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Malignant breast tumors laced with tiny blood vessels are at high risk of spreading and thus proving fatal, according to a new report. Women with such tumors may benefit from aggressive cancer therapy, the researchers conclude.

The new report, published in the Dec. 16 JOURNAL OF THE NATIONAL CANCER INSTITUTE, builds on research done last year by Noel Weidner, now at the University of California, San Francisco, and Judah Folkman of the Harvard Medical School in Boston. Weidner and Folkman discovered a link between the number of capillaries in a tumor and its propensity to metastasize, or spread (SN: 1/19/91, p. 45).

After hearing of the 1991 report, Italian researcher Giampietro Gasparini sent the U.S. team slides of breast cancer tissue taken from 165 women who had been treated at St. Bortolo Regional Hospital in Vicenza, Italy, where Gasparini works as a cancer specialist. All patients had undergone primary treatment to remove their tumor with surgery or radiation therapy, or both. To kill any remaining seeds of cancer, researchers gave some of the women additional therapy, such as chemotherapy Some women received hormonal treatment to prevent cancer recurrence.

The U.S. team then took the paper-thin slices of each patient's tumor, applied a stain that makes blood vessels appear bright orange, and looked at the slides under a microscope. The team examined each slide for "hot spots," areas of very dense blood vessel growth. The scientists homed in on such spots and counted the number of capillaries crowding the microscopic field.

Next, the researchers correlated the blood-vessel counts with what had happened to each patient. They discovered that breast cancer patients who had more than 100 vessels in the microscopic field had a 100 percent chance of tumor recurrence within 33 months. In contrast, cancer recurred in just 5 percent of the women who had 33 or fewer blood vessels per field.

Moreover, blood-vessel density was the only statistically significant predictor of a woman's chance of survival if she had so-called node-negative cancer, in which cancer has not spread to the lymph nodes, Folkman says. Doctors know that about 30 percent of women with node-negative breast cancer will suffer a recurrence, which is generally fatal. Yet, doctors don't have a good method of identifying women at high risk of such an event. Weidner and Folkman believe the blood vessel test may identify such women at the time of diagnosis, thus giving the oncologist an edge in the effort to prevent the cancer's spread.

The blood-vessel test outperformed many other markers of breast cancer recurrence, including size of the tumor and a test to determine whether the tumor contains certain hormone receptors, Folkman says.

David L. Page, a pathologist at the Vanderbilt University Medical Center in Nashville, Tenn., calls the correlation between survival and blood-vessel counts "an exciting observation." However, Page, who wrote an editorial in the same issue, cautions against "unbridled enthusiasm" for the test, which is not ready for widespread use. "There are too many problems with it:' he said. "It's labor-intensive and it's difficult to do:' Page adds. Weidner disagrees, saying that he thinks the test is ready for general use by pathologists.

The new test measures a tumor's ability to spread and thus may predict the course of other cancers, not just breast cancer. Folkman explains that a tumor starts its life as a tiny seed that can grow until it consists of about a million cells. At that stage, the tumor, which is roughly the size of a BB pellet, may begin to secrete substances that lure capillaries to the scene. With a fresh blood supply, the cancer starts to grow aggressively and will release millions of malignant cells into the bloodstream, a step that can lead to the deadly spread of this disease.
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Title Annotation:Hubble Space Telescope photographs give evidence that gaseous, planet-forming matter exists around stars
Author:Pendick, Daniel
Publication:Science News
Article Type:Brief Article
Date:Dec 19, 1992
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