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Sökning: WFRF:(Fjällskog Marie Louise)

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  • Nilsson, Cecilia, et al. (författare)
  • High proliferation is associated with inferior outcome in male breast cancer patients
  • 2013
  • Ingår i: Modern Pathology. - 0893-3952 .- 1530-0285. ; 26:1, s. 87-94
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Assessment of proliferation is important in female breast cancer and individual treatment decisions are based upon its results, especially in the lumina! subgroups. Gene expression analyses fail to group male breast cancer into the intrinsic subgroups previously established in female breast cancer. Even though proliferation has been shown to divide malebreast cancer into molecular subgroups with different prognoses, the clinical importance ofproliferation markers has not yet been elucidated. Previous studies in male breast cancer have demonstrated contradictory results regarding the prognostic impact of histological grade and Ki-67, parameters strongly associated with proliferation. The aim of the present project was to studyproliferation in male breast cancer by assessing other proliferation-related markers viz. cyclins A, B, D1 and mitotic count. A total of 197 male breast cancer cases with accessible paraffin-embedded material and outcome data were investigated. Immunohistochemical stainings were performed on tissue microarrays. Kaplan-Meier estimates and the Cox proportional regression models were used for survival analyses with breast cancer death as the event. The subset ofpatients with high expression of cyclin A (hazard ratio (HR) 3.7; P=0.001) and B (HR 2.7; P=0.02) demonstrated a poorer survival. Furthermore, high mitotic count was associated with an increased risk of breast cancer death (HR 2.5; P=0.01). In contrast, cyclin D1 overexpression was predictive of better breast cancer survival (HR 0.3; P=0.001). In conclusion, high levels of cyclin A and B expression and an elevated mitotic count result in a two to threefold higher risk forbreast cancer death, whereas cyclin D1 overexpression halves the risk. The clinical utility of these proliferation markers needs further elucidation. </p>
  • Nilsson, Cecilia, et al. (författare)
  • Similarities and differences in the characteristics and primary treatment of breast cancer in men and women : a population based study (Sweden)
  • 2011
  • Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 50:7, s. 1083-1088
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Purpose. Male breast cancer (MBC) is an uncommon disease. In the absence of randomized studies, current guidelines are mainly based on data on the management of female breast cancer (FBC). In light of concerns regarding the quality and extent of management in men, the aim of the present study was to investigate whether there are differences in tumor characteristics, treatment and outcome in male compared with FBC patients.</p> <p>Methods. Cohorts of male and female breast cancer were retrospectively analyzed. All male patients diagnosed with invasive breast cancer between 1993 and 2007 were identified from the Regional Breast Cancer Register of the Uppsala-rebro Region in Sweden. To increase the power of the study and obtain comparable cohorts we sampled four FBC patients (n = 396) for each MBC patient (n = 99) with similar age at diagnosis and time of diagnosis.</p> <p>Results. No differences were seen in stage at diagnosis between MBC and FBC. Men underwent mastectomy more often than women (92% vs. 44%, p &lt; 0.001). Radiotherapy was delivered less often to MBC than FBC (44% vs. 56%, p = 0.034), but radiotherapy given after mastectomy (44% vs. 39%, p = 0.47) did not differ between the groups. No differences were found regarding adjuvant chemotherapy (16% vs. 21%; p = 0.31) or adjuvant endocrine therapy (59% vs. 52%, p = 0.24). Both overall survival (41% vs. 55%, p = 0.001) and relative survival (74% vs. 88%, p = 0.015) were inferior in MBC compared to FBC.</p> <p>Conclusion. Concerns regarding less extensive treatment in MBC patients were not supported by this study. Although no differences in the stage of the disease or treatment intensity could be demonstrated, outcome was inferior in the male group.</p>
  • Nilsson-Ihrfelt, Elisabeth, et al. (författare)
  • Autobiographical memories in patients treated for breast cancer
  • 2004
  • Ingår i: Journal of Psychosomatic Research. - 0022-3999 .- 1879-1360. ; 57:4, s. 363-366
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Objective Previous research has shown that several clinical groups have difficulties with generating specific autobiographical memories. The aim of this study was to investigate autobiographical memory function in women who had been treated for breast cancer and to compare those patients who had undergone mastectomy only with those who had undergone breast reconstruction surgery after mastectomy. Method A sample of 26 women treated for breast cancer were tested via telephone using the Autobiographical Memory Test (AMT). Results Breast cancer patients had difficulty retrieving specific autobiographical memories compared to a group of age-matched controls without any history of breast cancer. There were essentially no differences between the two patient groups. Conclusion Since breast cancer patients are vulnerable to emotional distress, autobiographical memory deficits should be investigated further. © 2004 Elsevier Inc. All rights reserved.</p>
  • Nilsson-Ihrfelt, Elisabeth, et al. (författare)
  • Breast cancer on the Internet : The quality of Swedish breast cancer websites
  • 2004
  • Ingår i: Breast. - 0960-9776 .- 1532-3080. ; 13:5, s. 376-382
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>The aim of this study was to investigate the quality of Swedish-language breast cancer information available on the Internet. The questions explored were the extent and type of breast cancer information available, the coverage and correctness of that information, and whether the websites fulfilled the European Commission quality criteria for health-related websites. Three search engines were used to find websites containing medical information on breast cancer. An oncologist then evaluated the 29 relevant sites. Only seven of these were judged suitable for breast cancer patients. The coverage and correctness of the medical information varied considerably. None of the websites fulfilled the European Commission quality criteria. Therefore, considerable effort will be required before the Internet can serve as a valuable and up-to-date source of information on breast cancer for both professionals and laypersons. Our findings broadly match the results of earlier studies of English-language websites.</p>
  • Nordin, Karin, et al. (författare)
  • How can health care help female breast cancer patients reduce their stress symptoms? A randomized intervention study with stepped-care
  • 2012
  • Ingår i: BMC Cancer. - 1471-2407 .- 1471-2407. ; 12, s. 167
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: A life threatening illness such as breast cancer can lead to a secondary diagnosis of PTSD (post traumatic stress disorder) with intrusive thoughts and avoidance as major symptoms. In a former study by the research group, 80% of the patients with breast cancer reported a high level of stress symptoms close to the diagnosis, such as intrusive thoughts and avoidance behavior. These symptoms remained high throughout the study. The present paper presents the design of a randomized study evaluating the effectiveness and cost-effectiveness of a stress management intervention using a stepped-care design.</p><p>Method: Female patients over the age of 18, with a recent diagnosis of breast cancer and scheduled for adjuvant treatment in the form of chemotherapy, radiation therapy and/or hormonal therapy are eligible and will consecutively be included in the study. The study is a prospective longitudinal intervention study with a stepped-care approach, where patients will be randomised to one of two interventions in the final stage of treatment. The first step is a low intensity stress-management intervention that is given to all patients. Patients who do not respond to this level are thereafter given more intensive treatment at later steps in the program and will be randomized to more intensive stress-management intervention in a group setting or individually. The primary out-come is subjective distress (intrusion and avoidance) assessed by the Impact of Event Scale (IES). According to the power-analyses, 300 patients are planned to be included in the study and will be followed for one year. Other outcomes are anxiety, depression, quality of life, fatigue, stress in daily living and utilization of hospital services. This will be assessed with well-known psychometric tested questionnaires. Also, the cost-effectiveness of the intervention given in group or individually will be evaluated.</p><p>Discussion: This randomized clinical trial will provide additional empirical evidence regarding the effectiveness of a stress-management program given in group or individually during adjuvant therapy in terms of decreased stress, minimizing fatigue, and maintaining or enhancing patients' quality of life and psychological well-being.</p>
  • Strand, Carina, et al. (författare)
  • Combination of the proliferation marker cyclin A, histological grade, and estrogen receptor status in a new variable with high prognostic impact in breast cancer
  • 2012
  • Ingår i: Breast Cancer Research and Treatment. - 0167-6806 .- 1573-7217. ; 131:1, s. 33-40
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Global gene expression profiles, consisting mainly of genes associated with proliferation, have been shown to subdivide histological grade 2 breast cancers into groups with different prognosis. We raised the question whether this subdivision could be done using a single proliferation marker, cyclin A. Furthermore, we combined cyclin A (CA), histological grade (G), and estrogen receptor-ER (E) into a new variable, CAGE. Our aim was to investigate not only the prognostic importance of cyclin A alone but also the value of the combination variable CAGE. In 219 premenopausal node-negative patients, cyclin A was assessed using immunohistochemistry on tissue microarrays. High cyclin A was defined as above the seventh decile of positive cells. Only 13% of the patients received adjuvant systemic therapy. Cox proportional hazards regression was used to model the impact of the factors on distant disease-free survival (DDFS). Cyclin A divided histological grade 2 tumors into two groups with significantly different DDFS (hazard ratio [HR]: 15, P &lt; 0.001). When stratifying for ER status, cyclin A was a prognostic factor only in the ER positive subgroup. We found that CAGE was an independent prognostic factor for DDFS in multivariate analysis (HR: 4.1, P = 0.002), together with HER2. CAGE and HER2 identified 53% as low-risk patients with a 5-year DDFS of 95%. A new prognostic variable was created by combining cyclin A, histological grade, and ER (CAGE). CAGE together with HER2 identified a large low-risk group for whom adjuvant chemotherapy will have limited efficacy and may be avoided.</p>
  • Welin, Staffan, et al. (författare)
  • Expression of tyrosine kinase receptors in malignant midgut carcinoid tumors
  • 2006
  • Ingår i: Neuroendocrinology. - 0028-3835 .- 1423-0194. ; 84:1, s. 42-48
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: The expression of certain tyrosine kinase receptors (TKR) has been shown to have a prognostic value in many tumor entities. In recent years, inhibitors and monoclonal antibodies directed towards these receptors have been developed. Several have shown antitumoral effects and have been tested in clinical trials. We wanted to investigate whether midgut carcinoid tumors express TKR and therefore would be suitable for clinical trials with TKR inhibitors (TKRI) or monoclonal antibodies. Material and Methods: Tumor tissue from 36 patients (24 women and 12 men) with a malignant midgut carcinoid tumor was obtained. The tissues were examined with immunohistochemistry, using polyclonal antibodies against platelet-derived growth factor receptor-α (PDGFRα), platelet-derived growth factor receptor-β (PDGFRβ), epidermal growth factor receptor (EGFR) and c-kit. Human BON1 cells were cultivated and stimulated with PDGF-BB. We also present a case report of a patient with a malignant midgut carcinoid tumor who had stabilization of tumor growth during treatment with imatinib. Results: Immunohistochemical staining for PDGFRα in tumor cells showed immunoreaction for the receptor in 13/34 (38%) for PDGFRβ in 29/33 (88%), and 24/33 (73%) were immunoreactive for EGFR. No tumor tissue showed immunoreaction for c-kit. In tumor stroma PDGFRα was expressed in 35%, PDGFRβ in 94% and EGFR in 9%. We show that human neuroendocrine tumor cells respond to PDGF, indicating that these tumors express functional PDGF receptors. Conclusion: Malignant midgut carcinoid tumors may express three of the four TKR tested in this investigation. Therefore, these tumors might be susceptible for treatment with TKRI or monoclonal antibodies and this should be further explored in clinical trials.</p>
  • Zduniak, K., et al. (författare)
  • Nuclear osteopontin-c is a prognostic breast cancer marker
  • 2015
  • Ingår i: British Journal of Cancer. - 0007-0920 .- 1532-1827. ; 112:4, s. 729-738
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Although Osteopontin has been known as a marker for cancer progression, the elevated production of this cytokine is not specific for cancer. We have identified the splice variant Osteopontin-c as being absent from healthy tissue but associated with about 75% of breast cancer cases. However, in previous studies of Osteopontin-c, follow-up information was not available. Methods: Here we have analysed 671 patients, comprising a cohort of 291 paraffin blocks plus a population-based case-control study of 380 arrayed breast tumor tissues. Results: We find that high staining intensity of nuclear Osteopontin-c is strongly associated with mortality in patients with early breast cancer. Cytosolic staining for exon 4, reflective of Osteopontin-a and -b also predicts poor outcome. By contrast, total Osteopontin does not correlate with prognosis. These diverse assessments of Osteopontin also do not correlate with each other, suggesting distinct expression patterns for the variant forms. Consistent with its role in tumor progression, not tumor initiation, Osteopontin-c is not correlated with proliferation markers (Ki-67, cyclin A, cyclin B, cyclin E and cyclin D), neither is it correlated with ER, PR or HER2. Conclusions: The addition of Osteopontin-c immunohistochemistry to standard pathology work-ups may have prognostic benefit in early breast cancer diagnosis.</p>
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