Analysis of the prognosis of minimal and occult breast cancers.

Of 296 occult breast cancers diagnosed at Kaiser-Permanente Medical Center, Los Angeles, in the last ten years, 80 were classified as minimal and 167 as nonminimal. Minimal cancers were intraductal, lobular in situ, or invasive and 0.5 cm or less in diameter. In the occult-minimal group, no woman had axillary node metastases, and there were no recurrences. In the occult-nonminimal group, 26% of the patients had axillary nodal involvement, with a recurrence rate of 13% and a mortality of 11.6%. Occult breast cancers differed significantly between minimal and nonminimal tumors in both treatment and prognosis. Nonminimal cancers should be treated as any palpable carcinoma. More conservative approaches could be considered for the minimal group, but prospective controlled studies should be done to determine the long-term risks of such treatment.

Xeromammography in screening for breast cancer.

Xeromammography is a safe, low-dose type of breast x-ray study that often enables us to detect breast cancer before it is palpable and before it has metastasized. Xeromammographic identification of parenchymal pattern makes possible determination of risk of breast cancer and of appropriate intervals for follow-up mammographic examination. The real hazard is not in performing, but in omitting, xeromammography--a potentially lifesaving examination.

The use of screening mammography.

Screening mammography, breast x-ray examination of women without any symptoms or signs of breast cancer, is a safe and efficacious procedure. Modern mammography, which is a low-dose radiographic examination, allows safe and correct diagnosis of about 90% of the cancers. Occult breast cancers, those found only with screening mammography, have a much lower rate of axillary node metastases and a much better prognosis, when compared with palpable breast cancers. With screening mammography, minimal breast cancers that are early in their development and have a remarkably improved prognosis can often be detected also. It is generally agreed that women with minimal cancers do not require mastectomies.

Risk factors in breast cancer: are they important, are they the same in pre- and post-menopausal breast cancer patients?

The information derived from the mammographic history questionnaires of 450 breast cancer patients was collated and separated, comparing 332 post-menopausal and 118 pre-menopausal breast cancer patients. Our observations confirm the importance of risk factors in the development of breast cancer and show the similarity in the incidence of certain risk factors among pre- and post-menopausal breast cancer patients.

Nicotinamide adenine dinucleotide and nicotinamide adenine dinucleotide phosphate splitting enzyme(s) of sheep and rabbit erythrocytes: their effect on the growth of Haemophilus.

Fragility of rabbit erythrocytes in agar plates results in gradual release of their NAD and NADP contents into the medium. Due to high NADase and negligible NADPase activity of rabbit red blood cell stroma at neutral pH, the NAD released into the medium is hydrolyzed and NADP remains intact. Thus, rabbit erythrocytes and their lysates support the growth of NAD(P)-requiring Haemophilus by serving as a source of NADP. Stability of sheep erythrocytes in agar plates results in retention of their NAD and NADP contents and consequently in inhibition of growth of NAD(P)-requiring Haemophilus. The highly active NAD- and NADP-splitting enzyme(s) of sheep red blood cell stroma prevent(s) the growth of Haemophilus on sheep blood lysates through inactivation of both NAD and NADP which are released into the medium.

Risk factors and occult breast cancer in young women.

The National Cancer Institute guidelines for mammography in women 35--49 years old are challenged. Forty-nine occult breast cancer patients under 50 years of age were analyzed regarding risk factors and compared with an age-matched control group. Of the cancers, 86% would have been missed had NCI recommendations been followed. Results refuted the NCI guidelines and showed that late parity (over 28 years) and history of breast cancer in the extended family are statistically significant risk factors. Negative mode low-dose xeromammographic examinations permitted detection of 49 occult breast cancers, usually without axillary node metastases. Patients were screened because of risk factors enumerated in the article.

Xeromammography: five years and 559 carcinomas.

This study encompasses five years and includes 559 cancers, diagnosed at the Kaiser-Permanente Medical Center, Los Angeles, California. With current low-dose techniques, we have shown the efficacy of xeromammography, even in younger women. One third of the breast cancers, one third of the occult breast cancers, occurred in women under 50 years of age. Most important are the 161 occult cancers which were detected radiographically in these five years.

Counterimmunoelectrophoresis for early detection and rapid identification of Haemophilus influenzae type b and Streptococcus pneumoniae in blood cultures.

Counterimmunoelectrophortesis was shown to be a sensitive method for rapid detection of pneumococcal and Haemophilus influenzae type b antigens in blood cultures.

Xeroradiographic detection of occult breast cancer.

Seventy-five occult cancers of the breast were found in a group of 7010 patients examined by xeroradiography, an incidence of 1% of all patients referred in a group practice setting. Nonpalpable cancers can be shown as a mass with or without calcifications, or as clustered calcifications only. A technique for preoperative localization of occult cancer is discussed. This, plus accurate marking of the surgical specimen, is important in the management of these cases.

An analysis of the results of mammographically guided biopsies of the breast.

Three hundred and fifty-three women underwent 358 biopsies of the breast for nonpalpable mammographic lesions during a five year period. Cancer was identified in 95 (27 per cent). Mammographic findings in the patients with cancer were calcifications only (54 per cent), a mass (27 per cent), a mass with calcifications (15 per cent), an asymmetric distortion (1 per cent) and an asymmetric distortion with calcifications (3 per cent). Cancer was identified in 29 per cent of the biopsies done for calcifications, 20 per cent of those done for a mass with calcifications, 6 per cent of those done for an asymmetric distortion and 38 per cent of those done for an asymmetric distortion with calcifications. Forty-nine per cent of the mammographically suspicious calcifications were cancer, while 100 per cent of the indeterminate calcifications were benign. Forty-five per cent of the spiculated masses were cancerous, while only 3 per cent of the circumscribed masses were malignant. For those patients with carcinoma undergoing axillary lymph node dissection, 13 per cent had one or more positive nodes. A strategy for increasing the effectiveness of mammographically guided biopsies of the breast is presented.

Occult breast carcinomas detected by xeroradiography: clinical considerations.

One hundred and eighty-five breast cancers were demonstrated by xeroradiography in 6,238 patients. Sixty-two cancers were occult, and constituted one-third of the demonstrable breast cancers. Some of the patients with clinically nonpalpable carcinomas had high risk factors known to be associated with the development of breast cancer. The diagnosis was usually established and confirmed by wide excisional biopsy of the area containing the suspicious lesion. In some instances the lesion was localized preoperatively by xeroradiography using a technique of skin markings. Specimen xeroradiography was utilized if there were calcifications seen on the preoperative xeroradiograph. There was a significantly decreased incidence of axillary node metastases in the occult cases when compared to the dominant mass cases.