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Background Family physicians (FPS) play a role in aspects of personalized medicine in cancer, including assessment of increased risk because of family history. Little is known about the potential role of FPS in supporting cancer patients who undergo tumour gene expression profile (GEP) testing. Methods We conducted a mixed-methods study with qualitative and quantitative components. Qualitative data from focus groups and interviews with FPS and cancer specialists about the role of FPS in breast cancer GEP testing were obtained during studies conducted within the pan-Canadian canimpact research program. We determined the number of visits by breast cancer patients to a FP between the first medical oncology visit and the start of chemotherapy, a period when patients might be considering results of GEP testing. Results The FPS and cancer specialists felt that ordering GEP tests and explaining the results was the role of the oncologist. A new FP role was identified relating to the fp-patient relationship: supporting patients in making adjuvant therapy decisions informed by GEP tests by considering the patient's comorbid conditions, social situation, and preferences. Lack of FP knowledge and resources, and challenges in fp-oncologist communication were seen as significant barriers to that role. Between 28% and 38% of patients visited a FP between the first oncology visit and the start of chemotherapy. Conclusions Our findings suggest an emerging role for FPS in supporting patients who are making adjuvant treatment decisions after receiving the results of GEP testing. For success in this new role, education and point-of-care tools, together with more effective communication strategies between FPS and oncologists, are needed. [ABSTRACT FROM AUTHOR]

Desmoplastic small-round-cell tumors are rare aggressive malignancies that belong to the "small round blue cell" tumor family. They predominantly affect the abdomen in adolescent and young adult males. Computed tomography is currently the modality of choice both for diagnosis and follow-up assessment. In this review, the authors provide a concise yet comprehensive discussion of this condition with emphasis on the imaging findings. Pathologic correlation, differential diagnostic considerations, and treatment will also be presented. [ABSTRACT FROM AUTHOR]

The article discusses a study on the role of hormone therapy (HT) in treating menopausal symptoms in women without breast cancer and those with a personal history of breast cancer or at increased risk of breast cancer. It reviews the management of menopause-related symptoms centering on strategies to improve quality of life. It cites the theory that estrogen stimulation of mammary cells leads to the proliferation and subsequent transformation of cells together with DNA mutations and antiestrogen therapies like tamoxifen and aromatase inhibitors are considered as the standard of care for adjuvant endocrine treatment in estrogen receptor (ER) positive breast cancer. It suggests against endorsing systemic HT in women with a prior history of breast cancer.

Women with a germline BRCA1 or BRCA2 mutation or a hereditary predisposition for breast and ovarian cancer have substantial risk of breast or ovarian cancer relative to the general US population. Health care professionals can be instrumental in identifying women at increased risk through obtaining a comprehensive family history and becoming familiar with family history characteristics associated with hereditary predisposition for breast and ovarian cancer. BRCA carriers and women at very high risk benefit from multidisciplinary, individualized medical evaluation and risk management. We conducted a search of MEDLINE from 1989 through 2010 for the terms BRCA1, BRCA2, breast cancer, ovarian cancer, risk assessment, and genetic testing. We reviewed abstracts and relevant randomized and prospective studies that included very high-risk patient groups and BRCA mutation carriers. Herein, we review the role of genetic consultation and BRCA testing and the comprehensive, multisystem recommendations for risk management. A multidisciplinary approach offers the ability to educate those at very high risk about cancer prevention, reduce cancer risk, maximize early detection of breast and ovarian cancer, and improve survival. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the effectiveness of vitamin E, evening primrose oil (EPO), and the combination of vitamin E and EPO for pain control in women with cyclical mastalgia. PROCEDURE: A double-blind, randomized, placebo-controlled trial was conducted at two U.S. academic medical centers. Eighty-five women with premenstrual cyclical breast discomfort were enrolled. Participants were randomly assigned to one of four six-month oral treatments: vitamin E (1,200 IU per day), EPO (3,000 mg per day), vitamin E (1,200 IU per day) plus EPO (3,000 mg per day), or double placebo. The primary outcome measure was change in breast pain, measured by the modified McGill Pain Questionnaire at enrollment and at six months. RESULTS: Forty-one patients completed the study. Intent-to-treat analysis (pretesting and post testing) showed a difference in worst-pain improvement with the treatments EPO (p=0.005), vitamin E (p=0.04), and EPO plus vitamin E (p=0.05), but no difference with placebo (p=0.93). Results from two-sample t-test showed a nonsignificant decrease in cyclical mastalgia individually for the three treatment groups compared with the placebo group (EPO, p=0.18; vitamin E, p=0.10; and EPO plus vitamin E, p=0.16). The data were also analyzed with the separation test by Aickin, which showed a trend toward a reduction of cyclical mastalgia with vitamin E and EPO individually and in combination. CONCLUSION: Daily doses of 1,200 IU vitamin E, 3,000 mg EPO, or vitamin E and EPO in combination at these same dosages taken for six months may decrease the severity of cyclical mastalgia. [ABSTRACT FROM AUTHOR]

Endogenous estrogens can be bio-activated to endogenous carcinogens via formation of estrogen quinones. Estrogen-3,4-quinones react with DNA to form mutagenic depurinating estrogen-DNA adducts. The carcinogenicity of endogenous estrogens is related to unbalanced estrogen metabolism leading to excess estrogen quinones and formation of depurinating DNA adducts. The present studies were initiated to confi rm that relatively high levels of depurinating estrogen-DNA adducts are present in women at high risk for breast cancer or diagnosed with the disease. These adducts may be biomarkers for early detection of breast cancer risk. The estrogen metabolites, conjugates and depurinating DNA adducts were identifi ed and quantifi ed by using ultraperformance liquid chromatography/tandem mass spectrometry to analyze urine samples from 40 healthy control women, 40 high-risk women and 40 women with newly diagnosed breast cancer. Estrogen metabolism was shifted from protective methoxylation and conjugation pathways in healthy control women towards activating pathways leading to formation of depurinating DNA adducts in women at high risk or with breast cancer. These results support the hypothesis that breast cancer is initiated by mutations derived from depurination of estrogen-DNA adducts. Therefore, relative levels of depurinating estrogen-DNA adducts could become biomarkers for early detection of breast cancer risk and aid in determining preventive strategies. [ABSTRACT FROM AUTHOR]

Primary mammary lymphoma is a rare tumor that presents commonly as a large mass with no specific mammographic appearance and can be confused with poorly differentiated carcinoma on frozen section. With appropriate treatment, this breast malignancy has a relatively good prognosis. We report a case of primary mammary non-Hodgkin lymphoma in a 74-year-old woman that originally presented as locally advanced breast cancer with secondary inflammatory skin changes. Clinical findings, diagnostic work-up, and follow-up are provided along with a review of the literature on primary mammary lymphoma. [ABSTRACT FROM AUTHOR]

Pain is one of the most common breast symptoms experienced by women. It can be severe enough to interfere with usual daily activities, but the etiology and optimal treatment remain undefined. Breast pain is typically approached according to its classification as cyclic mastalgia, noncyclic mastalgia, and extramammary (nonbreast) pain. Cyclic mastalgia is breast pain that has a clear relationship to the menstrual cycle. Noncyclic mastalgia may be constant or intermittent but is not associated with the menstrual cycle and often occurs after menopause. Extramammary pain arises from the chest wall or other sources and is interpreted as having a cause within the breast. The risk of cancer in a woman presenting with breast pain as her only symptom is extremely low. After appropriate clinical evaluation, most patients with breast pain respond favorably to a combination of reassurance and nonpharmacological measures. The medications danazol, tamoxifen, and bromocriptine are effective; however, the potentially serious adverse effects of these medications limit their use to selected patients with severe, sustained breast pain. The status of other therapeutic strategies and directions for future research are discussed. [ABSTRACT FROM AUTHOR]