BACKGROUND: The incidence of female breast cancer has been increasing during last 10 years. There are many risk factors in breast cancer. We evaluated the relative risk of breast cancer in relation to obesity and body composition. Also we evaluated the Bioelectrical Impedance Analysis (BIA) for estimating the obesity. MATERIALS AN METHODS: The data were collected as a case-control study from September 1, 1997 to August 31, 1998. Cases were selected from newly diagnosed and treated breast cancer patients at Breast Clinic of Gil Medical Center, Gachon Medical College. Control group was randomly selected form women with benign breast disease or women in screening rest. All suspected risk factors including obesity indices and body composition were checked. Especially body fat percent, total body water and lean body mass were checked by BIA. RESULTS: There was no association between the relative risk of breast cancer and education, smoking, drinking, oral contraceptives use, reproductive factors and breast feeding factors. Data analysis showed the high possibility of positive relationship between early menarche factors( < or =14 years old) & late menopause ( > or =51 years old ) and the brest cancer, however there was no statistical significance. There was a statistical significance between risk group and control group in fat percent (p=0.0187) and WHR (waist-hip ratio) (p=0.0174) among obesity indicies. BMI & obesity (In the classification if Obesity by Japan Society for Study of Obesity) were associated with relative risk of breast cancer by menopausal status. In premenopausal women, breast cancer risk decreased in high BMI & obese group, however the increase was shown in postmenopausal women contrarily. . CONCLUSIONS: This study suggests that there I a significant difference in the relationship between the obesity index and the relative risk of breast cancer between Korean and Western women. Bioelectrical Impedance Analysis is a available method for estimating of obesity in relative risk of breast cancer women. Further studies will be needed for evaluating the role of BIA and the relationship of obesity with staging & prognosis of breast cancer.
Adipose Tissue ; Body Composition ; Body Water ; Breast Diseases ; Breast Feeding ; Breast Neoplasms* ; Breast* ; Case-Control Studies ; Classification ; Contraceptives, Oral ; Drinking ; Education ; Electric Impedance* ; Female ; Humans ; Incidence ; Japan ; Mass Screening ; Menarche ; Menopause ; Obesity* ; Prognosis ; Risk Factors ; Smoke ; Smoking ; Statistics as Topic

PURPOSE: It is well established that the presence of axillary nodal metastases is the most important prognostic factor in primary operable breast cancer. However, it has also been shown that 15-30% of patients without lymph node metastases as assessed by light microscopy have recurrence within 10 years. In this study, our aim was first to investigate the diagnostic value of immunohistochemical staining in detecting micrometastases and secondly to correlate their presence with prognosis (recurrence and survival) MATERIALS AND METHODS: We retrospectively analyzed 492 axillary nodes from 49 consecutive node-negative invasive breast cancers treated at Kyung-Hee University Hospital from 1991 to 1995 with average follow-up of 60.2 (21-100) months. An additional section of original paraffin blocks was cut and stained by immunohistochemical chemical technique using monoclonal antibodies (AE 1/3 and No.7) to cytokeratin. RESULTS: Micrometastases with individual cell and cell clusters were readily detected by this technique in 27% of the cases. These were no predictors of micrometastses among the clinicopathological data of patient. The presence of micometastases wes not associated with disease-free and overall survival but loco-regional recurrence rate. CONCLUSIONS: A combination of immunohistochemistry and serial sectioning of axillary lymph node would help evaluate the significance of occult axillary metastases. Patients with node-negative disease may relapse after many years and prolonged follow-up is required to establish the role of mirometastases. Such an approach, together with a search for bone marrow micrometastases and epidemiologic, clinical, pathologic and/or biochemical prognostic factors, may serve to identify high risk patients in the presumed node-negative group. It would provide a rational basis for the selective use of adjuvant therapy.
Antibodies, Monoclonal ; Bone Marrow ; Breast Neoplasms* ; Breast* ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Lymph Nodes ; Microscopy ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Paraffin ; Prognosis ; Recurrence ; Retrospective Studies*

Fluorouracil is well known as a standard chemotherapeutic drug in breast cancer and other cancers that is converted to flurodeoxyuridine monophosphate (FdUMP) and leads to the inhibition of thymidylate synthase (TS) in tumor tissue. The role of this enzyme is the catalysis of the methylation from deoxyuridine monophosphate (dUMP) to deozythymidine monophosphate (dUMP), which is a very important process for DNA synthesis in tumor tissues. Increased level of TS protein correlates inversely with sensitivity and response to 5 FU in human cancer cell lines. Authurs evaluated the TS expression level using the immunohistochmical staining and analysed their relationship with other prognostic factors and clinical outcome of breast cancer patients. The results were as follows; 1) TS level was not related histopathologic stage, involvement of axillary lymph nodes, estrogen receptor, progesterone receptor, recurrent type, primary tmor and recurrent tumors, disease free survival rate. 2) TS level was associated with e-erbB2 overexpression. 3) c-erbB2 overexpression was related with recurrence rate. 4) TS level appeared to be related with recurrence rate. So w conclude the TS level can be used as an independant prognostic predictor on breast cancer patients.
Breast Neoplasms* ; Breast* ; Catalysis ; Cell Line ; Deoxyuridine ; Disease-Free Survival ; DNA ; Estrogens ; Fluorouracil ; Humans ; Lymph Nodes ; Methylation ; Receptors, Progesterone ; Recurrence ; Thymidylate Synthase*

BACKGROUND: Cyclin D1 expression is closely related with ER in breast cancer. We conducted this study to evaluate whether therapeutic response to tamoxifen is varied with levels of cyclin D1 expression in ER positive breast cancer patients. MATERIALS AND METHODS: Immunohistochemical assay for cyclin D1 protein was performed in 66 patients tasted with tamoxifen for more than 2years. Patient survival and correlation between cyclin D1 expression and biologic data of the patients were analyzed RESULTS: Cyclin D1 expression was detected in 46 (69.7%) and significantly reduced in poorly differentiated cancer (p=0.023). Cyclin D1 expression was high in the tumors expressing Myc (15/15 vs 31/51; p=0.002), and was markedly increased in the tumors in which p27Kip1 expression was repressed (30/38, 78.9%). However, the difference was not statistically significant (p=0.051). There was no significant relationship between cyclin D1 expression and S-phase. Patients with tumors expressing cyclinD1 showed better disease free survival and overall survival but the difference was not statistically significant. CONCLUSIONS: Cyclin D1 expression was associated with cell differentiation but not useful in discriminating high risk group with tamoxifem treatment. Cyclin D1 may have a role in process other than cell cycle regulator in ER positive breast cancer, such as differentiation signal.
Breast Neoplasms ; Cell Cycle ; Cell Differentiation ; Cyclin D1* ; Cyclins* ; Disease-Free Survival ; Estrogens* ; Humans ; Prognosis ; Tamoxifen*

It is deirable to identify the tumoric factors anticipating the therapeutic failure in breast cancer patients received postoperative adjuvant chemotherapy. So, we studued the tumoric topoisomerase II alpha enzyme, c-erbB-2 oncoprotein, and Pgp expression in breast cancer tissues to identify the roles of these factors as the predictors of chemotherapeutic result. The results were as follows. 1) There wee no significant differences in the average value of topoisomerase II alpha enzyme, c-erb B-2 oncoportein overexpression, and Pgp expression according to stages. 2) CAF chemotherapy was suggested to be more effective than CMF chemotherapy in more advance stages. 3) There was a possible suggestion that the breast cancer with high topoisomerase II alpha enzyme activity might indicate the failure with CMF chemotherapy. 4) C-erbB-2 oncoportein overexperession suggested the possibility of therapeutic failure with CMF chemotherapy and the selection of CAF chemotherapy might improve the survival of advanced breast cancer patients with c-erbB-2 overexpression. In conclusion, it was suggested that c-erb-2 oncopotein overexpression and high topoisomerase II alpha activity might have a meaningful role in the selection of proper chemotherapeutic regimen in setting of adjuvant chemotherapy and predict the therapeutic failure of some chemotherapeutic agents for breast cancer. An expanded study for these factors is required to reveal the clinical significance in chemotherapy for breast cancer patients.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; DNA Topoisomerases, Type II* ; Drug Therapy* ; Humans ; P-Glycoprotein*

The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for recurrence and death. Recently, much experimental evidence has accumulated showing that tumor growth and metastasis are dependent on tumor angiogenesis. To investigate the status of angiogenesis in breast cancer, we counted the microvessel density (MVD) of brest cancer tissues, which were stained with anti-CD34 antibody, as a measure of tumor angiogenesis. We classified 43 breast-cancer patients into 22 with low MVD (<47/200xPF) and 21 with high MVD (> or =47/200xPF). We estimated the correlations between the MVD and other established prognostic factors. We also calculated survivals based on MVD. The MVD was in the range between 10 and 93 (mean+/-SD=46.9+/-21.7). The positive rate of lymph-node metastasis in high MVD patients was 32.6%, which was higher than the 23.3% for low-MVD patients. We found a significant correlation between MVD and histologic grade (p=0.037), but could not fine any significant correlation between MVD and menopausal status, tumor size, nuclear grade, estrogen receptor, or progesterone receptor. Retrospectively, the receptor status of estrogen and of progesterone had significant impacts on survival (ER: p=0.0001, PR: p=0.0001). The 4-year disease-free survival rate of high-MVD patients was 56.6+/-12.5%, and that of low-MVD patients was 69.0+/-10.8% (p=0.449). The 4-years overall survival rate of high-MVD patients was 71.1+/-11.1%, and that of low-MVD patients was 74.1+/-12.2 (p=0.449). In conclusion, the determination of MVD in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the MVD in a large number of patients before this conclusion can be stated with certainty.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Estrogens ; Humans ; Lymph Nodes ; Microvessels ; Neoplasm Metastasis ; Progesterone ; Receptors, Progesterone ; Recurrence ; Retrospective Studies ; Survival Rate

BACKGROUND: Breast reconstruction after a mastectomy is being performed in many cases by using a tissue expander or a TRAM flap. However, a conventional mastectomy leaves long linear scar formation on the breast skin after reconstruction. A skin-sparing mastectomy (SSM) with one-stage star flap nipple-areolar complex immediate reconstruction makes minimal scar tissue, and with a circumferential incision is made around the nipple, becoming virtually imperceptible. The purpose of this study is to identify the clinical indications, to evaluate the clinical results, and to encourage the application of thins method for the indicated patients. MATERIALS AND METHODS: During the recent 3 years, 1996 through 1999, there were 1027 breast-cancer surgeries. Among them, there were 61 reconstruction cases, a skin-sparing mastectomy (SSM) with immediate reconstruction was performed on 29 cases. Of these patients, 15 patients were taken SSM and TRAM flap reconstruction. Our patients selection criteria of SSM was as follows, diffuse DCIS that not candidates for breast conserving surgery, Paget's disease of the nipple, clinically early breast cancer without skin involvement, and the centrally located cancer that would require removal of the nipple-areolar complex. RESULTS: All the surgeries performed under these procedures were considered to be successful. All of the TRAM flap and star flap were alive. The main rawback was bleeding, which occurred in 6 patients but was managed by transfusion. The wound seroma occurred in 3 patients and was managed easily by repeated aspiration. CONCLUSIONS: Skin-sparing mastectomy with immediate TRAM and star flap reconstruction gives markedly improved results by reducing the scars on the reconstructed breast, providing a supple breast with a natural ptotic shape, and aesthetically satisfied. We propose more frequent application of this method for the indicated patients, but we need further follow-up of the local recurrence rate and the detection rate in these patients.
Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Cicatrix ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Mammaplasty ; Mastectomy* ; Mastectomy, Segmental ; Nipples ; Paget's Disease, Mammary ; Patient Selection ; Recurrence ; Seroma ; Skin* ; Tissue Expansion Devices ; Wounds and Injuries

PURPOSE: This study was performed to determine the incidence of BMM and to correlate the presence of these micrometastases with prognosis and other clinicopathologic features. MATERIALS AND METHODS: BMM was evaluated in 220 breast cancer patients between July, 1991 and January, 1997, using mouse monoclonal antibody (AEI/AE3) against cytokeratin in an immunofluorescent assay. RESULTS: Of the 220 patients, 71 (32.3%) were positive for BMM. There were no association between bone marrow positivity and nodal status, TNM stage, known histopathologic parameters, and hormonal receptor, Median follow-up for 220 patients was 41.6 month. The relapse rate was 16.8% (37/220). Twenty-four (33.8%) of 37 patients were positive for BMM and 13 (8.7%) were negative (p<0.05). Bone metastasis occurred in 16 cases, and was more common in BMM positive patients (14 of 24, 54.2%, versus 2 of 13, 15.4%, p<0.05). Twenty-six patients were died of relapsed breast cancer. In overall survival, patients who was negative for BMM showed higher survival rate (p=0.05). CONCLUSIONS: BMM was a good predictor for distant metastasis, especially bone matastasis, and for poor prognosis. But no association was found between bone marrow positivity and tumor size, nodal status, stage, histologic parameter and hormonal receptor status.
Animals ; Bone Marrow* ; Breast Neoplasms* ; Breast* ; Fluorescent Antibody Technique ; Follow-Up Studies ; Humans ; Incidence ; Keratins ; Mice ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Prognosis ; Recurrence ; Survival Rate

BACKGROUND: Chest CT after a mastectomy in breast cancer patients is usually performed to detect recurrence or metastasis. It is essential for surgeons an radiologists to know the appearance of the chest wall in a postmastectomy state. Especially, muscle atrophies of the chest wall, such as that of the pectoralis major muscle, indicate whether the modified radical mastectomy (MRM) was properly performed or not. MATERIALS AND METHODS: We performed a retrospective analysis of chest wall changes in mastectomy patients with follow-up chest CT finding to evaluate the results of MRMs. The medical records and CT findings of chest wall atrophy for a total of 38 patients who were treated at Kangnam St. Mary's Hospital, the Catholic University of Korea, were reviewed. The mean age was 58.3 years, and the interval between operation and follow-up CT was 6.6 years. The operations performed were a radical mastectomy (RM) in 3 patients and a MRM in 35 patients: Petey in 28 patients, Auchincloss in 6 patients, and Scanlon in 1 patient. RESULTS: In the RM, muscle atrophies were noted at the m, subscapularis in 3 patients (100%), the m. serratus anterior in 2 patients (66.7%), and the m. lattisimus dorsi in 1 patient (33.3%). In MRM, the Patey and Auchincloss operations showed m. pectoralis major atrophies in 22 patients (78.8%) and 5 patients (83.3%) respectively. Additionally m. pectoralis minor atrophy was noted in all 6 patients (100%) who underwent the Auchincloss operation. However. there was no muscle atrophy in patients who received Scanlon operation. CONCLUSIONS: These results suggest that lateral pectoral nerve injury is the main cause of m. pectoralis major atrophy in a MRM. The Scanlon operation which preserves the serve by dividing the pectoralis minor m. at its origin is a suitable operation for chest-wall muscle preservation. We hope that by the future study, we can confirm the best way of preventing chest-wall muscle atrophy in MRMs.
Atrophy ; Breast Neoplasms ; Follow-Up Studies ; Hope ; Humans ; Korea ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Medical Records ; Muscular Atrophy ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thoracic Nerves ; Thoracic Wall ; Thorax* ; Tomography, X-Ray Computed*

One hundred and fifty two patients presenting with palpable primary breast cancer were studied to evaluate accuracy of clinical assessment, mammography, and ultrasonography in measuring tumor size. The clinical, mammographic, and ultasonographic diameter of tumor size was compared to histological diameters. The histological diameter of tumors was 27.9+/-12.7mm. The average diameter of tumor on clinical assessment was 33.8+/-13.1mm and its correlation coefficient to the histological size was 0.73. The average size on the mammography was 21.4+/-9.0m and its correlation coefficient to the histological size is 0.71. The tumor size on the ultrasonography in 22 patients was is 22.3+/-10.4mm. The sonographic measurement dimonstrated the highest correlation coefficient (0.83). The clinical assessment overstimated the tumor size, but the mammogaphic and sonographic measurement understimated it compared with histological size. The combined measurement with clinical and ultrasonography could be useful method to estimate tumor size preoperatively. And when it is combined with clinical assessment, it is the most reliable and accurate technique.
Breast Neoplasms* ; Breast* ; Humans ; Mammography ; Ultrasonography