Åke Rimsten

Influence of height, weight and obesity on risk of breast cancer in an unselected Swedish population.

A number of recent studies have shown an association between breast-cancer risk and height, weight and dietary habits, especially fat consumption. In the present study, height and weight were determined for 179 consecutive, unselected, breast-cancer patients and age-matched controls selected from a computerized population register. Height and weight for these two groups were compared, including two different indices for overweight (Quetelets index and Brocas index). Comparisons were repeated after subdivision into pre- and postmenopausal women. In all calculations, the mean values of patients and controls were very similar and without significant difference. It therefore seems improbable that increased height and weight or obesity constitute risk factors for breast cancer. Earlier studies may have shown differences as the result of selection mechanisms not present in this study.

Age at first birth, parity and risk of breast cancer in a Swedish population

A case-control study was conducted over a period of 11 months in an area containing one-third of the Swedish population. One thousand and one patients participated, constituting 94% of all women newly diagnosed as having breast cancer within the area. They were compared with 1,001 age-matched, non-hospitalized controls without breast cancer, selected by paired sampling from a population register. The risk of breast cancer was slightly, but significantly, related to parity, the standardized relative risk (SRR) being 1.35 for nulliparous women as compared to ever parous. In the different parity groups a risk significantly lower than that for nulliparous women was found only for women with more than 2 children (SRR = 0.59) but the trend with parity was highly significant (P less than 0.001). Age at first birth was not found to be an important risk factor for breast cancer. SRR was lower than for nulliparous women in all groups of women with their first birth before the age of 35 years, but the difference was significant (P less than 0.05) only for those with the first birth between 20 and 24 (SSR = 0.69) and 25 and 29 (SRR = 0.69) years of age. The trend with age at first birth (P less than 0.05) disappeared after stratification for parity, suggesting that it was a confounding factor.

Characteristics of familial breast cancer in sweden: Absence of relation to age and unilateral versus bilateral disease

A case‐control study was conducted to examine the hypothesis that familiality in breast cancer is a heterogeneous entity. A study of 1330 women, recently diagnosed as having breast cancer, compared, by paired sampling from a population register, the same number of age‐matched women without a history of breast cancer. Data obtained by mailed questionnaires revealed a familial history in a first‐degree relative in 149 patients and 90 controls (standardized relative risk/SRR/ = 1.7). The figures for second degree relatives were 115 and 81, respectively (SRR = 1.5). A detailed analysis of age at diagnosis and the occurrence of bilateral disease in the probands and their first‐degree relatives with breast cancer failed to confirm any significant trend towards characterization of familial cases by early occurring or bilateral disease. The SRR for breast cancer in a first‐degree relative was 1.7 for women with unilateral disease and 2.2 for those with bilateral. A slightly higher but nonsignificant relative risk was found for women diagnosed before (SRR = 2.4) than after (SRR = 1.7) 50 years of age. Familial cases did not run a higher risk of developing bilateral disease than nonfamilial—6 and 5%, respectively. No patient or control reported premenopausal and bilateral disease in her mother, whereas three patients and five controls reported these characteristics in one of their sisters. The correlation between age at diagnosis in familial patients and their mothers or sisters with breast cancer was low—0.38 and 0.29, respectively—and there was no correlation with respect to the occurrence of bilateral disease within the families.

Malignant and benign human mammary disease: Estrogen binding in relation to clinical data

The estrogen binding capacity (EBC) of biopsies from human mammary carcinoma, benign mammary disease, and from “normal” tissue surrounding the tumors was measured. The biopsies were classified following a statistical criterion as positive (having EBC) or negative. Of 105 cases of breast carcinoma, 49% were positive and 51% were negative. Only 5 of 35 cases of benign disease were positive; no positive case of normal tissue was observed. There was no significant correlation between the presence of EBC in a tumor and tumor histology, differentiation, or cellularity, nor between EBC and the menopausal age of the patient or the clinical stage of the disease. On die other hand, the magnitude of the EBC was significantly higher in tumors of medium than of low differentiation and higher with high than with medium cellularity. Ductal carcinomas had higher EBC than adenocarcinomas. In a limited number of cases, EBC values were determined in primary and secondary tumors in the same patient. Provided differences in cellularity were taken into account, the assignment of EBC of the secondary tumor coincided with that of the primary tumor in 6 cases out of 8.

Familiality in breast cancer: a case-control study in a Sweden population.

1330 consecutively diagnosed breast-cancer patients, and an equal number of paired aged-matched controls without breast cancer, were investigated for a familial history of breast cancer. Patients and controls received identical questionnaires. One relative or more with breast cancer was reported by 18.6% of the patients and by 12.3% of the controls, giving a standardized relative risk (SRR) of 1.6 (P < 0.01). One or more first-degree relatives with breast cancer were reported by 11.2% of the patients and by 6.8% of the controls, with an SRR of 1.7 (P < 0.01). For second-degree relatives the SRR was 1.5 (P < 0.05). Of the patients, 3.9% had mothers with breast cancer compared to 2.7% of the controls (SRR = 1.4, N.S.). One or more sisters with breast canceer were reported by 10.1% of the patients and by 5.1% of the controls (SRR = 2.0, P < 0.01). No distinct difference in familiality between the different age groups was found.

Reproductive history and risk of breast cancer. A case‐control study in an unselected swedish populations

Variables in reproductive histories were studied in 179 consecutively detected, unselected breast cancer patients and age‐matched controls selected from a computerized population register. The comparison between patients and controls showed no significant difference in age at menarche, age at first birth, age at menopause or number of children. A subdivision into pre‐ and postmenopausal women yielded no further information. These results are at variance with most earlier reports, possibly because the controls here were selected from the whole female population instead of hospitalized patients. Our data do not support the view that it is possible to define groups at high risk for breast cancer on the basis of reproductive histories.

Survival and recurrences five years after selective treatment for breast carcinoma

110 consecutively diagnosed breast-cancer patients in all stages were included in a study to evaluate a selective surgical and radiotherapeutical treatment. The surgical treatment was total mastectomy and exploration of the axilla, with lymphnode biopsy and peroperative cytological examination. Axillary dissection was done only when this examination showed metastases. No radiotherapy was given to the axilla in patients with lateral cancers in the absence of metastases, or with limited metastasization (no periglandular growth, no growth in apical nodes). In medial and central cancers, radiotherapy was applied to the parasternal and supraclavicular nodes irrespective of axillary involvement. A staging system with a combined clinical and histopathological classification was used and formed the basis for the selective treatment. The corrected 5-year survival for the whole material was 80%, for those without axillary metastasis (Stage I) 95% and for those with axillary metastasis (Stage II) 68%. Six women were alive with known distant metastases. Of 63 patients without identified axillary metastases at the time of surgery, axillary recurrences occurred in only 3 (5%). It was concluded that patients without axillary metastases can be reliably selected by the peroperative examination used, and that in this group simple mastectomy results in a high disease-free survival. Early diagnosis and a possible beneficial effect of the actual therapeutic programme might both have contributed to the high overall survival.

Bilateral carcinoma of the breast. Epidemiology and histopathology.

A history of previous carcinoma in the contralateral breast was found in 66 of 1351 women (5%) consecutively diagnosed as having breast carcinoma. The mean time interval between the diagnosis of the first and second tumour was 10.0 years (range 0-37 years); 63 of the tumours were metachronous. No significant differences were found between the first and the second carcinoma with respect to the Ackerman malignancy grading or the frequency of axillary node involvement. High risk groups for bilateral disease could not be defined on the basis of information about familial occurrence, parity, age at first birth, or malignancy grade.

Symptoms and signs in benign and malignant tumours of the breast.

The diagnostic distribution and the relation between diagnosis and symptoms, symptom duration, tumour site, tumour size and breast size were studied in 1 244 women with breast symptoms examined at a special breast tumour clinic. 9% of the women had cancer, 62% fibroadenosis and 6% fibroadenoma. In 18% no breast disease was found. A painful tumour was experienced by 19% of all women with breast cancer, but by 54% of breast cancer patients below 50 years of age. 50% of the patients with fibroadenosis had a painful tumour. This symptom was thus not a discriminating feature between cancer and fibroadenosis in younger women. The reason that most breast tumours, both benign and malignant, are located in the upper outer quadrant is not known. It has been proposed that this might be due to the larger volume of this quadrant as compared with the others. The present results contradict this view.

ADIPOSE TISSUE AND ÆTIOLOGY OF BREAST CANCER

value of improving control is weakened by this lack of significant correlation in single-sex groups. As control improved in insulin-treated patients so the plasma-H.D.L.-cholesterol concentration rose. We agree with Boucher and Yudkin that our findings and theirs may reflect differences in clinic populations. We tend to discharge maturity-onset diabetics who are well-controlled or see them annually, retaining only those whose control is difficult because of dietary problems or who have diabetic complications or social difficulties. For this reason we think the data