Knut Aspegren

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.

Long-Term Psychological Sequelae of Mastectomy and Breast Conserving Treatment for Breast Cancer

Psychiatric and psychosocial adaptation to two types of treatment for primary breast cancer, modified radical mastectomy and partial mastectomy with radiotherapy, was studied five years after the primary treatment. 102 consecutive patients with pT1NOMO breast cancer were invited to follow-up which was done by standardized questionnaires. Nineteen women declined the invitation and 25 others were not included for various reasons, leaving 58 to complete the interviews. 30% of the women reported accentuated mental symptoms compared to the state before treatment, with no significant difference between the two treatment groups. Psychiatric state, marital adjustment and fear of cancer recurrence were also similar in the two groups. However, breast conserving treatment seems to preserve the womans female identity and acceptance of body configuration. We conclude that breast conservation does not in itself prevent mental sequelae after treatment for primary breast cancer. Selective psychoprophylactic programs and reorganization of the postoperative follow-up should be tried to diminish unwanted psychological reactions.

Validity of Breast Cancer Registration from One Hospital into the Swedish National Cancer Registry 1971–1991

To validate the Swedish Cancer Registry concerning breast tumours in female residents of Malmö 1971-1991, registry-entries were compared with clinical records. Correctness and completeness of entries was determined for invasive breast cancer (BC) and cancer in situ of the breast (CIS). As BC were registered 3,646 tumours. Of these 3,403 (93.3%) were confirmed as BC. Completeness was good with 1.1% of diagnosed tumours missing. Correctness of registered cases of CIS was 93.3%, but completeness only 63.3%. Most missing cases were registered as BC. In bilateral cancer correctness was 78.0% and completeness 77.2%. All aspects of registration improved during the period. Most differences between diagnosed and registered cases were due to coding CIS of intraductal type as BC. This practice changed in 1980 resulting in improved precision. Using registry data for epidemiological research the question of their validity must be addressed. Special consideration should be paid to coding practice at the registry.

Long-term effects of adjuvant tamoxifen and/or radiotherapy. The South Sweden Breast Cancer Trial.

In a multicenter trial of adjuvant therapy in stage II breast cancer, 719 postmenopausal patients were randomized to one of three treatment regimens: radiotherapy only or in combination with adjuvant tamoxifen for one year, or adjuvant tamoxifen without radiotherapy. At twelve years of follow-up (median 9 years), no statistically significant differences in survival or recurrence-free survival were observed. However, the rate of loco-regional recurrency was lower among patients treated with both radiotherapy and tamoxifen. The rate of bilateral breast cancer was reduced in tamoxifen-treated patients whereas the rate of new primary malignancies other than breast cancer was somewhat higher in tamoxifen-treated patients. Adjuvant therapy in breast cancer may influence not only breast cancer recurrences and mortality but also later disease patterns and cause-specific mortality.

Primary Prognostic Factors in Invasive Breast Cancer with Special Reference to Ductal Carcinoma and Histologic Malignancy Grade

Background. In a study of 2290 cases of invasive breast cancer in Malmö, the prognostic value of histologic typing and axillary nodal status was examined. Two periods were studied: Period 1, 1961–1970, and Period 2, 1981–1988.

Undifferentiated Giant and Spindle Cell Carcinoma of the Thyroid: Report on two combined treatment modalities

Undifferentiated giant and spindle cell carcinoma of the thyroid is a rapidly fatal disease. Most patients die from local tumour progression and with distant metastases. A combination of debulking surgery, irradiation and combination chemotherapy is reported. An improvement of the local results of treatment was observed. A combination of irradiation and chemotherapy resulted in local control in only one of 8 patients. Therefore, debulking surgery was added in the next 5 patients and a local control was achieved in 4.

Weekly-dose doxorubicin (WDA) in advanced breast cancer

Doxorubicin in a weekly fixed dose of 20 mg as i.v. bolus (WDA) was given to 48 patients with mostly pretreated progressing breast cancer. The response rate (CR + PR) was 9/48 (19%), and a further 16 (33%) of the patients achieved stable disease. Myelosuppression was mild and without clinical significance. Other side effects, particularly nausea, vomiting and hair loss were also relatively mild. Cardiac toxicity, however, was seen in six patients. Five of these six patients were previously treated with mitoxantrone or combination chemotherapy containing doxorubicin. Median response duration was 10+ months for responders and 11+ months in patients who had stable disease. It is concluded that weekly-dose doxorubicin has a favourable profile with a low frequency of side effects and that this treatment is an alternative to other cancer chemotherapy in breast cancer, especially when not only CR and PR but even stabilization of disease is considered of benefit to the patient.

Breast Cancer as Cause of Death a study over the validity of the officially registered cause of death in 2 631 breast cancer patients dying in Malmö, Sweden 1964–1992

The validity of registered official cause of death (COD) concerning breast cancer patients in Malmö 1964-1992 was analysed. There was a high frequency of autopsy in the material and, therefore, the number of diagnostic errors should be low. Found discordance thus mostly reflect the quality of certifying and registration of COD. Of 2631 deaths discordance was found as to underlying COD in 121 cases (4.6%). Ninety-four of these represent outright errors. In 27 there was doubt about the reported COD. The number of discordant cases increased with age at death. Two kinds of systematic bias were found. One was a tendency to report breast cancer as contributing COD in patients with clinical cure. The other was a practice at the Registry to register breast cancer as underlying COD in cases with breast cancer reported as contributing COD. This practice was changed in 1981 causing an artificial decrease in registered breast cancer mortality.

Quantitative Lymphoscintigraphy for Detection of Metastases to the Internal Mammary Lymph Nodes: Biokinetics of 99Tcm-sulphur colloid uptake and correlation with microscopy

Dymanic quantitative activity determination and accurate scintigraphic localization of parasternal lymph nodes were obtained from antero-posterior measurements with a scintillation camera. The scintigraphic observations were compared with microscopy of the nodes removed at operation. The 99Tcm-sulphur colloid indicated a high frequency (7/16) of absent uptake in normal lymph nodes. However, the technique used indicates that a similar technique with smaller particle size may be a useful method for proper classification of the clinical stage of carcinoma of the breast.

5-Fluorouracil and mitomycin C in advanced breast cancer

Fifty-seven patients with advanced breast cancer were treated with a combination of 5-fluorouracil and mitomycin C (FuMi). Fifty-three were previously treated with hormones and/or cytotoxic drugs. Complete and partial remissions (CR, PR) were seen in 16%, stationary disease in 46%, and progressive disease in 38%. The mean time to remission was 4.5 (CR) to 4.0 (PR) months. The toxicity was mild and consisted mainly of thrombocytopenia. The FuMi-regimen may be a useful alternative in advanced breast cancer, at least in progression after previous systemic therapy, and if a moderate toxicity is considered important.