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Current Research & Innovations

Breast

Comparison of the Insorb dermal stapler to standard techniques for closure of the dermal layer in incisional wounds. —We are comparing the results of wound closure with an absorbable dermal stapler to the results obtained with more traditional suture techniques. (Jeffrey Ascherman, MD)
Disparity in the expression of estrogen metabolizing gene Cytochrome P450 among African American and Caucasian breast cancer patients. —The goal of the present study is to characterize the differences in cytochrome P450 (Cyp) 1B1, 1A1, and 3A4 mRNA and protein expression levels in African American (AA) and Caucasian female breast tumors and non-neoplastic breast tissue. These Cyps proposed to be investigated in the present study are involved in the oxidative metabolism of exogenous and endogenous estrogens as well as of several xenobiotics, and are the only major Cyps consistently found in human female malignant and non-malignant breast tissue. Our preliminary data suggest that AA and Caucasian breast cancer tissues differ in the expression levels of Cyp 1B1 mRNA levels. (H. Bhat, MD)
Ductal Lavage and Lobular Carcinoma in Situ (LCIS) —Breast cancer starts in the cells that line the milk ducts of the breast. Women with LCIS are at an increased risk for breast cancer. This study will attempt to identify the presence of abnormal cells in the breast ductal fluid that may be associated with an increase in risk by using a novel technique called Ductal Lavage (DL). This technique allows for cells in the milk duct lining to be collected and analyzed for the presence or absence of abnormal changes in the breast, just like Pap smears allow cells to be collected and analyzed for any changes in the cervix. Ductal Lavage is a process that is used to flush out the breast nipple ducts with sterile solution and sample cells from the milk duct lining. Previous studies have utilized ductal lavage in women who have had different risk factors for breast cancer such as a personal history of breast cancer or a condition called atypical ductal hyperplasia, which is associated with an increased risk of breast cancer. However, the incidence of abnormal cells in ductal lavage fluid from women with LCIS is unknown. Information from this study will help us determine whether DL is feasible in women with LCIS, and help us understand how frequently women with LCIS have abnormal cells in their breast ductal fluid when it is collected with DL. This study would be an important contribution to better understand an individual woman's risk for breast cancer and can provide patients with additional breast cancer risk reduction strategies. (Kathie-Ann Joseph, MD, MPH)
Estrogen metabolism as a predictor of breast cancer among African American women. —The goal of this study is to: a. Identify the differences in estrogen content and metabolism between AA and Caucasian breast cancer patients. The activities of estradiol 2 and 4hydroxylase will be quantified in the breast tumor tissue of AA and Caucasian patients. These activities will be correlated with age and estrogen levels in breast tissue of the patients. Data will also be compared with enzyme and estrogen levels in non-tumor tissue of women obtained from breast reduction surgeries. b. Characterize the role of oxidative stress in unequal burden of breast cancer between AA and Caucasian patients. Redox cycling between catechol estrogens and estrogen quinones results in oxidative stress. Levels of 8epi Prostaglandin F2alpha(8epi PGF2) will be quantified in breast tissue as a marker of oxidative stress in the target organ. (Hari Bhat, PhD)
Estrogen metabolizing gene expression as a predictor of breast cancer. —The role of this project is to characterize the roles of E2, 2-OHE2 and 4-OHE2 in the regulation of estrogen metabolizing, estrogen detoxifying and oxidative stress genes as well as the regulation of these genes. (Mahmoud El-Tamer, )
HMGA2 Expression as a Predictor of Response to Treatment —HMGA2 is a transcription factor generally not found in healthy patients. Recent studies suggest that HMGA2 is found in patients with advanced cancers (breast, oral cavity, and lung) and its presence may predict a worse outcome than patients lacking HMGA2. Further studies have shown that HMGA2 mRNA expression in the peripheral circulation of breast cancer patients correlates with a poor clinical outcome and can be a better predictor of clinical outcome than even lymph node metastases. Patients diagnosed with Stage III and IV breast cancer with measurable disease will have HMGA2 levels measured in their tumors and blood prior to the start of chemotherapy and at three month intervals throughout treatment. We believe HMGA2 may serve as a useful marker of overall prognosis as well as response to treatment. (Kathie-Ann Joseph, MD, MPH)
Patient Assistance to Reduce Breast Cancer Disparities —This multi-center study will assess the effect of race on early stage breast cancer patient experience, and beliefs about and barriers to effective adjuvant treatment. The study will also determine the effectiveness of a patient assistance intervention. Newly diagnosed breast cancer patients who have undergone surgery will be contacted by an outreach worker from the study who will connect them with community and hospital-based patient assistance programs. Participation in the study involves a phone interview within four weeks after surgery regarding attitudes and beliefs regarding breast cancer and patients’ needs and barriers towards treatment. Patients will undergo a second telephone interview 6 months after treatment to assess the program's sustainability, determine whether the intervention increased the use of effective adjuvant breast cancer treatment overall and in minority populations, and determine whether the patient assistance intervention affects patients' knowledge, attitudes and behaviors. (Kathie-Ann Joseph, MD, MPH)
Phase IB randomized, double-blinded, placebo-controlled, dose escalation study of polyphenon-e (green tea) in women with a history of hormone receptor-negative breast cancer —Numerous observational studies have reported that consumption of green tea may reduce the incidence of a variety of cancers, including breast carcinoma. For example, in a population-based, case-control study of Asian American women, green tea intake was associated with a decreased breast cancer risk with 0-85.7 ml/day (OR 0.71, 95% CI 0.51-0.99) and > 85.7 ml/day (OR 0.53, 95% CI 0.35-0.78).39 Interestingly, the protective effect of green tea was observed only among individuals who possessed at least one low-activity polymorphism in catechol-O-methyltransferase (COMT), which is involved in the methylation of green tea constituents. Thus, differential metabolism of these xenobiotic compounds may explain the lack of agreement in the reports regarding green tea and cancer risk. In addition, drinking green tea was associated with decreased recurrence of breast cancer.

This is a Phase Ib, randomized, placebo-controlled, double-blinded study done in conjunction with the Division of Medical Oncology. We expect to enroll 40 patients, postmenopausal with stage I, II, or IIIA, hormone receptor negative breast cancer who have been diagnosed within the past four years. Patients will receive the study drugs for six months with monthly follow up and all patients will be followed for an additional month after completing treatment. ( Hirshman, Joseph, )
The Ductal Lavage Outcomes Tracking System (DLOTS) —Researchers at the Columbia-Presbyterian Comprehensive Breast Center of New York-Presbyterian Hospital are participating in a national trial using ductal lavage to better define an individual woman's risk of breast cancer. The Ductal Lavage Outcomes Tracking System (DLOTS) is an outcomes database designed to collect data on women undergoing ductal lavage including their demographics, breast cancer risk factors, and results of ductal lavage test. The purpose of DLOTS is to help physicians and breast centers determine the most clinically beneficial, appropriate and cost-effective use of ductal lavage in the management of patients at risk for breast cancer.

About Ductal Lavage
In women at risk of breast cancer, a new procedure called Ductal Lavage can detect cancerous changes in the breast at an early stage. Ductal lavage is a technique that flushes out the breast nipple ducts with sterile solution and samples cells from the milk duct lining in order to determine the presence or absence of abnormal and/or cancer cells. Because breast cancer originates in the milk ducts, analysis of the milk duct fluid can reveal the earliest signs of precancerous or cancerous changes. This parallels the way that Pap smears obtain cells to be analyzed for precancerous and cancerous changes in the cervix.

If you are interested in ductal lavage or participating in the DLOTS outcomes database, please contact one of the breast surgeons in our department. ( , )
The Interaction of Increasing Age and Breast Cancer Risk Factors. —Currently, there is no information on how risk factors predict breast cancer incidence in women who are ¡Ý70 years of age. This study explored the impact of known risk factors on high-risk women 70 years of age or older (J. , )
Validation of quality measures in Breast Cancer Surgery. —The purpose of the study is to validated quality measures in breast cancer Surgery (Mahmoud El-Tamer, )