George N. Peters

Breast cancer screening behaviors and attitudes in three racial/ethnic groups.

Data from a multiethnic sample of women participating in the American Cancer Society 1987 Texas Breast Screening Project was used to compare attitudes and behaviors related to breast cancer screening for whites, blacks, and Hispanics. In general, similar patterns of association were observed across racial/ethnic groups between a number of demographic and risk factors and prior mammography and recent clinical breast examination (CBE), although the magnitude of the associations varied somewhat across groups. Reasons for not having had prior mammography also were similar across groups, with lack of physician referral and cost cited as the two most important reasons. However, Hispanics were less likely than blacks or whites to report prior breast cancer screening, including mammography, CBE, and breast self‐examination (BSE). This study demonstrated that women of different racial/ethnic backgrounds can be successfully recruited to participate in a patient‐initiated, community‐based program. However, this programmatic approach requires augmentation with other intervention strategies designed to reach low‐income women because women with more years of education and higher family income were overrepresented in all three groups.

Clinical recognition and management of depression in node negative breast cancer patients treated with tamoxifen

SummaryDepression is not an uncommon complaint of women with breast cancer and is usually assumed to be related to the cancer diagnosis itself or its treatment. As part of a prospective clinical trial of adjuvant therapy of node negative breast cancer, 301 patients treated and assessed by one oncologist (SEJ) were serially questioned for symptoms of depression in the first 6–12 months after completing initial treatment (surgery, radiation therapy, and/or chemotherapy). Two hundred and fifty-seven patients were evaluable for assessment of depression; 155 were receiving tamoxifen and 102 were not. Twenty-six patients had symptoms of depression including 23 (15%) treated with tamoxifen compared to 3 (3%) in the group not placed on tamoxifen (p < 0.005). Of the 23 patients with depression in the tamoxifen group, symptoms were temporally related to the initiation of therapy and occurred generally in the first 2 months of treatment. Eight patients had mild symptoms not requiring a dose reduction, 8 had significant depression requiring a dose reduction to relieve symptoms, and 7 required discontinuation of tamoxifen. We conclude that clinical depression as a side effect of tamoxifen therapy may be more common than previously believed and should be further rigorously investigated to confirm or deny our clinical impressions.

Tuberculosis of the breast: Rare but still extant: Review of the literature and report of an additional case

Tuberculosis of the breast is a rare malady that is usually manifested by a unilateral mass suggestive of carcinoma or sometimes of abscess. Mammography also suggests carcinoma in most instances. However, at operation, the discovery of necrotic tissue or abscess may lead to the suspicion of infectious or inflammatory disease rather than neoplasm. The diagnosis of tuberculosis may be established by the demonstration of acid-fast bacilli in excised tissue, by culture studies, or by guinea pig inoculation; however, the diagnosis is usually not suspected. In the past, mastectomy was the usual treatment. Today, successful treatment combines antituberculous drug therapy with the removal of infected breast tissue. The prognosis for complete cure is excellent. One case of secondary tuberculous mastitis has been reported herein. The patient, an Egyptian woman residing in the United States since 1973, was treated in Egypt for pulmonary tuberculosis at age 17. She presented in 1982 with a breast mass that mimicked carcinoma on physical examination and mammograms, but excisional biopsy and histologic examination revealed a breast abscess that contained caseous material and a solitary acid-fast bacillus. The patient was cured of her disease after appropriate operation and a course of antituberculous drugs. This has been the only documented case of mammary tuberculosis at our institution. Despite its rarity, tuberculosis of the breast should not be forgotten in this age of world travel.

Stereotactic breast biopsy as an alternative to open excisional biopsy

AbstractBackground: Health care cost continues to play a dominant role in our society. Technological advances are expensive, with the possible exception of stereotactic breast biopsy. We must learn other alternatives that give the same diagnostic accuracy at lower cost. The intention of this study was to find other acceptable alternatives to open excisional breast biopsies. Methods: Patients were referred to Baylor University Medical Center betwee between May 1990 and June 1992 for stereotactic breast biopsy of nonpalpable mammographic abnormalities. Before stereotactic biopsy, lesions were categorized into low or high suspicion for malignancy based on screening mammography. Slides were reviewed by a pathologist and the histological diagnosis was compared with mammographic characterization. Benign histology confirming the low-suspicion mammographic abnormality demonstrated mammographic and histologic correlation. Mammographic follow-up was recommended. Results: Two hundred twenty-five women underwent 250 stereotactic breast biopsies. Malignancy was diagnosed in 47 patients; the remaining 203 lesions were benign on pathological examination and are being followed regularly. Seventy-eight percent of the lesions were characterized as low suspicion for malignancy, and 22% were characterized as high suspicion. The average cost saving per lesion using stereotactic biopsy was

New horizons in the diagnosis and treatment of breast cancer using magnetic resonance imaging.

1,629. Conclusion: Stereotactic breast biopsy is an acceptable, less expensive alternative to open excisional biopsy for diagnosing nonpalpable mammographic findings.

Tumor hormone receptor status and recurrences in premenopausal node negative breast carcinoma

A new nuclear magnetic resonance imaging (MRI) technique, Rotating Delivery of Excitation Off-resonance (RODEO), has been developed to assist surgeons in the diagnosis and treatment of breast cancer. A nonrandomized, prospective study of 100 patients with a high suspicion of breast cancer was conducted; these patients were examined by RODEO and conventional breast imaging, including mammography. Forty-one breasts were removed by mastectomy; each pathologic specimen was examined by sectional analysis. This study was undertaken to determine the extent that RODEO can aid in detecting breast tumors (including multicentric disease) and in evaluating candidates for conservative breast surgery. RODEO detected 85 pathologically confirmed lesions, 64 of which proved to be malignant. RODEO had a sensitivity of 95%, compared with a sensitivity of 58% for conventional imaging. More study is needed to determine distinguishing MRI characteristics that are suspicious for malignancy. RODEO may be used clinically to assess multicentricity and response to chemotherapy.

Phase I trial of adjuvant chemotherapy with cyclophosphamide, epirubicin and 5-fluorouracil (CEF) for stage II breast cancer

To ascertain the prognostic significance of tumor hormone receptor status in node negative, premenopausal patients with breast cancer, a retrospective view of 199 patients fitting these criteria was conducted. Of these 199 patients, 147 had estrogen receptor data available. There were 104 patients (71%) who were estrogen receptor negative, and 16 (15%) had developed local or distant recurrence with a median follow‐up of 44 months. Five patients had died of breast cancer. Of the 43 patients who were estrogen receptor positive, there was one recurrence, and no breast cancer deaths. This difference in recurrence is statistically significant (P < 0.01) by the log‐rank probability test. Of the 17 patients with recurrent disease, 14 (82%) had primary tumors 2 cm or larger in size. If only those patients with tumors 2 cm or larger are considered, 23% (13/57) who were estrogen receptor negative and 5% (1/19) who were estrogen receptor positive recurred. This remains statistically significant (P < 0.025). We conclude that tumor hormone receptor status and size of tumor are significant prognostic factors in identifying premenopausal, node negative women at risk for recurrent disease.

Magnetic Resonance Imaging of the Breast: Present and Future Roles

SummaryEpirubicin is a new anthracycline with a potentially more favorable toxicity profile than the parent compound, doxorubicin. Accordingly, the feasibility and toxicity of 6 courses of adjuvant chemotherapy with cyclophosphamide (C), epirubicin (E), and 5-fluorouracil (F) were assessed in 10 patients with Stage 2 (node positive) breast cancer. Doses of C and F were 600 mg/m2 and E was 75 mg/m2. Moderate granulocytopenia (median count = 610/mm3) occurred on day 14 of the first 21 day treatment course and was the main toxicity encountered with treatment, although there were no episodes of granulocytopenic fever. Grade 3 or 4 vomiting occurred in 40% and significant alopecia in 30% of patients. Four patients experienced transient asymptomatic decreases in calculated radionuclide cardiac ejection fraction of ≥ 10% but no signs or symptoms of cardiac failure were observed. If epirubicin proves to be less cardiotoxic than doxorubicin, this combination would merit further evaluation as potential adjuvant therapy for early breast cancer.

Tubular carcinoma of the breast. Clinical pathologic correlations based on 100 cases

New magnetic resonance imaging (MRI) methods have been developed for imaging a variety of breast disorders. Researchers at Baylor University Medical Center have established a world leadership posit...