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Home: Oncology Leader Commentary: J. Michael Dixon, MD

Click on the topic below for comments by Dr J. Michael Dixon to comment on. You will also find links to related articles and clinical trials.

Breast cysts as a cancer risk factor
Biochemistry of breast cysts
Intratumoral estrogen levels in breast cancer
Neoadjuvant endocrine therapy
Response rates with neoadjuvant endocrine therapy
Time to response with neoadjuvant endocrine therapy
Randomized trials of neoadjuvant Arimidex
Response criteria with neoadjuvant therapy
Biologic effect of endocrine agents
Combining endocrine agents
Quality of life with neoadjuvant endocrine therapy
Neoadjuvant endocrine therapy of locally advanced breast cancer
Neoadjuvant therapy of inflammatory breast cancer
Neoadjuvant therapy of elderly patients
Timing of surgery after neoadjuvant therapy
Neoadjuvant therapy with aromatase inhibitors

Breast cysts as a cancer risk factor

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We looked at 1,374 women with breast cysts followed-up for 10 years. Three thousand forty-one (3,041) cysts aspirated and followed-up 10 years later and showing that these women did indeed have an increased risk of breast cancer, particularly if the women were under the age of 45.

Palpable cysts, I think, are different from microscopic cysts and if you look at microscopic cysts, they aren’t a risk factor. Because microscopic cysts are really just an aging process. Whereas something has to happen for those microscopic cysts to become bigger and it’s whatever causes those cysts to become bigger that makes that population different from the rest of the population. And those women are at some increased risk, particularly if they are developing palpable breast cysts at a very young age. Because there’s got to be something odd about those women’s breasts that they develop these large cysts, and whatever’s odd about it makes them about six times more likely to get breast cancer at young age.

And it’s a very much age specific risk. In other words, if you are 42 when you had a cyst aspirated, you were at six times risk until the age of 45. Then from 45 to 50 that risk goes down to about three to four, and then when you get over 50 the risk really starts to go down fairly quickly. What I think it does is it points in the direction that there’s something strange about these women, and we should look at them.

Relevant Articles:

Risk of breast cancer in women with palpable breast cysts: a prospective study. Edinburgh Breast Group. Dixon JM. McDonald C. Elton RA. Miller WR. Lancet. 353(9166):1742-5, 1999.

Breast cancer in women with palpable breast cysts [letter]. Mannello F. Malatesta M. Gazzanelli G. Lancet. 354(9179):677-8, 1999.

Breast cancer in women with palpable breast cysts [letter]. Baum M. Lancet. 354(9179):677; discussion 678, 1999.

Breast cancer in women with palpable breast cysts [letter]. Palmieri C. Linardou H. Lancet. 354(9179):677; discussion 678, 1999.

Breast cancer screening among women younger than age 50: A current assessment of the issues [Review].
Smith, R. A.; Mettlin, C. J.; Davis, K. J., and Eyre, H. Ca: a Cancer Journal for Clinicians. 50(5):312-336, 2000 Sep-Oct.

Assessing the risk of breast cancer. [Review]. New England Journal of Medicine. 342(8):564-571, 2000 Feb 24. No abstract

Lack of utility in clinical practice of cytologic examination of nonbloody cyst fluid from palpable breast cysts.
Hindle WH. Arias RD. Florentine B. Whang J. American Journal of Obstetrics & Gynecology. 182(6):1300-5, 2000.

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