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The second 5-year study of postoperative adjuvant therapy in patients with breast cancer between 1985 and 1988 was performed by the Study Group for Adjuvant Chemoendocrine Therapy for Breast Canecr (ACETBC). This report describes the results of a meta-analysis of the outcome. A total of 3012 patients with stage II, estrogen-receptor-positive primary breast cancer who underwent radical surgery (total mastectomy with at least axillary dissection) were eligible for the analyses. On the day of surgery, all patients received 13 mg/m(2) of mitomycin C (MMC) intravenously. Patients were then given one of two adjuvant chemoendocrine therapies for 2 years:regimen A, consisting of tamoxifen citrate (TAM) 30 mg/day, or regimen B, consisting of TAM 30 mg/day plus tegafur (Futraful, FT)600 mg/day. The results from all eligible patients were included in a meta-analysis according to the method of Peto et al. The odds reduction rate was 12 +/-13% (log-rank test, P= 0.35)for the 5-year survival rate and 16 +/- 10% (log-rank test, P=0.093)for the 5-year non-recurrence rate. In terms of the 5-year non-recurrence rate. regimen B(with FT)yielded slightly, but not significantly, better results than regimen A. In addition, stratified analyses were carried out with respect to the 5-year non-recurrence rate. Regimen B(with FT)yielded significantly better results than regimen A in patients with four or more positive axillary nodes (log-rank test, P= 0.039) and yielded slightly, but not significantly, better results than regimen A in premenopausal patients (log-rank test, P= 0.079).

Germline mutations of BRCA2 were examined in 20 Japanese breast cancer families without BRCA1 mutations, including one demonstrating cancer development in a male. Three different mutations, resulting in truncation of the BRCA2 protein, were detected in 3 different families. They were 9474insA (exon 24, termination at codon 3110), C8729A (exon 20, S2834 ter) and 982del4 (exon 9, termination at codon 275). The 982del4 mutation was detected in the family with a case of male breast cancer. Age at onset was young, with a range of 28-43 years, in the 2 female breast cancer families with truncation mutations. One probable missense mutation, A10462G (13412V), was further detected in 2 families, although cosegregation of this allele with the breast cancer phenotype was not complete. The rate of BRCA2 mutations in Japanese families was suggested to be almost the same as in Western countries, and larger than it is the case for BRCA1.

The purpose of this study was to evaluate the diagnostic value and clinical significance of three-dimensional MR imaging of the breast in patients with mammographically detected suspicious microcalcifications.Forty patients with suspicious microcalcifications on mammography were evaluated with three-dimensional MR imaging. MR findings were grouped mainly by distribution of abnormal enhancement (linear, focal-clumped, segmental-clumped, segmental-stippled and diffuse-stippled). These findings were compared with the mammography findings according to the criteria of the Breast Imaging Reporting and Data System (BI-RADS) and histopathologic data.Twenty patients had proven malignancies, most frequently ductal carcinoma in situ. For all the cases, linear (100%) and segmental-clumped type (100%) enhancement on MR imaging showed a significantly higher risk for malignancy. Diffuse stippled type (7%) and no enhancement (0%) on MR imaging indicated the lowest possibility of malignancy. 3D-MR imaging showed a sensitivity of 90%, a specificity of 95% and an overall accuracy of 93% in this study.Three-dimensional MR imaging of the breast can more accurately diagnose ductal carcinoma in situ. Combined with mammography, this procedure is useful for reducing the number of false-positive biopsies and helpful for deciding the better management of patients with mammographically detected suspicious microcalcifications.

PURPOSE: To evaluate the CAD system for screening mammograms. MATERIALS AND METHODS: Mammograms of patients with asymptomatic breast cancerwere examined retrospectively. A total of 260 screening mammograms from 65 patients (bilateral cranio-caudal and medio-lateral-oblique views from each) were tested by using the CAD system (ImageChecker M1000 system, R2 Technology, Los Altos, CA, USA). Results: With 0.58 microcalcifications marks/film and 0.20 mass marks/film set as the false positive rate, 100% of microcalcifications cases and 79% of mass cases were detected correctly. Conclusion: The CAD system has the potential to become a second reader. Further developments are expected to improve the accuracy of detection of mass lesions

A multi-center, randomized controlled collaborative study was conducted in 310 institutions located throughout Japan for 3 years and 9 months from February 1985 until October 1988 to evaluate the efficacy of post-operative adjuvant therapy for patients who had previously undergone curative surgery for treatment of Stage IIIa breast cancer. Patients with estrogen receptor-positive [ER( + )] breast cancer were treated with two types of regimens, ie, cyclophosphamide + adriamycin + fluorouracil (CAF; 2 cycles) + Futraful (FT) or CAF (2 cycles) + FT + tamoxifen (TAM), and the clinical benefit of additional use of TAM was evaluated. Of the 509 ER( + ) patients registered for the trial, 473 patients (92.9%) were eligible for evaluation. The 5-year survival rate was 77.2% for the CAF + FT group and 74.6% for the CAF + FT+TAM group, and the 5-year disease-free survival rate was 56.7% for the CAF+FT group and 59.2% for the CAF + FT + TAM group. Neither the survival rate nor the disease-free survival rate differed significantly between the groups. Analyses by factor revealed that the 5-year disease-free rate for lymph node-negative patients in the CAF + FT + TAM group was significantly higher than that for the corresponding patients in the CAF + FT group. No differences were noted in the incidence of adverse reactions between the two treatment groups, other than an increase in LDH (the frequency of which was higher in the CAF + FT+TAM group than in the CAF + FT group). Patients with estrogen receptor-negative [ER( -)] breast cancer were treated with two types of regimens, ie, CAF + FT or CAF + FT + adriamycin (ADR), and the clinical benefit of the combined use of intermittent doses of ADR was evaluated. Of the 514 ER(-) patients registered in the trial, 478 (93.0%) were eligible for evaluation. The 5-year survival rate was 64.9% for the CAF + FT group and 63.0% for the CAF + FT + ADR group, and the 5-year disease-free survival rate was 59.2% for both CAF + FT and CAF + FT + ADR groups. Neither the survival rate nor the disease-free survival rate differed significantly between the groups. There were no significant differences between these groups in analyses by nodal or menopausal status. The incidences of adverse reactions including anorexia, nausea/vomiting and alopecia were higher in the CAF + FT+ADR group than in the CAF + FT group.

We describe herein the clinical characteristics of five male breast carcinoma (MBC) patients with a familial history of breast carcinoma (FHBC). Four of these patients suffered from multiple primary cancers, being gastric and prostate cancer in 1, gastric cancer in 1, and asynchronous bilateral breast cancers in 2. The average age of these patients at diagnosis was not lower than that of MBC patients with no such familial history. The aggregation of cancer in these families had three prominent characteristics: (1) The families included women with early-onset breast cancers which had occurred at the ages of 38, 38, and 35 years, respectively, and/or early-onset uterine cancer which had occurred at the age of 35 years. (2) The incidence of multiple primary cancers was significantly higher in the siblings of MBC patients with a FHBC than without. (3) There were many cancers in hormone-related organs in two families.

An association between hormone receptors in primary breast cancer and obesity determined prior to mastectomy was investigated in 128 Japanese women. The following criteria for obesity were used: (1) weight greater than or equal to 60 kg (132 lbs), (2) weight kg/height cm-105 greater than or equal to 1.3, (3) weight lbs/height in greater than or equal to 2.30, (4) body surface area greater than or equal to 1.56 m2. In view of the 4 criteria, tumor estrogen receptor (ER) values greater than or equal to 4 fmol/mg were observed in obese patients more often than in nonobese patients, though the difference was not statistically significant. The same tendency was observed in the postmenopausal subgroup, 62 patients, especially in the 36 patients more than 5 years beyond menopause. However, there was still no statistical difference between obese and nonobese patients because the number of subjects was small. The same tendency was observed in the case of progesterone receptor (PgR) (greater than or equal to 6 fmol/mg) as observed in the case of ER.

胃癌の手術に際し, リンパ節廓清は最も重要な点であるが, 第4群のリンパ節, 主として大動脈周囲リンパ節に転移をきたしたものは, 根治手術の適応外とされている. しかし, われわれは癌研外科において, 1946年から1969年までに大動脈周囲リンパ節陽性例を廓清した188例中, 肉眼的に癌が取り切れたと思われる74例 (相対非治癒切除) について治療成績を検討し, 6例 (8.1%) の5年生存例を得た. この6例は肉眼癌型が限局型5例, 中間型1例で, S0またはS1であつた. 大動脈周囲リンパ節陽性例においても, 肉眼癌型が限局型で, 漿膜浸潤が軽度なものでは, 大動脈周囲リンパ節の廓清を積極的に行えば長期生存例を得ることができることを報告した.

We present the diagnostic results of palpation, mammography (MMG) and ultrasound (US) in small breast cancers (t_??_2cm). 3106 patients with histologically diagnosed breast disease, including 1941 with small breast lesions, were studied. In each examinations we classified patients diagnosed as having definite or suspected cancer into a positive group and those diagnosed as benign lesions into a negative group. Positive predictive value of palpation, MMG, or US each was reduced significantly. However, that of combined examinations with palpation, MMG and US were not reduced. Combined examinations with palpation, MMG and US are necessary for the detection of small breast cancer. Adequate biopsy is also proposed.

The administration of Mitomycin C in prolonged small dose regimens was performed on 340 cases of gastric cancer after radical surgery. All the cases were followed postoperatively for 8–12 years. The cause of death was surveyed for the deceased cases for the evaluation of the inhibitory effect of the present method on recurrence in five types. Local recurrence was inhibited by a mean of 13% in cases of serosal involvement (S+), infiltrating tumor type, and undifferentiated cancer. Peritoneal dissemination was suppressed by a mean of 15.2% in cases of N2–N3 lymph node metastasis, S(+), infiltrating type, undifferentiated cancer, and vascular invasion (V+). Hematogenous metastasis was controlled by a mean of 13.8% in cases of localized and intermediate type and differentiated cancer and tended to be inhibited in cases of (V-).

Of 964 amputated breast cancers which had been examined preoperatively by ultrasound and mammography, 147 breast (17.0%) contained macroscopically circumscribed tumors and 596 cases (69.0%) showed infiltrative tumors on examination of the cut surface. It is well known that infiltrative types of cancer show ultrasonic images that usually possess clear cut signs of malignancy, such as jagged augmented boundary echoes and acoustic shadows. On the other hand, circumscribed types of cancer do not usually show such signs, but exhibit lobulated shapes and strong, coarse and non-uniform internal echoes. These latter features are intermediate between those of infiltrative cancers and those of solid benign tumors. As such circumscribed cancers are often difficult to diagnose correctly by ultrasonic techniques. The diagnostic accuracy rates by ultrasound were 88.0% in the infiltrative types and 69.4% in the circumscribed types. The ultrasonic pictures of the 147 cases of such circumscribed tumors are classified and discussed.

The physical and reproductive traits known to be risk factors for breast cancer were correlated with familial predisposition for this disease by the use of hospital records of 3,867 patients with breast cancer, of whom 186 had one or more relatives with breast cancer and were called "familial patients." Various characteristics in the total series of patients were compared with familial patients matched for year of birth. The mean age at menarche was significantly less in familial compared with the total series of patients, especially for premenopausal patients; however, no difference was observed in the mean age at marriage between the two groups. Familial patients were slightly taller as compared to the total series of patients, but no difference was detected in body weight between the two groups. Because age at menarche and the stature are highly correlated, they may be influenced by an underlying common hormone effect that may influence the familial nature of breast cancer.