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Natural history of ductal carcinoma in situ should be viewed from a public health perspective.pdf

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Natural history of ductal carcinoma in situ should be viewed from a public health perspective.pdf

The Breast (1999) 8, 154-156 ? 1999 Harcourt Publishers Ltd CORRESPONDENCE Sirs, Hormonal control of angiogenesis in breast cancer: TGF~, a missed link? The review article by Marson et al.1 focused on the impor- tance of angiogenesis in breast cancer. One interesting point raised by these authors is the putative role of oestrogens in angiogenesis. As pointed out by Marson et al, 1 there are several studies showing that oestrogens could stimulate endothelial cell outgrowth and prevent endothelial cell death by inhibiting apoptosis. On the other hand, other studies showed that oestrogen antagonists inhibited angiogenesis in the chick egg chorioallantoic membrane. Most of the oestrogen effects are mediated by oestrogen receptors (ER). By binding to its receptor in the nucleus, oestrogen acts as a transcriptional factor for many genes, thus leading to increased proliferation and turnout aggressiveness. Among the oestrogen-induced proteins is Transforming Growth Factor ~ (TGFct). TGFct is a peptide that shares 33% homology with Epidermal Growth Factor (EGF) and binds to its receptor (EGFR). Many studies report the expression of TGFo~ in the breast epithelium. TGFo~ immunostaining was present in normal breast epithelium, specially during pregnancy and lactational status.2 Furthermore, TGFtx immunoexpression has been associated with characteristics of poor prognosis in breast cancer. 2 Recently, our group studied the putative role of TGFct in angiogenesis in a series of 86 patients.3 TGF~ positivity was observed in 62 of the 86 cases (72.1%), both in0tumour cells and adjacent stromal cells. We found a significant association between TGFct expression and breast cancer angiogenesis. The TGFct positive cases showed an angiogenic index o f 48.1 _+ 28.0 (~t _+ SD) microvessels detected by a monoclonal antibody against Factor VIII-related antigen and quantified as previously described.4 In contrast, the TGFt~ negative cases had an angiogenic index of 31.8 _+ 20.0 (~ _+SD) (P=0.0