Objectives: A set of common epidemiologic risk factors have been associated with the risk of breast cancer despite of its molecular sub-classifications. We implemented a case series study with the primary objective of evaluating if obesity is associated with the diagnostic risk of "ER+ and/or PR+, HER2(+)", "ER-/PR-, HER2(-)", or "ER-/PR-, HER2(+)" relative to the most commonly diagnosed subtype of breast carcinoma, "ER+ and/or PR+, HER2(-)".Methods: Demographic, clinical and pathologic data were collected from existing databases. The statuses of HER2/neu biomarker and hormone receptors were dichotomized as either positive or negative. Immunohistochemical staining was used to assess the prevalence of different subtypes. Body mass index was calculated from weight and height data collected at the time of consultation.Conclusions: Findings from the present study suggest that excess body weight decreases the diagnostic risk of "ER-/PR-, HER2(-)", or "ER-/PR-, HER2(-)" relative to "ER+ and/or PR+, HER2(-)". Obese and overweight women are more likely to be diagnosed with to "ER+ and/or PR+, HER2(-)", the subtype that has best prognosis and mostly associated with personal lifestyle. Weight gain with the population attributable-risk factor of 21.3% contributes the most to the incidence of invasive post menopausal breast cancer. Younger pre-menopausal women were more likely to be diagnosed with "ER+ and/or PR+, HER2(+)". In younger women biology of breast cancers with positive expression for hormone receptors and epidermal growth factor is a complex that extends beyond the currently assessed prognostic markers. (C) 2008 Elsevier Ltd. All rights reserved.

The aim of this study is to determine the impact of different prognostic factors on the clinical outcome for patients with pathologic stage IIa (occult) endometrial adenocarcinoma who had surgical staging (SS) and received HDR adjuvant intravaginal brachytherapy (IVB) alone. SS is defined as pelvic washing and pelvic/paraaortic lymph node sampling. Sixty one consecutive patients with pathologic stage IIa (occult) endometrial adenocarcinoma, endometroid type were identified and their treatment charts were retrospectively reviewed. Data were analyzed using Kaplan-Meier and Cox proportional hazards regression methods. All patients had total abdominal hysterectomy and bilateral salpingoophorectomy between 7/1994 and 12/2005. At least 7 nodes were recovered in more than 86% of patients. Myometrial invasion was <50% in 33 patients and ≥50% for 28 patients. Lymphovascular space invasion (LVI) and lower uterine segment involvement (LUSI) were identified in 18% and 61% of patients, respectively. Median age at diagnosis was 64 (range, 46-71 years). All patients received adjuvant IVB with doses of 35-36 Gy in 4-5 fractions prescribed to the vaginal surface. At a median follow-up of 64 months (range, 8 to 153) there were 7 patients who developed recurrences (5 pelvic, 3 extra pelvic, and 1 with vaginal recurrence). For patients who relapsed, the median number of examined lymph nodes were 8 (range, 7-11). Univariate analysis showed that positive ALI, high grade tumors, and deep myometrial invasion were significant predictors of local recurrence and disease free survival (DFS). In regards to DFS, multivariate analysis showed that LVI (p = 0.019), and deep myometrial invasion (p = 0.035) were the only significant independent predictors of outcome. In regards to local control, LVI was the only significant independent predictors of local control with (p = 0.013). 5-year local control and disease free survival was 87% and 91%. Our results suggest that patients with occult stage IIa disease with lymphovascular space invasion, and deep myometrial invasion have a worse disease free survival and local control despite adjuvant intracavitary brachytherapy and reasonable pelvic lymph node assessment. Perhaps, using or adding external beam radiation treatment to this group of patients may improve clinical outcome.

22015 Background: Lifetime breast cancer (BC) incidence is lower yet BC mortality is higher for African American (AA) compared to White American (WA) women. These paradoxical patterns have generated speculation regarding a possible genetic association between BC risk and African ancestry. Little is known about the BC burden of Africa. The African ancestry of AA populations can be traced to western sub- Saharan Africa as a consequence of the colonial-era slave trade. We therefore studied BC patterns in Ghana, since contemporary Ghanaian/African (Afr) and AA women are likely to have some shared ancestry. Methods: Creation of an international BC registry was approved by IRBs of University of Michigan, Henry Ford Hospital (HFH) and Komfe Anoyke Teaching Hospital in Kumasi, Ghana. Features of Ghanaian breast tumors (25 unselected cases) were compared to 435 AA and 812 WA tumors from Michigan by t-test and Chi-squared analyses. Results: AA cases were younger than WA cases (mean age 62.4 versus 60.8 yrs; p=0.05); precise ages were unknown for several of the Afr cases, but it is known that more than half of the Afr cases were younger than 45 yrs. Significant differences were observed for estrogen receptor (ER) expression and frequency of “triple negative” disease (tumors neg for ER, PR and HER2/neu expression) between the three populations (Table). Frequency of ER-neg and triple neg tumors was highest in the Afr cases, lowest in WA cases, and intermediate in AA cases. Results were unchanged when cases were matched on tumor grade. Conclusion: AA and Afr women have an elevated risk of endocrine-resistant and triple-negative breast cancer. The sequential increase in frequency of these aggressive subtypes observed for WA versus AA versus Afr women suggests a possible association with extent of African ancestry. Future international studies of breast cancer in women with African ancestry may improve insights regarding the pathogenesis of ER-negative disease. Frequency of ER-negative breast CA in White American, African American, and Ghanaian African Women Marker Expression White American African American Ghanaian African p-Value ER-negative 21.5% 35.2% 64% < 0.001 ER/PR/HER2-negative 14.4% 24.4% 56% < 0.001 No significant financial relationships to disclose.

The article by Beier et al[1][1] makes an important contribution to the understanding of paroxysmal nocturnal hemoglobinuria (PNH) bone marrow failure syndrome. We are concerned about application of the statistical technique, which was potentially a consequence of a misconception about the study