Melvin J. Silverstein

Psychosocial outcomes of breast cancer therapies: lumpectomy versus mastectomy.

The psychological status of 50 patients who had been treated for breast cancer was assessed an average of 21 months after treatment. The patients were grouped according to major treatment modalities: mastectomy with breast reconstruction, mastectomy without breast reconstruction, or lumpectomy. Lumpectomy patients had a significantly more intact body image (p less than .008) and a greater sense of sexual desirability (p less than .009) than patients in the other groups. The patients did not differ on frequency of sexual relations or on emotional symptomatology. The results of this study generally validate those found in comparable studies showing that lumpectomy promotes a more intact body image but that no surgical procedure either produces or inhibits psychological symptomatology.

Intact humoral and cell-mediated immunity in chronic marijuana smoking

The immune system of 12 healthy chronic marijuana-smoking adults was evaluated while they smoked marijuana daily for 64 consecutive days under controlled hospitalized conditions. Studies included enumeration of B and T cell subpopulations, lymphocyte proliferative responses to PHA and to allogeneic cells, and serum immunoglobulin levels. Percent B cells, initially low in 2 patients, became normal. Baseline total B cells, determined either by surface immunoglobulins (338 cells/mm3 +/- 60 SEM) or complement receptors (162 cells/mms +/- 27) were significantly (p less than 0.05) less than control but increased to normal (485 +/- 97 and 239 +/- 47) over time. Percent T cells, initially low (less than 40%) in 4 patients, became normal. Baseline T cells (951 cells/mm3 +/- 70 SEM), significantly lower than controls (2,010 +/- 210, p less than 0.05), increased to normal by day 63 (1,875 +/- 281). In vitro lymphocyte response to graded doses of PHA and to allogeneic cells was normal initially and did not change over time. Serum IgG (1,064 +/- 33), IgA (166 +/- 13), and IgM (96 +/- 6) were normal. Serum IgE levels increased in 4 subjects without evidence of allergy. Short-term chronic marijuana use does not have a substantial adverse effect on B or T cells of young healthy adults.

Multimodality cancer therapy in man: A pilot study of adriamycin by arterial infusion

Adriamycin was given by an infra‐arterial route as part of a planned program of combined modality therapy in 10 patients with regionally advanced neoplasms. Doses ranged from 45–107 mg/m2 given as a continuous infusion over 1.5–3.0 days. Adriamycin was followed by radiation therapy and/or radical surgical excision of the tumor in most cases, making long‐term evaluation of response difficult. However, 4 of 7 evaluable patients had prompt partial responses prior to subsequent treatment. We conclude that adriamycin can be administered by the intra‐arterial route and that it may be useful as part of a program of combined modality therapy in selected patients. Cancer 33:1485–1490, 1974.

Normal Skin Test Responses in Chronic Marijuana Users

The cell-mediated immunity of 22 chronic marijuana smokers showed no difference from that of normal controls when evaluated by in vivo skin testing with 2,4-dinitrochlorobenzene. However, a significant difference was seen between these chronic marijuana users, all of whom could be sensitized to 2,4-dinitro-chlorobenzene, and age-matched cancer patients, who showed a decreased capacity to be sensitized.

Successful transurethral intralesional BCG therapy of a bladder melanoma

An isolated metastasis of malignant melanoma to the urinary bladder of a patient was successfully eradicated by transurethral intralesional injection of BCG. Total destruction of the tumor was confirmed by subsequent excision. Lymphocyte blastogenesis studies revealed no significant alteration in immunocompetence secondary to the therapy, except for an increased responsiveness to PPD. There was no evidence of presence of blocking factors following therapy; cytotoxicity against MLA‐14 melanoma cells sharply increased after the intralesional injection. Humoral antimelanoma antibody levels, determined by complement fixation, were decreased before the intralesional therapy, but increased markedly immediately following the transurethral BCG injection.

The Breast Center—A Multidisciplinary Model

The overall care in the United States for most women with breast cancer, while possibly the “best” in the world, is often fragmented and impersonal. A typical woman finding a palpable mass in her breast anxiously calls her family physician, internist, or gynecologist. She is usually reassured and sees her physican a few days later. Not uncommonly, a patient like this may be followed through one menstrual cycle and, if the lump persists, be referred for a mammogram. Leaving the radiologist’s office, she generally has not been informed of the results. Several days may pass before she hears from her primary physician that her mammogram was “normal” or that she must proceed with further workup.

Finding Earlier Nonpalpable Breast Cancers Using Hooked Wire Directed Biopsy and a Modified Overpenetrated Mammographic Technique

For most of this century, women with breast cancer presented with large palpable masses. The size gradually decreased so that by 1970, the average tumor was 3 cm in diameter [1]. Unfortunately, 50 percent of these patients had positive axillary lymph nodes [1–3], most of them going on to develop distant metastases. A technique for finding smaller, earlier breast cancer was urgently needed.