R. C. Bennett

Androgen receptors in breast cancer

Androgen receptor assays have been performed on 1371 specimens of histologically confirmed primary and recurrent breast cancer. Forty‐two patients who had received tamoxifen as treatment for advanced disease were assessed for objective response. Another 42 patients who had received chemotherapy were similarly studied. Patients with androgen receptor‐negative tumors had a significantly poorer response rate to hormone therapy than those with receptor‐positive tumors (P < 0.05). This clinical correlation is supported by survival data of 1181 patients with primary breast cancer which showed that patients with androgen receptor‐negative tumors had a highly significant trend toward shorter overall survival than those with receptor‐positive tumors (P < 0.001). Androgen receptor data added significantly to the information provided by estrogen receptor data both in terms of response to hormone treatment and survival.

Radical surgery with omental flap for uncontrolled locally recurrent breast cancer.

Background:  Uncontrolled chest wall disease due to breast cancer is a highly morbid condition causing pain, ulceration, malodour and the need for frequent dressings. Aggressive surgical approaches are rarely justified because most patients will succumb to metastatic breast cancer within a short period. A highly selected group of patients with minimal or no evidence of metastatic disease and good performance status may benefit from radical chest wall surgery. Omental transposition flaps are ideal for reconstructing extensive surgical defects following chest wall surgery.

Delayed presentation in breast cancer: relationship to tumour stage and survival

During 1976–1985, 20% of new breast cancer patients (109548) delayed presentation by 6 months or more. This study investigated the relationship between delay and outcome in symptomatic (as opposed to screen detected) women. Delay was associated with greater age (median 68 v 65 years, p=0.042) and progesterone receptor positivity (p=0.017, U-test) and advanced disease stage (p<0.0001, U-test). For those who delayed 6 months or more, 5-year survival was not impaired (53% v 56%). With 18 months or more delay, 5-year survival was worse (42% v 57%, p=0.030). When survival was recalculated from date of first symptom, those delaying 6 months or more lived longer (68% v 54%, p=0.014). This retrospective study provides no evidence that delay before presentation to hospital prejudices survival in symptomatic women. Instead, a prolonged preconsultation delay was associated with increased overall survival. The high incidence of associated advanced disease is, however, a cause for concern.

Tennessee antigen: The predictive value of preoperative and postoperative assays in large-bowel cancer

Twenty-nine of 31 patients bearing resectable colorectal cancers had elevated levels of serum Tennessee antigen in comparison with only eight of 31 patients for carcinoembryonic antigen. This high detection rate is, however, of limited value since the level of serum. Tennessee antigen is not specific for the presence of malignancy. There appeared to be no relationship between the level of preoperative serum Tennessee antigen and subsequent prognosis. Furthermore, in only nine of 31 patients did the serum Tennessee antigen level fall after removal of all macroscopic cancer. There also appeared to be no relationship between the level of serum TennaGen at three months after resection and subsequent prognosis. These findings are in contrast, to estimations of serum carcinoembryonic antigen.

Peripheral blood lymphocyte levels in large-bowel cancer

The relationship between peripheral blood lymphocyte levels and monitoring and assessment of prognosis of patients with large-bowel cancer has been assessed. There does not appear to be a correlation between the absolute lymphocyte count and the state of disease. Furthermore, the preresection and postresection lymphocyte levels do not accurately predict the likelihood of recurrent cancer subsequently developing, and the serial monitoring of patients with peripheral blood lymphocyte levels adds no important new information to clinical follow-up.

Tennessee antigen: Its value in the monitoring of patients with colorectal cancer

Serial estimations of serum Tennessee antigen have been performed at regular three-month intervals on 35 patients with colorectal cancer who had undergone resection of all macroscopically obvious tumor but who were considered to be at high risk of developing subsequent metastases. The results were interpreted by a panel of surgeons in order to assess the clinical relevance of using serum Tennessee antigen for monitoring of patients. The serial estimation of serum Tennessee antigen was found to be very variable, difficult to interpret, and clinically unreliable as an accurate marker for the development of recurrent cancer in this group of patients. There are unacceptably high false-positive and false-negative diagnostic rates for serum Tennessee antigen estimations in comparison with serial estimations of carcinoembryonic antigen.

The Experimental Application of Microsurgical Techniques to Internal Mammary to Coronary Artery Anastomosis

Obstructive coronary artery disease is in many patients a disease of the proximal arteries. Saphenous vein bypass grafts have been satisfactorily performed into vessels of diameters of 2.5 mm and above. A certain proportion of patients exist, however, in whom the only vessels available for grafting are of diameters of less than 2 mm. The purpose of this study was to test the feasibility of performing internal mammary to coronary artery anastomosis in the dog in vessels of diameters of 1-2 mm, using the operating microscope The study indicates that it is technically possible to perform these anastomoses with an acceptable immediate patency rate.