27 results on '"Kaelin CM"'
Search Results
2. Cancer and staying fit.
- Author
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Kaelin CM and Coltrera F
- Abstract
In the fight against breast cancer, researchers are discovering the benefits of regular exercise before and after the dreadful diagnosis. [ABSTRACT FROM AUTHOR]
- Published
- 2007
3. New hopes, longer life.
- Author
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Kaelin CM, Fuller AF Jr., and Coltrera F
- Published
- 2006
4. Implementing the gains in cancer prevention.
- Author
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Kaelin CM and Neugut AI
- Abstract
Prevention experts share the news -- good and bad -- to help you counsel patients on minimizing their risk for cancer. [ABSTRACT FROM AUTHOR]
- Published
- 2005
5. Ductal carcinoma in situ of the breast.
- Author
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Brown AP, Ellison MC, Kenney PJ, Kettritz U, Anderson WF, Chu KC, Burstein HJ, Wong JS, and Kaelin CM
- Published
- 2004
6. Ductal carcinoma in situ of the breast.
- Author
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Burstein HJ, Polyak K, Wong JS, Lester SC, Kaelin CM, Burstein, Harold J, Polyak, Kornelia, Wong, Julia S, Lester, Susan C, and Kaelin, Carolyn M
- Published
- 2004
7. Support needs and acceptability of psychological and peer consultation: attitudes of 108 women who had undergone or were considering prophylactic mastectomy.
- Author
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Patenaude AF, Orozco S, Li X, Kaelin CM, Gadd M, Matory Y, Mayzel K, Roche CA, Smith BL, Farkas W, and Garber JE
- Subjects
- Adaptation, Psychological, Adult, Breast Neoplasms genetics, Decision Making, Elective Surgical Procedures statistics & numerical data, Female, Genes, BRCA1, Genes, BRCA2, Humans, Middle Aged, Narration, Point Mutation genetics, Risk Reduction Behavior, Surveys and Questionnaires, Attitude to Health, Breast Neoplasms prevention & control, Interpersonal Relations, Mastectomy psychology, Peer Group, Social Support
- Abstract
Objective: Prophylactic mastectomy (PM) offers 90% or greater reduction in risk of breast cancer to women at increased hereditary risk. Nonetheless, acceptance in North America is low (0-27%) and 25-50% of women electing surgery report psychological distress and/or difficulty adapting following PM. Most women also report reduced cancer worry postoperatively. Psychological consultation to aid decision-making and post-surgical coping is not routinely offered. This retrospective, cross-sectional study explored interest in and acceptability of psychological consultation for issues related to PM among 108 women who had undergone or were considering surgery., Method: Qualitative interviews were conducted with 26 healthy women who had undergone prophylactic mastectomy of both (bilateral) breasts (BPM), 45 women who had undergone prophylactic mastectomy of one breast (unilateral contralateral) (UPM) after diagnosis of invasive breast cancer in the other breast or ductal carcinoma in situ (DCIS), and 37 women who were considering having PM surgery., Results: Of the women who had undergone PM, more than half felt pre-surgical psychological consultation was advisable; nearly 2/3 thought post-surgical psychological consultation would be helpful. All women currently considering PM believed psychological consultation would aid decision-making and preparation for surgery. Strong support was reported in all groups for the emotional and informational value of speaking with a woman who had previously undergone PM., Conclusions: Narratives illustrate the nature and intensity of the need for psychological support and describe preferences for the role of the psychologist. Suggestions are offered for integration of psychological services for women deciding about or adapting to PM.
- Published
- 2008
- Full Text
- View/download PDF
8. Incidence of major corrective surgery after post-mastectomy breast reconstruction and radiation therapy.
- Author
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Wong JS, Ho AY, Kaelin CM, Bishop KL, Silver B, Gelman R, Harris JR, and Hergrueter CA
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Humans, Incidence, Mastectomy, Modified Radical, Middle Aged, Radiotherapy, Adjuvant, Treatment Outcome, Breast Neoplasms radiotherapy, Breast Neoplasms surgery, Mammaplasty statistics & numerical data, Reoperation statistics & numerical data
- Abstract
To evaluate the likelihood of requiring major corrective surgery (MCS) after modified radical mastectomy (MRM), immediate reconstruction and radiation therapy (RT) to the reconstructed breast. The study population consisted of 62 patients who underwent MRM and immediate breast reconstruction between 1990 and 1999, had postoperative radiation and at least one follow-up visit or procedure > or = 2 months after radiation. Reconstruction consisted of a pedicled transverse rectus abdominis myocutaneous flap in 42 patients, latissimus dorsi flap in five, latissimus dorsi plus implant in six, and implant alone in nine. Median follow-up time after reconstruction was 13 months (range: 2-58) for non-implant patients and 10 months (range: 4-57) for implant patients. The primary endpoint was the incidence of major complications requiring MCS. Ten patients (16%) underwent MCS between 1 and 28 months after radiation (median in these patients of 8 months). 4/47 non-implant patients (9%) underwent MCS, compared to 6/15 implant patients (40%). Of patients followed > or = 6 months after RT, 0/38 non-implant patients underwent MCS within 6 months compared to 3/13 (23%) implant patients (p = 0.01); of patients followed for > or = 12 months after RT, the rates of MCS within 12 months were 1/24 (4%) and 2/7 (29%), respectively (p = 0.12). Patients who undergo immediate reconstruction after mastectomy using an implant followed by radiation have a high rate of subsequent MCS. The difference in the rate of MCS between the implant and non-implant groups is significant in early follow-up. Patients considering an implant followed by RT should be apprised of this increased risk. Prospective studies of these risks and the cosmetic outcomes are warranted.
- Published
- 2008
- Full Text
- View/download PDF
9. Prospective study of wide excision alone for ductal carcinoma in situ of the breast.
- Author
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Wong JS, Kaelin CM, Troyan SL, Gadd MA, Gelman R, Lester SC, Schnitt SJ, Sgroi DC, Silver BJ, Harris JR, and Smith BL
- Subjects
- Aged, Aged, 80 and over, Breast Neoplasms diagnostic imaging, Carcinoma, Intraductal, Noninfiltrating diagnostic imaging, Female, Humans, Incidence, Mammography, Middle Aged, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local prevention & control, Prospective Studies, Reoperation, Treatment Failure, Treatment Outcome, Breast Neoplasms pathology, Breast Neoplasms surgery, Carcinoma, Intraductal, Noninfiltrating pathology, Carcinoma, Intraductal, Noninfiltrating surgery, Mastectomy, Segmental
- Abstract
Purpose: It has been hypothesized that wide excision alone with margins > or = 1 cm may be adequate treatment for small, grade 1 or 2 ductal carcinoma in situ (DCIS). To test this hypothesis, we conducted a prospective, single-arm trial., Methods: Entry criteria included DCIS of predominant grade 1 or 2 with a mammographic extent of < or = 2.5 cm treated with wide excision with final margins of > or = 1 cm or a re-excision without residual DCIS. Tamoxifen was not permitted. The accrual goal was 200 patients., Results: In July 2002, the study closed to accrual at 158 patients because the number of local recurrences met the predetermined stopping rules. The median age was 51 and the median follow-up time was 40 months. Thirteen patients developed local recurrence as the first site of treatment failure 7 to 63 months after study entry. The rate of ipsilateral local recurrence as first site of treatment failure was 2.4% per patient-year, corresponding to a 5-year rate of 12%. Nine patients (69%) experienced recurrence of DCIS and four (31%) experienced recurrence with invasive disease. Twelve recurrences were detected mammographically and one was palpable. Ten were in the same quadrant as the initial DCIS and three were elsewhere within the ipsilateral breast. No patient had positive axillary nodes at recurrence or subsequent metastatic disease., Conclusion: Despite margins of > or = 1 cm, the local recurrence rate is substantial when patients with small, grade 1 or 2 DCIS are treated with wide excision alone. This risk should be considered in assessing the possible use of radiation therapy with or without tamoxifen in these patients.
- Published
- 2006
- Full Text
- View/download PDF
10. Preoperative therapy with trastuzumab and paclitaxel followed by sequential adjuvant doxorubicin/cyclophosphamide for HER2 overexpressing stage II or III breast cancer: a pilot study.
- Author
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Burstein HJ, Harris LN, Gelman R, Lester SC, Nunes RA, Kaelin CM, Parker LM, Ellisen LW, Kuter I, Gadd MA, Christian RL, Kennedy PR, Borges VF, Bunnell CA, Younger J, Smith BL, and Winer EP
- Subjects
- Adult, Aged, Antibodies, Monoclonal therapeutic use, Antibodies, Monoclonal, Humanized, Breast Neoplasms mortality, Breast Neoplasms pathology, Breast Neoplasms surgery, Combined Modality Therapy, Cyclophosphamide therapeutic use, Disease-Free Survival, Doxorubicin therapeutic use, Female, Humans, Middle Aged, Paclitaxel therapeutic use, Pilot Projects, Receptor, ErbB-2, Trastuzumab, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Breast Neoplasms drug therapy
- Abstract
Purpose: Trastuzumab combined with chemotherapy improves outcomes for women with human epidermal growth factor receptor 2 (HER2) overexpressing advanced breast cancer. We conducted a pilot study of preoperative trastuzumab and paclitaxel, followed by surgery and adjuvant doxorubicin and cyclophosphamide chemotherapy in earlier stage breast cancer., Patients and Methods: Patients with HER2-positive (2+ or 3+ by immunohistochemistry) stage II or III breast cancer received preoperative trastuzumab (4 mg/kg x 1, then 2 mg/kg/wk x 11) in combination with paclitaxel (175 mg/m(2) every 3 weeks x 4). Patients received adjuvant doxorubicin and cyclophosphamide chemotherapy following definitive breast surgery. Clinical and pathologic response rates were determined after preoperative therapy. Left ventricular ejection fraction and circulating levels of HER2 extracellular domain were measured serially., Results: Preoperative trastuzumab and paclitaxel achieved clinical response in 75% and complete pathologic response in 18% of the 40 women on study. HER2 3+ tumors were more likely to respond than 2+ tumors (84% v 38%). No unexpected treatment-related noncardiac toxicity was encountered. Four patients developed grade 2 cardiotoxicity (asymptomatic declines in left ventricular ejection fraction). Baseline HER2 extracellular domain was elevated in 24% of patients and declined with preoperative therapy. Immunohistochemical analyses of posttherapy tumor specimens indicated varying patterns of HER2 expression following trastuzumab-based treatment., Conclusion: Preoperative trastuzumab and paclitaxel is active against HER2 overexpressing early-stage breast cancer and may be feasible as part of a sequential treatment program including anthracyclines. The observed changes in cardiac function merit further investigation. Correlative analyses of HER2 status may facilitate understanding of tumor response and resistance to targeted therapy.
- Published
- 2003
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11. Feasibility of MR imaging-guided breast lumpectomy for malignant tumors in a 0.5-T open-configuration MR imaging system.
- Author
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Hirose M, Kacher DF, Smith DN, Kaelin CM, and Jolesz FA
- Subjects
- Feasibility Studies, Female, Humans, Magnetic Resonance Imaging instrumentation, Neoplasm, Residual diagnosis, Breast Neoplasms pathology, Breast Neoplasms surgery, Magnetic Resonance Imaging methods, Mastectomy, Segmental methods
- Abstract
Rationale and Objectives: The authors performed this study to develop the technology for and evaluate the utility of a 0.5-T vertical open-configuration magnetic resonance (MR) imaging system for imaging-guided breast lumpectomy of malignant tumors., Materials and Methods: Twenty women with breast cancer underwent MR imaging-guided lumpectomy in a 0.5-T vertical open-configuration MR system. During lumpectomy, pre- and postresection images were acquired with and without contrast material. Images were used both for tumor localization and to monitor resection. If residual enhancement was observed, additional resection was performed in an effort to secure negative pathologic margins., Results: The procedure evolved over time with technology innovations and improvements. Specifically, instruments were acquired that were compatible with MR imaging breast procedures, the echo time with the Dixon technique was modified to optimize image quality, contrast material injection was timed for maximum lesion enhancement, breath-hold image acquisition was instituted, and the biopsy cavity was filled with saline and the incision closed before image acquisition., Conclusion: All breast lesions were identified despite limited spatial resolution and fat-suppression techniques. The evolved techniques facilitated intraoperative margin evaluation and prompted additional surgical margin resection in five patients, sparing four from an additional surgical procedure. Intraoperative MR imaging has the potential to improve the complete pathologic excision of invasive breast cancer.
- Published
- 2002
- Full Text
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12. HIN-1, a putative cytokine highly expressed in normal but not cancerous mammary epithelial cells.
- Author
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Krop IE, Sgroi D, Porter DA, Lunetta KL, LeVangie R, Seth P, Kaelin CM, Rhei E, Bosenberg M, Schnitt S, Marks JR, Pagon Z, Belina D, Razumovic J, and Polyak K
- Subjects
- Amino Acid Sequence, Animals, Blotting, Northern, Blotting, Western, Breast cytology, Breast Neoplasms genetics, Breast Neoplasms pathology, CHO Cells, COS Cells, Carcinoma, Ductal, Breast genetics, Carcinoma, Ductal, Breast pathology, Carcinoma, Intraductal, Noninfiltrating genetics, Carcinoma, Intraductal, Noninfiltrating pathology, Carcinoma, Lobular genetics, Carcinoma, Lobular pathology, Cell Division, Cells, Cultured metabolism, Chlorocebus aethiops, Cricetinae, Cricetulus, Cytokines biosynthesis, Cytokines genetics, Cytokines physiology, DNA Methylation, Epithelial Cells metabolism, Female, Gene Library, Gene Silencing, Growth Inhibitors genetics, Growth Inhibitors physiology, Humans, Molecular Sequence Data, Neoplasm Proteins biosynthesis, Neoplasm Proteins genetics, Promoter Regions, Genetic, RNA, Messenger biosynthesis, RNA, Neoplasm biosynthesis, Recombinant Fusion Proteins physiology, Sequence Alignment, Sequence Homology, Amino Acid, Transfection, Tumor Cells, Cultured metabolism, Breast metabolism, Breast Neoplasms metabolism, Carcinoma, Ductal, Breast metabolism, Carcinoma, Intraductal, Noninfiltrating metabolism, Carcinoma, Lobular metabolism, Cytokines isolation & purification, Gene Expression Profiling, Gene Expression Regulation, Neoplastic, Genes, Tumor Suppressor, Neoplasm Proteins isolation & purification, Tumor Suppressor Proteins
- Abstract
To identify molecular alterations implicated in the initiating steps of breast tumorogenesis, we compared the gene expression profiles of normal and ductal carcinoma in situ (DCIS) mammary epithelial cells by using serial analysis of gene expression (SAGE). Through the pair-wise comparison of normal and DCIS SAGE libraries, we identified several differentially expressed genes. Here, we report the characterization of one of these genes, HIN-1 (high in normal-1). HIN-1 expression is significantly down regulated in 94% of human breast carcinomas and in 95% of preinvasive lesions, such as ductal and lobular carcinoma in situ. This decrease in HIN-1 expression is accompanied by hypermethylation of its promoter in the majority of breast cancer cell lines (>90%) and primary tumors (74%). HIN-1 is a putative cytokine with no significant homology to known proteins. Reintroduction of HIN-1 into breast cancer cells inhibits cell growth. These results indicate that HIN-1 is a candidate tumor suppressor gene that is inactivated at high frequency in the earliest stages of breast tumorogenesis.
- Published
- 2001
- Full Text
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13. A SAGE (serial analysis of gene expression) view of breast tumor progression.
- Author
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Porter DA, Krop IE, Nasser S, Sgroi D, Kaelin CM, Marks JR, Riggins G, and Polyak K
- Subjects
- Adult, Aged, Breast metabolism, Breast physiology, Breast Neoplasms metabolism, Carcinoma in Situ genetics, Carcinoma in Situ metabolism, Carcinoma in Situ pathology, Carcinoma, Ductal, Breast genetics, Carcinoma, Ductal, Breast metabolism, Carcinoma, Ductal, Breast pathology, Disease Progression, Epithelium metabolism, Epithelium physiology, Female, Gene Library, Humans, Middle Aged, Neoplasm Invasiveness, Neoplasm Metastasis, Breast Neoplasms genetics, Breast Neoplasms pathology, Gene Expression Profiling
- Abstract
To identify molecular alterations involved in the initiation and progression of breast carcinomas, we analyzed the global gene expression profiles of normal mammary epithelial cells and in situ, invasive, and metastatic breast carcinomas using serial analysis of gene expression (SAGE). We identified sets of genes expressed only or most abundantly in a specific stage of breast tumorigenesis or in a certain subtype of tumors through the pair-wise comparison and by hierarchical clustering analysis of these eight SAGE libraries (two/stage). On the basis of these comparisons, we made the following observations: Normal mammary epithelial cells showed the most distinct and least variable gene expression profiles. Many of the genes highly expressed in normal mammary epithelium and lost in carcinomas encoded secreted proteins, cytokines, and chemokines, implicating abnormal paracrine and autocrine signaling in the initiation of breast tumorigenesis. Very few genes were universally up-regulated in all tumors regardless of their stage and histological grade, indicating a high degree of diversity at the molecular level that likely reflects the clinical heterogeneity characteristic of breast carcinomas. Tumors of different histology type and stage had very distinct gene expression patterns. No genes seemed to be specific for metastatic or for in situ carcinomas. We found that the most dramatic and consistent phenotypic change occurred at the normal-to-in situ carcinoma transition. This observation, combined with the fact that many of the genes involved encode secreted, cell-nonautonomous factors, implies that the normal epithelium-to-in situ carcinoma transition may be the most promising target for cancer prevention and treatment.
- Published
- 2001
14. Nipple fluid carcinoembryonic antigen and prostate-specific antigen in cancer-bearing and tumor-free breasts.
- Author
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Zhao Y, Verselis SJ, Klar N, Sadowsky NL, Kaelin CM, Smith B, Foretova L, and Li FP
- Subjects
- Adult, Aged, Breast Neoplasms immunology, Female, Humans, Inhalation, Middle Aged, Nipples, Predictive Value of Tests, Sensitivity and Specificity, Biomarkers, Tumor analysis, Breast Neoplasms diagnosis, Carcinoembryonic Antigen analysis, Prostate-Specific Antigen analysis
- Abstract
Purpose: Mammograms and breast examinations are established methods for early breast cancer detection. Routine mammography screening reduces breast cancer mortality among women ages > or = 50 years, but additional screening methods are needed. We and others have found high levels of carcinoembryonic antigen (CEA) and prostate-specific antigen (PSA) in nipple aspirate fluids (NAFs), but the usefulness for these bio-markers for early breast cancer detection is unknown., Patients and Methods: NAFs from one or both breasts of 388 women were analyzed for CEA, PSA, and albumin levels. The study included 44 women with newly diagnosed invasive breast cancers, 67 women with proliferative breast lesions (ductal and lobular carcinoma in situ and atypical ductal hyperplasia), and 277 controls without these breast lesions. Analyses were conducted using the log(10)-transformed CEA and PSA levels to normalize the distributions of these tumor markers., Results: Nipple fluid CEAs are significantly higher for cancerous breasts than tumor-free breasts (median 1,830 and 1,400 ng/mL, respectively; P <.01). However, at 90% specificity of the assay (CEA = 11,750 ng/mL), the corresponding sensitivity for cancer detection is 32%. CEA levels are not significantly different for breasts with proliferative lesions compared with tumor-free breasts. Nipple fluid PSAs do not differ by tumor status. Analyses of NAF albumin-standardized CEAs and PSAs yield similar results. Nipple fluid CEA and PSA titers are correlated in the affected and unaffected breast of women with unilateral lesions., Conclusion: Nipple fluid CEAs are higher for breasts with untreated invasive cancers, but the test sensitivity is low. Nipple fluid PSA titers do not seem to be useful for breast cancer detection.
- Published
- 2001
- Full Text
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15. Case report: galactography-guided wire localization of an intraductal papilloma.
- Author
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Chow JS, Smith DN, Kaelin CM, and Meyer JE
- Subjects
- Adult, Biopsy methods, Breast Neoplasms pathology, Contrast Media, Female, Humans, Mammography methods, Papilloma, Intraductal pathology, Breast Neoplasms diagnostic imaging, Papilloma, Intraductal diagnostic imaging, Radiography, Interventional methods
- Abstract
Galactography is used to evaluate spontaneous unilateral nipple discharge by catheterization of the duct orifice and instillation of radiopaque contrast material. The most common cause of a bloody discharge is an intraductal papilloma which appears as a smooth lobulated intraluminal filling defect or a solitary obstructed duct on galactography. Carcinomas may be the cause of up to 13% [1] of abnormal nipple discharge and cannot be reliably distinguished from papillomas at galactography. Thus any intraductal filling defect or irregularity in symptomatic patients should be surgically evaluated to obtain a tissue diagnosis. Unfortunately, the histologic examination of the biopsy specimen does not always identify the lesion seen at galactography [2]. A potentially more reliable method of locating lesions identified on galactography is described. Chow, J. S. (2001). Clinical Radiology56, 72-73., (Copyright 2001 The Royal College of Radiologists.)
- Published
- 2001
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16. The utility of ultrasonographically guided large-core needle biopsy: results from 500 consecutive breast biopsies.
- Author
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Smith DN, Rosenfield Darling ML, Meyer JE, Denison CM, Rose DI, Lester S, Richardson A, Kaelin CM, Rhei E, and Christian RL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Biopsy, Needle methods, Female, Humans, Middle Aged, Ultrasonography, Breast Neoplasms diagnostic imaging, Breast Neoplasms pathology
- Abstract
Five hundred ultrasonographically guided large-core needle breast biopsies of solid masses were performed in 446 women. Histopathologic results were correlated with imaging findings. Ultrasonographically guided large-core needle biopsy resulted in diagnosis of malignancy (n = 124) or severe atypical ductal hyperplasia (n = 4) in 128 lesions (26%). In the remaining 372 lesions (74%), ultrasonographically guided large-core needle biopsy yielded benign pathologic results. Follow-up of more than 1 year (n = 225), results of surgical excision (n = 50), or both were obtainable in 275 (74%) of the benign lesions. No malignancies were discovered at surgical excision or during follow-up of this group of benign lesions. There were no complications related to large-core needle biopsy that required additional treatment. Ultrasonographically guided large-core needle biopsy is a safe and accurate method for evaluating breast lesions that require tissue sampling.
- Published
- 2001
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17. Phenol sulfotransferases: hormonal regulation, polymorphism, and age of onset of breast cancer.
- Author
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Seth P, Lunetta KL, Bell DW, Gray H, Nasser SM, Rhei E, Kaelin CM, Iglehart DJ, Marks JR, Garber JE, Haber DA, and Polyak K
- Subjects
- Adult, Age of Onset, Alleles, Arginine chemistry, Blotting, Northern, Case-Control Studies, Estrogens pharmacology, Exons, Female, Genotype, Histidine chemistry, Humans, Immunoblotting, Middle Aged, Polymerase Chain Reaction, Polymorphism, Restriction Fragment Length, RNA, Messenger metabolism, Reverse Transcriptase Polymerase Chain Reaction, Risk Factors, Tamoxifen pharmacology, Tumor Cells, Cultured, Arylsulfotransferase genetics, Arylsulfotransferase metabolism, Breast Neoplasms enzymology, Breast Neoplasms genetics, Polymorphism, Genetic
- Abstract
In recent years, significant effort has been made to identify genes that influence breast cancer risk. Because the high-penetrance breast cancer susceptibility genes BRCA1 and 2 play a role only in a small fraction of breast cancer cases, understanding the genetic risk of the majority of breast cancers will require the identification and analysis of several lower penetrance genes. The estrogen-signaling pathway plays a crucial role in the pathophysiology of breast cancer; therefore, polymorphism in genes involved in this pathway is likely to influence breast cancer risk. Our detailed analysis of gene expression profiles of estrogen- and 4-OH-tamoxifen-treated ZR75-1 breast cancer cells identified members of the sulfotransferase 1A (SULT1A) phenol sulfotransferase family as downstream targets of tamoxifen. On the basis of the induction of SULT1A by 4-OH-tamoxifen and the known inherited variability in SULT1A enzymatic activity, we hypothesized that polymorphism in sulfotransferase genes might influence the risk of breast cancer. Using an RFLP that distinguishes an arginine to histidine change in exon 7 of the SULT1A1 gene, we characterized SULT1A1 genotypes in relation to breast cancer risk. An analysis of 444 breast cancer patients and 227 controls revealed no effect of SULT1A1 genotype on the risk of breast cancer (P = 0.69); however, it did appear to influence the age of onset among early-onset affected patients (P = 0.04). Moreover, individuals with the higher activity SULT1A1*1 allele were more likely to have other tumors in addition to breast cancer (P = 0.004; odds ratio, 3.02; 95% confidence interval, 1.32, 8.09). The large number of environmental mutagens and carcinogens activated by sulfotransferases and the high frequency of the SULT1A1*1 allele in human populations warrants additional studies to address the role of SULT genes in human cancer.
- Published
- 2000
18. Patient preferences for axillary dissection in the management of early-stage breast cancer.
- Author
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Galper SR, Lee SJ, Tao ML, Troyan S, Kaelin CM, Harris JR, and Weeks JC
- Subjects
- Adult, Aged, Axilla, Breast Neoplasms pathology, Carcinoma, Ductal, Breast therapy, Carcinoma, Intraductal, Noninfiltrating therapy, Confounding Factors, Epidemiologic, Diagnosis, Differential, Female, Humans, Middle Aged, Neoplasm Staging, Prognosis, Reproducibility of Results, Surveys and Questionnaires, Breast Neoplasms diagnosis, Breast Neoplasms therapy, Carcinoma, Ductal, Breast diagnosis, Carcinoma, Intraductal, Noninfiltrating diagnosis, Lymph Node Excision adverse effects
- Abstract
Background: Recent data on the value of adjuvant therapy in lymph node-negative breast cancer and promising early data on less invasive strategies for managing the axilla have raised questions about the appropriate role of axillary lymph node dissection (ALND) in the management of early-stage breast cancer. We sought to evaluate how women weigh potential benefits of ALND-prognostic information, enhanced local control, and tailored therapy-against the risks of long-term morbidity that are associated with the procedure., Methods: We used hypothetical scenarios to survey 82 randomly selected women with invasive breast cancer who had been treated with ALND and 62 women at risk for invasive breast cancer by virtue of a history of ductal carcinoma in situ (DCIS) who had not undergone ALND., Results: Women in both the invasive cancer and the DCIS groups required substantial improvements in local control of the cancer (5% and 15%, respectively) and overall survival (3% and 10%, respectively) before they would opt for this procedure. Women with invasive cancer would choose ALND if it had only a 1% chance of altering treatment recommendations, whereas DCIS subjects required a 25% chance. Sixty-eight percent and 29% of women in the invasive cancer and DCIS groups, respectively, would accepted a 40% risk of arm dysfunction to gain prognostic information that would not change treatment., Conclusions: For most subjects treated previously for invasive breast cancer and almost half those at risk of the disease, the potential benefits of ALND, particularly the value of prognostic information, were sufficient to outweigh the risks of morbidity. However, women varied considerably in their preferences, highlighting the need to tailor decisions regarding management of the axilla to individual patients' values.
- Published
- 2000
- Full Text
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19. Sonographic Evaluation of Clinically Palpable Breast Cancers Invisible on Mammography.
- Author
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Durfee SM, Selland DL, Smith DN, Lester SC, Kaelin CM, and Meyer JE
- Abstract
The purpose of this study was to determine the utility of sonography in the evaluation of palpable breast cancers invisible on mammography. A retrospective review of the pathology department's database was used to identify patients with palpable breast cancers. Consecutive patients that had excision between January 1992 and September 1997 were included. Mammograms and breast ultrasounds were reviewed retrospectively and correlated with pathologic and surgical findings. During the study period 298 women presented with a palpable breast cancer for imaging at our institution. Of these, 38 cancers (12.8%) were not seen on mammography. In 32 patients where no mammographic abnormality was found, ultrasound was able to detect a mass corresponding to the area of clinical concern. Histologic tumor types included 30 invasive ductal carcinomas, 5 ductal carcinomas in situ, and 3 invasive lobular carcinomas. Mammographic density was mild with scattered fibroglandular densities in 2 (5%), heterogeneously dense in 12 (32%), and extremely dense in 24 (63%). Thirty-one masses (97%) were hypoechoic and 1 (3%) was echogenic. Lesion margins were irregular in 23 (72%), lobulated in 5 (16%), and well-circumscribed in 4 (12%). In this group of patients the combination of mammography and ultrasound of the mass demonstrated 99% of the palpable cancers. In patients presenting with a breast mass on physical examination in whom mammography fails to demonstrate an abnormality, supplemental ultrasound is helpful in most instances to further characterize the lesion.
- Published
- 2000
- Full Text
- View/download PDF
20. Cat scratch disease presenting as a breast mass.
- Author
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Fortune SM, Kaelin CM, Gulizia JM, and Daily JP
- Subjects
- Adult, Breast Neoplasms diagnosis, Female, Humans, Breast Diseases microbiology, Cat-Scratch Disease diagnosis
- Published
- 2000
- Full Text
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21. Linking gene expression patterns to therapeutic groups in breast cancer.
- Author
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Martin KJ, Kritzman BM, Price LM, Koh B, Kwan CP, Zhang X, Mackay A, O'Hare MJ, Kaelin CM, Mutter GL, Pardee AB, and Sager R
- Subjects
- Adult, Aged, Aged, 80 and over, Breast Neoplasms pathology, Breast Neoplasms therapy, Genes, Tumor Suppressor, Genes, p53 genetics, HSP90 Heat-Shock Proteins genetics, Humans, Keratins genetics, Middle Aged, Neoplasm Staging, Oligonucleotide Array Sequence Analysis, Prognosis, Proteins genetics, RNA, Messenger genetics, RNA, Messenger metabolism, Receptors, Estrogen physiology, Reproducibility of Results, Serpins genetics, Tumor Cells, Cultured, Breast Neoplasms diagnosis, Breast Neoplasms genetics, Gene Expression Profiling, Gene Expression Regulation, Neoplastic
- Abstract
A major objective of current cancer research is to develop a detailed molecular characterization of tumor cells and tissues that is linked to clinical information. Toward this end, we have identified approximately one-quarter of all genes that were aberrantly expressed in a breast cancer cell line using differential display. The cancer cells lost the expression of many genes involved in cell adhesion, communication, and maintenance of cell shape, while they gained the expression of many synthetic and metabolic enzymes important for cell proliferation. High-density, membrane-based hybridization arrays were used to study mRNA expression patterns of these genes in cultured cells and archived tumor tissue. Cluster analysis was then used to identify groups of genes, the expression patterns of which correlated with clinical information. Two clusters of genes, represented by p53 and maspin, had expression patterns that strongly associated with estrogen receptor status. A third cluster that included HSP-90 tended to be associated with clinical tumor stage, whereas a forth cluster that included keratin 14 tended to be associated with tumor size. Expression levels of these clinically relevant gene clusters allowed breast tumors to be grouped into distinct categories. Gene expression fingerprints that include these four gene clusters have the potential to improve prognostic accuracy and therapeutic outcomes for breast cancer patients.
- Published
- 2000
22. Gynecomastoid hyperplasia: imaging findings in six patients.
- Author
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Selland DL, Korbin CD, Lester SC, Lerner MH, Gulizia JA, Kaelin CM, and Meyer JE
- Subjects
- Adult, Biopsy, Diagnosis, Differential, Female, Humans, Hyperplasia, Middle Aged, Retrospective Studies, Breast pathology, Mammography, Ultrasonography, Mammary
- Abstract
This case series describes the radiologic appearances of gynecomastoid hyperplasia of the breast in our experience. The clinical histories, breast images, and histopathologic findings in six women were reviewed. At mammography, there was no abnormality in two women, an enlarging asymmetric density in three women, and a nodule in one woman. Breast ultrasonography showed a hypoechoic nodule in one woman. Gynecomastoid hyperplasia has a varied radiologic appearance.
- Published
- 2000
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23. Down-regulation of laminin-5 in breast carcinoma cells.
- Author
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Martin KJ, Kwan CP, Nagasaki K, Zhang X, O'Hare MJ, Kaelin CM, Burgeson RE, Pardee AB, and Sager R
- Subjects
- Breast cytology, Breast Neoplasms genetics, Breast Neoplasms pathology, Cell Adhesion Molecules biosynthesis, Cell Adhesion Molecules chemistry, Cells, Cultured, Epithelial Cells cytology, Epithelial Cells metabolism, Epithelial Cells pathology, Female, Gene Expression Regulation, Humans, RNA, Messenger analysis, Reference Values, Tumor Cells, Cultured, Kalinin, Breast metabolism, Breast Neoplasms metabolism, Cell Adhesion Molecules genetics, Gene Expression Regulation, Neoplastic, Transcription, Genetic
- Abstract
Background: Laminin-5 (ln-5), a large heterotrimeric glycoprotein consisting of an alpha 3, beta 3, and gamma 2 chain, is a component of epithelial cell basement membranes that functions as a ligand of the alpha 3 beta 1 and alpha 6 beta 4 integrins to regulate cell adhesion, migration, and morphogenesis. The ln-5 chains show tissue-specific patterns of regulation in tumors derived from different tissues. For example, ln-5 is often up-regulated in gliomas, gastric carcinomas, and squamous carcinomas and down-regulated in prostate and basal cell carcinomas. Ln-5 expression patterns may represent useful tumor markers and help to elucidate the role of ln-5 in tumor progression in different tissue types., Materials and Methods: We have studied ln-5 expression patterns in the breast. mRNA levels were examined in tumor and normal breast epithelial cell lines, tissue samples, and immunomagnetically sorted primary cultures using differential display, Northern blotting, and hybridization arrays. Protein levels were examined by immunoprecipitation. Gene integrity was assessed by Southern blotting of representative cell types., Results: Ln-5 alpha 3, beta 3, and gamma 2 mRNA expression was found to be markedly down-regulated in a panel of breast tumor cell lines when compared with normal breast epithelial cells. Ln-5 mRNA was expressed at relatively high levels in MCF-10A immortal normal breast epithelial cells, long-term cultures of normal breast cells, and sorted primary cultures of normal breast luminal epithelial and myoepithelial cells. Reduced, but detectable, levels of ln-5 tended to be expressed in cell lines derived from early-stage breast tumors, whereas expression was generally not detected in cell lines derived from later-stage tumors. In breast tumor tissue specimens, expression of ln alpha 3 and beta 3 mRNAs tended to be reduced relative to levels observed in adjacent nontumor tissue, whereas in gamma 2 levels were elevated in specimens with increased amounts of myoepithelial cells. These ln-5 expression changes could not be attributed to large-scale mutations or gene rearrangements. Ln-5 protein levels were found to reflect mRNA levels in representative cell lines. At senescence, a growth state believed to suppress tumorigenesis, expression of all three ln-5 mRNAs was up-regulated., Conclusion: The down-regulation of ln-5 mRNA expression in breast tumors cells provides a new molecular marker and suggests that ln-5 functions to control tumor progression in the breast.
- Published
- 1998
24. Impalpable breast cysts: utility of cytologic examination of fluid obtained with radiologically guided aspiration.
- Author
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Smith DN, Kaelin CM, Korbin CD, Ko W, Meyer JE, and Carter GR
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Fibrocystic Breast Disease diagnostic imaging, Humans, Mammography, Middle Aged, Palpation, Reproducibility of Results, Retrospective Studies, Ultrasonography, Mammary, Biopsy, Needle methods, Fibrocystic Breast Disease pathology, Radiography, Interventional methods, Ultrasonography, Interventional methods
- Abstract
Purpose: To evaluate the utility of cytologic analysis of fluid obtained from impalpable breast cysts by means of radiologically guided aspiration., Materials and Methods: The authors retrospectively reviewed the reports of cytologic examinations of fluid obtained with sonographically or mammographically guided aspiration of 660 impalpable breast cysts in 583 women during 3 1/2 years., Results: No malignant cells (541 cysts) or insufficient cellular material (86 cysts) was seen with cytologic examination of 95% of the aspirates. Atypical cells were seen with cytologic examination of fluid from 33 (5%) lesions. None of these 33 lesions were found to represent malignancy at the time of surgical excision (n = 9) or during clinical follow-up (n = 24)., Conclusion: Routine cytologic examination is unnecessary if the fluid obtained with radiologically guided aspiration from impalpable breast cysts is not bloody.
- Published
- 1997
- Full Text
- View/download PDF
25. Local recurrence after conservative surgery and radiation therapy for ductal carcinoma in situ: Possible importance of family history.
- Author
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Hiramatsu H, Bornstein BA, Recht A, Schnitt SJ, Baum JK, Connolly JL, Duda RB, Guidi AJ, Kaelin CM, Silver EB, and Harris JR
- Subjects
- Adult, Breast Neoplasms radiotherapy, Breast Neoplasms surgery, Carcinoma, Intraductal, Noninfiltrating radiotherapy, Carcinoma, Intraductal, Noninfiltrating surgery, Disease Progression, Family Health, Female, Follow-Up Studies, Humans, Mastectomy, Segmental, Middle Aged, Prognosis, Retrospective Studies, Breast Neoplasms therapy, Carcinoma, Intraductal, Noninfiltrating therapy, Neoplasm Recurrence, Local
- Abstract
Purpose: The optimal treatment of ductal carcinoma in situ is controversial. Traditionally, women with this disease have been treated with mastectomy with excellent results, but recently the need for such extensive surgery has been questioned. Long-term data on the use of conservative surgery and radiation therapy for treatment are limited. A retrospective analysis was performed to assess treatment outcome and prognostic factors for patients with ductal carcinoma in situ treated with conservative surgery and radiotherapy., Patients and Methods: From 1976 to 1990, 76 women with ductal carcinoma in situ were treated with conservative surgery followed by radiation therapy. The median age at diagnosis was 48 years. Seventeen patients had a positive family history of breast cancer in a first-degree (n=8) or second-degree (n=9) relative. Median follow-up interval was 74 months for the 71 survivors. In 54 patients, the carcinoma was detected by mammography alone; in 13 patients, by mammography and physical examination; and in 4 patients, by physical examination with a normal mammogram; and in 5 patients, by physical examination alone without mammography. Fifty patients had re-excision after initial biopsy. Final margins were positive in 11, close in 11, negative in 34, and unknown in 20. The median volume of excised tissue was 60 cm3. The axilla was surgically staged in 30 patients (39%) and all were negative. The whole breast was irradiated to a dose of 45 to 50 Gy in all patients. Seventy-two patients also received a boost to the primary site. The median total radiation dose to the primary site was 61 Gy (range, 46 to 71)., Results: Seven patients had a recurrence in the treated breast at 16, 18, 41, 63, 72, 83, and 104 months after treatment. The 5- and 10-year actuarial rates of local recurrence were 4% and 15%, respectively. Six of seven recurrences occurred in the vicinity of the original lesion. Four local recurrences were invasive, and three were ductal carcinoma in situ. Two patients developed a contralateral invasive carcinoma. The 5- and 10-year cause-specific survival rates were 100% and 96%, respectively. The 10-year actuarial rate of local recurrence was 25% in the group with a total excision volume less than 60 cm3, as compared with 0% in those with 60 cm3 or more excised (P=0.04). In patients with a positive family history, the 10-year actuarial rate of local recurrence was 37%, as compared with 9% in patients with a negative family history (P=0.008). Of the 17 patients with a positive family history, four developed either an ipsilateral or contralateral invasive breast cancer, whereas 1 of the 58 patients without a family history developed a subsequent invasive breast cancer (P=0.008)., Conclusion: These results suggest that patients with ductal carcinoma in situ treated with conservative surgery and radiotherapy (including a boost to the primary site) appear to benefit from wide, rather than limited, resection. These results also suggest that family history may be an important prognostic factor for progression of disease.
- Published
- 1995
26. Safety, accuracy, and diagnostic yield of needle localization biopsy of the breast performed using local anesthesia.
- Author
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Kaelin CM, Smith TJ, Homer MJ, Taback B, Azurin D, Schmid CH, and Weld L
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Biopsy, Needle adverse effects, Female, Humans, Middle Aged, Anesthesia, Local, Biopsy, Needle methods, Breast pathology, Breast Neoplasms pathology
- Abstract
Background: In changing our technique to performing needle localization breast biopsies (NLBB) using local anesthesia in an outpatient setting, we investigated whether or not our complication rates with local anesthesia were acceptable when compared with complications from a cohort of biopsies of the breast performed for palpable masses. We were also interested in determining whether or not our rate of missed biopsies was within acceptable ranges., Study Design: Complications occurring in 283 patients who underwent 301 NLBB using local anesthesia between 1983 and 1991 were compared with complications occurring after excision of 249 palpable masses of the breast excised using local anesthesia during this period., Results: Complications associated with NLBB were missed lesions, six (1.99 percent) of 301; hematoma, 12 (3.99 percent) of 301; abscess, three (0.99 percent) of 301; seroma, one (0.33 percent) of 301, and wound separation, two (0.66 percent) of 301, for a total of 24 complications (7.96 percent). These rates were not statistically different from the rates of complication after biopsies of palpable lesions using local anesthesia (p < 0.49). The 301 NLBB revealed 87 carcinomas (28.9 percent); 50 invasive and 37 in situ. Of the nonpalpable carcinomas, 43 percent were in situ. Only 11 percent carcinomas, 43 percent were in situ. Only 11 percent of the palpable lesions were in situ (p < 0.001). Forty-four patients with nonpalpable invasive carcinoma had a 25 percent rate of positive axillary lymph nodes., Conclusions: Needle localization breast biopsies can be performed using local anesthesia exclusively with less than a 2 percent chance of missed lesions and complication rates similar to those associated with biopsies of palpable lesions. The biology of these lesions varies. Although there is a high rate of in situ carcinoma, there is a significant rate of node positivity in the patients with nonpalpable invasive carcinoma.
- Published
- 1994
27. The effects of hyperbaric oxygen on free flaps in rats.
- Author
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Kaelin CM, Im MJ, Myers RA, Manson PN, and Hoopes JE
- Subjects
- Animals, Female, Rats, Rats, Inbred Strains, Tissue Survival, Hyperbaric Oxygenation, Surgical Flaps
- Abstract
The effects of hyperbaric oxygen on survival were investigated in free flaps and island flaps. Skin flaps transplanted following 18, 21, and 24 hours of preservation at 24 degrees C demonstrated survival rates of 20%, 10%, and 0%, respectively. Treatment with hyperbaric 100% oxygen improved the survival rates to 66%, 67%, and 40%. A preservation time of 21 to 24 hours at room temperature appears to be the threshold of irreversible ischemic damage. In acute island flaps, flap survival was improved significantly from 35% to 53% and 64% of the random flap area by preoperative or postoperative treatment, respectively. Prolonged preoperative and postoperative treatment improved survival to 66%.
- Published
- 1990
- Full Text
- View/download PDF
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