Patient case: 73-year-old female with breast cancer; genetic feature: CDKN2A

Clinical trial: High-Risk Breast Duct Epithelium

Summary: Background:
  Breast cancer is the most common malignancy in women, occurring in over 230,000 women annually in the United States.
  The vast majority of breast cancers originate in the single layer of epithelial cells that line the ductal/lobular system of the breast milk ducts. The premalignant changes which occur in the transformed epithelium are not well understood, however several cytologic or histologic changes have been identified which are associated with an increased risk for breast cancer, including ductal or lobular hyperplasia, hyperplasia with atypia, and lobular or ductal carcinoma in situ.
  The identification of cytological or histological abnormalities in breast epithelial cells is an important component of risk assessment.
  Objectives:
  The primary objectives are:
  To determine the incidence and nature of cytologic changes in ductal epithelial cells from the high risk breast, in specimens collected by breast duct lavage, and to determine if these cytologic findings are different from those of normal women not at increased risk for breast
  cancer.
  To characterize by breast duct endoscopy, high risk breast ductal epithelium and architecture, and correlate these findings with the cytologic findings from above.
  To determine what is the global gene expression pattern of high risk breast epithelial cells from the high risk breast, and does this differ from that of breast epithelial cells from normal women not at increased risk for breast cancer. The gene expression profile will be
  determined by cDNA microarray and validated by RT-PCR.
  Eligibility:
  Eligibility for high risk individuals will include:
  -  Women of any age with a unilateral invasive or noninvasive (DCIS) breast cancer of epithelial origin.
  -  Women without breast cancer, but with a Gail Index greater than 1.67%, or a cumulative lifetime risk greater than or equal to double the age- and race-matched general population risk.
  -  Women known to be BRCA1/2 or other hereditary genes mutation carriers.
  -  Women with cytologic or histologic evidence of ductal hyperplasia, atypical ductal hyperplasia, or lobular carcinoma in situ.
  -  Women may be either premenopausal or postmenopausal. Postmenopausal is defined by the absence of menstrual periods for at least 12 months.
  -  Postmenopausal women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of >40 IU/ml, and a serum estradiol level of less than40 pg/ml to document postmenopausal status.
  Eligibility for normal volunteers will include:
  -  Women who are premenopausal or postmenopausal with a Gail model risk index less than 1.67%, and without a cumulative lifetime risk greater than or equal to double the age- and racematched general population risk.
  -  Women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of >40 IU/ml, and a serum estradiol level of less than 40 pg/ml to document postmenopausal status.
  -  Both breasts must be free of any suspicious areas by physical examination and, for women over 30 years of age by mammogram. There must be no past history of atypical hyperplasia, invasive or in situ carcinoma.
  Both groups must have acceptable WBC and platelet counts.
  Design:
  Breast ductal epithelial cells will be collected by breast duct lavage from a.) the breast in women at increased risk for breast cancer, and b.) the breast of female normal volunteers who are not at increased risk for breast cancer.
  Ductal epithelial cell specimens will be analyzed cytologically for the presence of hyperplasia, atypia, or in situ changes.
  Breast duct endoscopy will be performed in breast cancer patients and in normal volunteers with cytologic atypia on ductal lavage to determine ductal architectural changes associated with increased risk for breast cancer, and to provide correlation with cytologic atypia.
  The gene expression profile of normal and high risk ductal epithelial cells will be studied by cDNA-microarray to determine changes in gene expression associated with increased risk for breast cancer.
  Additional molecular profiling experiments which will be performed as lavage cells are available include DNA whole exome sequencing, Comparative Genomic Hybridization (CGH), proteomic tissue lysate arrays, and identification of mammary stem cells.
  A total of 104 high risk subjects and 80 normal volunteers will be studied, divided approximately evenly between premenopausal and postmenopausal women.

Detailed description: Background:
  Breast cancer is the most common malignancy in women, occurring in over 230,000 women annually in the United States.
  The vast majority of breast cancers originate in the single layer of epithelial cells that line the ductal/lobular system of the breast milk ducts. The premalignant changes which occur in the transformed epithelium are not well understood, however several cytologic or histologic changes have been identified which are associated with an increased risk for breast cancer, including ductal or lobular hyperplasia, hyperplasia with atypia, and lobular or ductal carcinoma in situ.
  The identification of cytological or histological abnormalities in breast epithelial cells is an important component of risk assessment.
  Objectives:
  The primary objectives are:
  To determine the incidence and nature of cytologic changes in ductal epithelial cells from the high risk breast, in specimens collected by breast duct lavage, and to determine if these cytologic findings are different from those of normal women not at increased risk for breast
  cancer.
  To characterize by breast duct endoscopy, high risk breast ductal epithelium and architecture, and correlate these findings with the cytologic findings from above.
  To determine what is the global gene expression pattern of high risk breast epithelial cells from the high risk breast, and does this differ from that of breast epithelial cells from normal women not at increased risk for breast cancer. The gene expression profile will be
  determined by cDNA microarray and validated by RT-PCR.
  Eligibility:
  Eligibility for high risk individuals will include:
  -  Women of any age with a unilateral invasive or noninvasive (DCIS) breast cancer of epithelial origin.
  -  Women without breast cancer, but with a Gail Index greater than 1.67%, or a cumulative lifetime risk greater than or equal to double the age- and race-matched general population risk.
  -  Women known to be BRCA1/2 or other hereditary genes mutation carriers.
  -  Women with cytologic or histologic evidence of ductal hyperplasia, atypical ductal hyperplasia, or lobular carcinoma in situ.
  -  Women may be either premenopausal or postmenopausal. Postmenopausal is defined by the absence of menstrual periods for at least 12 months.
  -  Postmenopausal women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of >40 IU/ml, and a serum estradiol level of less than40 pg/ml to document postmenopausal status.
  Eligibility for normal volunteers will include:
  -  Women who are premenopausal or postmenopausal with a Gail model risk index less than 1.67%, and without a cumulative lifetime risk greater than or equal to double the age- and racematched general population risk.
  -  Women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of >40 IU/ml, and a serum estradiol level of less than 40 pg/ml to document postmenopausal status.
  -  Both breasts must be free of any suspicious areas by physical examination and, for women over 30 years of age by mammogram. There must be no past history of atypical hyperplasia, invasive or in situ carcinoma.
  Both groups must have acceptable WBC and platelet counts.
  Design:
  Breast ductal epithelial cells will be collected by breast duct lavage from a.) the breast in women at increased risk for breast cancer, and b.) the breast of female normal volunteers who are not at increased risk for breast cancer.
  Ductal epithelial cell specimens will be analyzed cytologically for the presence of hyperplasia, atypia, or in situ changes.
  Breast duct endoscopy will be performed in breast cancer patients and in normal volunteers with cytologic atypia on ductal lavage to determine ductal architectural changes associated with increased risk for breast cancer, and to provide correlation with cytologic atypia.
  The gene expression profile of normal and high risk ductal epithelial cells will be studied by cDNA-microarray to determine changes in gene expression associated with increased risk for breast cancer.
  Additional molecular profiling experiments which will be performed as lavage cells are available include DNA whole exome sequencing, Comparative Genomic Hybridization (CGH), proteomic tissue lysate arrays, and identification of mammary stem cells.
  A total of 104 high risk subjects and 80 normal volunteers will be studied, divided approximately evenly between premenopausal and postmenopausal women.

Eligibility: -  INCLUSION CRITERIA:
  -  Breast Cancer and High Risk Patients:
  -  Women of any age with a unilateral invasive or noninvasive (DCIS) breast cancer of epithelial origin.
  -  Women without breast cancer, but with a Gail Index greater than 1.67%, or a cumulative lifetime risk greater than or equal to double the age- and race-matched general population risk.
  -  Women known to be BRCA1/2 or other hereditary genes mutation carriers.
  -  Women with cytologic or histologic evidence of ductal hyperplasia, atypical ductal hyperplasia, or lobular carcinoma in situ.
  -  Women may be either premenopausal or postmenopausal. Postmenopausal is defined by the absence of menstrual periods for at least 12 months.
  -  Postmenopausal women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of greater than 40 IU/ml, and a serum estradiol level of less than 40 pg/ml to document postmenopausal status.
  -  Breast cancer may be invasive or noninvasive, and in the past or the present.
  -  The contralateral breast of women with breast cancer, or the normal breast of high risk subjects, must be free of any suspicious areas by physical examination and mammogram, and without past history of invasive ductal or in situ ductal carcinoma. A past history of atypia or LCIS on a previous biopsy is acceptable.
  -  Women who are from a family with heritable breast cancer with a known deleterious BRCA1/2 or other hereditary genes mutation, who themselves have been tested and to not carry this mutation. These women are not at increased risk for breast cancer due to the familial mutation and are eligible to participate as normal volunteers.
  -  WBC greater than 2500.
  -  Platelets greater than 50,000.
  -  Normal Volunteers:
  -  Women who are premenopausal or postmenopausal with a Gail model risk index less than 1.67%, and without a cumulative lifetime risk greater than or equal to double the age- and race-matched general population risk.
  -  Women who have previously undergone a hysterectomy without oophorectomy must have a serum FSH level of greater than 40 IU/ml, and a serum estradiol level of less than 40 pg/ml to document postmenopausal status.
  -  Both breasts must be free of any suspicious areas by physical examination and, for women over 30 years of age by mammogram. There must be no past history of atypical hyperplasia, invasive or in situ carcinoma.
  -  WBC greater than 2500.
  -  Platelets greater than 50,000.
  EXCLUSION CRITERIA:
  -  Breast Cancer Patients:
  -  Contralateral breast prosthesis.
  -  Pregnancy.
  -  History of radiation therapy to the contralateral breast.
  -  Lactating breasts.
  -  Chemotherapy within the past 1 month.
  -  Current antiestrogen therapy.
  -  Current hormonal replacement therapy or oral contraceptives.
  -  Concurrent infection.
  -  Previous contralateral major duct excision.
  -  High Risk Subjects:
  -  Bilateral breast prosthesis.
  -  Pregnancy.
  -  Lactating breasts.
  -  Current antiestrogen therapy.
  -  Current hormonal replacement therapy or oral contraceptives.
  -  Concurrent infection.
  -  Previous bilateral major duct excision.
  -  History of therapeutic mediastinal radiation.
  -  Normal Volunteers:
  -  Bilateral breast prosthesis.
  -  Pregnancy.
  -  Lactating breasts.
  -  Current antiestrogen therapy.
  -  Current hormonal replacement therapy or oral contraceptives.
  -  Concurrent infection.
  -  Previous bilateral major duct excision.
  -  History of therapeutic mediastinal radiation.

Relevance to patient case: not relevant