P<0.01 (n=22) were genotyped in replication samples from Ireland, Germany and Bulgaria consisting of a total of 1664 cases with schizophrenia and 3541 controls. Only one SNP, rs17101921, was nominally significant after meta-analyses across the replication samples and this was genotyped in an additional six samples from the United States/Australia, Germany, China, Japan, Israel and Sweden (n=5142 cases/6561 controls). Across all replication samples, the allele at rs17101921 that was associated in the GWAS showed evidence for association independent of the original data (OR 1.17 (95% CI 1.06-1.29), P=0.0009). The SNP maps 85 kb from the nearest gene encoding fibroblast growth factor receptor 2 (FGFR2) making this a potential susceptibility gene for schizophrenia.

The expression of sequences similar to the human c-erb-A oncogene are regulated in a tissue and stage specific manner in Drosophila melanogaster.

The gene encoding the human thyroid hormone receptor, c-erb-A, is hypothesized to be a member of a superfamily of genes, which originated from a primordial receptor encoding gene. To trace the molecular evolutionary background of this gene, we initiated the search for it in the genome of Drosophila melanogaster by using low stringency hybridization analysis. We report here the presence of more than one gene in Drosophila with varying degrees of sequence similarity. By RNA blot hybridization analyses utilizing both wild type and a temperature sensitive ecdysone deficient mutant strain, ecd1, with a human c-erb-A probe, we show that a single high molecular weight RNA of 6.8kb in size is recognized by human c-erb-A, is regulated in a stage and tissue specific manner, and is also inducible in organisms of the ecd1 mutant strain in the presence of exogeneous ecdysone.

Carbon dynamics of logarithmetic and stationary phase phytoplankton as determined by track autoradiography.

Track autoradiographic analysis of photosynthetic radiocarbon incorporation at the cellular level indicated that the carbon uptake rate and carbon pool size of exponentially growing (log phase) Scenedesmus cells was threefold that of stationary phase cells, while carbon turnover rates were similar. Carbon fixation was uncoupled from growth and cell division in the stationary phase cells, which were larger and contained less chlorophyll per unit volume than log phase cells. Changes in the temporal pattern of isotope incorporation were evident at the cell level prior to the cessation of division and transition to stationary phase, while bulk carbon fixation responded only the second day after cell division ceased. The carbon uptake patterns of a marine nanoplankter from a nutrient-enriched natural sample resembled that of log phase cells while the control population pattern resembled that of stationary cells. The physical, biochemical, and metabolic differences between log and stationary phase cells are potentially measurable by flow cytometry procedures currently in use and under development. The use of flow cytometry to sort cell types for analysis by track autoradiography and subsequent correlation of metabolic characteristics with flow cytometry signatures is a feasible means of investigating the heterogeneity of phytoplankton metabolic state in the marine environment.

Induction of alcohol dehydrogenase by ethanol in Drosophila melanogaster.

When Drosophila melanogaster larvae were fed a defined fat-free, low sucrose medium, alcohol dehydrogenase (ADH) was increased to a higher activity with a moderate, nontoxic level of ethanol (2.5% vol/vol) within 5 h. Ethanol-stimulated increases in ADH activity and cross-reacting material in late third-instar larvae were paralleled by increases in the larval ADH mRNA as indicated by dot blot analysis. Northern blot observations indicated that both adult and larval ADH messages were increased by dietary ethanol. The increased levels of the ADH mRNA transcribed from the proximal and distal promoters of ethanol-fed larvae argue that the induction is a consequence of elevated levels of mRNA, not a result of changes in enzyme stability or synthesis. To determine whether the induction is of nutritional significance to larvae, the rate of flux from ethanol to lipid was estimated in control larvae and larvae that were pre-fed ethanol. Flux changes occurred; the rate of incorporation of [14C]ethanol into body lipid showed a strong association with larval ADH activity. Because the induced increase in larval ADH activity did not extend into the adult stage and attempts to stimulate ADH activity by exposing adults to ethanol were unsuccessful, the modulation of ADH activity by dietary ethanol may be a mechanism by which larvae utilize environmental ethanol as a resource, especially when free sugar levels are low. In addition, ADH in larvae is postulated to perform a second, nonethanol function that expedites the conversion of sugars to lipid when habitats are low in fats, low in ethanol and high in sugars.