Freya R. Schnabel, M.D.

Erratum: The cognitive effects of chemotherapy in post-menopausal breast cancer patients: A controlled longitudinal study (Breast Cancer Research and Treatment DOI: 10.1007/s10549-009-0606-8)
Tager F.A.; McKinley P.S.; Schnabel F.R.; El-Tamer M.; Cheung Y.K.K.; Fang Y.; Golden C.R.; Frosch M.E.; Habif U.; Mulligan M.M.; Chen I.S.; Hershman D.L.
2011 ;126(1):271-272, Breast cancer research & treatment
— id: 122703, year: 2011, vol: 126, page: 271, 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 cognitive effects of chemotherapy in post-menopausal breast cancer patients: a controlled longitudinal study
Tager, Felice A; McKinley, Paula S; Schnabel, Freya R; El-Tamer, Mahmoud; Cheung, Ying Keun K; Fang, Yixin; Golden, Claire R; Frosch, Margery E; Habif, Ulya; Mulligan, Margaret M; Chen, Ivy S; Hershman, Dawn L
2010 Aug;123(1):25-34, Breast cancer research & treatment
Studies suggest that adjuvant chemotherapy for early stage breast cancer (BC) is associated with cognitive impairment related to attention, memory, and visuospatial functioning. However, other studies have failed to confirm that relationship. We report one of the first longitudinal, controlled studies of cognitive effects of chemotherapy in older post-menopausal women. Sixty-one post-menopausal women with non-metastatic BC were administered neuropsychological tests before adjuvant therapy (Time1), six months after treatment (Time2), and at a final 6-month follow-up (Time3). Thirty women were treated with chemotherapy; thirty-one women who received no chemotherapy were controls. Cognitive domains measured included motor, language, attention/concentration/working memory, visuospatial, and memory (verbal and visual). Time-by-treatment interaction was significant in the motor domain (P = 0.007) with poorer performance in women treated with chemotherapy. For the other domains, scores did not significantly vary over time by group. In post-menopausal women, chemotherapy was not associated with changes in cognitive function in areas reported by BC survivors: attention, memory, and information processing. Motor slowing in women treated with chemotherapy could be secondary to peripheral neuropathy rather than an indication of more general declines in cognitive processing. Future studies should control for the independent effects of slowed motor functioning when looking to study possible chemotherapy related cognitive processing deficits
— id: 133360, year: 2010, vol: 123, page: 25, 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,

Breast cancer risk factors in younger and older women
Chun, Jennifer; Pocock, Ben; Joseph, Kathie-Ann; El-Tamer, Mahmoud; Klein, Laura; Schnabel, Freya
2009 Jan;16(1):96-99, Annals of surgical oncology
Information is lacking regarding the interaction of established breast cancer risk factors and patient age. We attempted to study this interaction in high-risk women at the extremes of age in our population. The Women-At-Risk Registry was queried for women who were < or =35 and > or =70 years of age. Enrollment criteria included: strong family history of breast cancer (FHBC), and/or biopsy-proven history of atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), or lobular carcinoma in situ (LCIS). Descriptive analyses and Fisher's exact tests were used to analyze these factors and to assess their influence on breast cancer development. Our population included 1,412 high-risk women with median follow-up of 4 years. Of 195 women < or =35 years, 3 (1.5%) developed breast cancer. All three had strong FHBC and none had a prior high-risk lesion. Of 82 women > or =70 years, 6 (7.3%) developed breast cancer. Mean Gail score for women > or =70 years was 4.3, as compared with 4.7 in the subset of older women diagnosed with cancer. Fisher's tests demonstrated that ADH (p = 0.15), ALH (p = 1.0), LCIS (p = 1.0), and FHBC (p = 1.0) were not associated with breast cancer development in older women. We conclude that, for women < or =35 years, a significant FHBC may be a stronger predictor for breast cancer development than high-risk lesions. For women > or =70 years, FHBC and history of ADH, ALH, and LCIS were not predictors of breast cancer. This study emphasizes the importance of defining age-appropriate recommendations for breast cancer risk management, including surveillance and chemoprevention
— id: 97575, year: 2009, vol: 16, page: 96, 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,

Breast cancer risk factors in younger and older women
Chun, J; Pocock, BJ; Joseph, K; Klein, L; El-Tamer, M; Schnabel, FR
2008 FEB ;15(1):74-74, Annals of surgical oncology
— id: 75983, year: 2008, vol: 15, page: 74, stat: Journal Article,

Assessing a Bayesian risk prediction model in a high-risk breast cancer population
Chun, Jennifer; Schnabel, Freya; Ogunyemi, Omolola
2007 ;:913-913, AMIA ... Annual Symposium proceedings
The purpose of this study was to utilize a Bayesian risk prediction model to predict the incidence of breast cancer in a high risk population. 10-fold cross-validation was performed using a Naive Bayes classifier. The area under the ROC curve (AUC) was used to measure prediction accuracy. These results were then compared to the ROC curve (AUC) results of the Gail Model Risk Assessment Tool
— id: 149783, year: 2007, vol: , page: 913, stat: Journal Article,

Therapeutic options for Paget's disease: A single institution long-term follow-up study
Joseph, Kathie-Ann P; Ditkoff, Beth Ann; Estabrook, Alison; El-Tamer, Mahmoud B; Banarjee, Subhendra; Schnabel, Freya R
2007 Jan-Feb;13(1):110-111, Breast journal
— id: 79353, year: 2007, vol: 13, page: 110, stat: Journal Article,

Disparities in time to definitive surgical treatment between black and white women diagnosed with ductal carcinoma in situ
Pocock, Benjamin; Nash, Sarah; Klein, Laura; El-Tamer, Mahmoud; Schnabel, Freya R; Joseph, Kathie Ann
2007 Oct;194(4):521-523, American journal of surgery
BACKGROUND: Although black women develop invasive breast cancer at a lower incidence than white women, the cancers they develop tend to be of a higher grade and are more likely estrogen receptor negative. There is very little information with regard to black women and ductal carcinoma in situ (DCIS). In addition, although various reasons have been proposed for the delay to screening for black women, a delay after diagnosis has also been recognized. PURPOSE: The purpose of this study was to investigate disparities in time to treatment between black women and white women once DCIS has been diagnosed. METHODS: A retrospective analysis of 37 black women and 37 matched white women treated for DCIS was performed. Matches were made based on the date of birth, date of diagnosis, date and type of surgery, and age at diagnosis. The time from the date of diagnosis to the date of surgery was ascertained. RESULTS: Black women were 64% more likely to undergo a delay to surgery (>50 days) compared with white women (21% versus 13%, P < .05). CONCLUSION: Black women are more likely not to reach surgery within 50 days of diagnosis, which is concerning, and further studies to investigate the cause of these delays are warranted
— id: 79354, year: 2007, vol: 194, page: 521, stat: Journal Article,

Predictors of breast cancer development in a high-risk population
Chun, Jennifer; El-Tamer, Mahmoud; Joseph, Kathie-Ann; Ditkoff, Beth Ann; Schnabel, Freya
2006 Oct;192(4):474-477, American journal of surgery
BACKGROUND: The purpose of this study was to investigate the strongest predictors of breast cancer in a high-risk population and to increase our understanding of the possible interactions between risk factors. METHODS: The Women At Risk High-Risk Registry provided the study population. The variables of interest included age at enrollment, presence of lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, family history of breast cancer, body mass index, and Gail scores (5-year high-risk > or =1.7%). Univariate and multivariate analyses were conducted with the Cox proportional hazards regression model and years of follow-up evaluation as the time scale. RESULTS: Out of 1553 high-risk women, 79 (5%) developed breast cancer during a median follow-up period of 5 years. Results from the multivariate Cox model demonstrated that FHBC (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.05-2.97), ADH (HR = 1.90; 95% CI, 1.16-3.13), LCIS (HR = 1.71; 95% CI, .99-2.95), and a body mass index > or =30 (HR = 2.22; 95% CI, 1.14-4.35) were statistically significant predictors of breast cancer within this high-risk population. CONCLUSIONS: These results support current literature showing the synergistic increase in risk for patients with ADH, LCIS, and a positive family history of breast cancer. Obesity was also a strong predictor of breast cancer risk, which suggests that there may be a potentiating effect of obesity on other risk factors. Obesity may represent a modifiable risk factor, providing women with an opportunity to reduce their risk with lifestyle modification. Women with a strong family history of breast cancer or a diagnosis of ADH or LCIS may benefit most from risk-reduction strategies, chemoprevention, and surveillance
— id: 79350, year: 2006, vol: 192, page: 474, stat: Journal Article,

Long-term outcomes of malignant phyllodes tumors patients: an institutional experience
Fou, Adora; Schnabel, Freya R; Hamele-Bena, Diane; Wei, Xiao-Jun; Cheng, Bin; El Tamer, Mahmoud; Klein, Laura; Joseph, Kathie Ann
2006 Oct;192(4):492-495, American journal of surgery
BACKGROUND: Malignant phyllodes tumors are an extremely rare breast tumor. Prognostic features and overall survival data have not been consistent across studies. METHODS: Retrospectively, we examined the clinicopathologic features of 27 breast cancer patients treated for malignant phyllodes tumors from 1995 to 2004 and analyzed their recurrence and survival outcomes using contingency tables, a logistic regression model, or a proportional hazard model. RESULTS: The mortality rate was 12% (n = 3) of the cohort and 75% of the group with distant metastases. The median follow-up period was 51 months (range, 12-192 mo). A mitotic index greater than 10 per high-powered field, the presence of stromal overgrowth, mastectomy at initial surgery, and larger tumor size were associated with an increased incidence of distant metastases. Larger tumor size also was associated with an increased incidence of death. CONCLUSIONS: Most patients with malignant phyllodes tumors will enjoy significant long-term survival if treated appropriately with local excision with clear margins
— id: 73201, year: 2006, vol: 192, page: 492, stat: Journal Article,

The value of clinical characteristics and breast-imaging studies in predicting a histopathologic diagnosis of cancer or high-risk lesion in patients with spontaneous nipple discharge
Adepoju, Linda J; Chun, Jennifer; El-Tamer, Mahmoud; Ditkoff, Beth-Ann; Schnabel, Freya; Joseph, Kathie-Ann
2005 Oct;190(4):644-646, American journal of surgery
BACKGROUND: The purpose of this study was to determine the utility of breast-imaging studies in identifying cancer and high-risk lesions among patients with spontaneous, single-duct, nipple discharge (SSND). METHODS: The medical records of 168 cases with SSND treated with duct excision between June 1998 and May 2004 were reviewed. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mammogram, ultrasound, and ductogram in predicting high-risk lesions and cancer were calculated. RESULTS: The sensitivity of mammography was 10%, the specificity 94%, the NPV 88%, and the PPV 18%. Ultrasonography had a sensitivity of 36%, specificity of 68%, PPV of 14%, and NPV of 89%. Ductography had a sensitivity of 75%, specificity of 49%, and NPV and PPV of 93% and 18%, respectively. CONCLUSIONS: Conventional imaging studies do not accurately identify cancer or high-risk lesions in patients with SSND.All patients with SSND should be offered duct excision
— id: 79345, year: 2005, vol: 190, page: 644, stat: Journal Article,

Cohort study of women at risk for breast cancer and gross cystic disease
Chun, Jennifer; Joseph, Kathie-Ann; El-Tamer, Mahmoud; Rundle, Andrew; Jacobson, Judith; Schnabel, Freya
2005 Oct;190(4):583-587, American journal of surgery
BACKGROUND: Gross cystic disease (GCD) is a common benign breast condition. Previous studies have reported conflicting results regarding the relationship of GCD and subsequent risk of developing breast cancer. This cohort study was conducted to investigate the association of GCD and breast cancer among women at high risk for breast cancer. METHODS: The Women At Risk Registry provided the study population. The variables of interest included age at enrollment, age at breast cancer diagnosis, body mass index (BMI), presence of lobular carcinoma in situ (LCIS), and Gail scores. Statistical significance was determined by calculating multivariable-adjusted rate ratios using Cox proportional hazards regression model with years of follow-up as the time scale. RESULTS: The study population included 1317 high-risk women, including 363 (28%) with GCD. The mean follow-up was 5.9 years for the GCD cohort, and 5.1 years for the non-GCD cohort (P < .001). The GCD and non-GCD groups differed by Gail score (P < .001), BMI (P < .01), presence of atypical hyperplasia (P < .001), presence of LCIS (P < .001), and family history of breast cancer (P < .001). Within the total population of 1317 women, 79 (6%) developed breast cancer; 28 (35%) out of the 79 had a prior history of GCD. Results from the Cox proportional hazards regression model showed a nonstatistically significant association of GCD and breast cancer (hazard ratio = 1.48, 95% confidence interval 0.88-2.51). The Kaplan-Meier overall survival estimate between the exposed and unexposed groups indicate that there are no differences in overall survival between the 2 groups (P = .5). CONCLUSIONS: These results do not support the contention that gross cystic disease is a significant risk factor for breast cancer
— id: 79344, year: 2005, vol: 190, page: 583, stat: Journal Article,

Cutaneous subareolar leiomyoma: a rare clinical entity
Joseph, Kathie-Ann; Shutter, Jamie; El-Tamer, Mahmoud; Schnabel, Freya
2005 Nov-Dec;11(6):501-502, Breast journal
— id: 79347, year: 2005, vol: 11, page: 501, stat: Journal Article,

Allergic reactions to isosulfan blue in sentinel lymph node mapping
Komenaka, Ian K; Bauer, Valerie P; Schnabel, Freya R; Horowitz, Elizabeth; Joseph, Kathie Ann; Ditkoff, Beth-Ann; El-Tamer, Mahmoud B
2005 Jan-Feb;11(1):70-72, Breast journal
BACKGROUND: Sentinel lymph node (SLN) biopsy is often used in the assessment of lymph node status in melanoma and early stage breast cancer. With the rapidly increasing use of the technique, we can now better characterize and assess the rate of adverse reactions to the dye. METHODS: A retrospective review of all patients undergoing SLN mapping at the Columbia-Presbyterian Breast Center were identified from June 2000 to July 2002. All patients who experienced allergic reactions were documented and records examined. RESULTS: In total, three out of 351 patients had allergic complications from the procedure. All three patients developed 'blue hives' after injection with isosulfan blue. The incidence at our Breast Center was 0.9%. All were treated with intravenous corticosteroids and diphenhydramine and recovered within twenty-four hours. CONCLUSIONS: The increasing utilization of the sentinel lymph node technique will make these complications more common. A high index of suspicion and appropriate clinical management are recommended to minimize the potential morbidity of these reactions
— id: 79342, year: 2005, vol: 11, page: 70, stat: Journal Article,

Men with breast cancer have better disease-specific survival than women
El-Tamer, Mahmoud B; Komenaka, Ian K; Troxel, Andrea; Li, Huiling; Joseph, Kathie-Ann; Ditkoff, Beth-Ann; Schnabel, Freya R; Kinne, David W
2004 Oct;139(10):1079-1082, Archives of Surgery (Chicago)
HYPOTHESIS: Male breast cancer patients have better disease-specific survival than carefully matched female breast cancer patients. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS AND METHODS: Each man in the breast cancer database at Columbia-Presbyterian Medical Center (New York, NY) between the years 1980 and 1998 was matched with a woman. Matching was done based on age and date of diagnosis, stage, and primary histologic findings. MAIN OUTCOME MEASURES: The overall survivals and disease-specific survivals of the male breast cancer group and female breast cancer group were compared. RESULTS: Fifty-three male patients were matched with an equal number of female breast cancer patients. The Kaplan-Meier curves demonstrated that there was no significant difference in overall survival. The 5- and 10-year survivals for women were 0.77 and 0.51, and for men 0.77 and 0.56. When the Kaplan-Meier curves for breast cancer-specific survival were compared, however, there was a significant difference in the 5- and 10-year survivals (P = .05, log-rank test). For women, the 5- and 10-year disease-specific survival was 0.81 and 0.7, respectively, while for men it was 0.9 and 0.9, respectively. In a Cox regression analysis for time to death from breast cancer, stage was the only predictor of death that approached significance (P = .06). CONCLUSIONS: While the overall survivals were equivalent, male breast cancer patients had significantly better disease-specific survivals compared with their female counterparts. Male patients were 4 times more likely to die of other causes than their breast cancer
— id: 79341, year: 2004, vol: 139, page: 1079, stat: Journal Article,

Survival and recurrence after breast cancer in BRCA1/2 mutation carriers
El-Tamer, Mahmoud; Russo, Donna; Troxel, Andrea; Bernardino, Lourdes P; Mazziotta, Robert; Estabrook, Alison; Ditkoff, Beth-Ann; Schnabel, Freya; Mansukhani, Mahesh
2004 Feb;11(2):157-164, Annals of surgical oncology
BACKGROUND: Genetic mutation is responsible for approximately 10% of breast cancers. The purpose of this study was to compare breast cancer survival and recurrence rates between BRCA1/2 mutation carriers and noncarriers. METHODS: Using the Columbia Presbyterian breast cancer database, we collected the tissue blocks of all patients younger than 65 years of age and of Jewish descent. The patients were contacted and the data updated. DNA was extracted from the tissue blocks and tested for the common mutations. The results of the genetic mutation and updated database were anonymized and merged. The survival and recurrence rates were compared between mutation carriers and noncarriers. RESULTS: A total of 739 breast cancer cases in 715 patients were identified. We were able to test 487 patients. We identified 30 BRCA1 and 21 BRCA2 mutation carriers, for an incidence of 10.36%. The median follow-up for the patients tested was 50 months. BRCA1 patients more frequently had estrogen- and progesterone-negative tumors and had a higher incidence of positive nodes. BRCA1 patients received chemotherapy more frequently. The incidence of in situ disease was similar for mutation and non-mutation carriers. BRCA1/2 mutation carriers had a higher incidence of bilateral disease. There was no difference in 5- or 10-year overall and breast cancer-specific survival between mutation and non-mutation carriers. CONCLUSIONS: Breast cancer patients with BRCA1/2 mutations have a similar outcome as non-mutation carriers
— id: 79333, year: 2004, vol: 11, page: 157, stat: Journal Article,

Current comprehensive assessment and management of women at increased risk for breast cancer
Hollingsworth, Alan B; Singletary, S Eva; Morrow, Monica; Francescatti, Darius S; O'Shaughnessy, Joyce A; Hartman, Anne-Renee; Haddad, Becky; Schnabel, Freya R; Vogel, Victor G
2004 Mar;187(3):349-362, American journal of surgery
The potential for reducing the risk of breast cancer through selective estrogen receptor modulators, aromatase inhibitors, and surgery has generated interest in the use of quantitative models of risk assessment. With the addition of ductal lavage cytology to traditional epidemiologic risk factors, a discovery of cellular atypia can result in refinement of assigned risk values, while simultaneously optimizing patient selection for selective estrogen receptor modulators utilization. In view of increasing complexity in this arena, a Risk Assessment Working Group was formed to outline management strategies for the patient at an elevated risk for the development of breast cancer. No longer a statistical exercise, quantitative risk assessment is part of basic breast care and comprehensive management includes a discussion of the following: ductal lavage for improved risk stratification, multiple options for risk reduction, and high risk surveillance strategies that might incorporate investigational imaging protocols
— id: 79335, year: 2004, vol: 187, page: 349, stat: Journal Article,

Acquired arteriovenous fistula of the breast
Joseph, Kathie-Ann; Ditkoff, Beth Ann; Komenaka, Ian; Mercado, Cecilia L; Millman, Shara L; Lantis, John; El-Tamer, Mahmoud; Horowitz, Elizabeth; Schnabel, Freya
2004 Mar-Apr;10(2):156-158, Breast journal
— id: 79336, year: 2004, vol: 10, page: 156, stat: Journal Article,

Predictors of nonsentinel node metastasis in patients with breast cancer after sentinel node metastasis
Joseph, Kathie-Ann; El-Tamer, Mahmoud; Komenaka, Ian; Troxel, Andrea; Ditkoff, Beth Ann; Schnabel, Freya
2004 Jun;139(6):648-651, Archives of Surgery (Chicago)
HYPOTHESIS: The presence of nonsentinel lymph node (NSLN) metastasis after having a positive sentinel lymph node dissection finding is associated with tumor size and stage, the presence of lymphovascular invasion, micrometastasis, and extranodal extension. DESIGN: Retrospective case series. SETTING: University hospital. PATIENTS: Four hundred seven consecutive patients at a single institution who underwent sentinel lymph node dissection as part of breast conservation or mastectomy with biopsy-proved cancer. INTERVENTION: Completion axillary lymph node dissection and definitive therapy. MAIN OUTCOME MEASURES: Sentinel node metastasis, NSLN metastasis, tumor size and stage, lymphovacular invasion, micrometastasis, extronodal extension, histological tumor characteristics, and number of sentinel nodes removed. RESULTS: In a univariate analysis, size of the primary tumor and extranodal extension were associated with having positive NSLN findings. The presence of micrometastasis was associated with negative NSLN findings. When all factors were included in a logistic regression analysis, the significant predictor of NSLN metastasis was extranodal extension (P =.002). Lymphovascular invasion was not associated with positive NSLN findings (P =.11). The number of sentinel nodes removed also had no bearing on the status of the NSLNs (P =.37). CONCLUSIONS: Although primary tumor size and micrometastases correlate with the status of the NSLNs, extranodal extension is the most important independent predictor of NSLN metastasis. These findings may ultimately spare patients a full axillary lymph node dissection. However, pending results of larger clinical trials, full axillary lymph node dissection is still recommended for patients with sentinel lymph node metastases
— id: 79340, year: 2004, vol: 139, page: 648, stat: Journal Article,

Synchronous presentation of breast cancer and pheochromocytoma in a 57-year-old woman
Joseph, Katie-Ann; El-Tamer, Mahmoud; Ditkoff, Beth Ann; Chabot, John; Komenaka, Ian; Horowitz, Liz; Schnabel, Freya; Shutter, Jamie
2004 Jan-Feb;10(1):63-64, Breast journal
— id: 79332, year: 2004, vol: 10, page: 63, stat: Journal Article,

Interpectoral nodes as the initial site of recurrence in breast cancer
Komenaka, Ian K; Bauer, Valerie P; Schnabel, Freya R; Joseph, Kathie-Ann; Horowitz, Elizabeth; Ditkoff, Beth-Ann; El-Tamer, Mahmoud B
2004 Feb;139(2):175-178, Archives of Surgery (Chicago)
HYPOTHESIS: Interpectoral nodes can be the initial site of recurrent breast cancer. DESIGN: Retrospective review. SETTING: Comprehensive breast center, located in a university-based tertiary care center. PATIENTS: All patients undergoing operations for breast cancer at our breast center from 1995 to 2002 were reviewed. MAIN OUTCOME MEASURES: Patients with interpectoral node recurrence as the initial site of recurrent breast cancer were identified. RESULTS: During the 8-year period, 4097 patients underwent surgical management for breast cancer. During this time, 4 patients (0.1%) had recurrence at the interpectoral nodes. Three of the 4 patients were node-negative at the original operation. All lesions were mammographically occult. Preoperative needle biopsy was effective in the confirmation of malignancy. All 4 underwent excision without complications. CONCLUSIONS: Recurrence at the interpectoral nodes can be the initial site of surgical failure. These nodes may represent the site of primary drainage in a percentage of patients. The sentinel node identification technique, therefore, should diminish the number of patients affected by recurrence at this site. In patients with a palpable mass in the infraclavicular location, however, a high index of suspicion should be maintained. Workup should include additional breast imaging and needle biopsy prior to operation
— id: 79334, year: 2004, vol: 139, page: 175, stat: Journal Article,

Free silicone injection causing polyarthropathy and septic shock
Komenaka, Ian K; Ditkoff, Beth Ann; Schnabel, Freya; Marboe, Charles C; Mercado, Cecilia
2004 Mar-Apr;10(2):160-161, Breast journal
— id: 79337, year: 2004, vol: 10, page: 160, stat: Journal Article,

The development of interval breast malignancies in patients with BRCA mutations
Komenaka, Ian K; Ditkoff, Beth-Ann; Joseph, Kathie-Ann; Russo, Donna; Gorroochurn, Prakash; Ward, Marie; Horowitz, Elizabeth; El-Tamer, Mahmoud B; Schnabel, Freya R
2004 May 15;100(10):2079-2083, Cancer
BACKGROUND: At present, there is no consensus regarding how frequently BRCA mutation carriers should be screened for malignancies using breast imaging techniques. An interval malignancy is defined as a malignancy that becomes evident during the period between annual screening mammography scans; the finding of such a malignancy indicates that the malignancy either went undetected by the last breast imaging scan or developed during the interval since that last scan. METHODS: The authors retrospectively reviewed the medical charts of all BRCA mutation carriers who were followed by the genetic counselor at the Columbia-Presbyterian Comprehensive Breast Center (New York, NY) between September 1995 and September 2002. RESULTS: Thirteen BRCA mutation carriers elected to undergo close surveillance and thus were followed at our institution. Three of these 13 patients (23%) did not develop breast carcinoma, 4 (31%) developed breast carcinoma that was detected at the time of annual screening, and 6 (46%) developed palpable interval malignancies in less than 12 months. Among the six patients who developed interval malignancies, the mean time between the last screening mammogram and disease presentation was 5.1 months (range, 2-9 months); the average tumor size in this patient subgroup was 1.7 cm (range, 0.8-3 cm). Two of these six patients had ductal carcinoma in situ, whereas the remaining four had invasive breast carcinoma; three patients had positive lymph nodes at presentation. All six patients who developed interval disease exhibited dense breast tissue on the previous mammogram. Focused breast ultrasonography was able to identify the tumor mass in 3 of 4 patients (75%). CONCLUSIONS: Nearly half of all BRCA-positive women who chose to undergo close surveillance in the current study developed malignant disease less than a year after exhibiting normal findings on screening mammography. Half of these interval malignancies were positive for lymph node involvement. These results suggest that strong consideration should be given to screening BRCA-positive women at more frequent intervals and to using additional imaging techniques, such as breast ultrasonography and/or breast magnetic resonance imaging, as a part of this screening
— id: 79339, year: 2004, vol: 100, page: 2079, stat: Journal Article,

Pure mucinous carcinoma of the breast
Komenaka, Ian K; El-Tamer, Mahmoud B; Troxel, Andrea; Hamele-Bena, Diane; Joseph, Kathie-Ann; Horowitz, Elizabeth; Ditkoff, Beth-Ann; Schnabel, Freya R
2004 Apr;187(4):528-532, American journal of surgery
BACKGROUND: The lack of a standard definition of 'pure' mucinous carcinoma of the breast has made it difficult to compare data from different studies. This study used the most stringent criteria to define parameters for truly pure lesions. METHODS: Sixty-five patients were identified. The database was used to evaluate patients' demographics, tumor characteristics, and outcomes. Survival curves and predictors of survival were analyzed. RESULTS: The mean age of presentation was 67 years. The majority (96%) of patients presented with early-stage disease. The 5- and 10-year overall survival rates were 93.6% and 72.8%, respectively. The number of involved axillary lymph nodes was the only significant predictor of death (P = 0.02). CONCLUSIONS: Pure mucinous carcinoma of the breast has a favorable prognosis. Tumor size does not appear to impact survival, perhaps because the volume of mucin overestimates tumor burden. The number of involved axillary lymph nodes was the only significant predictor of death from disease
— id: 79338, year: 2004, vol: 187, page: 528, stat: Journal Article,

The management of lobular neoplasia identified on percutaneous core breast biopsy
Bauer, Valerie P; Ditkoff, Beth Ann; Schnabel, Freya; Brenin, David; El-Tamer, Mahmoud; Smith, Suzanne
2003 Jan-Feb;9(1):4-9, Breast journal
The management of lobular neoplasia (LN) found on percutaneous core biopsy remains a clinical dilemma. The purpose of this study was to establish guidelines for the management of LN when obtained on percutaneous core needle biopsy. A retrospective review of the Breast Imaging Tissue Sampling Database at New York Presbyterian Hospital-Columbia Comprehensive Breast Center was performed from 1998 to 2000. A total of 1460 percutaneous core breast biopsies were performed using 11- or 14-gauge needles with LN identified in 43 biopsies from 34 patients. Eleven biopsies were ultrasound guided for nonpalpable masses and 32 were stereotactically guided for mammographically detected densities (10) and microcalcifications (22). The 43 LN biopsies were divided into three groups based on additional findings associated with LN on core biopsy: group I (n = 19), LN with invasive cancer or ductal carcinoma in situ (DCIS); group II (n = 11), LN plus a second indication for open surgical biopsy, such as atypical ductal hyperplasia (ADH), radial scar, phyllodes tumor, or intraductal papilloma; and group III (n = 13), LN plus benign fibrocystic changes. In group I, 19 of 19 biopsies (100%) yielded invasive cancer or DCIS on surgical biopsy versus 3 of 11 (27%) for group II, and 1 of 13 (8%) for group III. Outcomes in group III are described as follows: three patients were lost to follow-up, three patients did not undergo surgical biopsy but demonstrated more than 1 year of mammographic stability following core biopsy. Of the remaining seven patients, two had LN and ADH on surgical biopsy (one had a contralateral cancer), one had atypical lobular hyperplasia (with a contralateral cancer), two had LN and benign fibrocystic changes, one had LN and intraductal papilloma, and one had LN and invasive ductal carcinoma (IDC) with DCIS (with a contralateral cancer). These results suggest that surgical biopsy is indicated for patients with LN when found on core biopsy and when the biopsy demonstrates invasive cancer, DCIS, or other indications for surgical biopsy such as ADH, or in the examination of a patient with a synchronous contralateral breast cancer. The diagnosis of LN alone without these indications on percutaneous biopsy may not warrant routine surgical biopsy
— id: 79325, year: 2003, vol: 9, page: 4, stat: Journal Article,

Pulse oximeter changes with sentinel lymph node biopsy in breast cancer
El-Tamer, Mahmoud; Komenaka, Ian K; Curry, Saundra; Troxel, Andrea B; Ditkoff, Beth-Ann; Schnabel, Freya R
2003 Nov;138(11):1257-1260, Archives of Surgery (Chicago)
HYPOTHESIS: The changes reported with pulse oximetry after the injection of isosulfan blue for sentinel lymph node identification in patients with breast cancer are consistent and predictable. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS AND METHODS: The complete anesthesia records of 92 patients who underwent sentinel lymph node biopsy with intraparenchymal injection of isosulfan blue were reviewed. The study extended from January 1999 to February 2000. The operations were all performed after the patient received general anesthesia. We injected 5 mL of isosulfan blue into the breast tissue surrounding the tumor. The data reviewed included preinjection pulse oximeter saturation readings and postinjection values continuing until the readings returned to baseline levels in the postanesthesia care unit. MAIN OUTCOME MEASURES: Changes in oxygen saturation readings with the pulse oximeter before and after injection of isosulfan blue. RESULTS: Isosulfan blue injection interfered with pulse oximeter measurements for a substantial time-as much as 195 minutes. The mean time to the maximum change in the pulse oximeter reading was 35 minutes. The median decrease in oxygen saturation was 5%. The maximum decrease in the pulse oximeter reading was 11%. CONCLUSIONS: Although the changes in pulse oximeter readings can be substantial, their course appears to be predictable, and therefore in most otherwise healthy patients with normal pulmonary function, invasive monitoring is not necessary
— id: 79330, year: 2003, vol: 138, page: 1257, stat: Journal Article,

Racial/ethnic differences and potential psychological benefits in use of the internet by women with breast cancer
Fogel, Joshua; Albert, Steven M; Schnabel, Freya; Ditkoff, Beth Ann; Neugut, Alfred I
2003 Mar;12(2):107-117, Psycho-oncology
Many websites on the Internet offer information to breast cancer patients and are increasingly being used. The authors investigated the potential psychological benefits of Internet use and how it varied as a function of race/ethnicity among 180 white, African American, and Hispanic American breast cancer patients who used the Internet for medical information. Using standardized psychological measures, as measured by the Interpersonal Support Evaluation List (ISEL), Internet use among minorities was associated with greater overall, appraisal, and tangible social support (p's<0.05) but not belonging and self-esteem social support than among whites. No differences were observed for stress, depressive symptoms, loneliness, and coping. Since numerous studies suggest that social support may be related to survival, Internet use for breast health issues may have special clinical relevance to racial/ethnic minority groups
— id: 79326, year: 2003, vol: 12, page: 107, stat: Journal Article,

A 40-year delayed locoregional recurrence of breast carcinoma following mastectomy
Joseph, Kathie-Ann; El-Tamer, Mahmoud; Ditkoff, Beth Ann; Komenaka, Ian; Horowitz, Liz; Schnabel, Freya
2003 Nov;69(11):1015-1016, American surgeon
A 90-year-old woman who underwent a left modified radical mastectomy 40 years ago with no further adjuvant treatment presented with a left chest wall mass at the suture line. A biopsy of the mass confirmed that it was invasive ductal carcinoma of the breast. After a negative metastatic work-up, the patient underwent a local resection of the chest wall mass with clear margins. We present here the longest documented delayed recurrence after modified radical mastectomy reported in the literature
— id: 79331, year: 2003, vol: 69, page: 1015, stat: Journal Article,

Recurrent eosinophilic mastitis
Komenaka, Ian K; Schnabel, Freya R; Cohen, Jason A; Saqi, Anjali; Mercado, Cecilia; Horowitz, Elizabeth; Hamele-Bena, Diane; Joseph, Kathie-Ann
2003 Jul;69(7):620-623, American surgeon
Systemic diseases rarely present with manifestations in the breast. Disorders such as sarcoidosis and pyoderma gangrenosum have been described to produce signs and symptoms in the breast. Peripheral eosinophilia is a systemic disease associated with a finite group of conditions including asthma, allergic or atopic disease, collagen vascular disease, and parasitic infection. In addition it has been described in association with several malignancies. A 50-year-old woman with a history of asthma and significant eosinophilia presented with an enlarging breast mass. Complete excision of the mass revealed eosinophilic mastitis. Two years later the patient again presented with a large mass in the same breast. Repeat excision demonstrated the same pathology. The clinical significance of this lesion is important because it presents as an enlarging, painless, dominant mass. Excision is necessary for management and to conclusively rule out malignancy. Its recurrence despite excision to negative margins, however, may indicate that control of the eosinophilia--and possibly the underlying disorder--is important to prevent further recurrence
— id: 79329, year: 2003, vol: 69, page: 620, stat: Journal Article,

Sulfotransferase 1A1 (SULT1A1) polymorphism, PAH-DNA adduct levels in breast tissue and breast cancer risk in a case-control study
Tang, Deliang; Rundle, Andrew; Mooney, Laverne; Cho, Stan; Schnabel, Freya; Estabrook, Alison; Kelly, Amalia; Levine, Richard; Hibshoosh, Hannina; Perera, Frederica
2003 Mar;78(2):217-222, Breast cancer research & treatment
Gene-environment interactions are hypothesized to be major contributors to susceptibility to environmental carcinogens and interindividual variability in cancer risk. We present findings on associations between genetic susceptibility due to inherited polymorphisms of the Phase II detoxification enzyme sulfotransferase 1A1 (SULT1A1), breast cancer risk, and polycyclic aromatic hydrocarbon (PAH)-DNA adducts. A hospital based case-control study was conducted at the New York-Presbyterian Medical Center (NYPMC). The study utilized two control groups: one comprised of women with benign breast disease (BBD) and the other comprised of women visiting NYPMC for routine gynecologic checkups (healthy controls). Blood samples were collected from cases and controls; and breast tissue from pathology blocks was collected from cases (tumor and non-tumor tissue) and BBD controls (benign tissue). PAH-DNA adduct levels were measured by immunohistochemistry in breast tissue samples, and the SULT1A1 (Arg/His) polymorphism at codon 213 was determined by PCR RFLP analyses using DNA from white blood cells. Increasing number of His alleles was modestly associated with breast cancer case-control status, when cases were compared to healthy controls (p for trend = 0.08), when cases were compared to BBD controls (p for trend = 0.08) and when cases were compared to both control groups combined (p for trend = 0.07). Contrary to our hypothesis PAH-DNA adduct levels in breast tissue were not associated with SULT1A1 genotype. Our findings are consistent with a prior report that the Arg/His polymorphism in SULT1A1 is associated with breast cancer risk
— id: 79328, year: 2003, vol: 78, page: 217, stat: Journal Article,

Internet use and social support in women with breast cancer
Fogel, Joshua; Albert, Steven M; Schnabel, Freya; Ditkoff, Beth Ann; Neugut, Alfred I
2002 Jul;21(4):398-404, Health psychology
Many Web sites offer information to breast cancer patients, who are increasingly using these sites. The authors investigated the potential psychological benefits of Internet use for medical information by breast cancer patients. Of the 251 women approached, 188 were successfully interviewed (74.9%). Forty-two percent used the Internet for medical information related to breast health issues and did so for an average of 0.80 hr per week. The Interpersonal Support Evaluation List and the UCLA Loneliness Scale, with results controlled for covariates, showed that Internet use for breast health issues was associated with greater social support and less loneliness than Internet use for other purposes or nonuse. Breast cancer patients may obtain these psychological benefits with only a minimal weekly time commitment
— id: 79316, year: 2002, vol: 21, page: 398, stat: Journal Article,

Use of the Internet by women with breast cancer
Fogel, Joshua; Albert, Steven M; Schnabel, Freya; Ditkoff, Beth Ann; Neugut, Alfred I
2002 Apr-Nov;4(2):E9-E9, Journal of medical Internet research
BACKGROUND: Recently, many cancer patients have been using the Internet for information with which to make informed choices. We are not aware of any studies that investigate this Internet use among breast cancer patients or women. OBJECTIVE: We investigate the prevalence and predictors of Internet use for medical information among women with breast cancer. METHODS: We used a cross-sectional design and approached 251 women with breast cancer being treated at a university-based hospital. We successfully interviewed 188 (74.9%), through mailed self-report questionnaires. Medical information was obtained from the hospital tumor registry. We used t tests and chi-square tests to assess differences in Internet use for breast health issues and binary logistic regression to estimate the odds ratio (OR) for predictors of Internet use for breast health issues. RESULTS: In our sample, 41.5% of patients used the Internet for medical information. Internet users differed from nonusers on income level, educational level, and by race/ethnicity. After controlling for the other predictors, Internet users had a higher income (OR = 3.10; 95% CI = 1.09-8.85) and tended to be more educated (OR = 2.59; 95% CI = 0.87-7.74) than nonusers. There was also a suggestion that those of nonwhite ethnicity were less likely to use the Internet (OR = 0.39; 95% CI = 0.14-1.11). Increasing age, length of time since diagnosis, and breast cancer stage had no effect. CONCLUSIONS: A substantial proportion of breast cancer patients used the Internet as a source of information. Patients with higher income or education, and patients of white race/ethnicity are more likely to use the Internet for breast health issues
— id: 79324, year: 2002, vol: 4, page: E9, stat: Journal Article,

Environmental toxins and breast cancer on Long Island. I. Polycyclic aromatic hydrocarbon DNA adducts
Gammon, Marilie D; Santella, Regina M; Neugut, Alfred I; Eng, Sybil M; Teitelbaum, Susan L; Paykin, Andrea; Levin, Bruce; Terry, Mary Beth; Young, Tie Lan; Wang, Lian Wen; Wang, Qiao; Britton, Julie A; Wolff, Mary S; Stellman, Steven D; Hatch, Maureen; Kabat, Geoffrey C; Senie, Ruby; Garbowski, Gail; Maffeo, Carla; Montalvan, Pat; Berkowitz, Gertrud; Kemeny, Margaret; Citron, Marc; Schnabel, Freya; Schuss, Allan; Hajdu, Steven; Vinceguerra, Vincent
2002 Aug;11(8):677-685, Cancer epidemiology biomarkers & prevention
Polycyclic aromatic hydrocarbons (PAH) are potent mammary carcinogens in rodents, but their effect on breast cancer development in women is not clear. To examine whether currently measurable PAH damage to DNA increases breast cancer risk, a population-based case-control study was undertaken on Long Island, NY. Cases were women newly diagnosed with in situ and invasive breast cancer; controls were randomly selected women frequency matched to the age distribution of cases. Blood samples were donated by 1102 (73.0%) and 1141 (73.3%) of case and control respondents, respectively. Samples from 576 cases and 427 controls were assayed for PAH-DNA adducts using an ELISA. The geometric mean (and geometric SD) of the log-transformed levels of PAH-DNA adducts on a natural scale was slightly, but nonsignificantly, higher among cases [7.36 (7.29)] than among controls [6.21 (4.17); P = 0.51]. The age-adjusted odds ratio (OR) for breast cancer in relation to the highest quintile of adduct levels compared with the lowest was 1.51 [95% confidence interval (CI), 1.04-2.20], with little or no evidence of substantial confounding (corresponding multivariate-adjusted OR, 1.49; 95% CI, 1.00-2.21). There was no consistent elevation in risk with increasing adduct levels, nor was there a consistent association between adduct levels and two of the main sources of PAH, active or passive cigarette smoking or consumption of grilled and smoked foods. These data indicate that PAH-DNA adduct formation may influence breast cancer development, although the association does not appear to be dose dependent and may have a threshold effect
— id: 79318, year: 2002, vol: 11, page: 677, stat: Journal Article,

Environmental toxins and breast cancer on Long Island. II. Organochlorine compound levels in blood
Gammon, Marilie D; Wolff, Mary S; Neugut, Alfred I; Eng, Sybil M; Teitelbaum, Susan L; Britton, Julie A; Terry, Mary Beth; Levin, Bruce; Stellman, Steven D; Kabat, Geoffrey C; Hatch, Maureen; Senie, Ruby; Berkowitz, Gertrud; Bradlow, H Leon; Garbowski, Gail; Maffeo, Carla; Montalvan, Pat; Kemeny, Margaret; Citron, Marc; Schnabel, Freya; Schuss, Allan; Hajdu, Steven; Vinceguerra, Vincent; Niguidula, Nancy; Ireland, Karen; Santella, Regina M
2002 Aug;11(8):686-697, Cancer epidemiology biomarkers & prevention
Whether environmental contaminants increase breast cancer risk among women on Long Island, NY, is unknown. The study objective is to determine whether breast cancer risk is increased in relation to organochlorines, compounds with known estrogenic characteristics that were extensively used on Long Island and other areas of the United States. Recent reports do not support a strong association, although there are concerns with high risks observed in subgroups of women. Blood samples from 646 case and 429 control women from a population-based case-control study conducted on Long Island were analyzed. No substantial elevation in breast cancer risk was observed in relation to the highest quintile of lipid-adjusted serum levels of p,p'-bis(4-chlorophenyl)-1,1-dichloroethene (DDE) [odds ratio (OR), 1.20 versus lowest quintile; 95% confidence interval (CI), 0.76-1.90], chlordane (OR, 0.98; 95% CI, 0.62-1.55), dieldrin (OR, 1.37; 95% CI, 0.69-2.72), the sum of the four most frequently occurring PCB congeners (nos. 118, 153, 138, and 180; OR, 0.83; 95% CI, 0.54-1.29), and other PCB congener groupings. No dose-response relations were apparent. Nor was risk increased in relation to organochlorines among women who had not breastfed or were overweight, postmenopausal, or long-term residents of Long Island; or with whether the case was diagnosed with invasive rather than in situ disease, or with a hormone receptor-positive tumor. These findings, based on the largest number of samples analyzed to date among primarily white women, do not support the hypothesis that organochlorines increase breast cancer risk among Long Island women
— id: 79319, year: 2002, vol: 11, page: 686, stat: Journal Article,

Association between the ras p21 oncoprotein in blood samples and breast cancer
Rundle, Andrew; Tang, Deliang; Brandt-Rauf, Paul; Zhou, Jingzhi; Kelly, Amalia; Schnabel, Freya; Perera, Frederica P
2002 Nov 8;185(1):71-78, Cancer letters
To assess the potential of using oncoprotein levels in blood as a marker of breast cancer status, we measured ras p21 in blood samples taken from 34 breast cancer cases and 60 non-cancer controls including 26 women with benign breast disease (BBD) and 34 healthy women. Plasma samples drawn before surgery or at routine office visit were analyzed for ras p21 by Western blot with computer aided image analysis to measure staining intensity in integrated pixel units (IPU). We found detectable levels of ras p21 in 53% of the blood samples of cases, in 27% of the BBD controls and 26% of the healthy controls. Comparing cases to the combined control group (n=60) and controlling for known breast cancer risk factors, ras p21 was associated with breast cancer status (odds ratio=5.22, 95% CI=1.58-17.23). The median levels of ras p21 staining were higher in cases (7.04 IPU, P=0.03) compared to BBD controls (0.00 IPU) or healthy controls (0.00 IPU). The sensitivity of the assay for detecting breast cancer was 50% which compares favorably with that seen for erbB-2 ( approximately 10%), a more extensively studied blood-borne tumor marker. Ras p21 may be useful in the early detection of breast tumors and in post-surgical follow-up of patients, giving patients and physicians new tools for managing breast cancer
— id: 79317, year: 2002, vol: 185, page: 71, stat: Journal Article,

Molecular epidemiologic studies of polycyclic aromatic hydrocarbon-DNA adducts and breast cancer
Rundle, Andrew; Tang, Deliang; Hibshoosh, Hanina; Schnabel, Freya; Kelly, Amalia; Levine, Richard; Zhou, Jingzhi; Link, Bruce; Perera, Frederica
2002 ;39(2-3):201-207, Environmental & molecular mutagenesis
We review our studies on the role of polycyclic aromatic hydrocarbon (PAH)-DNA adducts in breast cancer. Additionally we report on analyses of the reliability of the scoring procedures used with immunohistochemical assay for PAH-DNA adducts and of potential bias arising from the use of benign breast disease (BBD) controls. We conducted a case-control study utilizing two control groups: BBD controls who donated tissue and blood samples, and healthy controls who donated blood samples. In comparisons of tumor tissue from cases and benign tissue from BBD controls, increasing adduct levels were significantly associated with case-control status [odds ratio (OR) = 2.40, 95% confidence interval (CI) 1.18-4.92], whereas in comparisons of nontumor tissue from cases and benign tissue from BBD controls the association was nonsignificant (OR = 1.97, 95% CI 0.94-4.17). We also show among cases, but not among BBD controls, that the GSTM1 null genotype is associated with increased adduct levels in breast tissue. Our reliability study found the scoring procedures used with the immunohistochemical assay to have high reliability, 0.93 in nontumor, 0.82 in tumor, and 0.74 in benign tissues. However, we found that the technician significantly contributed to the total variability of a series of data. Finally, we did not find a consistent bias to the null associated with the use of BBD controls; however, BBD controls may overestimate the prevalence of family history of breast cancer compared to that of healthy controls (18% vs.14%). We hypothesize that the higher prevalence results from a referral bias and discuss how this may influence our results
— id: 79313, year: 2002, vol: 39, page: 201, stat: Journal Article,

Polymorphisms in the DNA repair enzyme XPD are associated with increased levels of PAH-DNA adducts in a case-control study of breast cancer
Tang, Deliang; Cho, Stan; Rundle, Andrew; Chen, Senqing; Phillips, David; Zhou, Jingzhi; Hsu, Yanzhi; Schnabel, Freya; Estabrook, Alison; Perera, Frederica P
2002 Sep;75(2):159-166, Breast cancer research & treatment
We present findings on the associations between DNA adduct levels in breast tissue, risk of breast cancer, and polymorphisms in the DNA repair enzyme XPD. Breast cancer cases, benign breast disease (BBD) controls, and healthy controls were enrolled. Polycyclic aromatic hydrocarbons (PAH)-DNA adduct levels were measured by immunohistochemistry in breast tissue samples from cases and BBD controls. XPD polymorphisms at codons 312 and 751 was determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis using white blood cell DNA. Neither of the polymorphisms were associated with case-control status, both in comparisons of cases and BBD controls, and cases and healthy controls. XPD polymorphisms at codons 312 and 751 were associated with higher levels of PAH-DNA in tumor tissue from breast cancer cases. Subjects with an Asp/Asn or Asn/Asn polymorphic genotype in codon 312 of XPD had elevated levels of PAH-DNA adducts compared to subjects with the Asp/Asp genotype (0.55 optical density (OD) v.s. 0.33 OD, p < 0.01). PAH-DNA adducts were associated with increasing copy number of the Gln allele for the codon 751 polymorphism (p for trend <0.01). Among subjects with the Asp/Asn or Asn/Asn genotype at codon 312, adduct levels were higher in tumor tissue compared to tissue from BBD controls (0.55 OD v.s. 0.36 OD, p = 0.003). Among subjects with the Gln/Gln genotype at codon 751 adduct levels were higher in tumor tissue compared to tissue from BBD controls (0.68 OD v.s. 0.40 OD, p = 0.01). The trend of increasing PAH-DNA adduct levels with either the Asn/Asn or Gln/Gln genotype was greater in tumor tissue than the trend in BBD control tissue
— id: 79321, year: 2002, vol: 75, page: 159, stat: Journal Article,

Estimating the effect of an intensive surveillance program on stage of breast carcinoma at diagnosis: a propensity score analysis
Mitra, N; Schnabel, F R; Neugut, A I; Heitjan, D F
2001 May 1;91(9):1709-1715, Cancer
BACKGROUND: The authors used propensity score adjustment to investigate the impact of intensive screening on stage of breast carcinoma at diagnosis in women who were at elevated risk for breast carcinoma. METHODS: The authors compared 58 women participating in a surveillance program at the Columbia Presbyterian Medical Center of New York Presbyterian Hospital who developed breast carcinoma with 3022 nonparticipating breast carcinoma patients. A propensity score was constructed for each woman by using important background covariates, and multivariable regression modeling was used to estimate the association of program membership with disease stage after adjusting for the propensity score. RESULTS: Before propensity score adjustment, nine baseline covariates significantly differed between the two groups (number of pregnancies, number of births, age at first delivery, race, how the tumor was discovered, history of prior breast disease, breast carcinoma in mother, breast carcinoma in maternal aunt, and breast carcinoma in sister), and there was a significant difference in stage at diagnosis. After adjustment, no significant differences remained. Program participants were more likely to have lower stage tumors at diagnosis than nonparticipants, but this association did not reach statistical significance (odds ratio, 1.52; 95% confidence interval, 0.94--2.46). CONCLUSIONS: Propensity score methods can remove bias in treatment comparisons in observational studies. An intensive surveillance program at a major cancer center may have had some effect on improving stage at diagnosis, but this effect was not statistically significant
— id: 79308, year: 2001, vol: 91, page: 1709, stat: Journal Article,

The relationship of urinary thromboxane excretion to cyclosporine nephrotoxicity
Schnabel, F R; Wait, R B; Kahng, K U
1991 Mar;51(3):686-689, Transplantation
Alterations in renal prostaglandin production have recently been postulated to modulate the decrease in renal blood flow associated with cyclosporine nephrotoxicity. In particular, increases in renal production of the potent vasoconstrictor thromboxane A2 have been implicated in the pathogenesis of this disorder. The present study was undertaken to explore the relationship between alterations in urinary thromboxane B2 excretion (UTxB2V) and CsA nephrotoxicity in two rat models. Male Sprague-Dawley (SD) rats were treated for 14 days with CsA 50 mg/kg/day (n = 8) or olive oil (C) (n = 9) by gavage. Creatinine clearance (Ccr), urine flow (V), and urinary excretion rates of sodium, N-acetyl-beta-D-glucosaminidase (NAG), glucose, and TxB2 were determined before and after treatment. A similar study was conducted using Fischer rats (CsA: n = 10, C: n = 13). In Fischer rats, CsA caused a 35% decrease in Ccr (P = 0.01), a 33% decrease in sodium excretion (P = 0.02), and a greater than 2-fold increase in NAG excretion (P = 0.03), while V, glucose excretion, and UTxB2V did not change. Although similar changes in sodium and NAG excretion were seen after CsA administration in SD rats, Ccr was not affected. Additional findings in SD rats included a 3-fold increase in V (P less than 0.01), a 24-fold increase in glucose excretion (P = 0.03), and a 5-fold increase in UTxB2V (P = 0.04). Thus, Fischer rats developed CsA nephrotoxicity in the absence of increased UTxB2V. In contrast, SD rats failed to develop nephrotoxicity despite a marked increase in UTxB2V. We conclude that changes in renal TxA2 production are unrelated to the development of CsA nephrotoxicity
— id: 79356, year: 1991, vol: 51, page: 686, stat: Journal Article,

Effect of cyclosporine administration on vascular reactivity in the rabbit
Schnabel, F R; Wait, R B; Aaronson, P; Kahng, K U
1989 Feb;21(1 Pt 1):918-921, Transplantation proceedings
— id: 79357, year: 1989, vol: 21, page: 918, stat: Journal Article,

Renal vascular reactivity in the bile duct-ligated rat
Kahng, K U; Monaco, D O; Schnabel, F R; Wait, R B
1988 Aug;104(2):250-256, Surgery
The renal dysfunction associated with liver disease appears to be caused by decreased renal perfusion. Altered renal vascular reactivity (RVR) may contribute to the development of decreased renal blood flow. This study was undertaken to assess the effect of bile duct ligation (BDL) on RVR to norepinephrine and angiotensin II in the rat and to evaluate the role of prostaglandins in the modulation of altered RVR. Male Sprague-Dawley rats underwent either sham operation (SO) or BDL. Four days later, isolated kidney perfusions were established. Dose-response curves to norepinephrine (SO, n = 9; BDL, n = 10) and angiotensin II (SO, n = 7; BDL, n = 9) were obtained. The perfusate was modified to contain indomethacin, 10(-6) mol/L, and dose-response curves to norepinephrine (SO, n = 10; BDL, n = 8) and angiotensin II (SO, n = 4; BDL, n = 8) were obtained as well. Baseline resistances did not differ between any of the groups. RVR to norepinephrine did not appear to be altered by BDL; however, increased RVR to norepinephrine was unmasked by inhibition of prostaglandin synthesis. BDL did not affect the RVR to angiotensin II with or without indomethacin. BDL is associated with an increase in renal vascular sensitivity to norepinephrine, which is balanced by a compensatory increase in renal prostaglandin activity in response to norepinephrine stimulation. These findings are consistent with theories that decreased renal perfusion associated with liver disease may be mediated by catecholamines
— id: 79358, year: 1988, vol: 104, page: 250, stat: Journal Article,