Breast Cancer

The article by Dr. William Small on the role of radiation therapy in the treatment of breast cancer is a comprehensive review of the current standards of care and highlights the controversies surrounding recent trends. Breast cancer treatment has come full circle in the last 20 years, with emphasis now being placed on technical advances and treatment techniques as new data substantiate the impact of radiation therapy on survival following local surgery and mastectomy.

Dr. Small is to be commended for a well-written succinct review of the role of radiation therapy in the treatment of breast cancer. As he notes, there is still controversy in the management of these patients. However, as more evidence-based data are accumulated, the role of radiation therapy is being clarified.

Radiation therapy in combination with lumpectomy and axillary dissection has remained standard therapy for early-stage disease since the 1970s. Although there has been no definitive trial in patients with ductal carcinoma

The role of radiation therapy in the management of breast cancer has continued to evolve over the past several years, in both the breast-conserving and postmastectomy settings. In this issue of ONCOLOGY, Dr. William Small provides a thorough yet concise review of current practices in radiation therapy for ductal carcinoma in situ (DCIS), early-stage invasive breast cancer managed conservatively, and postmastectomy situations. These discussions are supported by a well-selected group of publications on each topic. In addition, the author summarizes the available data and some of the controversies surrounding the use of nodal irradiation, especially in this era of sentinel node biopsy. We would like to mention a few points that warrant further discussion.

WASHINGTON-A new analysis of data from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) shows that among women who received their first NBCCEDP Pap test between 1991 and 1998, American Indian and Alaskan Native (AI/AN) women had the highest proportion of abnormal Pap tests, while white women had the highest rate of serious cervical lesions detected by biopsy.

SAN ANTONIO-The mitotic activity index (MAI), a measure of tumor cell proliferation, has been shown to be an independent prognostic factor for recurrence-free survival in breast cancer. It is being used in the Netherlands to select which node-negative patients require adjuvant chemotherapy, Elsken van der Wall, MD, PhD, said at the 23rd Annual San Antonio Breast Cancer Symposium.

SAN ANTONIO-Two computer programs designed to aid women with early breast cancer and their physicians in making decisions about adjuvant therapy will soon be available, according to presentations at the 23rd Annual San Antonio Breast Cancer Symposium.

SAN ANTONIO-A negative sentinel lymph node (SLN) biopsy is an accurate indicator of the absence of nodal metastases in patients with invasive breast cancer and predicts recurrence-free survival, according to the early results of a study conducted at the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida.

WASHINGTON-Adding fish oil to the diet of mice implanted with human breast cancer cells increased the efficacy of doxorubicin while reducing hematologic side effects, W. Elaine Hardman, PhD, of the University of Texas Health Science Center at San Antonio, said at the Susan G. Komen Breast Cancer Foundation grants conference.

SAN ANTONIO-Ductal lavage, used to detect atypical and malignant cells in the milk ducts, may be a useful adjunct to mammography and other screening tools for women at high risk of developing breast cancer.

SAN ANTONIO-R115777, an orally active farnesyl transferase inhibitor (FTI), has shown clinical activity in the first phase II trial of an FTI in breast cancer, according to Stephen RD Johnston, PhD, senior lecturer and consultant medical oncologist, Royal Marsden Hospital and Institute of Cancer Research, London.

SAN ANTONIO-Women with breast cancer associated with germline BRCA1 or BRCA2 mutations can undergo breast-conserving surgery, if they so desire, since their risk of ipsilateral breast cancer recurrence is only slightly increased, according to a study from Memorial Sloan-Kettering Cancer Center presented at the 23rd Annual San Antonio Breast Cancer Symposium.

CHICAGO-Rates of breast-conserving surgery for breast cancer typically are lower in the Southeast than in other parts of the United States. According to a study presented at the 86th Annual Meeting of the Radiological Society of North America (RSNA), this difference has less to do with geography than with the surgeon who treats the patient.

SAN ANTONIO-The aromatase inhibitor letrozole (Femara) was more effective than tamoxifen (Nolvadex) in reducing tumor size before surgery and increasing the number of women eligible for breast-conserving therapy, said Matthew J. Ellis, MD, PhD, on behalf of the Letrozole Neoadjuvant Breast Cancer Study Group Breast Cancer Program.

WASHINGTON-Breast cancer patients with high levels of hepatocyte growth factor exhibit higher rates of proliferation and poorer prognosis, Wen G. Jiang, MD, of the University of Wales, Cardiff, said at the Susan G. Komen Breast Cancer Foundation grants conference. But a newly discovered antagonist to this factor may be used to reduce metastasis.

SAN ANTONIO-A randomized dietary intervention study of 3,100 breast cancer survivors requires the study group to eat five vegetable servings and 16 oz of vegetable juice daily, a level of vegetable intake that has not previously been examined. By comparison, the women in the control group are following the National Cancer Institute (NCI) diet, which includes only three vegetable servings and no vegetable juice.

A study headed by the National Institutes of Health (NIH) human genome scientists on the genetic patterns of inherited breast cancer has uncovered unexpected findings regarding nonhereditary breast and ovarian cancers. These unanticipated findings,

This superb review by Drs. Kimmick and Muss clearly and concisely summarizes the literature on the prevention and treatment of breast cancer in "older" women.

Cancer and aging seem to go hand in hand. Most cancers and most cancer deaths occur in individuals over age 65 years. Likewise, as we age, osteoarthritis, heart disease, diabetes, and memory lapses seem to become part of our daily burden. Drs. Kimmick and Muss have detailed a strategy for managing breast cancer in older women. However, as they point out, there are several problems with defining optimal therapy for the elderly.

Breast cancer is a common problem in older women. As the number of medical illnesses increases with age and the life expectancy decreases, the benefits of systemic therapy for women with breast cancer become questionable. All women over age 65 years are at high enough risk of breast cancer to consider the risk/benefit ratio of preventive therapy with tamoxifen (Nolvadex) or participation in the Study of Tamoxifen and Raloxifene (STAR) trial. Adjuvant chemotherapy and hormonal therapies for early breast cancer significantly improve disease-free and overall survival; recommendations for their use are based on risk of tumor recurrence. Use of tamoxifen in the adjuvant setting in women with receptor-positive tumors is a relatively simple decision in light of its favorable toxicity profile. The delivery of adjuvant chemotherapy is a more complicated decision, and the patient’s wishes, estimated life expectancy, presence of comorbid conditions, and estimated benefit from treatment should be considered. The primary goal of the treatment of metastatic breast cancer is palliation. We discuss trials specific to older women and make appropriate treatment recommendations. Unfortunately, there is a paucity of data from clinical trials in women over age 70 years. However, because the clinical trial is the primary scientific mechanism for testing the efficacy of a treatment, every effort should be made to enter older women into treatment protocols. [ONCOLOGY 15(3):280-299, 2001]

CHICAGO-Computer-aided detection (CAD) is proving to be a technologic leap in the identification of breast tumors with subtle findings on mammography that can easily be missed by the radiologist, said Timothy W. Freer, MD, director of the Women’s Diagnostic and Breast Health Center, Plano, Texas.

EAST HANOVER, NJ-Novartis Oncology has announced that the FDA has approved Femara (letrozole tablets) for the first-line treatment of postmenopausal women with hormone-receptor-positive or hormone-receptor-unknown, locally advanced or metastatic breast cancer. Most postmenopausal women with advanced breast cancer fall into these tumor-receptor categories, the company said in a news release.

This second edition of the text edited by Bland and Copeland represents a comprehensive reference that reviews the history, pathobiology, and current clinical management of diseases of the breast. Much more than a book about breast

SAN ANTONIO-At a gala reception held during the 23rd Annual San Antonio Breast Cancer Symposium, nine cancer organizations released its list of the "top 100" breast cancer researchers- those with the most published studies in the 20th century advancing breast cancer treatment.

SAN ANTONIO-In the treatment of early-stage breast cancer, postoperative radiation therapy after sector resection (breast-conserving surgery) reduces recurrences but does not influence survival, according to a Swedish study presented at the 23rd Annual San Antonio Breast Cancer Symposium.

SAN ANTONIO-The Y-box-binding protein-1 (YB-1) appears to be a clinically significant tumor marker in breast cancer, according to results of a pilot study presented by Nadia Harbeck, MD, PhD, at the 23rd Annual San Antonio Breast Cancer Symposium.

SAN ANTONIO-Adding weekly paclitaxel (Taxol) and carboplatin (Paraplatin) to trastuzumab (Herceptin) improves disease control among women with advanced breast cancer, according to results of an ongoing phase II trial reported by Howard A. Burris III, MD, director of drug development, Sarah Cannon Cancer Center, Nashville.

For the first time, researchers believe they may be able to predict which breast cancer patients are at high risk of developing bone metastases. By identifying these patients, researchers say drugs now used to treat bone cancer may also prove useful in

Novartis Oncology recently announced that the US Food and Drug Administration (FDA) has approved letrozole (Femara) tablets for the first-line treatment of postmenopausal women with hormone-receptor-positive or hormone-receptor-unknown

The 4th National Institutes of Health (NIH) Consensus Conference on Adjuvant Therapy of Breast Cancer, held November 1-3, 2000, concluded that decreasing breast cancer mortality rates in the United States were due, at least in part, to advances made in adjuvant treatment. This fact lends credence to the importance of incremental improvements that have resulted from randomized, controlled clinical trials of adjuvant therapy, and underscores the value of this approach. With 185,000 new diagnoses of breast cancer expected in the United States in 2000, over 100,000 women may be candidates for some form of adjuvant therapy each year.[1]