Deborah M Axelrod, M.D.

Nonimage-guided fine needle aspiration biopsy of palpable axillary lymph nodes in breast cancer patients
Marti, Jennifer L; Ayo, Diego; Levine, Pascale; Hernandez, Osvaldo; Rescigno, John; Axelrod, Deborah M
2012 Jan;18(1):3-7, Breast journal
Synopsis We report the utility of office-based, nonimaged guided fine needle aspiration of palpable axillary lymph nodes in breast cancer patients. We examine the sensitivity and specificity of this procedure, and examine factors associated with a positive fine needle aspiration biopsy result. Abstract: Although the utility of ultrasound-guided fine needle aspiration biopsy (FNA) of axillary lymph nodes is well established, there is little data on nonimage guided office-based FNA of palpable axillary lymphadenopathy. We investigated the sensitivity and specificity of nonimage-guided FNA of axillary lymphadenopathy in patients presenting with breast cancer, and report factors associated with a positive FNA result. Retrospective study of 94 patients who underwent office-based FNA of palpable axillary lymph nodes between 2004 and 2008 was conducted. Cytology results were compared with pathology after axillary sentinel node or lymph node dissection. Nonimage-guided axillary FNA was 86% sensitive and 100% specific. On univariate analysis, patients with positive FNA cytology had larger breast tumors (p = 0.007), more pathologic positive lymph nodes (p < 0.0001), and were more likely to present with a palpable breast mass (p = 0.006) or with radiographic lymphadenopathy (p = 0.002). FNA-positive patients had an increased presence of lymphovascular invasion (p = 0.001), higher stage of disease (p < 0.001), higher N stage (p < 0.0001), and higher rate of HER2/neu expression (p = 0.008). On multivariate analysis, radiographic lymphadenopathy (p = 0.03) and number of positive lymph nodes (p = 0.04) were associated with a positive FNA result. Nonimage-guided FNA of palpable axillary lymphadenopathy in breast cancer patients is an inexpensive, sensitive, and specific test. Prompt determination of lymph node positivity benefits select patients, permitting avoidance of axillary ultrasound, sentinel lymph node biopsy, or delay in receiving neoadjuvant therapy. This results in time and cost savings for the health care system, and expedites definitive management
— id: 149784, year: 2012, vol: 18, page: 3, stat: Journal Article,

A Community Intervention: AMBER: Arab American Breast Cancer Education and Referral Program
Ayash, Claudia; Axelrod, Deborah; Nejmeh-Khoury, Sana; Aziz, Arwa; Yusr, Afrah; Gany, Francesca M
2011 Dec;13(6):1041-1047, Journal of Immigrant & Minority Health
Although the number of Arab Americans is growing in the United States, there is very little data available on this population's cancer incidence and screening practices. Moreover, there are few interventions addressing their unique needs. This study aims to determine effective strategies for increasing breast cancer screening in at-risk underserved Arab American women. AMBER utilizes a community based participatory approach to conduct formative research and program interventions, including culturally appropriate Arabic language breast cancer education, screening coordination, and cultural competency training for healthcare professionals in New York City. In 2 years, 597 women were educated, 189 underserved women were identified as being in need of assistance, 68 were screened, one new case of breast cancer was detected, and four active cases in need of follow-up reconnected with care. The AMBER model is an important intervention for breast cancer screening and care in the underserved Arab American community
— id: 140520, year: 2011, vol: 13, page: 1041, stat: Journal Article,

Surgical outcomes of 63 patients from an international trial of preoperative concurrent paclitaxel- Radiation in locally advanced breast cancer
Dhage S.; Axelrod D.; Guth A.; Vijaykumar D.K.; Apffelstaedt J.; Formenti S.
2011 ;18:S166-S166, Annals of surgical oncology
Objective: Locally advanced breast cancer (LABC) is the most common presentation of breast cancer worldwide. In the United States, neoadjuvant therapy has become the standard of care for LABC. Recently, Adams et al reported a 34% pathologic response rate among 105 patients with LABC treated with taxanebased, preoperative chemo-radiation: 5-year DFS and OS results were comparable to those of much more aggressive chemotherapy regimens in the neoadjuvant setting. As is reported for patients treated by neoadjuvant chemotherapy, the achievement of a pathological response to chemo-radiation reflected better DFS and OS. Importantly, a pathological response occurred in 54% of patients with hormone-negative tumors. Since this approach is simple and cost-effective, it has attracted interest from several international centers. We report the surgical outcomes after taxane-radiation in 63 LABC patients treated in a multiinstitutional clinical trial in India, South Africa, and the United States. Methods: Women with LABC (stages IIB-IIIC), ECOG performance status of 0 to 1, were eligible. Patients were treated with paclitaxel (30 mg/m(2) intravenously twice a week) for 6-12 weeks. Daily radiotherapy was delivered to breast, axillary, and supraclavicular lymph nodes during weeks 2-7 of paclitaxel treatment, at 1.8 Gy per fraction to a total dose of 45 Gy with a tumor boost of 14 Gy at 2 Gy/fraction. Seventeen of 63 patients received four cycles of doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 prior to the paclitaxel -RT regimen. Mastectomy or lumpectomy, as decided by each surgeon, was performed 4 weeks after completion of preoperative therapy or upon recovery of chemoradiationinduced dermatitis. All patients had a level I/II axillary lymph node dissection. Postoperatively, patients who responded to paclitaxel and RT received four cycles of doxorubicin/paclitaxel, whereas patients who did not respond received doxorubicin/cytoxan. Surgical complications were recorded. Results: Forty-three patients underwent modified radical mastectomyand 20 underwent lumpectomy. Of mastectomy patients, 17 (39.5%) underwent immediate breast reconstruction: free flap reconstruction (8), pedicle flaps (3), advancement flaps(2), tissue expander placement (2), and major chest wall and sternum reconstruction (1). Of lumpectomy patients, five (25%) had further surgery for positive margins; a second lumpectomy (3), and a mastectomy (2). All revealed residual disease and negative margins were achieved. Twenty-one patients had at least 1 complication of whom 17 were treated as outpatients. Eleven (17.4%) had a recurrent seroma, 8 (12.7%) had delayed healing, and 7 (11.1%) developed a postoperative infection. Of the 17 who underwent reconstruction, 3 (17.6%) developed flap necrosis, requiring surgical debridement. The degree of acute chemo-radiation dermatitis was analyzed to explore correlation with the surgical complications. Dermatitis was grade 1 in 21 patients, grade 2 in 29 patients, grade 3 in 11 patients, and 2 had none. The grade of dermatitis did not correlate with risk of complications. Conclusions: Preoperative paclitaxel with radiotherapy is relatively well tolerated. Risk of complication is similar to that reported in the literature for patients treated with neoadjuvant therapy. The highest morbidity was associated with immediate free flap reconstruction. Delayed reconstruction may be advisable for patients treated with neoadjuvant chemo-radiation. (Table presented)
— id: 137914, year: 2011, vol: 18, page: S166, stat: Journal Article,

The effects of symptomatic seroma on lymphedema symptoms following breast cancer treatment
Fu, M R; Guth, A A; Cleland, C M; Lima, E D R P; Kayal, M; Haber, J; Gallup, L; Axelrod, D
2011 Sep;44(3):134-143, Lymphology
It has been speculated that symptomatic seroma, or seroma requiring needle aspiration, is one of the risk factors for lymphedema symptoms following breast cancer treatment. These symptoms exert tremendous impact on patients' quality of life and include arm swelling, chest/breast swelling, heaviness, tightness, firmness, pain, numbness, stiffness, or impaired limb mobility. Our aim was to explore if symptomatic seroma affects lymphedema symptoms following breast cancer treatment. Data were collected from 130 patients using a Demographic and Medical Information interview tool, Lymphedema and Breast Cancer Questionnaire, and review of medical record. Arm swelling was verified by Sequential Circumferential Arm Measurements and Bioelectrical Impedance Spectroscopy. Data analysis included descriptive statistics, Chi-squared tests, regression, exploratory factor analysis and exploratory structural equation modeling. Thirty-five patients (27%) developed symptomatic seroma. Locations of seroma included axilla, breast, and upper chest. Significantly, more women with seroma experienced more lymphedema symptoms. A well-fit exploratory structural equation model [X2(79) = 92.15, p = 0.148; CFI = 0.97; TLI = 0.96] revealed a significant unique effect of seroma on lymphedema symptoms of arm swelling, chest/breast swelling, tenderness, and blistering (beta = 0.48, p < 0.01). Patients who developed symptomatic seroma had 7.78 and 10.64 times the odds of developing arm swelling and chest/breast swelling versus those who did not, respectively (p < 0.001). Symptomatic seroma is associated with increased risk of developing lymphedema symptoms following breast cancer treatment. Patients who develop symptomatic seroma should be considered at higher risk for lymphedema symptoms and receive lymphedema risk reduction interventions
— id: 146268, year: 2011, vol: 44, page: 134, stat: Journal Article,

Effects of iron deficiency and iron overload on angiogenesis and oxidative stress-a potential dual role for iron in breast cancer (vol 50, pg 841, 2011)
Jian, Jinlong; Yang, Qing; Dai, Jisen; Eckard, Jonathan; Axelrod, Deborah; Smith, Julia; Huang, Xi
2011 JUL 1 ;51(1):243-243, Free radical biology & medicine
— id: 134497, year: 2011, vol: 51, page: 243, stat: Journal Article,

Effects of iron deficiency and iron overload on angiogenesis and oxidative stress-a potential dual role for iron in breast cancer
Jian, Jinlong; Yang, Qing; Dai, Jisen; Eckard, Jonathan; Axelrod, Debrah; Smith, Julia; Huang, Xi
2011 Apr 1;50(7):841-847, Free radical biology & medicine
Estrogen alone cannot explain the differences in breast cancer (BC) recurrence and incidence rates in pre- and postmenopausal women. In this study, we have tested a hypothesis that, in addition to estrogen, both iron deficiency due to menstruation and iron accumulation as a result of menstrual stop play important roles in menopause-related BC outcomes. We first tested this hypothesis in cell culture models mimicking the high-estrogen and low-iron premenopausal condition or the low-estrogen and high-iron postmenopausal condition. Subsequently, we examined this hypothesis in mice that were fed iron-deficient and iron-overloaded diets. We show that estrogen only slightly up-regulates vascular endothelial growth factor (VEGF), an angiogenic factor known to be important in BC recurrence. It is, rather, iron deficiency that significantly promotes VEGF by stabilizing hypoxia-inducible factor-1alpha. Conversely, high iron levels increase oxidative stress and sustain mitogen-activated protein kinase activation, which are mechanisms of known significance in BC development. Taken together, our results suggest, for the first time, that an iron-deficiency-mediated proangiogenic environment could contribute to the high recurrence of BC in young patients, and iron-accumulation-associated pro-oxidant conditions could lead to the high incidence of BC in older women
— id: 130294, year: 2011, vol: 50, page: 841, stat: Journal Article,

Axillary dissection in women with sentinel node metastasis
Rescigno, John; Axelrod, Deborah
2011 ;342:d2510-d2510, British medicial journal. BMJ (Clinical research ed.)
— id: 149785, year: 2011, vol: 342, page: d2510, stat: Journal Article,

Prevention of breast cancer: the case for studying inhibition of IGF-1 actions
Smith, J; Axelrod, D; Singh, B; Kleinberg, D
2011 Jan;22 Suppl 1:i50-i52, Annals of oncology
Measures to prevent breast cancer are receiving particular attention by women at high risk from either clinico-pathologic findings or genetic susceptibility. Life-style and nutritional interventions have been difficult to quantify, but merit further study. Chemoprevention with tamoxifen and subsequently with the related raloxifene demonstrates some efficacy, but may be not be applicable to premenopausal women (with regard to raloxifene), or have low acceptance (with regard to tamoxifen). Based on the importance of the insulin-like growth factor-1 pathway in mammary gland development, and the availability of a potent inhibitor, pilot studies are ongoing to evaluate such an inhibitor in women with demonstrable high risk to develop breast cancer. Short-term interventions with the inhibitor have been completed, and subsequent interventions are planned
— id: 134119, year: 2011, vol: 22 Suppl 1, page: i50, stat: Journal Article,

The Association Between Lobular Involution and Histology in Older Women With Nonpalpable Lesions
Checka, Cristina; Chun, Jennifer; Schnabel, Freya; Darvishian, Farbod; Axelrod, Deborah; Siegel, Beth; Roses, Daniel
2010 APR ;17(2):S166-S166, Annals of surgical oncology
— id: 132518, year: 2010, vol: 17, page: S166, stat: Journal Article,

The effect of providing information about lymphedema on the cognitive and symptom outcomes of breast cancer survivors
Fu, Mei R; Chen, Constance M; Haber, Judith; Guth, Amber A; Axelrod, Deborah
2010 Jul;17(7):1847-1853, Annals of surgical oncology
BACKGROUND: Despite recent advances in breast cancer treatment, breast cancer related lymphedema (BCRL) continues to be a significant problem for many survivors. Some BCRL risk factors may be largely unavoidable, such as mastectomy, axillary lymph node dissection (ALND), or radiation therapy. Potentially avoidable risk factors unrelated to breast cancer treatment include minor upper extremity infections, injury or trauma to the arm, overuse of the limb, and air travel. This study investigates how providing information about BCRL affects the cognitive and symptomatic outcome of breast cancer survivors. METHODS: Data were collected from 136 breast cancer survivors using a Demographic and Medical Information interview instrument, a Lymphedema Education Status interview instrument, a Knowledge Test for cognitive outcome, and the Lymphedema and Breast Cancer Questionnaire for symptom outcome. Data analysis included descriptive statistics, t tests, chi-square (chi(2)) tests, and regression. RESULTS: BCRL information was given to 57% of subjects during treatment. The mean number of lymphedema-related symptoms was 3 symptoms. Patients who received information reported significantly fewer symptoms and scored significantly higher in the knowledge test. After controlling for confounding factors, patient education remains an additional predictor of BCRL outcome. Significantly fewer women who received information about BCRL reported swelling, heaviness, impaired shoulder mobility, seroma formation, and breast swelling. CONCLUSIONS: Breast cancer survivors who received information about BCRL had significantly reduced symptoms and increased knowledge about BCRL. In clinical practice, breast cancer survivors should be engaged in supportive dialogues so they can be educated about ways to reduce their risk of developing BCRL
— id: 149786, year: 2010, vol: 17, page: 1847, stat: Journal Article,

Breast Cancer Chemoprevention in Pre-Neoplastic Lesions with a Somatostatin Analog in Nine Women: A Proof of Principle Trial
Axelrod, D; Smith, JA; Singh, B; Ruan, W; Lubitz, S; Kleinberg, DL
2009 DEC 15 ;69(24):552S-552S, Cancer research
— id: 106452, year: 2009, vol: 69, page: 552S, stat: Journal Article,

Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up
Bernik, Stephanie F; Troob, Scott; Ying, Benjamin L; Simpson, Scott A; Axelrod, Deborah M; Siegel, Beth; Moncrief, Robyn M; Mills, Christopher; Aziz, Mohamed
2009 Apr;197(4):473-478, American journal of surgery
BACKGROUND: Papillary breast lesions comprise a spectrum of histopathologic diagnoses ranging from benign papillomas to papillary carcinomas. There is ongoing controversy regarding the management of papillary lesions diagnosed by core needle biopsy (CNB). Some authors advocate observation of papillary lesions when the CNB is benign, while others recommend surgical excision of all papillary lesions. The current study assessed the adequacy of CNB in evaluating papillary breast lesions. METHODS: A search of the pathology database at our institution identified 122 papillary lesions diagnosed by CNB. The study population consisted of 71 papillary lesions that were subsequently surgically excised. RESULTS: Of the 71 papillary lesions excised, 8 were malignant, 16 were atypical, and 47 were benign at the time of CNB. Of the 47 papillary lesions thought to be benign, 13 (28%) revealed atypia and 4 (9%) revealed malignancy upon surgical excision. Of the 13 atypical papillary lesions on CNB, 7 lesions (54%) were associated with malignancy upon excision. Slightly over half the upgrades were due to finding atypia or malignancy in the tissue surrounding the papillary lesion. The total rate of upgrades from the CNB diagnosis to the excisional diagnosis was 38%. CONCLUSIONS: When a core biopsy of a papillary lesion is encountered, there is a strong likelihood of discovering atypia or malignancy in the index lesion or in close proximity. Therefore, surgical excision should be performed to avoid missing a malignancy and to allow for accurate breast cancer risk assessment that can impact survival and decisions regarding chemoprevention
— id: 93491, year: 2009, vol: 197, page: 473, stat: Journal Article,

Mammographic Density and Lobular Involution in Older Women with Abnormal Breast Imaging
Checka, CM; Chun, J; Schnabel, FR; Darvishian, F; Lee, J; Bergknoff, Y; Axelrod, DM; Siegel, BM; Roses, DF
2009 DEC 15 ;69(24):847S-847S, Cancer research
— id: 106458, year: 2009, vol: 69, page: 847S, stat: Journal Article,

Non-image guided fine needle aspiration of palpable axillary lymph nodes in breast cancer patients
Marti, JL; Ayo, D; Levine, P; Hernandez, O; Rescigno, J; Axelrod, DM
2009 ;69(2):109S-110S, Cancer research
— id: 93514, year: 2009, vol: 69, page: 109S, stat: Journal Article,

Patterns of axillary surgical care for breast cancer in the era of sentinel lymph node biopsy
Rescigno, John; Zampell, Jamie C; Axelrod, Deborah
2009 Mar;16(3):687-696, Annals of surgical oncology
BACKGROUND: Population-based overall patterns of surgical management of the axilla in women with operable breast cancer during the era of adoption of sentinel lymph node biopsy (SLNB) were studied. METHODS: Women with operable breast carcinoma residing in 14 geographic areas of the Surveillance, Epidemiology, and End Results (SEER) cancer registries (1998-2004, n=239,661) were assessed for axillary surgical patterns of care. RESULTS: Use of SLNB increased from 11 to 59%. Use of no axillary surgery decreased from 14 to 6.6%. In pathologic node-negative women, use of axillary lymph node dissection (ALND) decreased from 94 to 36%. Independent factors most associated with failure to receive SLNB included diagnosis year (2000: 62%; 2004: 29%), surgery (mastectomy: 64%; breast-conserving surgery: 36%), tumor size (T3: 71%; T2: 56%; T1: 40%), age (>or= 70 years: 50%; <70 years: 45%), grade (high: 42%; low: 38%), urbanity (non-large metropolitan area: 49%; large metropolitan area: 42%), and, by quartile, poverty (highest: 47%; lowest: 35%), and white-collar employment (lowest: 56%; highest: 47%). In pathologic node-positive women who had SLNB, failure to undergo completion ALND increased from 20% in 1998 to 32% in 2004. Patients with smaller, lower-grade tumors, and those with smaller size of nodal metastasis, lack of extracapsular extension, age >or= 70 years, increased linguistic isolation, African-American or Hispanic race/ethnicity, and white-collar employment were less likely to undergo completion ALND. CONCLUSIONS: Management of the axilla changed dramatically during the period of rapid adoption of SLNB. Patterns of care suggest both appropriate and inappropriate selection for SLNB and ALND
— id: 93492, year: 2009, vol: 16, page: 687, stat: Journal Article,

Evidence that SOM230 can prevent experimental mammary hyperplasia by blocking IGF-I and thus estrogen action in the mammary gland: preliminary evidence for an effect in humans
Ruan, W; Singh, B; Smith, J; Axelrod, D; Kleinberg, DL
2009 ;69(2):325S-326S, Cancer research
— id: 93515, year: 2009, vol: 69, page: 325S, stat: Journal Article,

Sucess of Brochure/One Page Universal Consent for Biospecimen Donation
Singh, B; Roses, DF; Guth, AA; Schnabel, FR; Shapiro, RL; Axelrod, DM; Ginsberg, A; Ziguridis, N
2009 DEC 15 ;69(24):849S-850S, Cancer research
— id: 106460, year: 2009, vol: 69, page: 849S, stat: Journal Article,

The psychological and psychiatric implications during and after a diagnosis of cancer: advocating on their behalf
Axelrod D
2008 ;15(10):35-37, Primary Psychiatry
— id: 93533, year: 2008, vol: 15, page: 35, stat: Journal Article,

Breast Cancer in Young Women (vol 206, pg 1193, 2008)
Axelrod, D; Smith, J; Kornreich, D
2008 ;207(4):621-621, Journal of the American College of Surgeons
— id: 93507, year: 2008, vol: 207, page: 621, stat: Journal Article,

Breast cancer in young women
Axelrod, Deborah; Smith, Julia; Kornreich, Davida; Grinstead, Eve; Singh, Baljit; Cangiarella, Joan; Guth, Amber A
2008 Jun;206(3):1193-1203, Journal of the American College of Surgeons
— id: 79248, year: 2008, vol: 206, page: 1193, stat: Journal Article,

Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy?: a report of 38 cases and review of the literature
Cangiarella, Joan; Guth, Amber; Axelrod, Deborah; Darvishian, Farbod; Singh, Baljit; Simsir, Aylin; Roses, Daniel; Mercado, Cecilia
2008 Jun;132(6):979-983, Archives of pathology & laboratory medicine
CONTEXT: Both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) have traditionally been considered to be risk factors for the development of invasive carcinoma and are followed by close observation. Recent studies have suggested that these lesions may represent true precursors with progression to invasive carcinoma. Due to the debate over the significance of these lesions and the small number of cases reported in the literature, the treatment for lobular neoplasia diagnosed by percutaneous core biopsy (PCB) remains controversial. OBJECTIVE: To review our experience with pure LCIS or ALH diagnosed by PCB and correlate the radiologic findings and surgical excision diagnoses to develop management guidelines for lobular neoplasia diagnosed by PCB. DESIGN: We searched the pathology database for patients who underwent PCB with a diagnosis of either pure LCIS or ALH and had subsequent surgical excision. We compared the core diagnoses with the surgical excision diagnoses and the radiologic findings. RESULTS: Thirty-eight PCBs with a diagnosis of ALH (18 cases) or LCIS (20 cases) were identified. Carcinoma was present at excision in 1 (6%) of the ALH cases and in 2 (10%) of the LCIS cases. In summary, 8% (3/38) of PCBs diagnosed as lobular neoplasia (ALH or LCIS) were upgraded to carcinoma (invasive carcinoma or ductal carcinoma in situ) at excision. CONCLUSIONS: Surgical excision is indicated for all PCBs diagnosed as ALH or LCIS, as a significant percentage will show carcinoma at excision
— id: 79288, year: 2008, vol: 132, page: 979, stat: Journal Article,

Isolated tumor cells on sentinel lymph node biopsy: Our experience over a decade
Darvishian, F; Guth, A; Dhage, S; Singh, B; Roses, D; Axelrod, D; Mercado, C; Cangiarella, J
2008 JAN ;21(2):27A-28A, Modern pathology
— id: 75903, year: 2008, vol: 21, page: 27A, stat: Journal Article,

Lymphedema education and risk reduction in breast cancer survivors
Fu, M; Haber, J; Axelrod, D
2008 MAY ;35(3):546-546, Oncology nursing forum
— id: 86960, year: 2008, vol: 35, page: 546, stat: Journal Article,

Breast-cancer-related lymphedema: information, symptoms, and risk-reduction behaviors
Fu, Mei R; Axelrod, Deborah; Haber, Judith
2008 ;40(4):341-348, Journal of Nursing Scholarship
PURPOSE: To explore the effect of providing lymphedema information on breast cancer survivors' symptoms and practice of risk-reduction behaviors. DESIGN: A cross-sectional design was used to obtain data from 136 breast-cancer survivors in New York City from August 2006 to May 2007. Descriptive statistics, t tests, chi-square tests, and correlations were calculated. METHODS: Data were collected using a demographic and medical information interview tool, two questions regarding status of receiving lymphedema information, the Lymphedema and Breast Cancer Questionnaire, and Lymphedema Risk-Reduction Behavior Checklist. FINDINGS: Fifty-seven percent of the participants reported that they received lymphedema information. On average, participants had three lymphedema-related symptoms. Only 18% of participants were free of symptoms. Participants who received information reported significantly fewer symptoms (t=3.03; p<0.00) and practicing more risk-reduction behaviors (t=2.42; p=0.01). CONCLUSIONS: Providing lymphedema information has an effect on symptom reduction and more risk-reduction behaviors being practiced among breast cancer survivors. CLINICAL RELEVANCE: In clinical practice, nurses and other healthcare professionals could consider taking the initiative to provide adequate and accurate information and engage breast-cancer survivors in supportive dialogues concerning lymphedema risk-reduction
— id: 93493, year: 2008, vol: 40, page: 341, stat: Journal Article,

Can axillary dissection be avoided in patients with sentinel node micrometastasis? The role of pathologic assessment of breast tumors in predicting non-sentinel node metastasis
Gupta, R; Cangiarella, J; Singh, B; Gath, A; Axelrod, D; Roses, D; Darvishian, F
2008 JAN ;21(2):35A-35A, Modern pathology
— id: 75905, year: 2008, vol: 21, page: 35A, stat: Journal Article,

Can axillary dissection be avoided in patients with sentinel node micrometastasis? The role of pathologic assessment of breast tumors in predicting non-sentinel node metastasis
Gupta, R; Cangiarella, J; Singh, B; Guth, A; Axelrod, D; Roses, D; Darvishian, F
2008 JAN ;88(2):35A-35A, Laboratory investigation
— id: 75927, year: 2008, vol: 88, page: 35A, stat: Journal Article,

A decade of change : an institutional experience with breast surgery in 1995 and 2005
Guth AA; Shanker BA; Roses DF; Axelrod D; Singh B; Toth H; Shapiro RL; Hiotis K; Diflo T; Cangiarella JF
2008 ;1:51-55, Breast cancer : basic & clinical research
— id: 93532, year: 2008, vol: 1, page: 51, stat: Journal Article,

A decade of change: an institutional experience with breast surgery in 1995 and 2005
Guth, Amber A; Shanker, Beth Ann; Roses, Daniel F; Axelrod, Deborah; Singh, Baljit; Toth, Hildegard; Shapiro, Richard L; Hiotis, Karen; Diflo, Thomas; Cangiarella, Joan F
2008 ;1:51-55, Breast cancer : basic & clinical research
INTRODUCTION: With the adoption of routine screening mammography, breast cancers are being diagnosed at earlier stages, with DCIS now accouting for 22.5% of all newly diagnosed breast cancers. This has been attributed to both increased breast cancer awareness and improvements in breast imaging techniques. How have these changes, including the increased use of image-guided sampling techniques, influenced the clinical practice of breast surgery? METHODS: The institutional pathology database was queried for all breast surgeries, including breast reconstruction, performed in 1995 and 2005. Cosmetic procedures were excluded. The results were analysed utilizing the Chi-square test. RESULTS: Surgical indications changed during 10-year study period, with an increase in preoperatively diagnosed cancers undergoing definitive surgical management. ADH, and to a lesser extent, ALH, became indications for surgical excision. Fewer surgical biopsies were performed for indeterminate abnormalities on breast imaging, due to the introduction of stereotactic large core biopsy. While the rate of benign breast biopsies remained constant, there was a higher percentage of precancerous and DCIS cases in 2005. The overall rate of mastectomy decreased from 36.8% in 1995 to 14.5% in 2005. With the increase in sentinel node procedures, the rate of ALND dropped from 18.3% to 13.7%. Accompanying the increased recognition of early-stage cancers, the rate of positive ALND also decreased, from 43.3% to 25.0%. CONCLUSIONS: While the rate of benign breast biopsies has remained constant over a recent 10-year period, fewer diagnostic surgical image-guided biopsies were performed in 2005. A greater percentage of patients with breast cancer or preinvasive disease have these diagnoses determined before surgery. More preinvasive and Stage 0 cancers are undergoing surgical management. Earlier stage invasive cancers are being detected, reflected by the lower incidence of axillary nodal metastases
— id: 149787, year: 2008, vol: 1, page: 51, stat: Journal Article,

How children live with parental cancer
Kornreich, Davida; Mannheim, Harriet; Axelrod, Deborah
2008 ;15(10):64-70 Oct, Primary Psychiatry
A parental diagnosis of cancer can have a powerful psychological effect on a child. Although responses vary significantly with age and the individual, children often react with uncertainty fear, guilt and anxiety It is up to the parents and the healthcare team to maintain awareness of this growing issue and respond accordingly Parents can minimize their child's distress by maintaining open communication throughout the diagnosis, treatment, and recovery processes. Furthermore, an informative, timely, and supportive response from a multidisciplinary healthcare team can successfully reduce stressors and guide the child through the experience. As cancer becomes a more chronic issue, it is becoming imperative that medical physicians address its psychological impacts on the patient and family in order to both improve the quality of life during illness and reduce the long-term negative consequences for years after.
— id: 97950, year: 2008, vol: 15, page: 64, stat: Journal Article,

Sonographically guided marker placement for confirmation of removal of mammographically occult lesions after localization
Mercado, Cecilia L; Guth, Amber A; Toth, Hildegard K; Moy, Linda; Axelrod, Deborah; Cangiarella, Joan
2008 Oct;191(4):1216-1219, American journal of roentgenology
OBJECTIVE: We evaluated the benefit of placing a marker under sonographic guidance at the time of localization to aid in identifying mammographically occult lesions within the specimen at the time of surgical excision and to evaluate margin status. MATERIALS AND METHODS: We reviewed 135 sonographically guided needle localizations performed on mammographically occult lesions. Imaging during the localization procedure, marker placement, and specimen radiographs were reviewed, and the findings were correlated with the histopathologic findings. RESULTS: Of the 135 mammographically occult lesions, 77 were localized without marker placement and 58 with marker placement. The 58 localizations with marker placement were for masses with a mean lesion size of 9 mm. Specimen radiography of these lesions showed a marker within the specimen in 56 cases (97%) and visualization of the lesion in only seven cases (12%). Specimen radiography of localizations without marker placement showed visualization of the lesion in 18 cases (23%). Of the 11 malignant lesions (19%) localized with marker placement, none had a positive inked margin, but five (46%) had close margins necessitating reexcision. Of the 26 malignant lesions (34%) localized without marker placement, two (8%) had a positive inked margin, and eight (31%) had close margins necessitating reexcision. CONCLUSION: At needle localization of breast lesions, marker placement under sonographic guidance is beneficial because it enables immediate confirmation of accurate surgical removal of the localized lesion at surgical excision. Use of marker placement, however, does not reduce the percentage of cases with close margins necessitating reexcision
— id: 93371, year: 2008, vol: 191, page: 1216, stat: Journal Article,

Impact of micropapillary type of ductal carcinoma in situ on rate of re-excision after breast conserving therapy
Wen, H; Roses, D; Guth, A; Axelrod, D; Singh, B
2008 OCT ;53(1):72-72, Histopathology
— id: 91388, year: 2008, vol: 53, page: 72, stat: Journal Article,

Rate of re-excision with breast conserving therapy with and without additional margins in patients with ductal carcinoma in situ
Wen, YH; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Berman, R; Singh, B
2008 FEB ;15(1):75-76, Annals of surgical oncology
— id: 98149, year: 2008, vol: 15, page: 75, stat: Journal Article,

Personal care products that contain estrogens or xenoestrogens may increase breast cancer risk
Donovan, Maryann; Tiwary, Chandra M; Axelrod, Deborah; Sasco, Annie J; Jones, Lovell; Hajek, Richard; Sauber, Erin; Kuo, Jean; Davis, Devra L
2007 ;68(4):756-766, Medical hypotheses
Established models of breast cancer risk, such as the Gail model, do not account for patterns of the disease in women under the age of 35, especially in African Americans. With the possible exceptions of ionizing radiation or inheriting a known genetic mutation, most of the known risk factors for breast cancer are related to cumulative lifetime exposure to estrogens. Increased risk of breast cancer has been associated with earlier onset of menses or later age at menopause, nulliparity or late first parity, use of hormonal contraceptives or hormone replacement therapy, shorter lactation history, exposure to light at night, obesity, and regular ingestion of alcohol, all of which increase circulating levels of unbound estradiol. Among African Americans at all ages, use of hormone-containing personal care products (PCPs) is more common than among whites, as is premature appearance of secondary sexual characteristics among infants and toddlers. We hypothesize that the use of estrogen and other hormone-containing PCPs in young African American women accounts, in part, for their increased risk of breast cancer prior to menopause, by subjecting breast buds to elevated estrogen exposure during critical windows of vulnerability in utero and in early life. These early life and continuing exposures to estrogenic and xenoestrogenic agents may also contribute to the increased lethality of breast cancer in young women in general and in African American women of all ages. Public disclosure by manufacturers of proprietary hormonally active ingredients is required for this research to move forward
— id: 69410, year: 2007, vol: 68, page: 756, stat: Journal Article,

Intraparenchymal leiomyoma of the breast: a case report and review of the literature
Ende, Lauren; Mercado, Cecilia; Axelrod, Deborah; Darvishian, Farbod; Levine, Pascale; Cangiarella, Joan
2007 Summer;37(3):268-273, Annals of clinical & laboratory science
We report a case of an intraparenchymal leiomyoma of the breast with description of the radiologic, histopathologic, and immunohistochemical findings. To the best of our knowledge, this is the first case of an intraparenchymal leiomyoma of the breast diagnosed by core needle biopsy and the 22nd case described in the literature. In addition, we review the literature on this uncommon breast neoplasm
— id: 73878, year: 2007, vol: 37, page: 268, stat: Journal Article,

Prospective trial of individual optimal positioning (prone versus supine) for whole breast radiotherapy: results of 194 patients
Formenti, SC; Guth, AA; Axelrod, DM; Goldberg, JD; DeWyngaert, JK
2007 DEC ;106(1):S194-S194, Breast cancer research & treatment
— id: 75805, year: 2007, vol: 106, page: S194, stat: Journal Article,

Accuracy of preoperative evaluation of the axilla with MRI in breast cancer
Kaufman, G; Guth, AA; Axelrod, D; May, L
2007 DEC ;106(1):S45-S45, Breast cancer research & treatment
— id: 75801, year: 2007, vol: 106, page: S45, stat: Journal Article,

The utility of MRI in preoperative planning for brest-conserving therapy
Kaufman, G; Guth, AA; Singh, A; Axelrod, D; Moy, L
2007 DEC ;106(1):S43-S43, Breast cancer research & treatment
— id: 75800, year: 2007, vol: 106, page: S43, stat: Journal Article,

The need to develop centers for environmental oncology
Lee Davis, Devra; Donovan, Maryann; Herberman, Ronald; Gaynor, Mitchell; Axelrod, Deborah; van Larebeke, Nik; Sasco, Annie J
2007 Dec;61(10):614-622, Biomedicine & pharmacotherapy
The scale and scope of the cancer problem in the United States today is much greater than four decades ago when the formal war against the disease was first announced. Patterns of the disease are not fully explained by known risk factors. Much progress has been made in understanding the molecular basis of carcinogenesis, particularly the near consensus (realization) that virtually all cancers arise from an accumulation of genetic mutations and the more recent recognition of the role of inflammation and the tissue microenvironment, in particular for hormone-dependent cancers. However, most genetic mutations that contribute to cancer are not inherited, and thus must be attributable to accumulation of somatic mutations and epigenetic changes, from as yet poorly understood environmental factors, that certainly cannot be explained entirely by tobacco, use and arise over the course of a lifetime. Much of the national effort to control cancer has focused on detecting and treating the disease--not on seeking approaches to prevent cases from arising. Given this reality, we present a cross-disciplinary framework for establishing comprehensive research and policy centers focused on environmental oncology to be based at selected academic cancer centers across the country. The principal goal of such centers is to improve the ability to prevent cancer, by developing effective interventions based on insights obtained from epidemiology, including molecular epidemiology and basic scientific research on genomic, metabolomic, and other biomarkers of exposure, susceptibility, and disease. As the needed scientific evidence for environmental factors contributing to cancer is revealed, these academic centers will develop specific interventions and/or policy recommendations regarding ways to lower the burden of cancer, based on existing information about cancer hazards in the personal, occupational, and general environment. Ultimately the centers will improve the ability to identify and control the underlying causes of the occurrence of cancer and its progression
— id: 133536, year: 2007, vol: 61, page: 614, stat: Journal Article,

Does Sonographically Guided Clip Placement Facilitate Confirmation of Removal of Mammographically Occult Lesions After Localization?
Mercado CL; Guth AA; Axelrod DM; Moy L; Toth HK; Cangiarella J
2007 ;188:A32-A34 #110, American journal of roentgenology
— id: 97098, year: 2007, vol: 188, page: A32, stat: Journal Article,

Fine-needle aspiration biopsy of benign adenomyoepithelioma of the breast: radiologic and pathologic correlation in four cases
Mercado, Cecilia L; Toth, Hildegard K; Axelrod, Deborah; Cangiarella, Joan
2007 Nov;35(11):690-694, Diagnostic cytopathology
Benign adenomyoepithelioma of the breast is a rare tumor in which the cytologic findings have been described in only a few cases. While benign, the imaging and pathologic features may be mistaken for malignancy. We report the aspiration biopsy findings in four cases of adenomyoepithelioma with radiologic and histologic correlation. Cytopathologists should familiarize themselves with this entity to avoid a misdiagnosis of carcinoma
— id: 75455, year: 2007, vol: 35, page: 690, stat: Journal Article,

Accuracy of intraoperative sentinel lymph node evaluation for breast
Richards, V; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, J; Ziguridis, N; Darvishian, F
2007 ;20(3):195-273, Modern pathology
— id: 93501, year: 2007, vol: 20, page: 195, stat: Journal Article,

Accuracy of intraoperative sentinel lymph node evaluation for breast cancer
Richards, V; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, J; Ziguridis, N; Darvishian, F; Singh, B
2007 ;87(3):195-273, Laboratory investigation
— id: 93502, year: 2007, vol: 87, page: 195, stat: Journal Article,

Trends in breast cancer surgery: Comparison of an institutional experience between 1995 and 2005
Shanker, BA; Guth, AA; Roses, DF; Axelrod, D; Singh, B; Shapiro, RL; Diflo, T; Cangiarella, JA
2007 FEB ;14(2):88-88, Annals of surgical oncology
— id: 71055, year: 2007, vol: 14, page: 88, stat: Journal Article,

Three-dimensional imaging provides valuable clinical data to aid in unilateral tissue expander-implant breast reconstruction
Tepper, OM; Karp, NS; Small, K; Unger, J; Pritchard, A; Roses, D; Shapiro, R; Guth, A; Axelrod, D; Choi, M
2007 DEC ;106(1):S239-S239, Breast cancer research & treatment
— id: 75806, year: 2007, vol: 106, page: S239, stat: Journal Article,

Impact of complete removal of breast carcinoma by aggressive biopsy techniques
Wen, YH; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, J; Ziguridis, N; Darvishian, F; Mercado, C; Singh, B
2007 ;20(2):226-50, Modern pathology
— id: 93504, year: 2007, vol: 20, page: 226, stat: Journal Article,

Impact of complete removal of breast carcinoma by aggressive biopsy techniques
Wen, YH; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, J; Ziguridis, N; Darvishian, F; Mercado, C; Singh, B
2007 ;87(2):226-50, Laboratory investigation
— id: 93505, year: 2007, vol: 87, page: 226, stat: Journal Article,

Prophylactic mastectomy - trends in pathology findings
Wen, YH; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, J; Ziguridis, N; Darvishian, F; Singh, B
2007 DEC ;106(1):S136-S136, Breast cancer research & treatment
— id: 75803, year: 2007, vol: 106, page: S136, stat: Journal Article,

Breast carcinoma in women 30 years and younger
Wen, YH; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, JF; Ziguridis, N; Darvishian, F; Singh, B
2007 ;14(2):50-50, Annals of surgical oncology
— id: 93503, year: 2007, vol: 14, page: 50, stat: Journal Article,

Prognostic factors in node-negative male breast cancer
Avisar, Eli; McParland, Elaine; Dicostanzo, Damian; Axelrod, Deborah
2006 Oct;7(4):331-335, Clinical breast cancer
BACKGROUND: Male breast cancer has traditionally been compared with female breast cancer, using the same staging system and prognostic indicators. A variety of histochemical and pathologic factors commonly used in node-negative female breast cancer were applied to 18 node-negative male breast cancers to assess their relevance to survival. PATIENTS AND METHODS: A slide review was performed for nuclear grade, lymphocytic infiltration, and lymphatic and vascular invasion. Flow cytometry was available on all the specimens. Immunohistochemistry was used to assess p53, estrogen receptors (ERs), cathepsin D, Ki-67, and c-erbB-2 (HER2/neu). A clinical correlation was performed based on chart reviews and phone interviews, recording demographics, treatment, and long-term survival. RESULTS: The average age at diagnosis was 64 years (range, 34-85 years). There were 15 T1 lesions, 2 T2 lesions, and 1 T3 lesion. All patients had a modified radical mastectomy. None received radiation therapy. The mean follow-up was 73 months. Three patients died of their disease (17.6%), 2 patients died from unrelated reasons, 1 patient was lost to follow-up, and the other 12 patients are alive with no evidence of disease. The actuarial 5-year survival was 83%. Estrogen receptor and HER2/neu overexpression were significantly more predominant in male breast cancer than in female breast cancer. Estrogen receptor positivity was present in 17 of 18 patients and HER2/neu overexpression in 10 of 18. A positive ER status and overexpression of cathepsin or p53 were correlated with a better survival, but only ER (P = 0.026) and p53 (P = 0.023) reached statistical significance. CONCLUSION: In this study, ER status was the only commonly used prognostic marker for female breast cancer found to be applicable in node-negative male breast cancer
— id: 69411, year: 2006, vol: 7, page: 331, stat: Journal Article,

The management of atypical lobular hyperplasia and lobular carcinoma in-situ diagnosed by core biopsy: is surgical excision necessary?
Cangiarella, J; Axelrod, D; Guth, A; Singh, B; Skinner, K; Roses, D; Simsir, A; Mercado, C
2006 FEB ;100(2):S176-S176, Breast cancer research & treatment
— id: 71008, year: 2006, vol: 100, page: S176, stat: Journal Article,

Evaluation of aromatherapy in treating postoperative pain: pilot study
Kim, Jung T; Wajda, Michael; Cuff, Germaine; Serota, David; Schlame, Michael; Axelrod, Deborah M; Guth, Amber A; Bekker, Alex Y
2006 Dec;6(4):273-277, Pain practice
This study compared the analgesic efficacy of postoperative lavender oil aromatherapy in 50 patients undergoing breast biopsy surgery. Twenty-five patients received supplemental oxygen through a face mask with two drops of 2% lavender oil postoperatively. The remainder of the patients received supplemental oxygen through a face mask with no lavender oil. Outcome variables included pain scores (a numeric rating scale from 0 to 10) at 5, 30, and 60 minutes postoperatively, narcotic requirements in the postanesthesia care unit (PACU), patient satisfaction with pain control, as well as time to discharge from the PACU. There were no significant differences in narcotic requirements and recovery room discharge times between the two groups. Postoperative lavender oil aromatherapy did not significantly affect pain scores. However, patients in the lavender group reported a higher satisfaction rate with pain control than patients in the control group (P = 0.0001)
— id: 69409, year: 2006, vol: 6, page: 273, stat: Journal Article,

Qualitative criteria to evaluate sentinel lymph node frozen sections for breast cancer
Singh, B; Ziguridis, N; Guzman, SA; Axelrod, DM; Shapiro, RL; Guth, AA; Skinner, KA; Cangiarella, J; Roses, DF
2006 ;100(2):S173-S173, Breast cancer research & treatment
— id: 93506, year: 2006, vol: 100, page: S173, stat: Journal Article,

Plasmacytoma in the breast with axillary lymph node involvement: a case report
Taylor, Lesley; Aziz, Mohamed; Klein, Paula; Mazumder, Amitabha; Jagannath, Sundar; Axelrod, Deborah
2006 Apr;7(1):81-84, Clinical breast cancer
Plasmacytic tumors in the breast are extremely rare neoplasms that can mimic mammary adenocarcima. A literature review revealed approximately 43 reports worldwide of plasmacytic tumors in the breast since 1928, the majority with a synchronous diagnosis of multiple myeloma. We discuss management of a 78-year-old man with plasmacytoma in the breast who underwent a left total mastectomy and axillary lymph node dissection. This report characterizes the histologic and immunochemical characteristics of plasmacytoma in the breast and reviews the consensus on treatment. This could be the first recorded account of plasmacytomas in the breast with axillary lymph node involvement and extracapsular extension of tumor
— id: 69412, year: 2006, vol: 7, page: 81, stat: Journal Article,

Three-dimensional imaging in breast reconstruction: a useful adjunct to surgical planning and assessment
Tepper, OM; Karp, NS; Small, K; Rudolph, L; Roses, D; Shapiro, R; Guth, A; Axelrod, D; Choi, M
2006 FEB ;100(2):S119-S119, Breast cancer research & treatment
— id: 71006, year: 2006, vol: 100, page: S119, stat: Journal Article,

Predicting negative axillary lymph node dissection in patients with positive sentinel lymph node biopsy: can a subset of patients be spared axillary dissection?
Rescigno, J; Taylor, LA; Aziz, MS; Axelrod, DM; Bernik, S; Vallejo, CE; Riegel, AC; Troob, SH; Klein, P
2005 ;94(10):S35-S36, Breast cancer research & treatment
— id: 93513, year: 2005, vol: 94, page: S35, stat: Journal Article,

"Hormesis"--an inappropriate extrapolation from the specific to the universal
Axelrod, Deborah; Burns, Kathy; Davis, Devra; von Larebeke, Nicolas
2004 Jul-Sep;10(3):335-339, International journal of occupational & environmental health
Although it is generally accepted that some chemicals may have beneficial effects at low doses, incorporating these effects into risk assessments generally ignores well-established factors related to exposure and human susceptibility. The authors argue against indiscriminate application of hormesis in assessments of chemical risks for regulatory purposes
— id: 50279, year: 2004, vol: 10, page: 335, stat: Journal Article,

Acute toxicity of high-dose-rate intracavitary brachytherapy with the MammoSite applicator in patients with early-stage breast cancer
Richards, Gregory M; Berson, Anthony M; Rescigno, John; Sanghavi, Seema; Siegel, Beth; Axelrod, Deborah; Bernik, Stephanie; Scarpinato, Vincent; Mills, Christopher
2004 Aug;11(8):739-746, Annals of surgical oncology
BACKGROUND: Intracavitary brachytherapy with the MammoSite applicator as the sole radiation treatment in breast-conserving therapy is an option for women with early-stage breast cancer; we evaluated the acute toxicities associated with this treatment method. METHODS: Thirty-one patients with 32 stage I or II breast carcinomas underwent breast-conserving therapy, which included lumpectomy with negative margins, sentinel node biopsy, or axillary dissection, followed by brachytherapy with the MammoSite applicator. Acute radiation skin complications were graded on the day of radiotherapy completion and at weeks 2, 4, 6, and 12 after radiation treatment. Cosmesis was graded on the Harvard Scale at all follow-ups. RESULTS: The median follow-up was 11 months (range, 4-15 months). Twenty-seven of the 31 patients were treated with the device as the sole method of radiotherapy. No acute toxicities occurred during the 5 days of treatment. Nineteen patients (68%) had no to mild acute skin reactions, and 25% developed bright erythema and patchy moist desquamation. Two patients (7%) developed confluent moist desquamation within the first 4 weeks (grade 3); this healed by week 12. All skin reactions were localized to the area overlying the balloon. Sixteen percent (5 of 32) of all breasts with implants developed infection. Cosmesis was good to excellent in 86% of cases. CONCLUSIONS: Most acute skin toxicities were mild. Our infection rate was higher than in prior studies that used interstitial brachytherapy. Cosmesis was good to excellent in most patients. Breast brachytherapy with the MammoSite catheter was well tolerated; further investigations of breast brachytherapy with this system are warranted
— id: 69414, year: 2004, vol: 11, page: 739, stat: Journal Article,

Alternative lymphatic pathway after previous axillary node dissection in recurrent/primary breast cancer
Sood, Aswani; Youssef, Irini M; Heiba, Sherif I; El-Zeftawy, Hossam; Axelrod, Deborah; Seigel, Beth; Mills, Christopher; Abdel-Dayem, Hussein M
2004 Nov;29(11):698-702, Clinical nuclear medicine
OBJECTIVES: The sentinel lymph node approach has almost become the standard procedure of choice in the management of patients with early breast cancer. The status of sentinel nodes, whether or not pathologically involved by cancer cells, represents those of the axillary nodes with a negative predictive value of almost 100%. If the axillary lymphatic nodal drainage is altered, alternative lymphatic pathways and accordingly sentinel node location will be changed. METHODS: In this article, 4 patients are presented, 3 with recurrent breast cancer who had already undergone lumpectomy, axillary node dissection, and radiotherapy in the past and 1 with primary breast cancer after surgical removal of a malignant melanoma on her back and had axillary node dissection on the same side as the breast cancer. These patients underwent lymphoscintigraphy followed by sentinel node localization using the gamma probe and also blue dye injection during surgery. RESULTS: All patients showed alternate lymphatic pathways, 1 had an ipsilateral internal mammary node and crossed lymphatics to a contralateral axillary node, 2 had intramammary sentinel nodes, and 1 had an internal mammary on the same side. Pathologic examination of the intramammary and contralateral sentinel nodes were negative for metastases. Internal mammary sentinel nodes were not biopsied. CONCLUSION: We feel that sentinel node lymphoscintigraphy should be done even in patients who have altered lymphatic pathways resulting from previous axillary node dissection. It allows identifying and biopsy of the sentinel node at its new unpredicted location
— id: 69413, year: 2004, vol: 29, page: 698, stat: Journal Article,

Factors contributing to nonvisualization of sentinel lymph node (SLN) in breast cancer lymphoscintigraphy
Youssef IM; Quimbo R; Rogpman A; Heiba SI; Axelrod D; Seigel B; Mills C; Bernik S; Abdel-Dayem HM
2004 ;45(5):357-357, Journal of nuclear medicine
— id: 93580, year: 2004, vol: 45, page: 357, stat: Journal Article,

Incidence of non-sentinel lymph node involvement in breast cancer in presence of macro or micro metastatic involvement of sentinel lymph node
Youssef IM; Quimbo R; Rogpman A; Heiba SI; Axelrod D; Seigel B; Mills C; Bernik S; Abdel-Dayem HM
2004 ;29(2):137-137, Clinical nuclear medicine
— id: 93579, year: 2004, vol: 29, page: 137, stat: Journal Article,

Influence of postmenopausal hormone replacement therapy on an estrogen metabolite biomarker of risk for breast cancer
Alvarez-Vasquez, R B; Axelrod, D; Frenkel, K; Newman, M C; Sepkovic, D W; Bradlow, H L; Zumoff, B
2003 Jun;35(6):358-361, Hormone & metabolic research
Whether postmenopausal hormone-replacement therapy (HRT) increases the risk of breast cancer remains controversial, despite numerous epidemiological studies. We approached the question from a biochemical rather than an epidemiological direction - we hypothesized that if estrogen administration increases the risk of breast cancer, it should also alter a known estrogen biomarker of risk towards what has been observed in patients who already have breast cancer. The specific biomarker we studied was the ratio of the urinary excretion of two principal estradiol metabolites, 2-hydroxyestrone and 16 alpha-hydroxyestrone, which is markedly decreased in women with breast cancer and women with familial risk for breast cancer. We studied 34 healthy postmenopausal women not on HRT and 19 women on HRT (Premarin 0.625 mg daily plus Provera, 2.5 mg daily, in women with a uterus and Premarin alone in women without a uterus); treatment duration ranged from 3 months to 15 years. We also studied four women with recently diagnosed, untreated breast cancer. The women with breast cancer showed a significantly lower 2-hydroxyestrone to 16 alpha-hydroxyestrone ratio than control women on HRT (1.35 +/- 0.13 vs. 2.71 +/- 0.84; p < 0.0001). There was no significant difference in the metabolite ratio between healthy women on HRT and women not on HRT (2.82 +/- 0.92 vs. 2.71 +/- 0.84). There was no significant difference between women receiving Premarin alone and women receiving Premarin plus Provera (2.46 +/- 0.84 vs. 3.13 +/- 0.90), and neither differed significantly from women not on HRT (2.71 +/- 0.84). The finding that the ratio of women on HRT was not decreased to or toward the ratio in women with breast cancer can be interpreted, we believe, as a suggestive item of biochemical evidence that HRT is not a risk for breast cancer
— id: 38127, year: 2003, vol: 35, page: 358, stat: Journal Article,

Retrospective analysis of sentinel node localization in multifocal, multicentric, palpable, or nonpalpable breast cancer
Kumar, Rakesh; Jana, Suman; Heiba, Sherif I; Dakhel, Mahmoud; Axelrod, Deborah; Siegel, Beth; Bernik, Stephanie; Mills, Christopher; Wallack, Marc; Abdel-Dayem, Hussein M
2003 Jan;44(1):7-10, Journal of nuclear medicine
Multicentric or multifocal breast cancer is considered as one of the limitations for sentinel lymph node (SLN) localization. We did a retrospective analysis to evaluate the success rate, sensitivity, accuracy, and negative predictive values of SLN localization in multicentric or multifocal breast lesions. METHODS: Fifty-nine patients with multifocal or multicentric breast lesions proven by either fine-needle aspiration (19/59), core biopsy (39/59), or lumpectomy (8/59) underwent SLN localization. Of these patients, 46 had SLN localization by both radiocolloid and blue dye, and 13 had SLN localization by radiocolloid alone. Approximately 10 MBq (99m)Tc-labeled unfiltered sulfur colloid in 0.3-0.4 mL were injected intradermally over the 1 or 2 breast tumor locations 2-4 h before surgery. During surgery, vital blue dye was injected intraparenchymally in 4-6 places around the tumor. All lymph nodes with counts of >10 times that of the background counts, whether or not blue dye positive, and all blue dye-positive lymph nodes, whether or not radiocolloid positive, were excised and labeled accordingly. All lymph nodes underwent frozen sectioning and were examined by hematoxylin and eosin and immunohistologic (cytokeratin) staining. RESULTS: Of the 59 patients, 48 had axillary lymph node dissection irrespective of the results of pathologic examination of the SLN. The success rate, sensitivity, negative predictive value, and accuracy were 93%, 100%, 100%, and 100% using the radiocolloid probe, 87%, 100%, 100%, and 100% using blue dye, and 93.5%, 100%, 100%, and 100% using combined methods, respectively. Concordance between blue dye and radiocolloid was 91% (the incidence of the number of sentinel nodes detected was 37.5%, 30.3%, 10.7%, and 21.4% for 1, 2, 3, and 4 or more lymph nodes, respectively). Metastatic lymph node involvement was found in 39.5% of patients. CONCLUSION: The sentinel node localization approach showed a high negative predictive value in breast cancer patients with multifocal or multicentric lesions, contrary to the common belief of significant false-negative results in these patients
— id: 69415, year: 2003, vol: 44, page: 7, stat: Journal Article,

BreastDoc.com
Axelrod, Deborah
2002;:- [Web site], 2002,
— id: 150917, year: 2002, vol: , page: , stat: Web Site,

Do we have to revise inclusion criteria for sentinel node localization in breast cancer?
Jana S; Kumar R; Heiba S; Dakhel M; Axelrod D; Siegel B; Bernik S; Mills C; Abdel-Dayem HM
2002 ;29(1):S131-S131, European journal of nuclear medicine & molecular imaging
— id: 93578, year: 2002, vol: 29, page: S131, stat: Journal Article,

Is axillary dissection mandatory for all patients of breast cancer (CA) with tumor size 4 cm or more?
Jana, S; Dakhel, M; Heiba, S; El-Zeftawy, H; Axelrod, D; Seigel, B; Bernik, S; Mills, C; Wallack, M; Luo, J; Abdel-Dayem, HM
2002 171-10;43(5):UNSP 200670-, Journal of nuclear medicine
— id: 93509, year: 2002, vol: 43, page: UNSP 200670, stat: Journal Article,

Multifocal/multicentric breast carcinoma(CA): Is it an absolute contraindication for Sentinel Node localization?
Jana, S; Kumar, R; Dakhel, M; Heiba, S; El-Zeftawy, H; Axelrod, D; Seigel, B; Bernik, S; Mills, C; Wallack, M; Luo, J; Abdel-Dayem, HM
2002 1-10;43(5):UNSP 200403-, Journal of nuclear medicine
— id: 93508, year: 2002, vol: 43, page: UNSP 200403, stat: Journal Article,

It's time to rethink dose: the case for combining cancer and birth and developmental defects
Axelrod, D; Davis, D L; Hajek, R A; Jones, L A
2001 Jun;109(6):A246-A249, Environmental health perspectives
— id: 93490, year: 2001, vol: 109, page: A246, stat: Journal Article,

Mammotome core biopsy for mammary microcalcification: analysis of 160 biopsies from 142 women with surgical and radiologic followup
Cangiarella J; Waisman J; Symmans WF; Gross J; Cohen JM; Wu H; Axelrod D
2001 Jan 1;91(1):173-177, Cancer
BACKGROUND: Although stereotaxic fine-needle aspiration biopsy or core biopsy (14-gauge) have proven to be accurate techniques for the evaluation of mammographically detected microcalcification, the development of the Mammotome Biopsy System (Biopsys Medical, Inc., Irvine, CA) has led many medical centers to use this vacuum-assisted device for the sampling of microcalcification. METHODS: One hundred forty-two women underwent 160 stereotaxic Mammotome core biopsies of mammographic calcification over a 1-year period. The stereotaxic procedure was performed by radiologists using the Mammotome Biopsy System. Microcalcification was evident on specimen radiographs and microscopic slides in 99% of the cases. Excisional biopsy was recommended for diagnoses of atypia or carcinoma. Patients with benign diagnoses underwent mammographic followup. RESULTS: One hundred thirty-two benign, 12 atypical, and 15 adenocarcinoma diagnoses (comprising 1 lobular adenocarcinoma in situ [LCIS], 1 invasive ductal adenocarcinoma [IDC], and 13 intraductal adenocarcinomas [DCIS]: 10 comedo, 1 cribriform, 2 mixed cribriform and micropapillary) were rendered. Surgical excision in eight patients with atypia on Mammotome biopsy (two refused surgery, two were lost to followup) showed ductal hyperplasia in three, atypical ductal hyperplasia (ADH) in three and DCIS (low grade, solid) in two patients. Surgical excisions in 14 patients diagnosed with carcinoma (1 patient lost to followup) showed ADH in 3, ADH and LCIS in 1, residual DCIS in 8, IDC in 1, and microinvasive carcinoma in 1 patient. CONCLUSIONS: A diagnosis of atypia on Mammotome biopsy warranted excision of the atypical area, yet the underestimation rate for the presence of carcinoma remained low. The likelihood of an invasive component at excision was low for microcalcification diagnosed as DCIS on Mammotome biopsy. Mammotome biopsy proved to be an accurate technique for the sampling and diagnosis of mammary microcalcification
— id: 26637, year: 2001, vol: 91, page: 173, stat: Journal Article,

Radial sclerosing lesion: correlation between mammotome core biopsy and surgical excision
Cangiarella, J; Waisman, J; Cohen, J M; Chhieng, D; Symmans, W F; Axelrod, D; Gross, J
2001 Jan-Feb;7(1):66-67, Breast journal
— id: 97085, year: 2001, vol: 7, page: 66, stat: Journal Article,

Affect of excisional biopsy (Bx) of breast mass on negative predictive value (NPV), accuracy (ACC) or Success Rate (SR) of sentinel node (SN) localization
Jana, S; Dakhel, M; Axelrod, D; Siegel, B; Bhaskaran, S; Mills, C; Heiba, S; Wallack, M; Luo, J; Sadek, S; Abdel-Dayem, H
2001 ;28(8):PS189-10, European journal of nuclear medicine
— id: 93510, year: 2001, vol: 28, page: PS189, stat: Journal Article,

Does excisional biopsy (BX) of breast mass affect the negative predictive value (NPV), accuracy (ACC) or success rate (SR) of sentinel node (SN) localization?
Jana, S; Dakhel, M; Axelrod, D; Siegel, B; Bhaskaran, S; Mills, C; Heiba, S; Wallack, M; Luo, J; Sadek, S; Abdel-Dayem, HM
2001 ;42(5):576-10, Journal of nuclear medicine
— id: 93511, year: 2001, vol: 42, page: 576, stat: Journal Article,

Hormone therapy and risk for venous thromboembolism: Comments and correction
Waitkevicz, HJ; Axelrod, D
2001 ;134(1):80-81, Annals of internal medicine
— id: 93500, year: 2001, vol: 134, page: 80, stat: Journal Article,

Waiting For Science Can Cost Lives
Axelrod, Deborah
2000 Dec 31;:B.05-?, Newsday
Consider this. Our research at Cornell Medical Center has shown that a number of widely used chemical compounds, such as some pesticides and fuels, alter the production of hormones, much the same way as do known cancer-causing agents. Researchers at the U.S. National Toxicology Program have identified numerous such compounds that create mammary tumors in male rodents. Chances are very good that these substances cause cancer in humans. Every compound known to cause cancer in humans also produces cancer in animals, when adequately tested. And the compounds are not only present on Long Island; they're present everywhere. Because many of them are so widely available in the environment, it becomes very difficult to find anyone who is not exposed. To insist on proof of human harm before taking action treats people like lab rats. A recent report from the American Health Foundation about Long Island breast cancer, for example, found no difference in organochlorine residues in women with breast cancer and those without the disease who lived on Long Island and New York City. Unfortunately, there are three major problems with this approach. First, women with advanced disease may have undergone changes in metabolism that alter what remains in their bodies, especially fat- loving, organochlorine residues. Second, critical exposures to cancer- causing agents from early in life cannot be measured years later. Finally, women who have lived in the same area are likely to have undergone similar exposures, which lowers the chance of finding an effect from their environment. In fact, recent studies from Canada and Denmark that have taken samples from women more than a decade before cancer arises, and compared with women from different regions, have found that early exposures to higher levels of some organochlorine compounds do increase the risk of developing cancer
— id: 93529, year: 2000, vol: , page: B.05, stat: Journal Article,

The incidence of positive margins with breast conserving therapy following mammotome biopsy for microcalcification
Cangiarella J; Gross J; Symmans WF; Waisman J; Petersen B; D'Angelo D; Singer C; Axelrod D
2000 Aug;74(4):263-266, Journal of surgical oncology
BACKGROUND AND OBJECTIVES: The ability to achieve clean margins with breast conserving therapy varies greatly even when the diagnosis of carcinoma is known beforehand. Although several reports reveal that the incidence of positive margins decreases after stereotaxic core biopsy of nonpalpable lesions and fine-needle aspiration biopsy of palpable lesions, the data on the results following mammotome biopsy (mmbx) is scanty. METHODS: Two hundred and ninety-eight biopsy specimens for mammographically indeterminate microcalcification from 1/97 through 3/30/98 were reviewed. Biopsies were performed using the biopsys method utilizing an 11-gauge multidirectional, vacuum-directed device. RESULTS: Ten percent (n = 31) of the mammotome biopsies were atypical and 9% (n = 27) were malignant. These 58 cases (19%) were recommended for surgical excision. The incidence of positive margins in this subset was determined. Of patients who underwent lumpectomy as their initial surgical procedure 69% had negative surgical margins. Seventy-seven percent of patients with carcinoma diagnosed by mammotome biopsy had definitive initial surgery with a single surgical procedure. CONCLUSIONS: Mmbx facilitates fewer surgical procedures to achieve negative margins, and thus provides a better cosmetic result.
— id: 11527, year: 2000, vol: 74, page: 263, stat: Journal Article,

Mammotome core biopsy for mammographic microcalcification: Analysis of 161 cases with surgical and radiologic followup
Cangiarella, J; Symmans, W F; Waisman, J; Gross, J; Cohen, J M; Wu, H; Axelrod, D
2000 ;80(Suppl 1):18A-18A, Laboratory investigation
— id: 15788, year: 2000, vol: 80, page: 18A, stat: Journal Article,

When is treatment for the axilla justified in early stage breast cancer presenting with positive sentinel lymph nodes (SLN)?
Chadha, M.; Peterson, B.; Axelrod, D.; Nugent, A.; Cohen, J. M.; Gold, E.; Estabrook, A.
2000 ;56(Supplement 1):S93-36, Radiotherapy & oncology
— id: 93495, year: 2000, vol: 56, page: S93, stat: Journal Article,

First aid yourself : essential breast cancer websites
Dance, Betsy; Axelrod, Deborah
Manakin-Sabot VA : Hope Springs Press, 2000,
— id: 1790, year: 2000, vol: , page: , stat: ,

Evaluation of success rate, accuracy and negative predictive value of sentinel node localization in breast cancer using blue dye and radiocolloid methods with histopathological correlation
Jana S; Axelrod D; Siegel B; Santiago JF; Mills C; Heiba S; Salem S; Wallack MK; Sethi Y; Luo J; Abdel-Dayam HM
2000 ;27(8):974-974, European journal of nuclear medicine & molecular imaging
— id: 93577, year: 2000, vol: 27, page: 974, stat: Journal Article,

Correlation of sentinel node localization using blue dye and radiocolloid methods in T-1 & T-2 breast cancer (CA BR) with histopathological findings: Assessing accuracy and negative predictive value (NPV) according to tumor size
Jana, S; Axelrod, D; Siegel, B; Santiago, JF; Mills, C; Heiba, S; Salem, S; Wallack, MK; Sethi, Y; Luo, J; Abdel-Dayem, HM
2000 ;41(5):1230-10, Journal of nuclear medicine
— id: 93512, year: 2000, vol: 41, page: 1230, stat: Journal Article,

Minimising discomfort with fine-needle aspiration cytology of the breast
Ngadiman, S; Vallejo, C E; Siegel, B; Axelrod, D
2000 Nov 18;356(9243):1701-1701, Lancet
— id: 93528, year: 2000, vol: 356, page: 1701, stat: Journal Article,

Bosom buddies : lessons and laughter on breast health and cancer
O'Donnell, Rosie; Axelrod, Deborah; Semler, Tracy Chutorian
New York : Warner Books, 1999,
— id: 1789, year: 1999, vol: , page: , stat: ,

Pure mucinous carcinoma of the breast: a clinicopathologic correlation study
Avisar, E; Khan, M A; Axelrod, D; Oza, K
1998 Jul-Aug;5(5):447-451, Annals of surgical oncology
BACKGROUND: Pure mucinous carcinoma (PMC) of the breast has a better prognosis than does invasive ductal carcinoma not otherwise specified and is more prevalent in older patients. We investigated the correlation between prognostic indices and clinical outcome in this histologic subset. METHODS: A retrospective review was done of patients with PMC treated between 1989 and 1996. Demographic data, pathologic indices of prognosis, axillary nodal status, and outcome were assessed. RESULTS: Out of 6083 cases of breast carcinoma, 30 were PMC. Only 3 of 25 (12%) axillary dissections were positive. The average age of the group with positive nodes was 57 years, as compared to 69.5 years (95% CI; 63.24-75.76) in the group with negative nodes. All the tumors with positive nodes were aneuploid and had a high nuclear grade, compared to a 31.25% aneuploidy rate in the group without nodal disease (P = .058). Negative ER receptors were found in only 2 of 20 (10%) of the patients tested. Both had axillary disease (P = .016). Tumor size did not correlate with axillary metastasis. Two of the 29 patients died from unrelated diseases. The other 27 patients are alive with no evidence of disease. CONCLUSIONS: Axillary nodal disease is rare in PMC and correlates with a younger age, aneuploidy, high nuclear grade, or a negative ER receptor status. Sentinel lymph node biopsy may help identify the need for axillary dissection
— id: 93489, year: 1998, vol: 5, page: 447, stat: Journal Article,

Rethinking breast cancer risk and the environment: the case for the precautionary principle
Davis, D L; Axelrod, D; Bailey, L; Gaynor, M; Sasco, A J
1998 Sep;106(9):523-529, Environmental health perspectives
The World Health Organization recently reported that breast cancer has become the most common cancer in women throughout the world. Known risk factors account for less than half of all cases of breast cancer, and inherited germ line mutations occur in at most only 10% of all cases. Cumulative exposure to estradiol and other hormones links many of the established risk factors for breast cancer. This paper reviews epidemiologic and toxicologic evidence on breast cancer risks and presents a comprehensive construct of risk factors intended to focus on the identification of those factors that can be controlled or modified. We attempt to provide a framework for interpreting the etiologic interplay of endogenous metabolic changes and environmental changes in the etiology of breast cancer. The construct we develop distinguishes between those risk factors that are directly causal, such as ionizing radiation and inherited germ cell defects, those vulnerability factors that extend the time period during which the breast undergoes development, and those contributing factors that increase total hormonal stimulation of the breast. Some hormonally active compounds, such as those in soy and broccoli and other phytoestrogen-containing foods, can be protective against breast cancer, while others, such as some environmental contaminants, appear to increase the risk of the disease by increasing levels of harmful hormones. Efforts to explain patterns of breast cancer should distinguish between these different risk factors. Identification of vulnerability and contributing risk factors can foster the development of public policy to reduce the burden of this prevalent cancer. Prudent precautionary principles suggest that reducing exposure to avoidable or modifiable risk factors should receive high priority from the public and private sectors
— id: 93488, year: 1998, vol: 106, page: 523, stat: Journal Article,

Is axillary dissection always indicated in invasive breast cancer?
Chadha, M; Axelrod, D
1997 Oct;11(10):1463-1468, Oncology
In light of the changing trends in the diagnosis and management of invasive breast cancer, the practice of routine axillary dissection should be reevaluated. A growing number of patients with breast cancer are diagnosed as having small tumors with an associated low risk of lymph node metastases. The pathologic features of the primary tumor are increasingly being used as a prognostic guide for recommendations about adjuvant systemic therapy, and there are recent reports suggesting a superior prognostic value for tumor cells detected in bone marrow, as compared to axillary lymph node metastases. Consequently, axillary lymph node status is no longer the single prognostic guide for recommendations about adjuvant systemic therapy. For treatment of the axilla, there is evidence that, in clinical N0 patients, radiation therapy to the axilla is an effective alternative to axillary dissection. Finally, there are cost and morbidity considerations for patients undergoing axillary dissection in whom the indications of the procedure are equivocal. In the management of invasive breast cancer, a selective policy toward axillary lymph node dissection should be considered. This review discusses the nonsurgical management of the axilla; ie, radiation therapy to the axilla and observation of the axilla as an alternative to axillary dissection
— id: 93486, year: 1997, vol: 11, page: 1463, stat: Journal Article,

Environmental influences on breast cancer risk
Davis DL; Axelrod DM; Osborne NP; Telang NT
1997 May/June;:56-63, Science & Medicine
— id: 93531, year: 1997, vol: , page: 56, stat: Journal Article,

Avoidable causes of breast cancer: the known, unknown, and the suspected
Davis, D L; Axelrod, D; Osborne, M; Telang, N; Bradlow, H L; Sittner, E
1997 Dec 29;833:112-128, Annals of the New York Academy of Sciences
— id: 93487, year: 1997, vol: 833, page: 112, stat: Journal Article,

Management of the swollen extremity
Axelrod DM; Osborne MP
Manual of oncologic therapeutics Philadelphia PA : Lippincott, 1995,
— id: 4967, year: 1995, vol: , page: ?, stat: Chapter,

Lymphedema reduction by non-invasive complex lymphedema therapy
Axelrod DM; Gold E
1994 ;8(9):109-110, Oncology
— id: 93530, year: 1994, vol: 8, page: 109, stat: Journal Article,

Control of local infection and necrosis
Axelrod DM; Osborne MP
Manual of oncologic therapeutics, 1991/1992 Philadelphia PA : Lippincott, 1991,
— id: 4966, year: 1991, vol: , page: 395, stat: Chapter,

Management of the swollen extremity
Axelrod DM; Osborne MP
Manual of oncologic therapeutics, 1991/1992 Philadelphia PA : Lippincott, 1991,
— id: 4965, year: 1991, vol: , page: 405, stat: Chapter,

A HAMARTOMATOUS POLYP ASSOCIATED WITH JEJUNITIS CYSTICA PROFUNDA
MONDSCHEIN R; CHABON A; FRIEDMAN I; AXELROD D
1991 ;39(5):31-36, Contemporary surgery
A patient with intermittent epigastric pain was found to have a hamartomatous polyp of the jejunum as the lead point of an intussusception. The bowel adjacent to the hamartoma had intramural and subserosal mucinous cysts consistent with jejunitis cystica profunda. To our knowledge, this is the second case described in the English literature
— id: 93494, year: 1991, vol: 39, page: 31, stat: Journal Article,

Biotransformation of estradiol by explant culture of human mammary tissue
Telang, N T; Axelrod, D M; Wong, G Y; Bradlow, H L; Osborne, M P
1991 Jan;56(1):37-43, Steroids
In vivo experiments on strains of mice that differ in the risk of developing mammary cancer have demonstrated a correlation between the extent of 16 alpha-hydroxylation of estradiol and incidence of mammary cancer. The ability of human mammary terminal duct lobular unit (TDLU), the site of neoplastic transformation, to metabolize estradiol or to accumulate estradiol metabolites has not been unequivocally established. Using a newly developed human mammary TDLU explant culture system and a radiometric assay for estradiol metabolism, we compared the site-specific metabolism of estradiol by the 17-oxidation, 2-hydroxylation, and 16 alpha-hydroxylation pathways in noninvolved human mammary tissue. The relative extent of estradiol 16 alpha-hydroxylation was found to be increased in TDLU from patients in the luteal phase of the menstrual cycle in relation to either those from patients in the follicular phase or from postmenopausal subjects. This study demonstrates that TDLU can metabolize estradiol extrahepatically and that 16 alpha-hydroxylation in the target tissue is dependent on the phase of the menstrual cycle. Furthermore, the specific, risk-related increase in 16 alpha-hydroxylation suggests that intrinsic metabolic ability of the target tissue leading to the formation of 16 alpha-hydroxyestrone from estradiol may be a determinant in, or a marker for, the relative risk of developing mammary cancer
— id: 69416, year: 1991, vol: 56, page: 37, stat: Journal Article,

Metabolic biotransformation of estradiol in human mammary explant cultures
Telang, N T; Axelrod, D M; Bradlow, H L; Osborne, M P
1990 ;586:70-78, Annals of the New York Academy of Sciences
The metabolism of E2 via the 16 alpha-hydroxylation pathway is reported to be elevated in breast cancer patients as well as in subjects at high risk for developing breast cancer. The biological relevance of the metabolic pathway during the initiational events that lead to the tumorigenic transformation of mammary epithelium is not fully understood. The results obtained from the in vitro experiments discussed in this report permit the following conclusions: 1. Human mammary TDLU, the presumptive target site for breast cancer, possesses metabolic competence to biotransform E2. 2. The biotransformation of E2 in TDLU via the 16 alpha-hydroxylation pathway is responsive to endogenous hormonal changes and to the presence of cancer, and is susceptible to carcinogenic insult. 3. The relative extent of E2 16 alpha-hydroxylation may constitute a sensitive metabolic marker for evaluating the susceptibility of noninvolved mammary epithelium to carcinogen-induced transformation
— id: 69417, year: 1990, vol: 586, page: 70, stat: Journal Article,

Management of the swollen extremity
Axelrod DM; Osborne MP
Manual of oncologic therapeutics, 1989/1990 Philadelphia PA : Lippincott, 1989,
— id: 4964, year: 1989, vol: , page: 565, stat: Chapter,

Mrs. R's problems : a useful guide
Axelrod D
1988 ;1(2):18-18, Medical herald
— id: 93581, year: 1988, vol: 1, page: 18, stat: Journal Article,

Levels of estrogen and progesterone receptor proteins in patients with breast cancer during various phases of the menses
Axelrod, D M; Menendez-Botet, C J; Kinne, D W; Osborne, M P
1988 ;6(1):7-14, Cancer investigation
Analysis of estrogen and progesterone receptor proteins was carried out in 75 premenopausal and 79 postmenopausal patients with primary operable breast carcinoma who were treated from January 1983 to December 1984. The frequency of estrogen receptor protein positive/progesterone receptor protein positive (+/+); estrogen receptor protein negative/progesterone receptor protein negative (-/-); estrogen receptor protein negative/progesterone receptor protein positive (-/+); and estrogen receptor protein positive/progesterone receptor protein negative (+/-) was 40.5%, 30.5%, 23%, and 6% in premenopausal patients, respectively, and 52%, 24%, 2.5%, and 21.5% in postmenopausal patients, respectively (p less than 0.001). The mean positive estrogen receptor protein concentration (expressed as femtomoles per milligram of protein +/- SEM) was significantly higher in postmenopausal patients (54 +/- 6) than in premenopausal patients (19 +/- 2) (p less than 0.005). The progesterone receptor protein values did not differ significantly between these two groups. The phase of the menstrual cycle was recorded at the time of surgery in the 75 premenopausal women. Maximum receptor positivity occurred in the secretory phase, however, this difference is not statistically significant, and our data suggest that there are no distributional differences between the phase of menses and positivity of estrogen and progesterone receptor proteins. Future studies which included analyses of circulating sex steroid levels and receptor proteins will provide a better understanding of complex hormonal regulatory mechanisms which exist in patients with breast cancer
— id: 69419, year: 1988, vol: 6, page: 7, stat: Journal Article,

Colorectal carcinoma in the young. A case report and review of the literature
Rose, R H; Axelrod, D M; Aldea, P A; Beck, A R
1988 Feb;27(2):105-108, Clinical pediatrics
A case of sigmoid carcinoma in a 16-year-old boy is presented and the topic of colonic carcinoma in the young is reviewed. Although colon carcinoma in the younger patient is uncommon, its prognosis is distinctly worse than in the adult population, because the preponderance of mucinous adenocarcinoma in children and young adults represents a more virulent type of colonic malignancy and because the delay in diagnosis contributes to a more advanced stage of the disease at the time of presentation. When dealing with symptoms potentially referrable to this disease, a thorough diagnostic work-up should ensue
— id: 69418, year: 1988, vol: 27, page: 105, stat: Journal Article,

CHEMICAL CARCINOGEN-MEDIATED ENHANCEMENT OF RAS PROTO-ONCOGENE EXPRESSION IN BENIGN HUMAN MAMMARY TISSUE
TELANG N T; BASU A; KURIHARA H; AXELROD D M; MODAK M J; OSBORNE M P
1988 ;29(1):466-78, Proceedings (American Association for Cancer Research)
— id: 93496, year: 1988, vol: 29, page: 466, stat: Journal Article,

Distinguishing features of primary hyperparathyroidism in patients with breast cancer
Axelrod, D M; Bockman, R S; Wong, G Y; Osborne, M P; Kinne, D W; Brennan, M F
1987 Oct 1;60(7):1620-1624, Cancer
Thirty-five women with breast cancer and primary hyperparathyroidism (1 degree HPT) were admitted to Memorial Hospital during a 25-year period. The incidence of primary hyperparathyroidism in the breast cancer patients was similar to the incidence in the total patient population at Memorial Sloan-Kettering Cancer Center (0.15% and 0.14%, respectively). The patients with 1 degree HPT disease had clinical findings which distinguished them from those patients with cancer-related hypercalcemia. Eighty percent of the breast cancer patients with primary hyperparathyroidism had earlier stage disease (Stage 0, Stage 1, Stage 2); whereas 97% of the patients with breast cancer and hypercalcemia (not due to 1 degree HPT) had advanced disease. There appeared to be a trend towards improved survival in the breast cancer patients with primary hyperparathyroidism when compared to patients of similar stage of disease who did not have parathyroid disease
— id: 69420, year: 1987, vol: 60, page: 1620, stat: Journal Article,

MOLECULAR EFFECTS OF CHEMICAL CARCINOGENS ON EXPLANT CULTURE OF HUMAN MAMMARY TERMINAL DUCT-LOBULAR UNITS(TDLU)
TELANG, N; BASU, A; KURIHARA, H; AXELROD, D; MODAK, M; OSBORNE, M
1987 ;10(1):91-91, Breast cancer research & treatment
— id: 93497, year: 1987, vol: 10, page: 91, stat: Journal Article,

LONG-TERM SURVIVAL OF BENIGN HUMAN MAMMARY TERMINAL DUCT LOBULAR UNITS (TDLU) IN A CHEMICALLY-DEFINED, SERUM-FREE MEDIUM
AXELROD, DM; TELANG, N; ROSEN, PP; OSBORNE, MP
1986 ;27(1):30-30, Proceedings (American Association for Cancer Research)
— id: 93498, year: 1986, vol: 27, page: 30, stat: Journal Article,

INVITRO METABOLISM OF ESTRADIOL IN HUMAN-BREAST EPITHELIUM
AXELROD, DM; TELANG, NT; BRADLOW, HL; OSBORNE, MP
1986 ;8(1):108-108, Breast cancer research & treatment
— id: 93499, year: 1986, vol: 8, page: 108, stat: Journal Article,