Karin Lindholm

Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial.

STUDY OBJECTIVE--To determine whether mortality from breast cancer could be reduced by repeated mammographic screening. DESIGN--Birth year cohorts of city population separately randomised into study and control groups. SETTING--Screening clinic outside main hospital. PATIENTS--Women aged over 45; 21,088 invited for screening and 21,195 in control group. INTERVENTIONS--Women in the study group were invited to attend for mammographic screening at intervals of 18-24 months. Five rounds of screening were completed. Breast cancer was treated according to stage at diagnosis. END POINT--Mortality from breast cancer. MEASUREMENTS AND MAIN RESULTS--All women were followed up and classed at end point as alive without breast cancer, alive with breast cancer, dead from breast cancer, or dead from other causes. Cause of death was taken from national mortality registry and for patients with breast cancer was validated independently. Mean follow up was 8.8 years. Altogether 588 cases of breast cancer were diagnosed in the study group and 447 in the control group; 99 v 94 women died of all causes and 63 v 66 women died of breast cancer (no significant difference; relative risk 0.96 (95% confidence interval 0.68 to 1.35)). In the study group 29% more women aged less than 55 died of breast cancer (28 v 22; relative risk 1.29 (0.74 to 2.25)). More women in the study group died from breast cancer in the first seven years; after that the trend reversed, especially in women aged greater than or equal to 55 at entry. Overall, women in the study group aged greater than or equal to 55 had a 20% reduction in mortality from breast cancer (35 v 44; relative risk 0.79 (0.51 to 1.24)). OTHER FINDINGS--In the study group 100 (17%) cancers appeared in intervals between screenings and 107 (18%) in non-attenders; 51 of these women died from breast cancer. Cancers classed as stages II-IV comprised 33% (190/579) of cancers in the study group and 52% (231/443) in the control group. CONCLUSIONS--Invitation to mammographic screening may lead to reduced mortality from breast cancer, at least in women aged 55 or over.

Herpes simplex virus--the most frequently isolated pathogen in the lungs of patients with severe respiratory distress

308 consecutive patients with severe or complicated respiratory tract infections underwent fiber-optic bronchoscopy in the search for a microbiological etiology. Protected brush specimens were used for bacterial cultures and bronchoalveolar lavage (BAL) for virus isolation and cytological examination. Herpes simplex virus (HSV) was the most commonly found pathogen and was isolated in 37 patients. 20 (54%) of them also had serological and/or cytological signs of HSV infection. 132 patients required assisted ventilation (AV) and in this group 34 (92%) of the 37 HSV positive patients were found. Isolation of HSV was significantly (p less than 0.001) associated with AV compared to patients not requiring AV. Of all patients treated with AV 26% had positive HSV isolation in conjunction with suspected acute lower respiratory infection. Coinfection with HSV and bacteria occurred in only 8 (22%) patients. HSV was more common in patients with burns (47%) compared to other patient groups such as patients with AIDS (3%) or other immunodeficiencies (9%).

X-ray guided fine-needle aspiration for the cytologic diagnosis of nonpalpable breast lesions

X‐ray guided localization of 215 nonpalpable, mammographically detected, breast lesions for fine‐needle aspiration biopsy was performed using a two‐dimensional coordinate grid. Representative material was obtained in 64% of the lesions. Very strict criteria of representativity were observed. The sensitivity of the cytologic procedure was 92%, the specificity 95%, the predictive value of positive cytologic diagnosis 88%, and the predictive value of a negative cytologic diagnosis 97%. Potential pitfalls in the localization and aspiration procedures are discussed. The results of cytologic examination should always be correlated with the mammographic findings, and further diagnostic and therapeutic decisions should be based on both modalities. In this setting, x‐ray guided fine‐needle aspiration cytologic study is a highly valuable diagnostic tool.

Flow dna analysis in the characterization of carcinoma of the renal pelvis and ureter

A prospective study comprised operative specimens from 11 patients with transitional cell carcinoma of the renal pelvis or ureter. DNA analysis of the primary tumor and of multiple biopsy specimens from preselected sites of the surrounding urothelium was performed with flow cytometry. All Grade 3 tumors and 50% of the Grade 2 tumors were aneuploid, and the remainder were Grade 2 and diploid. All invasive tumors were aneuploid. Carcinoma in situ was found in some of the preselected biopsy specimens, all of which were aneuploid, from two patients. Close correlation thus was observed between aneuploidy and tumor invasiveness, whereas diploidy was seen only in noninvasive tumors with lower malignancy grade. Aneuploidy was also associated with increased risk of carcinoma in situ. The study indicated that DNA analysis may be useful for defining the malignant potential of urothelial tumors of the upper urinary tract more fully than conventional grading and staging permit.

Endometriosis in the uterosacral ligament giving orthopedic symptoms through compression of the sciatic nerve and surgically treated via an extraperitoneal approach keeping the pelvic organs intact.

Sciatic pain in a young woman was not relieved by orthopedic treatment. The gynecologist found a large hard tumor‐like mass in the uterosacral ligament extending to the pelvic wall. Cytologic examination of fine needle aspirate indicated an endometriotic lesion. The large tumor‐like mass was extirpated by an extraperitoneal technique and the pain disappeared.

Intravesical Adriamycin Therapy in Carcinoma in Situ of the Urinary Bladder

Intravesical Adriamycin treatment was given to 22 patients with carcinoma in situ of the urinary bladder. The treatment schedule consisted of monthly Adriamycin instillations in a dose related to bladder capacity. Endoscopic inspection with multiple bladder biopsies and cytoanalysis of urine was performed after every third instillation. In two patients there was lasting disappearance of the carcinoma in situ. Another 10 patients possibly had a beneficial effect of the treatment. The remaining 10 patients showed persistent malignancy and in 6 of these, progression of carcinoma in situ during Adriamycin treatment necessitated cystectomy or radiotherapy. The histologic and cytologic findings showed distinct variability in most patients, with atypia or even absence of malignant cells often followed by recurrence. Adriamycin was discontinued in four cases because of severe cystitis, and in one case because of an anaphylactoid reaction following instillation of the drug.

Human papilloma virus types in routine cytological screening and at colposcopic examinations.

Certain types of human papillomaviruses (HPV) play a crucial role in the development of anogenital cellular dysplasia and cancer. We have searched for a broad spectrum of HPV-types by PCR in cervical cell samples from 230 women aged 20-29 years enrolled at routine gynecological health control and 506 women referred to colposcopy due to suspected cytological changes. Thirteen percent of the health control women had HPV DNA of identified types. Half of the colposcopy patients showed benign histology with corresponding HPV DNA prevalence of 18%, while among the patients with cervical intraepithelial neoplasia between 61% and 78% had HPV DNA. Among both women with normal cytology or histology and those with various degrees of cervical dysplasia, cancer-related HPV types represented about 85% of the types found. The strong correlation between HPV infections and development of cervical dysplasia is an argument for HPV DNA testing of certain patient groups.

Primary culture of squamous head and neck cancer with and without 3T3 fibroblasts and effect of clinical tumor characteristics on growth in vitro.

Twenty‐one tumors from patients with squamous cell carcinoma of the head and neck (SCC H/N) were cultured with and without 3T3 fibroblasts in order to determine whether, on the basis of improved tissue culture medium, 3T3 cells could be deleted without altering growth and cloning efficiency. Thirty‐five additional primary SCC H/N specimens, cultured in the presence of 3T3 fibroblasts, were studied to assess the effect of tumor differentiation, site of primary tumor, and site of specimen procurement on growth. The authors conclude that 3T3 cells remain essential for optimal growth and cloning efficiency. Also, 3T3 cells improved the number of successful cultures by 33% to 100% depending on the plating density, and cloning efficiency was improved by 50% in the presence of 3T3 cells. Growth did not correlate with tumor differentiation or site of origin of the tumor specimen. Culture of specimens from the primary site resulted in growth significantly more frequently than culture of specimens obtained from metastatic neck nodes.

Carcinoma in situ of the Renal Pelvis after Cystectomy

Carcinoma in situ of the renal pelvis in a patient with an ileal conduit is reported. By fiberendoscopy, using gastrointestinal instruments, both ureters were catheterized. Cytological investigation of urine from each kidney revealed that malignant cells were exfoliated from the left side exclusively. The correct diagnosis of a carcinoma in situ of the left renal pelvis was confirmed by a histological examination of the operative specimen.

Intravesical mitomycin C for carcinoma in situ of the urinary bladder.

Mitomycin C was given intravesically over periods of 2-32 months to 34 patients with carcinoma in situ of the urinary bladder. Initial complete response was obtained in 17 patients, 14 of whom remained without evidence of disease during follow-up averaging 28 months from cessation of mitomycin therapy. In three responding patients malignant cells reappeared in the urine during follow-up, although no recurrence of carcinoma could be proven in bladder biopsy specimens. In eight of the 17 non-responders, muscle invasion and/or metastatic disease developed during or after mitomycin treatment. The prostatic urethra was involved in five cases. Chemotherapy had to be discontinued because of chemical cystitis in three cases. Mitomycin C appears to be effective for intravesical treatment of carcinoma in situ of the urinary bladder. Close surveillance of these patients is mandatory, however, and must include monitoring not only of the bladder, but also of the prostatic urethra and the upper urinary tract.