1980: Breast cancer in Tunisia appears to be a more aggressive malignancy than in other parts of the world.
ASCO Poster 682, Levine, PH
“More than 55% of Tunisian breast cancer patients have RPBC which appears to be refractory to local/regional control and which includes many patients with clinical signs of inflammation similar to inflammatory breast cancer in the United States. We have tried to characterize RPBC pathologically and immunologically, comparing its features to breast cancer in the U.S. In a study of 143 biopsies obtained from Tunisian breast cancer patients, we found that RPBC was associated with a poor nuclear grade and plugging of the dermal lymphatics with tumor microemboli. Our studies indicate that RPBC is an entity that occurs in unusually high frequency in Tunisia but has a less well recognized counterpart in the United States.”
1980: Epidemiologic features of rapidly progressing breast cancer in Tunisia.
Cancer 1980 Dec 15;46(12):2741-6, Mourali, N, et al.
“A form of breast cancer characterized by rapid disease progression, inflammation, and edema is found in approximately 55% of the breast cancer patients presenting at the Institute Salah Azaiz, Tunis (Tunisia). Rural residence, blood type A, and recent pregnancy are risk factors among premenopausal women, but older age, rural residence, blood type A, late menarche, and delay in diagnosis are associated with postmenopausal rapidly progressing breast cancer. The most significant risk factors were rural residence and blood type A. Rapidly progressing breast cancer was diagnosed in two of every three breast cancer patients coming from a rural environment. Forty-three percent of 203 patients with rapid disease progression were blood type A, a significantly higher percentage than the 33% found in the general Tunisian population and the breast cancer patients without evidence of rapidly progressive disease. We observed that the risk factors for disease progression were quite different from those reported to influence the incidence of breast cancer.”
1981: Studies on the role of cellular immunity and genetics in the etiology of rapidly progressing breast cancer in Tunisia.
Int J Cancer 1981 May 15;27(5):611-5, Levine PH, et al.
“It has been suggested that poussee evolutive (PEV) or rapidly progressing breast cancer (RPBC) represents a failure in the host immune system to control the proliferation of breast cancer cells. Normal Tunisians were more immunocompetent, however, an appeared to have a higher level of immune activity than normal individuals in the United States. In a second, independent series, an increased frequency of blood group A was found in RPBC patients, suggesting a genetic predisposition to this form of breast cancer. However HLA typing for A, B and DRW antigens revealed no specific RPBC-associated HLA antigen. Our studies clearly demonstrate that RPBC, or PEV, is not a reflection of immunodeficiency.”
1982: Histopathological features of rapidly progressing breast carcinoma in Tunisia: a study of 94 cases.
Int J Cancer 1982 Jul 15;30(1):35-7, Costa, J, et al.
“The histological features of 94 cases of carcinoma of the breast seen in Tunisia were recorded and subsequently correlated with the clinical classification of the patients in terms of poussee evolutive (PEV) categories. Histological features analyzed in the breast tissues and skin included tumor type, nuclear grade, number of mitoses, involvement of the dermis, cutaneous inflammatory infiltrate and edema. Twenty-eight percent of the cases in which the skin was examined showed tumor emboli in the lymphatics of the dermis. The frequency of cutaneous permeation correlated with the PEV categories. The percentage of cases with nuclear grade 3 was higher for the group with rapid progression of the disease (PEV 1,2,3) than for the cases belonging to the PEV-0 category (90% versus 64.2%). The present study demonstrates that a large proportion of breast carcinoma patients in Tunisia suffer from “inflammatory carcinoma of the breast.”
1983: Metastases to the breast.
AJR Am J Roentgenol 1983 Oct;141(4):685-90, McCrea, ES, et al.
“Metastases to the breast are uncommon, with about 250 cases reported from clinical and autopsy series. The mammographic findings in 16 new cases revealed a spectrum of changes that included solitary or multiple lesions, well demarcated or poorly marginated masses, and diffuse involvement of skin or parenchyma or both. Diffuse disease was seen more frequently in this series (4/16), at times simulating inflammatory breast cancer. Although diagnosis of a primary malignancy usually preceded detection of the breast lesion, 40% (6/16) had no history of malignancy. Prognosis remains poor; however, it has improved in the lymphoma-leukemia group due to improved immunotherapeutic and chemotherapeutic regimens. The clinical, radiologic, and pathologic features are discussed. Some of the lesions encountered can be confused with a primary breast malignancy or a benign lesion, necessitating prompt and accurate biopsy to preclude unnecessary major surgery and to improve survival in cancers amenable to current therapy.”
1984: Increased incidence of mouse mammary tumor virus-related antigen in Tunisian patients with breast cancer.
Int J Cancer 1984 Mar 15;33(3):305-8, Levine, PH, et al.
“We conclude that the identification of gp52-related antigens in the breast cancer biopsies from North African women has implications different from those observed in other populations. While thus far not indicative of disease aggressiveness and prognosis, the higher frequency of detectable antigen in comparison to biopsies obtained from patients born in the United States and Europe may have relevance to the etiology and pathogenesis of the disease.”
1984: Hormone receptors in rapidly progressing breast cancer.
Cancer 1984 Dec 15;54(12):3012-6, Levine, PH, et al.
“Tunisian patients with rapidly progressing breast cancer (RPBC) had lower ER levels than American patients or Tunisian patients without evidence of RPBC. Lower ER levels in the earliest stage of RPBC, which presents without inflammatory signs, supported epidemiologic and pathologic studies indicating that rapid growth as reported by the patient is an important aspect of RPBC.“
