M. M. Roberts

The Edinburgh randomised trial of screening for breast cancer: description of method.

Edinburgh was selected as one of the centres in the UK Seven-year Trial of Breast Screening of women aged 45-65 which began in 1979. Subsequently, our study was extended to a randomised trial with its own control population within the city. Half the practices were randomly allocated for screening, giving a cluster sampling of women. The total number in the trial is 65,000. Women with previously diagnosed breast cancer are excluded. Women allocated for screening are invited to the clinic and screened according to the procedures specified in the U.K. protocol, having clinical examination every year and mammography on alternate years. The two modalities of screening are assessed independently and the role of nurses is being evaluated. Breast cancer incidence is monitored by pathology register and the local cancer registry office and deaths from the General Register office. Long-term follow-up will be obtained through flagging at NHS Central Register. To determine the value of screening, standard statistical methods will be used to compare breast cancer mortality rates in the whole of the screening population with that of the controls. This trial has a power of 83% of detecting a reduction in mortality of 35% after 7 years of follow-up and a power of 95% of detecting a similar reduction at 10 years (alpha = 0.05, one-sided test).

Serum immunoglobulin levels in patients with breast cancer.

Serum immunoglobulin levels IgA, IgG, and IgM have been estimated in 92 patients with breast cancer and 50 control patients, 40 of whom had benign disease of the breast. In the patients with breast cancer, IgA was significantly raised at all stages and IgG was significantly reduced, but the two abnormalities were not necessarily concomitant. These findings may suggest a disturbance in the secretory immune system, and immunologic defect even when the cancer is localized to the breast.

Plasma prolactin and breast cancer

Using a homologous radioimmunoassay we have compared plasma prolactin concentrations in 49 patients with breast cancer and 39 hospital controls. When a drug history was taken into account no difference was found. In addition we have studied the effect of Stilbestrol in 6 females with advanced breast cancer. Remission of disease has been noted in the face of elevated prolactin levels.

Local Immunoglobulin Production in Breast Cancer

Immunoglobulin levels (IgA, IgG, IgM) have been estimated in protein extracts of 55 malignant and 20 benign tumours of the breast, and in 17 normal tissues from a cancer bearing breast. IgA and IgG were significantly reduced in cancer compared with both benign and normal tissues but IgM, detected in only a third of tumours, was significantly increased. Total immunoglobulin levels and IgG in the malignant tumours correlated with plasma cell infiltration.The menstrual status of the patient had no influence on these findings.

Oestrogen receptor activity in breast cancer detected at a prevalence screening examination

SummaryIn view of the possible introduction of screening programmes, this study compares oestrogen receptor (ER) levels in a series of women whose primary tumour was detected by screening and an age-matched consecutive series of women whose tumours were diagnosed after symptomatic presentation. Because of missing data and other statistical considerations, the comparison was made using T1 and T2 categories of tumour only. Some differences were found: the distribution of ER levels was significantly different in the two groups, with more extreme values in the symptomatic series; the screening series, however, had more moderate/rich ER levels than the symptomatic group. Tumours of special pathological type (for example, tubular, cribriform, lobular, medullary, and mucoid) were more likely to be ER-moderate or -rich, and there were more of these tumours in the screening series. The relationship of these findings to tumour growth rate is discussed. The study highlights the difficulty of obtaining sufficient tissue for conventional DCC biochemical assays from the small non-invasive tumours found by screening, and suggests that newer alternative methods employing monoclonal antibodies may be required for such types of tumour.

Pituitary Ablation by Yttrium-90

The method of pituitary ablation which we use is that of transphenoidal yttrium-screw implantation (Fig. 1) (Forrest, Blair, and Valentine, 1958). This modification of our original technique by which the yttrium rod is incorporated in a stainless steel screw unit was introduced to enable us to fix the radioactive source in an optimum position in the pituitary fossa (Forrest and Peebles Brown 1955, Forrest et al. 1956, Forrest et al. 1959).

Precipitation of Serum and Tissue Proteins by Phytohaemagglutinin (PHA) in Breast Cancer Patients

Precipitation of serum proteins by PHA showed a normal pattern in 36 cancer patients, compared with 42 controls, the reaction being strongest in the α-globulin region, and may be due to both α2