Faculty Bibliography

The scale and scope of the cancer problem in the United States today is much greater than four decades ago when the formal war against the disease was first announced. Patterns of the disease are not fully explained by known risk factors. Much progress has been made in understanding the molecular basis of carcinogenesis, particularly the near consensus (realization) that virtually all cancers arise from an accumulation of genetic mutations and the more recent recognition of the role of inflammation and the tissue microenvironment, in particular for hormone-dependent cancers. However, most genetic mutations that contribute to cancer are not inherited, and thus must be attributable to accumulation of somatic mutations and epigenetic changes, from as yet poorly understood environmental factors, that certainly cannot be explained entirely by tobacco, use and arise over the course of a lifetime. Much of the national effort to control cancer has focused on detecting and treating the disease--not on seeking approaches to prevent cases from arising. Given this reality, we present a cross-disciplinary framework for establishing comprehensive research and policy centers focused on environmental oncology to be based at selected academic cancer centers across the country. The principal goal of such centers is to improve the ability to prevent cancer, by developing effective interventions based on insights obtained from epidemiology, including molecular epidemiology and basic scientific research on genomic, metabolomic, and other biomarkers of exposure, susceptibility, and disease. As the needed scientific evidence for environmental factors contributing to cancer is revealed, these academic centers will develop specific interventions and/or policy recommendations regarding ways to lower the burden of cancer, based on existing information about cancer hazards in the personal, occupational, and general environment. Ultimately the centers will improve the ability to identify and control the underlying causes of the occurrence of cancer and its progression

BACKGROUND: Male breast cancer has traditionally been compared with female breast cancer, using the same staging system and prognostic indicators. A variety of histochemical and pathologic factors commonly used in node-negative female breast cancer were applied to 18 node-negative male breast cancers to assess their relevance to survival. PATIENTS AND METHODS: A slide review was performed for nuclear grade, lymphocytic infiltration, and lymphatic and vascular invasion. Flow cytometry was available on all the specimens. Immunohistochemistry was used to assess p53, estrogen receptors (ERs), cathepsin D, Ki-67, and c-erbB-2 (HER2/neu). A clinical correlation was performed based on chart reviews and phone interviews, recording demographics, treatment, and long-term survival. RESULTS: The average age at diagnosis was 64 years (range, 34-85 years). There were 15 T1 lesions, 2 T2 lesions, and 1 T3 lesion. All patients had a modified radical mastectomy. None received radiation therapy. The mean follow-up was 73 months. Three patients died of their disease (17.6%), 2 patients died from unrelated reasons, 1 patient was lost to follow-up, and the other 12 patients are alive with no evidence of disease. The actuarial 5-year survival was 83%. Estrogen receptor and HER2/neu overexpression were significantly more predominant in male breast cancer than in female breast cancer. Estrogen receptor positivity was present in 17 of 18 patients and HER2/neu overexpression in 10 of 18. A positive ER status and overexpression of cathepsin or p53 were correlated with a better survival, but only ER (P = 0.026) and p53 (P = 0.023) reached statistical significance. CONCLUSION: In this study, ER status was the only commonly used prognostic marker for female breast cancer found to be applicable in node-negative male breast cancer

This study compared the analgesic efficacy of postoperative lavender oil aromatherapy in 50 patients undergoing breast biopsy surgery. Twenty-five patients received supplemental oxygen through a face mask with two drops of 2% lavender oil postoperatively. The remainder of the patients received supplemental oxygen through a face mask with no lavender oil. Outcome variables included pain scores (a numeric rating scale from 0 to 10) at 5, 30, and 60 minutes postoperatively, narcotic requirements in the postanesthesia care unit (PACU), patient satisfaction with pain control, as well as time to discharge from the PACU. There were no significant differences in narcotic requirements and recovery room discharge times between the two groups. Postoperative lavender oil aromatherapy did not significantly affect pain scores. However, patients in the lavender group reported a higher satisfaction rate with pain control than patients in the control group (P = 0.0001)

Plasmacytic tumors in the breast are extremely rare neoplasms that can mimic mammary adenocarcima. A literature review revealed approximately 43 reports worldwide of plasmacytic tumors in the breast since 1928, the majority with a synchronous diagnosis of multiple myeloma. We discuss management of a 78-year-old man with plasmacytoma in the breast who underwent a left total mastectomy and axillary lymph node dissection. This report characterizes the histologic and immunochemical characteristics of plasmacytoma in the breast and reviews the consensus on treatment. This could be the first recorded account of plasmacytomas in the breast with axillary lymph node involvement and extracapsular extension of tumor