Faculty Bibliography

Consider this. Our research at Cornell Medical Center has shown that a number of widely used chemical compounds, such as some pesticides and fuels, alter the production of hormones, much the same way as do known cancer-causing agents. Researchers at the U.S. National Toxicology Program have identified numerous such compounds that create mammary tumors in male rodents. Chances are very good that these substances cause cancer in humans. Every compound known to cause cancer in humans also produces cancer in animals, when adequately tested. And the compounds are not only present on Long Island; they're present everywhere. Because many of them are so widely available in the environment, it becomes very difficult to find anyone who is not exposed. To insist on proof of human harm before taking action treats people like lab rats. A recent report from the American Health Foundation about Long Island breast cancer, for example, found no difference in organochlorine residues in women with breast cancer and those without the disease who lived on Long Island and New York City. Unfortunately, there are three major problems with this approach. First, women with advanced disease may have undergone changes in metabolism that alter what remains in their bodies, especially fat- loving, organochlorine residues. Second, critical exposures to cancer- causing agents from early in life cannot be measured years later. Finally, women who have lived in the same area are likely to have undergone similar exposures, which lowers the chance of finding an effect from their environment. In fact, recent studies from Canada and Denmark that have taken samples from women more than a decade before cancer arises, and compared with women from different regions, have found that early exposures to higher levels of some organochlorine compounds do increase the risk of developing cancer

BACKGROUND: Pure mucinous carcinoma (PMC) of the breast has a better prognosis than does invasive ductal carcinoma not otherwise specified and is more prevalent in older patients. We investigated the correlation between prognostic indices and clinical outcome in this histologic subset. METHODS: A retrospective review was done of patients with PMC treated between 1989 and 1996. Demographic data, pathologic indices of prognosis, axillary nodal status, and outcome were assessed. RESULTS: Out of 6083 cases of breast carcinoma, 30 were PMC. Only 3 of 25 (12%) axillary dissections were positive. The average age of the group with positive nodes was 57 years, as compared to 69.5 years (95% CI; 63.24-75.76) in the group with negative nodes. All the tumors with positive nodes were aneuploid and had a high nuclear grade, compared to a 31.25% aneuploidy rate in the group without nodal disease (P = .058). Negative ER receptors were found in only 2 of 20 (10%) of the patients tested. Both had axillary disease (P = .016). Tumor size did not correlate with axillary metastasis. Two of the 29 patients died from unrelated diseases. The other 27 patients are alive with no evidence of disease. CONCLUSIONS: Axillary nodal disease is rare in PMC and correlates with a younger age, aneuploidy, high nuclear grade, or a negative ER receptor status. Sentinel lymph node biopsy may help identify the need for axillary dissection

The World Health Organization recently reported that breast cancer has become the most common cancer in women throughout the world. Known risk factors account for less than half of all cases of breast cancer, and inherited germ line mutations occur in at most only 10% of all cases. Cumulative exposure to estradiol and other hormones links many of the established risk factors for breast cancer. This paper reviews epidemiologic and toxicologic evidence on breast cancer risks and presents a comprehensive construct of risk factors intended to focus on the identification of those factors that can be controlled or modified. We attempt to provide a framework for interpreting the etiologic interplay of endogenous metabolic changes and environmental changes in the etiology of breast cancer. The construct we develop distinguishes between those risk factors that are directly causal, such as ionizing radiation and inherited germ cell defects, those vulnerability factors that extend the time period during which the breast undergoes development, and those contributing factors that increase total hormonal stimulation of the breast. Some hormonally active compounds, such as those in soy and broccoli and other phytoestrogen-containing foods, can be protective against breast cancer, while others, such as some environmental contaminants, appear to increase the risk of the disease by increasing levels of harmful hormones. Efforts to explain patterns of breast cancer should distinguish between these different risk factors. Identification of vulnerability and contributing risk factors can foster the development of public policy to reduce the burden of this prevalent cancer. Prudent precautionary principles suggest that reducing exposure to avoidable or modifiable risk factors should receive high priority from the public and private sectors

In light of the changing trends in the diagnosis and management of invasive breast cancer, the practice of routine axillary dissection should be reevaluated. A growing number of patients with breast cancer are diagnosed as having small tumors with an associated low risk of lymph node metastases. The pathologic features of the primary tumor are increasingly being used as a prognostic guide for recommendations about adjuvant systemic therapy, and there are recent reports suggesting a superior prognostic value for tumor cells detected in bone marrow, as compared to axillary lymph node metastases. Consequently, axillary lymph node status is no longer the single prognostic guide for recommendations about adjuvant systemic therapy. For treatment of the axilla, there is evidence that, in clinical N0 patients, radiation therapy to the axilla is an effective alternative to axillary dissection. Finally, there are cost and morbidity considerations for patients undergoing axillary dissection in whom the indications of the procedure are equivocal. In the management of invasive breast cancer, a selective policy toward axillary lymph node dissection should be considered. This review discusses the nonsurgical management of the axilla; ie, radiation therapy to the axilla and observation of the axilla as an alternative to axillary dissection

A patient with intermittent epigastric pain was found to have a hamartomatous polyp of the jejunum as the lead point of an intussusception. The bowel adjacent to the hamartoma had intramural and subserosal mucinous cysts consistent with jejunitis cystica profunda. To our knowledge, this is the second case described in the English literature