Abstracts of the 3rd Nottingham International Breast Cancer Meeting 189

vanced breast cancer offer theoretical advantages including early combatance of microscopic metastases and downstaging of tumours. Some groups have argued that the latter may allow less radical, breast-conserving surgery for this condition.

We have previously reported and validated primary endo- crine therapy (tamoxifen) for this stage of disease in a ran- domized trial comparing with radiotherapy as initial treatment. However, despite treatment both arms of this former study suffered from a high rate (25%) of unpleasant local disease (skin ulceration). To improve local disease control in parti- cular. in 1989 we introduced a second randomized trial comparing tamoxifen (‘minimal arm’, N = 46) to a combina- tion of primary chemotherapy, mastectomy, radiotherapy, then tamoxifen (‘maximal arm’, N = 45) as initial treatment for these women. Early results show no difference in survival between treatment groups although locoregional disease control is significantly better in the ‘maximal arm’, with a substantial reduction in uncontrolled local disease. A response rate of 46% has been observed to the primary chemotherapy alone (4 cycles of mitozantrone, methotrexate and mitomycin C) with complete clinical remission in 5%. However, no complete pathological remissions were found on subsequent mastectomy.

In conclusion, a combination of primary systemic and ag- gressive local therapies may be the best treatment strategy for stage 111 breast cancer. Our results argue for caution in plan- ning less radical local treatment after neoadjuvant regimens if uncontrolled local disease is to be avoided.

16 Experience with a breast cancer family screening clinic

E. H. Smyth, E. D. C. Anderson, C. M. Steel MRC Human Genetics Unit South-East Scotland Breast Screening Service, Edinburgh. UK

A clinic has recently been set up in Edinburgh to provide a screening and counselling service predominantly for young (~50 years) women at increased risk of breast cancer from familial causes.

This clinic is run jointly by staff from the South-East of Scotland Breast Screening Service and the MRC Human Genetics Unit with support from a clinical psychologist. Women were referred either by their general practitioner (25%) or from hospital out-patient clinics (75%). Following a detailed history of familial and other recognised risk factors, each individual was discussed at a case conference and a risk estimate calculated using previously published epidemiolo- gical data. All information obtained from consultants was confirmed through hospital records and the Registrar General’s records for Scotland. Patients were then recalled for counsel- ling and screening at 3 months.

To date 103 patients (median age 42 years; range 19-73) have been seen. Detailed information on family history is com- plete in 62 cases. 50 (81%) women were considered to be at true increased risk (at least 2 times the general population risk) and were enrolled in a screening programme. Of these, II women had a single first degree relative (mother or sister) affected premenopausally and a further 11 had 2 or more first degree relatives affected premenopausally. 3 women gave a history of their mothers being affected post-menopausally, one with bilateral disease. The remaining 25 had multiple affected relatives with 22 of these having at least one affected first degree relative. Further examination of pedigrees identified 65 additional women who could potentially benefit from breast screening (median age 28 years; range 3-50). In addition, 2 families were considered at risk of ovarian cancer and a further 4 at risk of colon cancer. Individuals from these families have been offered appropriate screening. Five new families have been identified in which the history may be strong enough to

provide data for linkage analysis. 12 women were discharged; 5 to the national breast screening programme and in 7 the addi- tional risk was not thought high enough to merit regular screening (<x2).

17 Early diagnosis of familial breast cancer

P. Moller, E. M. Sager, P. Helgerud. C. TropC. S. Kvinnsland The Norwegian Radium Hospital, Oslo, NorMlay

We have established operational criteria for familial breast cancer, and decided on follow-up routines for those at risk (J Cancer Care, 1993; 2: 94-99). Women considered to have RR > = 3 (corresponding with lifetime risk >25%) have been invited to clinical and radiographical examinations.

As of April 1993, 160 women have been examined for breast cancer. Three definite cancers and one carcinoma in situ have been found in asymptomatic women. Two of these were in women belonging to breast-ovarian cancer families. In these breast-ovarian families, one ovarian cancer, one ovarian villous adenoma with atypia and two villous adenomas without atypia was also found in the 45 women so far examined. Com- bined, in the breast-ovarian families 8% of the examined women had cancer or carcinoma in situ, and two additional women had villous adenomas without atypia considered as probable precancers.

The limited data so far obtained, may indicate that women in breast or breast-ovarian families may benefit from diagnos- tic examinations.

18 Identification of women at high risk of breast cancer during attendance at NHSBSP

D. De Silva, F. Gilbert, G. Needham, H. Deans, N. Haites Department of Medical Genetics, North of Scotland Breast Screening Centre. Aberdeen, UK.

The North of Scotland Breast Screening Service offers a service covering the Grampian region, Orkney and Shetland (pop 500 000) inviting women between the ages of 50-64 years of age for mammography every 3 years. Since August 1990, a cancer genetic clinic has been operating in Aberdeen. Women are referred to this clinic if a positive family history is obtained on attendance at breast screening using the following guidelines.

I. First degree relative with bilateral breast cancer 2. Two first degree relatives with breast and/or ovarian cancer 3. First degree male relative with breast cancer 4. First degree relative with CA breast ~50 y or CA ovary

<55 y 5. Cases of extreme anxiety or an apparently highly suspi-

cious family history.

36 000 women were screened up to Feb 1993 and a total of 236 individuals fulfilling the above criteria with a lifetime risk greater than twice the population risk of breast cancer were identified.

Of these 23 (10%) were uninterested in attending the genetic clinic. 60 (25%) are awaiting further contact with the geneti- cist. A total of 133 (56%) have been counselled at the clinic, and of these women, 74 (56%) had a family history conferring > x2 risk and including 20 where dominant inheritance is likely. The following cancers were associated in the families, breast and ovarian cancer (5). breast and GI cancers (14) and other malignancies (15). 59 individuals had < x2 risk although younger family members at higher risk were identified. In total, 195 other at risk relatives have been identified. Details of protocols and workload implications will be discussed.