Breast Cancer and Socio-Economic Factors

Purpose: The aim of this study is twofold – on the one hand, to analyze the relationship between incidence of breast cancer, income per capita and medical equipment across countries; after that, the study here discusses the drivers of the incidence of breast cancer across countries in order to pinpoint differences and similarities. Methods: The indicators used are incidence of breast cancer based on Age-standardized rate (ASW); Gross domestic product (GDP) per capita by purchasing power parity (current international $); computed tomography (CT) for cancer diagnosis. Data include 52 countries. The statistical analysis is carried out by correlation, ANOVA and an econometric modeling based on a multiple regression model of the breast cancer incidence on two explanatory variables. Results: Partial correlation is higher: rbreast cancer, GDP CT=60.3% (sign.0.00). The estimated relationship shows an expected incidence of breast cancer increase of approximately 0.05% for a GDP increase of 1% and an expected incidence of breast cancer increase of approximately 3.23% for a CT increase of 1%. ANOVA confirms that incidence of breast cancer is higher across richer countries, ceteris paribus. Conclusions: Empirical evidence shows that the breast cancer tends to be higher across richer countries, measured by GDP per capita and number of Computed Tomography. The main determinants of these findings can be due to several socio-economic factors, mainly localized in richer countries. In addition, this research may provide an alternative interpretation to the theory of Oh et al. (2010) on the influence of latitude on breast cancer, focusing on socio-economic factors rather than biologic root causes

Clinicopathological features of young versus older patients With breast cancer at a single Pakistani institution and a comparison with a national US database

METHODS: We conducted a retrospective review of patients with symptoms of breast cancer presenting to Aga Khan University Hospital (AKUH), a large tertiary care center in Pakistan, between 2001 and 2010; we compared young (≤ 40 years) versus older (\u3e 40 years) patients in terms of their clinicopathological characteristics. We also compared this Pakistani cohort with the US population using data from the National Cancer Database (NCDB). RESULTS: A total of 1,334 patients with breast cancer presented to our center over the 10-year review period. The median age at diagnosis was 50 years, compared with 60 years for patients in the NCDB. In the AKUH cohort, younger patients were significantly more likely than their older counterparts to present with metastatic disease (13.1% v 10.8%; P \u3c .01). They also were more likely to present with higher-grade tumors (grade 3: 40.1% v 28.3%; P \u3c .001), have triple hormone receptor-negative phenotype (25.4% v 14.1%, P \u3c .001), and have positive axillary lymph node involvement (70.9% v 57.5%; P \u3c .001) compared with older women. Younger and older patients in the AKUH cohort tended to present with higher-stage disease ( P \u3c .001) and were more likely to have triple hormone receptor-negative disease ( P \u3c .001), compared with all patients in the NCDB and with those of Indo-Pakistani origin. CONCLUSION: Young Pakistani women, similar to their Western counterparts, present with more advanced disease and more aggressive tumor biology than their older counterpart

Sentinel node staging for breast cancer: Intraoperative molecular pathology overcomes conventional histologic sampling errors

BACKGROUND: When sentinel node dissection reveals breast cancer metastasis, completion axillary lymph node dissection is ideally performed during the same operation. Intraoperative histologic techniques have low and variable sensitivity. A new intraoperative molecular assay (GeneSearch BLN Assay; Veridex, LLC, Warren, NJ) was evaluated to determine its efficiency in identifying significant sentinel lymph node metastases (\u3e.2 mm). METHODS: Positive or negative BLN Assay results generated from fresh 2-mm node slabs were compared with results from conventional histologic evaluation of adjacent fixed tissue slabs. RESULTS: In a prospective study of 416 patients at 11 clinical sites, the assay detected 98% of metastases \u3e2 mm and 88% of metastasis greater \u3e.2 mm, results superior to frozen section. Micrometastases were less frequently detected (57%) and assay positive results in nodes found negative by histology were rare (4%). CONCLUSIONS: The BLN Assay is properly calibrated for use as a stand alone intraoperative molecular test

Intraoperative Injection of Technetium-99m Sulfur Colloid for Sentinel Lymph Node Biopsy in Breast Cancer Patients: A Single Institution Experience

Background. Most institutions require a patient undergoing sentinel lymph node biopsy to go through nuclear medicine prior to surgery to be injected with radioisotope. This study describes the long-term results using intraoperative injection of radioisotope. Methods. Since late 2002, all patients undergoing a sentinel lymph node biopsy at the Yale-New Haven Breast Center underwent intraoperative injection of technetium-99m sulfur colloid. Endpoints included number of sentinel and nonsentinel lymph nodes obtained and number of positive sentinel and nonsentinel lymph nodes. Results. At least one sentinel lymph node was obtained in 2,333 out of 2,338 cases of sentinel node biopsy for an identification rate of 99.8%. The median number of sentinel nodes found was 2 and the mean was 2.33 (range: 1-15). There were 512 cases (21.9%) in which a sentinel node was positive for metastatic carcinoma. Of the patients with a positive sentinel lymph node who underwent axillary dissection, there were 242 cases (54.2%) with no additional positive nonsentinel lymph nodes. Advantages of intraoperative injection included increased comfort for the patient and simplification of scheduling. There were no radiation related complications. Conclusion. Intraoperative injection of technetium-99m sulfur colloid is convenient, effective, safe, and comfortable for the patient

Increased epigenetic age in normal breast tissue from luminal breast cancer patients

BACKGROUND: Age is one of the most important risk factors for developing breast cancer. However, age-related changes in normal breast tissue that potentially lead to breast cancer are incompletely understood. Quantifying tissue-level DNA methylation can contribute to understanding these processes. We hypothesized that occurrence of breast cancer should be associated with an acceleration of epigenetic aging in normal breast tissue. RESULTS: Ninety-six normal breast tissue samples were obtained from 88 subjects (breast cancer = 35 subjects/40 samples, unaffected = 53 subjects/53 samples). Normal tissue samples from breast cancer patients were obtained from distant non-tumor sites of primary mastectomy specimens, while samples from unaffected women were obtained from the Komen Tissue Bank (n = 25) and from non-cancer-related breast surgery specimens (n = 28). Patients were further stratified into four cohorts: age < 50 years with and without breast cancer and age ≥ 50 with and without breast cancer. The Illumina HumanMethylation450k BeadChip microarray was used to generate methylation profiles from extracted DNA samples. Data was analyzed using the "Epigenetic Clock," a published biomarker of aging based on a defined set of 353 CpGs in the human genome. The resulting age estimate, DNA methylation age, was related to chronological age and to breast cancer status. The DNAmAge of normal breast tissue was strongly correlated with chronological age (r = 0.712, p < 0.001). Compared to unaffected peers, breast cancer patients exhibited significant age acceleration in their normal breast tissue (p = 0.002). Multivariate analysis revealed that epigenetic age acceleration in the normal breast tissue of subjects with cancer remained significant after adjusting for clinical and demographic variables. Additionally, smoking was found to be positively correlated with epigenetic aging in normal breast tissue (p = 0.012). CONCLUSIONS: Women with luminal breast cancer exhibit significant epigenetic age acceleration in normal adjacent breast tissue, which is consistent with an analogous finding in malignant breast tissue. Smoking is also associated with epigenetic age acceleration in normal breast tissue. Further studies are needed to determine whether epigenetic age acceleration in normal breast tissue is predictive of incident breast cancer and whether this mediates the risk of chronological age on breast cancer risk

Festschrift in honour of Roger Keith

Afestschrift is a collection of essays written to honour the contributions of a colleague during his or her career. These essays are not about the colleague, but about the science. A theme is often chosen to align with the interests of the honoree. In June 2017, several colleagues of Dr. Roger Keith will gather in Saskatoon, Sask., to discuss topics regarding the past and future of surgery and its subspecialties, particularly surgical education and hepatopancreatobiliary surgery. The Canadian Journal of Surgery is pleased to collaborate in the production of this festschrift for its former editor, Dr. Keith. Roger Keith was born in Calgary in August 1940. After completing his medical doctorate at the University of Alberta and general surgery residency at the University of Toronto, Dr.  Keith went to Toulouse (Professor Jean Escat), London (Sir Rodney Smith), Los Angeles (Dr. William Longmire) and Seattle (Dr. Thomas T. White) to gain the best training in liver and pancreatic surgery (known today as HPB surgery). Hepatopancreatobiliary surgery, including endoscopic retrograde cholangiopancreatography, became Dr. Keith’s specialty, and he led its development in Canada over the next 40 years. In 1990 he moved back west and became the professor and head of surgery at the University of Saskatchewan. He contributed to the rapid development of surgical education through leadership roles, many of which continue today, at the Royal College of Physicians and Surgeons of Canada, the American College of Surgeons, the Canadian Association of General Surgeons, the American Surgical Association and the James IV Association of Surgeons. Dr. Keith was editor-in-chief of the Canadian Journal of Surgery from 1992 to 1998.1 Vivian McAlister, MB Accepted Dec. 21, 2016 Correspondence to: V. McAlister Department of Surgery Western University London ON N6A 5A5 [email protected] DOI: 10.1503/cjs.016816 The festschrift in honour of Dr. Roger Keith, past editor of the Canadian Journal of Surgery, includes essays (available at canjsurg.ca), written from a personal perspective, on the development of specialty surgery in Canada (Richard Nason, Michael Marcaccio, Michael Kelly and Lissa Peeling), evolution of the certification examination (Ward Davies), building of a megahospital (Gerald Fried) and on the changes in surgical education (Grant Miller, Anees Chagpar, Christopher DeGara, E. Christopher Ellison, Richard Prinz and William Pollett), as well as personal reflections (Andrew Warshaw, Stewart Hamilton). Summary Dr. Roger Keith, editor-in-chief of the Canadian Journal of Surgery from 1992 to 1998. COMMENTARY Can J Surg, Vol. 60, No. 1, February 2017 7 This festschrift is opened by a description of challenges facing medical schools in the 21st century (Dr. Grant Miller, University of Saskatchewan) and continues with essays on the development surgery in Canada: neurosurgery in Saskatchewan (Drs. Michael Kelly and Lissa Peeling, University of Saskatchewan); HPB surgery, including transplantation (Dr. William Wall, University of Western Ontario); head and neck surgery (Dr. Richard Nason, University of Manitoba) and endoscopy (Dr. Michael Marcaccio, McMaster University) as well as a personal account of participation in Canada’s military hospital in Kandahar, Afghanistan, as a civilian surgeon (Dr. Stewart Hamilton, University of Alberta). Essays on surgical education include the topics of undergraduate education (Dr.  Christopher DeGara, University of Alberta), postgraduate education (Dr. E. Christopher Ellison, Ohio State University; Dr. Anees Chagpar, Yale University School of Medicine), academic surgery (Dr. Richard Prinz, University of Chicago) and continuing education (Dr. William Pollett, Memorial University of Newfoundland). Chief examiner Dr.  Ward Davies (University of Western Ontario) reflects on the evolution of the certification examinations of the Royal College. Dr.  Gerald Fried (McGill University) describes the development of Canada’s latest megahospital in Montreal. These essays are written from a personal perspective by surgical colleagues of Dr. Keith who also have a lifetime of contributions to the science. As Dr.  Andrew Warshaw (Harvard Medical School) remarked referring to  his idol of outcome research in surgery, Dr.  Ernest Codman (1869–1940), that Dr. Keith’s career would have met with praise and approval from Dr. Codman, a sentiment echoed in the essays of this festschrift

Do non-melanoma skin cancer survivors use tanning beds less often than the general public?

Purpose Indoor tanning is associated with an increased risk of non-melanoma skin cancers (NMSC), yet little is known about indoor tanning habits of individuals with a history of NMSC. Methods We examined self-reported history of NMSC and tanning bed use among non-Hispanic white respondents in the 2010 National Health Interview Survey (NHIS), a cross-sectional population-based survey designed to be representative of the civilian US population. We computed weighted population estimates and standard errors using the Taylor series linearization method. We then evaluated chi-square tests of independence and conducted weighted logistic regression analyses to evaluate if NMSC status was a predictor of indoor tanning. Results In our analytic sample of 14,400 non-Hispanic white participants, representing 145,287,995 in the population, 543 participants (weighted proportion = 3.45%) self-reported a history of NMSC or “skin cancer type not known.” In multivariate analyses, non-melanoma skin cancer survivors were no less likely to use tanning beds in the last 12 months than skin cancer free controls (OR = 0.70, 95% CI: 0.34-1.43, p = 0.33). Conclusions Non-melanoma skin cancer survivors should be educated on their increased risk of recurrence and other skin cancers and in particular the role of indoor tanning in skin tumorigenesis