Adel Gad

REDUCTION IN MORTALITY FROM BREAST CANCER AFTER MASS SCREENING WITH MAMMOGRAPHY: Randomised Trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare

A randomised controlled trial to investigate the efficacy of mass screening with single-view mammography in reducing mortality from breast cancer was started in Sweden in 1977. 162 981 women aged 40 years or more and living in the counties of Kopparberg and Ostergötland were enrolled in the study and divided at random into 2 groups. Each woman in the study group was offered screening every 2 or 3 years depending on age. Women in the control group were not offered screening. This report is confined to the 134 867 women aged 40-74 years at date of entry. The results to the end of 1984 show a 31% reduction in mortality from breast cancer and a 25% reduction in the rate of stage II or more advanced breast cancers in the group invited to screening. 7 years after the start of the study the excess of stage I cancers in the study group largely outweighs the deficit of advanced cancers.

Efficacy of breast cancer screening by age. New results swedish two‐county trial

Background. Several studies have found a smaller effect of breast cancer screening on breast cancer mortality in women aged younger than 50 years compared with older women. Various possible reasons have been suggested for this, but none firmly is established.

Tumour development, histology and grade of breast cancers: Prognosis and progression

Using 1,973 breast tumours from women aged 40–69 participating in the Swedish two‐county trial of mammographic screening for breast cancer, we examined the effect of histological type on prognosis and sojourn time (the duration of the preclinical screen‐detectable phase) by age. The hypothesis of dedifferentiation, according to which a cancer of mixed malignancy grade drifts towards grade 3 as the more poorly differentiated part of the tumour grows faster than the well‐differentiated part, was also assessed. Ductal carcinoma in situ, invasive ductal carcinoma of grade 1, mucinous carcinoma and tubular carcinoma were all associated with good survival. Ductal carcinoma of grade 3 was associated with poor survival. Ductal carcinoma of grade 2, lobular and medullary carcinoma were associated with intermediate survival. These patterns were much the same in women aged 40–49 as in women aged 50–69. In women aged 40–49, sojourn time was estimated at about 2 years regardless of histological type. For women aged 50–69, there was a marked association of sojourn time with histological type, the shortest sojourn time being observed for lobular (2 years) and medullary (1.2 years) carcinoma, and the longest for ductal carcinoma grade 1 (7.7 years) and tubular carcinoma (7.1 years). There was strong evidence of a potential to dedifferentiation. A mover‐stayer mixture of Markov chain models estimated that, in women aged 40–54, 91% of ductal tumours have the potential to dedifferentiate and, in women aged 55–69, 38% of ductal tumours have such a potential.

Screening for Breast Cancer in Women Aged under 50: Mode of Detection, Incidence, Fatality, and Histology

Objective — To assess the effect of screening for breast cancer in women aged 40–49 in the Swedish two county trial, in terms of mortality reduction, advanced cancer reduction, mode of detection, and the histology of tumours detected. Setting — The Swedish two county trial of screening for breast cancer, in which 77080 women aged 40–74 (19 844 aged 40–49) were randomly allocated to receive regular invitation to mammographic screening for breast cancer, and 55985 women aged 40–74 (15 604 aged 40–49) were allocated to an unscreened control group. Methods — The screening interval in the younger age group was two years and in the older age group about three years. Statistical analysis of mortality and incidence rates was performed by Poisson regression. Relative survival was estimated using proportional hazards regression. Results — The relative mortality for the group invited to screening compared with the control group was 0·87 (95% confidence interval 0·54 to 1·41) in the 40–49 age group, in close agreement with the relative incidence of advanced cancers. For Kopparberg county the relative mortality was 0·73 (95% CI 0·37 to 1·41) and for Ostergotland 1·02 (95% CI 0·52 to 1·99). The lesser effect in the 40–49 group as a whole was largely due to a higher rate of interval cancers in this age group, and the occurrence in Ostergotland of a higher number of cancers after randomisation, but before screening started, and in women who refused screening. The higher interval cancer rate was consistent with the higher proportion of ductal grade 3 and medullary cancers in women aged 40–49 at diagnosis. Conclusions — A major difficulty in screening women aged 40–49 is the rapid progression of a subset of tumours arising in this age group. Shortening the screening interval from two years would be necessary to achieve a higher mortality reduction.

Primary retroperitoneal mucinous tumor of low malignant potential: histogenetic aspects and review of the literature

We report an unusual mucinous tumor of low malignant potential, of ovarian‐like type, arising in the retroperitoneum of an otherwise healthy 33‐year‐old woman. This is the fifth described case of such a tumor in the world literature, and the first reported in Scandinavia or Europe. We also discuss aspects of the histogenesis of this type of tumor and review the available literature. The histological heterogeneity and metastatic potential of the tumor warrant careful histopathologic analysis and follow‐up of patients presenting with such lesions.

Allelic loss is heterogeneous throughout the tumor in colorectal carcinoma.

Loss of heterozygosity (LOH) at 17p and 18q in colorectal carcinoma has been depicted as a potential prognostic marker for the disease. However, conclusions vary among reports, and evidence of clinically useful genetic prognostic markers is still lacking. As a rule, single biopsies are used. In this study, the authors hypothesized that an important cause of earlier contradictory results was the heterogeneity of colorectal neoplasms.

Adenocarcinoid of the Liver Arising Within an Area of Hamartoma With Predominant Bile Duct Component

Malignant transformation in bile duct hamartomas has been previously reported in very rare instances. Here, we describe a unique case of a neuroendocrine tumor of the liver arising within an area of unusually large hamartoma with predominant bile duct component, hitherto unreported and distinct from the conventional von Meyenburg complex. The tumor was apparently secreting gastrin and chromogranin, with associated gastrinoma syndrome over several years. The histologic picture was reminiscent of a moderately differentiated adenocarcinoid, with positive mucin staining in a signet ring pattern. Tumor cells showed positive staining for neuron-specific enolase, chromogranin A, gastrin, and serotonin. Staining for pancreatic hormone peptides was negative. Resection of the tumor was apparently curative, with complete resolution of the patients symptoms.

Intracerebroventricular administration of somatostatin prevents and attenuates adjuvant arthritis

The effects of somatostatin on the development of adjuvant arthritis induced by Mycobacterium butyricum were studied. Somatostatin was injected into the lateral cerebral ventricle every day for 14 days beginning on the first day of mycobacteria inoculation in the preventive group. In the treatment group, somatostatin was injected from day 17 until day 30 post-mycobacteria inoculation. Arthritis was evaluated by measuring ankle joint circumference and diameter as well as microscopic examination of ankle joint sections. Somatostatin profoundly inhibited the development of adjuvant arthritis and an anti-inflammatory action was observed in the treatment group. These results suggest that somatostatin has a central action that can prevent or attenuate symptoms associated with arthritis.

Intracerebroventricular met-enkephalin administration modulates adjuvant arthritis.

The purpose of this study was to investigate the anti-inflammatory properties of intracerebroventricular met-enkephalin (met-enk) administration in an animal model of arthritis. Adjuvant arthritis was induced in rats by intradermal inoculation of mycobacterium butyricum and the effects of intraventricular met-enk+thiorphan (enkephalinase inhibitor) were studied. Treatment was initiated either simultaneously with the bacterial inoculation (preventive group) or on post-inoculation day 17 after the appearance of inflammation (treatment group). The degree of inflammation was evaluated by measuring the diameter and the circumference of the ankle joint immediately before the sacrifice (day 31) and by histologic examination of ankle joint sections. The results of this study revealed that combined intraventricular injections of met-enk+thiorphan reduced the arthritic-like inflammation in the preventive group as well as in the treatment group. These findings suggest that centrally applied met-enk+thiorphan may suppress the development adjuvant arthritis as well as the symptoms of manifest arthritis. Thus central met-enk may be involved in both hypothalamic pituitary adrenal axis and immune forms of stress-induced modulation.

Expression of CD44 variants in differential diagnosis of ulcerative colitis and Crohn's disease

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