Screening for breast cancer has been shown in several European randomized trials and case-control studies to reduce breast cancer mortality. These studies highlight the importance of quality assurance in the whole screening process. The Europe Against Cancer Program (EAC) is funding the European pilot breast cancer screening network, in which quality improvement based on the European quality assurance guidelines is the central target.
Major advances are taking place in the field of breast cancer, particularly in the understanding of which women are at high risk, says Professor Bruce Ponder of the Department of Clinical Oncology, Addenbrookes Hospital, Cambridge, United Kingdom. But, as yet, there are no prognostic markers to tell us that screening-detected or genetic breast cancer should be treated differently from clinically detected breast cancer.
Testing in the population at large, or of women with only one or two affected relatives is, in general, premature. We also know that some uncommon genes predispose some people to cancer. These provide the basis for DNA based tests for cancer susceptibility, but the ethical issues that surround these tests are exceedingly complex, he added.
We know already that more than 10% of cases of breast cancer are attributable to mutations in susceptible genes, such as BRCA1 and 2. The challenge now for medical oncologists is to integrate traditional systemic breast cancer therapies, such as hormone and chemotherapy, with genetic approaches.
For the present, however, Dr. Marie Overgaard, from the Aarhus University Hospital in Denmark, has shown how existing therapies can be used to the best effect. Her study demonstrates that survival in high-risk patients with breast cancer is significantly improved by an optimal combination of surgery and irradiation plus adjuvant systemic therapy, when compared with adjuvant therapy alone (see below).