Prophylaxis and Early Detection for Breast Cancer

Abstract: Breast cancer is steadily increasing in number in Japan due to less child bearing, less breast-feeding, and more westernization of life style than ever. Cancer registration in Osaka reported the incidence of breast cancer in 1996 to 1998 to be 41.1/100,000, four-times higher than the value in 1966-1968. Avoiding overweight, animal fat intake and mental stresses is a basic and easy measure for prevention of breast cancer. A unique study performed in Japan shows that daily intake of 10 or more cups of green tea inhibits development of breast cancer. A large-scale study by National Surgical Adjuvant Breast and Bowel Project (NSABP) revealed that 5-year tamoxifen administration to high-risk women decreased the incidence of breast cancer to 1/2 of the value for control women. Early diagnosis of breast cancer is most effectively achieved by fine needle aspiration cytology if the tumor is palpable with joint work with capable cytologists. More recently, stereo-tactic biopsy devices are available for non-palpable lesions. Mammography is more frequently used in mass screening system though its essential merit is yet to be investigated

Association between Mammographic Breast Density and Lifestyle in Japanese Women

A high mammographic breast density is considered to be a risk factor for breast cancer. However, only a small number of studies on the association between breast density and lifestyle have been performed. A cross-sectional study was performed using a survey with 29 questions on life history and lifestyle. The breast density on mammography was classified into 4 categories following the BI-RADS criteria. The subjects were 522 women with no medical history of breast cancer. The mean age was 53.3 years old. On multivariate analysis, only BMI was a significant factor determining breast density in premenopausal women (parameter estimate, －0.403;p value, 0.0005), and the density decreased as BMI rose. In postmenopausal women, BMI (parameter estimate, －0.196;p value, 0.0143) and number of deliveries (parameter estimate, －0.388;p value, 0.0186) were significant factors determining breast density;breast density decreased as BMI and number of deliveries increased. Only BMI and number of deliveries were identified as factors significantly influencing breast density. BMI was inversely correlated with breast density before and after menopause, whereas the influence of number of deliveries on breast density was significant only in postmenopausal women in their 50 and 60s

Effects of lifestyle and single nucleotide polymorphisms on breast cancer risk: a case-control study in Japanese women

Background: Lifestyle factors, including food and nutrition, physical activity, body composition and reproductive factors, and single nucleotide polymorphisms (SNPs) are associated with breast cancer risk, but few studies of these factors have been performed in the Japanese population. Thus, the goals of this study were to validate the association between reported SNPs and breast cancer risk in the Japanese population and to evaluate the effects of SNP genotypes and lifestyle factors on breast cancer risk. Methods: A case-control study in 472 patients and 464 controls was conducted from December 2010 to November 2011. Lifestyle was examined using a self-administered questionnaire. We analyzed 16 breast cancer-associated SNPs based on previous GWAS or candidate-gene association studies. Age or multivariate-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were estimated from logistic regression analyses. Results: High BMI and current or former smoking were significantly associated with an increased breast cancer risk, while intake of meat, mushrooms, yellow and green vegetables, coffee, and green tea, current leisure-time exercise, and education were significantly associated with a decreased risk. Three SNPs were significantly associated with a breast cancer risk in multivariate analysis: rs2046210 (per allele OR = 1.37 [95% CI: 1.11-1.70]), rs3757318 (OR = 1.33[1.05-1.69]), and rs3803662 (OR = 1.28 [1.07-1.55]). In 2046210 risk allele carriers, leisure-time exercise was associated with a significantly decreased risk for breast cancer, whereas current smoking and high BMI were associated with a significantly decreased risk in non-risk allele carriers. Conclusion: In Japanese women, rs2046210 and 3757318 located near the ESR1 gene are associated with a risk of breast cancer, as in other Asian women. However, our findings suggest that exercise can decrease this risk in allele carriers

〈Originals〉Mammographic breast density change following postoperative adjuvant therapy in hormone receptor-positive breast cancer patients

Several studies have been reported that postoperative adjuvant endocrine therapy decreases mammographic breast density and that breast density change may be a prognostic factor for recurrence, however there are few studies on relationship between postoperative adjuvant therapy and breast density in Japan. We investigated changes in the breast density following postoperative adjuvant therapy in hormone receptor (HR)-positive breast cancer and whether breast density change is related to recurrence. We analyzed data from 240 HRpositive breast cancer patients who underwent surgery and received postoperative adjuvant therapy at our institution. The breast density was measured by contralateral breast mammography (MMG) using the Breast Imaging Reporting and Data System (the BI-RADS) classification, and breast density reduction was defined as the reduction of the BI-RADS density score on follow-up MMG compared with the pretreatment value. The breast density was reduced in 22 (9.2%) patients. Of patients with breast density reduction, 19 (86.4%) received a selective estrogen receptor modulator (SERM), and these patients showed significantly higher rates of breast density reduction compared with those receiving an aromatase inhibitor (AI ; p< 0.001). The addition of chemotherapy was not associated with the breast density reduction. Fifteen (6.1%) patients had recurrent disease. There was no patient with breast density reduction showed recurrence, however no significant correlation between breast density reduction and recurrence. In this study, the breast density reduction in adjuvant therapy of Japanese HRpositive breast cancer patients did not become a predictor of recurrence

Case report: schwannoma arising from the unilateral adrenal area with bilateral hyperaldosteronism

Abstract Background We report a rare case of a juxta-adrenal schwannoma that could not be discriminated from an adrenal tumor before surgical resection and was complicated by bilateral hyperaldosteronism. To the best of our knowledge, this is first case in which both a juxta-adrenal schwannoma and hyperaldosteronism co-existed. Case presentation A 69-year-old male treated for hypertension was found to have a left supra-renal mass (5.8 × 5.2 cm) by abdominal computed tomography. His laboratory data showed that his plasma aldosterone concentration (PAC) was within the normal range, but his plasma renin activity (PRA) was reduced, resulting in an increased aldosterone/renin ratio (ARR). Load tests of captopril or furosemide in the standing position demonstrated autonomous aldosterone secretion and renin suppression. Adrenal venous sampling (AVS) with ACTH stimulation indicated bilateral hypersecretion of aldosterone. A left supra-renal tumor was resected because of the possibility of malignancy and was found to be a benign schwannoma arising from the juxta-adrenal region together with an adrenal gland. The dissected left adrenal gland was morphologically hyperplastic in the zona glomerulosa, but was immunohistochemically negative for CYP11B2 (aldosterone synthase). Multiple CYP11B2-positive adrenocortical micronodules were detected in the adrenal gland, indicating micronodular hyperplasia. Although bilateral aldosteronism was indicated by AVS before the operation, the PRA, PAC and ARR values were within their respective reference ranges after resection of the unilateral tumor, suggesting that the slight increase in hormone secretion from the remaining right-sided lesion could not be detected after resection. Conclusion A clinical and morphologic diagnosis of juxta-adrenal schwannoma is difficult, particularly in a case of hyperaldosteronism, as shown in this case. These data suggest the complexity and difficulty diagnosing adrenal incidentaloma