Charles M. Huguley

The value of breast self‐examination

In this study of 2092 women with cancer of the breast, those who had practiced breast self‐examination (BSE) had earlier cancer than did those who had not practiced BSE. This was true for both black and white races, all educational and economic levels, each age group, and within each period of delay between first symptom and medical consultation. The practice of BSE increased as the educational level rose and diminished as age advanced. A higher percentage of whites than blacks used the procedure. Breast self‐examination is safe and without cost to the women who practice it. It has the potential for helping more women to find their breast cancer early than any other method now available and feasible for widespread use. Cancer 47:989–995, 1981.

Breast self-examination and survival from breast cancer

The relationship between breast self‐examination (BSE) and survival was evaluated in 2093 women with breast cancer newly diagnosed between June 1975 and February 1979. In this population self‐examiners were younger, more educated, and more likely to be white, premenopausal, and married than nonexaminers. Self‐examiners also tended to seek medical care more rapidly and to have earlier stages of disease at diagnosis. Five years after diagnosis, the cumulative observed survival rates from breast cancer were 76.7% among self‐examiners and 60.9% among nonexaminers (P < 0.0001). In a multivariate analysis known sociodemographic and treatment confounders accounted for 25% of the excess of breast cancer deaths among nonexaminers. Approximately half of the remaining survival differential was attributable to the more limited disease among selfexaminers. The residual association between BSE and survival may be related to uncontrolled effects of stage or other unrecognized confounders.

Metabolic and therapeutic effects of allopurinol in patients with leukemia and gout

Abstract 4-Hydroxypyrazolo pyrimidine (allopurinol) has proved to be an effective agent in reducing uric acid concentrations in the serum and urine by in vivo inhibition of xanthine oxidase. The catabolism of 6-mercaptopurine (6-MP) was inhibited in patients with acute leukemia but it is not certain that this offers a therapeutic advantage. However, one of six patients refractory to 6-MP alone responded with complete remission when treated with a combination of allopurinol and 6-MP. This suggests that further trials be undertaken to determine the therapeutic efficacy of this combination. Allopurinol effected a prompt reduction in uric acid excretion, alleviating the threat of acute renal failure secondary to urolithiasis. In patients with gout, allopurinol was effective in lowering the uric acid levels in serum and urine and ultimately led to dissolution of tophi and a reduction of the threat of urolithiasis. It was well tolerated by patients when given in therapeutic doses. No renal or hepatic toxicity was noted. Except for a mild reticulocytosis in one patient and leukopenia in another, neither of which was proved to be due to allopurinol, no hematologic effects were noted.

Treatment of chronic lymphocytic leukemia using chlorambucil and prednisone with or without cycle-active consolidation chemotherapy .A southeastern cancer study group trial

Patients with untreated chronic lymphocytic leukemia (CLL) received protocol treatment with 6 months of chlorambucil (CB) (30 mg/M2) and prednisone (P) (80 mg/d × 5) every 2 weeks. Complete and partial responders (CR, PR) were then randomized to consolidation with six more courses of CB and P or to four courses of cytosine arabinoside (25 mg/M2 every 12 hours × 8, subcutaneously) and cyclophosphamide (25 mg/M2 every 12 hours × 8, orally) every three weeks. Of the 178 eligible patients entered, 138 (78%) were evaluable for induction therapy which produced a 22% hematologic CR and an overall response rate (CR + PR) of 74%. Eighty‐two patients received adequate consolidation, at the end of which 43 were in CR. No difference was seen in response or survival between the two consolidation treatments. Responders had longer survival than nonresponders (P = 0.0001) even when a 6‐month ‘guarantee time’ was excluded, but there was no survival difference between CR and PR. Thus, intermittent CB and P is a well‐tolerated, useful therapy for CLL but the addition of cyclophosphamide and cytosine arabinoside does not improve results.

A comparison of nitrogen mustard, vincristine, procarbazine, and prednisone (mopp) vs. nitrogen mustard in advanced hodgkin's disease

A randomized study of patients with advanced Hodgkins disease was designed to determine whether the improved therapeutic effectiveness of combination chemotherapy was due to the use of a combination of drugs or might be achieved with a single agent if given as intensively and for as long a period. A combination of nitrogen mustard, vincristine, procarbazine, and prednisone (MOPP) was compared with nitrogen mustard (HN2) alone. Treatment with both regimens was given to tolerance on cyclic basis and was continued for six cycles of treatment. Sixty‐one evaluable patients were treated with MOPP and 47 with HN2. The complete remission rate of 47.5% with MOPP was significantly better than the 12.8% with HN2 (p < .05). Complete remission lasted a median of 15 months after MOPP and 12 months after HN2. The survival of patients initially treated with MOPP was significantly better than that of those initially treated with HN2.

Methotrexate for advanced cancer of the breast

Forty‐one patients with hormone refractory metastatic breast carcinoma were treated with 5‐day courses of methotrexate alone or in combination with androgens and/or prednisone. Of 33 who received at least three courses of methotrexate, 15 achieved objective remissions which lasted for an average of 9 months. There were no significant differences in frequency or duration of responses in the group treated with methotrexate alone and those treated with methotrexate plus androgens and/or prednisone. Subjective remissions were seen in an additional 11 patients.

Comparison of methotrexate with 6‐mercaptopurine–prednisone in treatment of acute leukemia in adults

A randomized study of methotrexate vs. 6‐mercaptopurine and prednisone was carried out in 45 previously untreated patients with acute leukemia. Methotrexate was given orally in divided daily doses for 5‐day courses at intervals of ten to 14 days. Six‐mercaptopurine and prednisone were given daily until toxicity or hematologic response occurred. Patients surviving 6 weeks and failing to respond to the first treatment regimen were switched to the second program. Five of 29 patients who received methotrexate either as first or second treatment responded—four with partial remissions and one with a complete remission. Eight of 34 patients who received 6‐mercaptopurine and prednisone responded—two with complete remissions and six with partial remissions. The response rate in both groups of patients was low and there was no significant difference between the two groups. In a second unrandomized group of 20 patients treated with methotrexate there were two partial, responses.

Chronic myelocytic and chronic lymphocytic leukemia

The current status of chemotherapy for the chronic leukemias is reviewed. Chronic myelocytic leukemia is well controlled in about 90% of patients by use of busulfan or dibromomannitol. Patients who respond poorly are often considerably improved by use of hydroxyurea or mercaptopurine. Nevertheless, no improvement in survival has resulted. The majority of patients develop a “blast crisis” after a few years. Others develop progressive marrow fibrosis or become refractory to treatment for other reasons. No effective means of preventing the blast crisis has been developed, and treatment is unsatisfactory. The outlook for chronic lymphocytic leukemia is more promising. Serial studies indicate an improvement in survival since 1955, except for patients past 65 years of age. A greater than 10% rate of “complete remission” has been reported after chlorambucil and after whole body irradiation and particularly with a combination of chlorambucil and prednisone. Patients reported to have obtained a “complete remission” have enjoyed an especially long survival.

The Value of Breast Self-Examination

In this study of 2092 women with cancer of the breast, those who had practiced breast self-examination (BSE) had earlier cancer than did those who had not practiced BSE. This was true for both black and white races, all educational and economic levels, each age group, and within each period of delay between first symptom and medical consultation. The practice of BSE increased as the educational level rose and diminished as age advanced. A higher percentage of whites than blacks used the procedure. Breast self-examination is safe and without cost to the women who practice it. It has the potential for helping more women to find their breast cancer early than any other method now available and feasible for widespread use.