Phytoestrogens and PCBs are environmental exposures that may delay breast development, especially in conjunction with BMI, which governs the endogenous hormonal milieu. Further research to confirm these findings may improve our understanding of the role of early life development in breast cancer risk and other chronic diseases related to obesity.

Lower socioeconomic status and lack of access to care are often implicated as plausible causes for African American women to present with later stage breast cancer than Caucasian women. Our objective is to determine if racial differences are present in newly diagnosed breast cancer in women of equivalent socioeconomic status. A retrospective review of prospectively gathered data from women with newly diagnosed breast cancer was performed. All women presented to the indigent (uninsured and below the poverty line) breast clinic for evaluation and treatment of their breast pathology. Data pertaining to epidemiologic factors, diagnosis, pathology, and treatment were collected. The data were analyzed by chi-squared and tailed t-tests. Between March 2002 and May 2004, 52 women (African American=36, Caucasian=16) were diagnosed with breast cancer at our clinic. The median age for both groups at presentation was 56.6 years. The staging assessment based on the pathologic size of the tumor was also equivalent between African American and Caucasian women at 2.29 cm and 2.21 cm, respectively. Metastatic lymph node involvement occurred in 14 women (African American=7, Caucasian=7), with 19.4% African American and 43.8% Caucasian being node positive (p=0.068). In fact, there were no statistically significant differences between the races for menarche, menopause, body mass index (BMI), duration of symptoms before presentation, type of diagnostic biopsy or surgery chosen, histology, receptor status, utilization of chemotherapy and radiation, and length of follow-up. The only statistical differences found were in the age of the first live birth (African American=19, Caucasian=22; p=0.028), the use of ultrasound in initial evaluation of a breast mass (less use in African American; p=0.012), and utilization of sentinel lymph node biopsy (Caucasian=75%, African American=42%; p=0.026). Breast cancer in African American women traditionally presents at a more advanced stage and with poor prognostic features. However, when matched for lower socioeconomic status, racial disparities essentially disappear.

Male breast cancer is a rare clinical entity accounting for approximately 1 per cent of all breast cancers. The present study investigated changes in patient characteristics, disease patterns, treatment, and outcomes over a 30-year period. A retrospective chart review was performed on male breast cancer patients treated between 1975 and 2005 at Eastern Virginia Medical School, Norfolk, VA. Demographic, pathologic, treatment, and survival information was collected. To facilitate comparison of trends, the patients were divided into two groups: Cohort A (1972–1991, previously reported) and Cohort B (1992–2005). Both cohorts included 28 male patients. Comparing the cohorts, no statistical differences were noted in median age, ethnicity, presenting symptoms, or progesterone receptor status. In Cohort A, 70 per cent of patients were estrogen receptor positive, compared with 100 per cent of Cohort B ( P = 0.02). Her2/neu was positive in three of five patients in Cohort B. There was a trend toward more conservative surgery, with no radical mastectomy or orchiectomy performed in Cohort B. Only two patients had sentinel lymph node mapping, both from Cohort B. Infiltrating ductal carcinoma was more prevalent in Cohort B ( P = 0.04). For Cohort A and B, 5-year survival was 43 per cent and 51 per cent, respectively, which was not statistically significant. For male breast cancer, radical mastectomy is no longer a common treatment modality. Male breast cancer of today is more hormonally responsive which may have important implications for therapy. Survival has not significantly improved over the previous 30 years. Compilation of multi-institutional data of male breast cancer is needed to advance the treatment of this uncommon disease.

Infectious complications in the intensive care unit (ICU) are classically identified when an elevated temperature triggers obtaining cultures. Elevated temperature, however, is a nonspecific marker of infection and may occur well into the course of the infection. The goal of this study was to evaluate whether escalating insulin demands may serve as an earlier marker for infection. A retrospective review of a prospective database from a trauma ICU over a 6-month period was done for all patients who developed infection while in the ICU. All patients in the ICU are placed at admission on an intensive insulin protocol with target blood glucose levels between 80 and 110 mg/dL. Data were collected on infection, insulin needs, blood glucose levels, temperature, white blood cell count, and antibiotic use. Twenty-four infections were identified, with 16 pneumonias, four bloodstream infections, and four urinary tract infections. Twelve of the 24 patients had increasing insulin needs in the 3 days preceding their infection diagnosis, with nine of the 12 requiring continued escalation of insulin needs from preinfection Day 3 to 2 to 1 (D3, D2, D1). In five of the 12 patients, the escalation of insulin dose preceded the elevated temperature, and in three of the 12 patients, the escalation preceded elevation of the white blood cell count above 12. For all 24 patients, the average insulin dose increased steadily, from 1.8 U/hr on D3 preinfection to 2.5 U/hr D2 and 3.1 U/hr D1. Infection does seem to be preceded by escalating insulin demands in many patients. A prospective study to evaluate the value of increased insulin demand as a marker for developing infection is warranted.