Anne C. Carter

Breast self‐examination, relationship to stage of breast cancer at diagnosis

Data from 996 newly diagnosed breast cancer patients indicated a highly significant association (P < 0.001) between periodic breast self‐examination (BSE) and pathologic stage of disease. Among women reporting periodic BSE, only small differences were noted between those who practiced monthly and those who practiced several times annually. Average maximum tumor diameter and frequency of tumors 4 cm or larger were significantly greater (P < 0.01) among women who rarely or never practiced BSE. The relationship between the periodic practice of BSE and the diagnosis of breast cancer before nodal involvement was present even after controling for a wide variety of variables. The regular practice of BSE was associated with a one‐third reduction in the likelihood of diagnosis of disease with positive nodes. This difference translated to a 10% decline in five‐year mortality for whites and a 17% decline for nonwhites.

Immunofluorescent detection of estrogen receptors in breast cancer. Comparison with dextran‐coated charcoal and sucrose gradient assays

Biopsy specimens from 106 women with primary operable, recurrent or metastatic breast cancer were analyzed in a double blind study designed to compare the results of a new fluorescent antibody method for detection of estrogen receptors with estrogen receptors measured biochemically with dextran‐coated charcoal and sucrose gradient assay techniques. Assay results correlated in 89.4% of tumors analyzed, and molecular receptor forms (8S and 4S) were accurately predicted in 94.7% of neoplasms studied. Divergent results most often occurred in specimens sparsely populated with malignant cells. The new technique permitted recognition of possible sources of false negative results such as necrosis, absence of tumor and, on occasion, estrogen bound in vivo. It was possible to analyze by the immunofluorescence method two specimens of insufficient size for biochemical assay.

Adipokinetic Effect of Intravenous Cortisol in Human Subjects.

Summary 1. Intravenous injection of cortisol caused a significant rise in serum free fatty acids of 103% and a fall of 38% in serum triglycerides in healthy fasting human subjects. 2. Injection of either saline or cortisol vehicle induced a significantly lesser rise in serum free fatty acid levels and no significant change in serum triglyceride levels.

Carcinoembryonic Antigen: Its Role as a Marker in the Management of Cancer. A National Institutes of Health Consensus Development Conference

Excerpt A consensus development conference was held 29 September to 1 October 1980, at the National Institutes of Health, to address issues concerning the role of carcinoembryonic antigen (CEA) as ...

Histochemical assay of estrogen and progesterone receptors in breast cancer: Correlation with biochemical assays and patients' response to endocrine therapies

Estrogen (ER) and progesterone (PgR) receptors were assayed by histochemistry in primary, recurrent, and metastatic breast cancer. Ligand‐conjugates composed of 17β‐estradiol and 11α‐hydroxyprogesterone covalently linked to bovine serum albumin and labelled with fluorescin isothiocyanate were employed. Results were compared with those of conventional biochemical receptor assays and correlated for ER in 92% of 314 tumors and for PgR in 86% of 86 specimens. ER and PgR determinations by both assay systems were correlated with clinical response to various endocrine therapies in 40 women with Stage IV disease. The histochemical assay enabled successful prediction of response in 80% of cases including eight which could not be fully analyzed biochemically.

The effects of patient delay and symptoms other than a lump on survival in breast cancer.

This study examined the relationship of survival in breast cancer to delay in treatment and the presence of symptoms. Data were analyzed for 664 patients diagnosed from 1975–1979 at 15 hospitals in Brooklyn, New York. Pathologic risk factors were defined to classify breast cancer into less (Class I) or more aggressive (Class III) disease. Delay and survival were not significantly associated among women diagnosed with Class I disease. Delay was associated with poor survival for patients with Class III disease (P < 0.001). The presence of symptoms other than a lump was associated with longer delay and poorer survival in patients with Class II and III disease. These findings suggest that the contradictory relationship between delay and survival reported by others may be due to variations in the proportions of slow and fast growing tumors and that fast growing tumors must be treated promptly for a successful result.

STUDIES ON THE MECHANISM OF THE PLASMA 17-HYDROXYCORTICOSTEROID ELEVATION INDUCED IN MAN BY ESTROGENS*

The administration of estrogens to man produces sustained elevation above normal levels of plasma 17-hydroxycorticosteroids (17-OHCS) (1, 2). The elevated levels of plasma 17-OHCS are associated with an augmented response of plasma levels of these steroids to exogenous adrenocorticotropic hormone (ACTH) and with a marked delay in the rate of clearance of exogenous cortisol from plasma (2). The last trimester of pregnancy is associated with similar changes in levels of plasma 17-OHCS and in their response to exogenous ACTH (3-9). In the last trimester of pregnancy there is a variable increase in urinary 17-OHCS excretion, a decrease in the rate of clearance of exogenous cortisol from plasma (9-11), a decrease in the rate of clearance of exogenous tetrahydrocortisone from plasma (11) and an increase in corticosteroid-binding protein (12). The apparently normal adrenal status of pregnant women and of patients treated with estrogens for long periods of time suggests that the administration of estrogens to man elevates plasma 17-OHCS levels by altering the normal metabolism of endogenous cortisol by a mechanism similar to that seen in pregnancy. Studies have been made of urinary 17-OHCS excretion, of clearance of tetrahydrocortisone from plasma, and of plasma corticosteroid-binding protein after the administration of estrogens to man.

Cardiac tamponade in primary myxedema and review of the literature.

A case of cardiac tamponade secondary to primary myxedema is described. The nature of the patients pericardial fluid and clinical course compared with other cases in the literature is reviewed. The patient had no recurrence of cardiac tamponade. Complete resolution of the pericardial effusion occurred 10 months followint initial pericardiocentesis and L-thyroxine therapy.

Methods of motivating the practice of breast self-examination: a randomized trial.

A randomized trial of 1,733 women compared three methods of motivating the practice of breast self-examination (BSE): (a) cognitive teaching which emphasized factual knowledge; (b) affective teaching which stressed feelings, attitudes, and values; and (c) a mixed approach which combined features of both. Subjects returned for follow-up at 3, 12, and 24 months or at 6 and 12 months, at which times they completed questionnaires and were evaluated by nurses. They demonstrated how they performed BSE and palpated breast models for lumps. No differences were observed among the teaching groups for any of several indicators of BSE practice, such as frequency, knowledge about when to do BSE, technique, or number of lumps detected in the model. However, these measures were associated with womens initial confidence in practicing BSE. Women in all teaching groups improved their BSE technique over time. Women in this study practiced BSE more frequently and detected more lumps than reported in other studies. The better performance of subjects in the present study might be ascribed to the amount of time spent teaching and to reinforcement from repeated follow-ups. The affective and cognitive approaches were equally effective in motivating the practice of BSE.

Effects of Halofenate on Glucose Tolerance in Patients with Hyperlipoproteinemia

Halofenate, a triglyceride- and uric acid-lowering drug, potentiated the effect of oral hypoglycemics. Its effect on serial glucose tolerance was evaluated in ten patients with hypertriglyceridemia without overt diabetes. Six-hour oral glucose tolerance tests were done during a control period and every 24 weeks over two years of halofenate treatment. Abnormal glucose tolerance (chemical diabetes) was observed during the control period in six of ten patients. The number of abnormal tests gradually decreased to none by 48 weeks. Plasma glucose, insulin, and free fatty acid values during the glucose tolerance tests were reduced significantly. Halofenate induced significant serum uric acid reduction. No significant regressions were observed among levels of lipids, hormones, glucose, and uric acid. The mechanisms by which lipid-lowering drugs improve glucose tolerance are as yet unexplained.