Breast Cancer

FORT LAUDERDALE, Fla--The National Comprehensive Cancer Network (NCCN), a consortium of 16 leading US cancer centers, has ventured into the contentious area of breast cancer screening, and in its first draft, the breast cancer screening committee has recommended annual mammography screening for all women age 40 and over.

VILLEJUIF, France--The addition of a retinoid to adjuvant chemotherapy provided a hint of a survival advantage over chemotherapy alone for breast cancer patients, but the difference did not achieve statistical significance, according to 13-year follow-up data from a randomized clinical trial.

To determine the most effective strategies for the treatment of postmenopausal hormone dependent breast cancer, we recently developed a model system in nude mice. In this model, estrogen receptor-positive human breast cancer cells (MCF-7) stably transfected with the aromatase gene are inoculated into ovariectomized, immunosuppressed (nude) mice.

Toremifene (Fareston) received FDA approval in 1997 for the first-line treatment of postmenopausal women with estrogen receptor (ER)-positive or -unknown metastatic breast cancer. Phase II and III trials have demonstrated that first-line therapy with toremifene, 60 mg/d, is as effective and as well tolerated as tamoxifen (Nolvadex), 20 or 40 mg/d, in such patients.

Various ongoing double-blind clinical trials are evaluating the use of tamoxifen (Nolvadex) as chemoprevention for breast cancer. A total of over 24,000 healthy women have been randomized to these trials, and it should be possible, by the year 2000, to detect any preventive effect of tamoxifen in healthy women. Furthermore, with the large numbers of women involved, it should be possible to evaluate prevention in subgroups of participants according to risk of the disease, particularly those women carrying high-risk genes, such as BRCA1 and BRCA2.

Tamoxifen is by far the most clinically tested antiestrogenic drug currently used as adjuvant therapy for breast cancer and it continues to provide considerable benefit in this setting. The balance from clinical trials indicates a strong association between the use of tamoxifen and an increase in uterine tumors (three to sixfold). In rats, tamoxifen is a mutagenic, genotoxic hepatocarcinogen.

When results from the phase II trials of toremifene (Fareston) and tamoxifen (Nolvadex) in metastatic breast cancer were published, the Finnish Breast Cancer Group began to plan the first trial of toremifene in an adjuvant setting. This multicenter, randomized trial is comparing toremifene (40 mg/d) to tamoxifen (20 mg/d) in postmenopausal lymph node-positive breast cancer patients.

Letrozole (Femara) is a nonsteroidal aromatase inhibitor that is approximately 10,000 times as potent as aminoglutethimide in vivo. Two pivotal multinational phase III trials have compared letrozole (0.5 and 2.5 mg/d) against megestrol acetate and aminoglutethimide, respectively, in patients with locally advanced or metastatic breast cancer.

The new generation of potent steroidal and nonsteroidal inhibitors of the enzyme aromatase act by decreasing estrogen production throughout the body in postmenopausal women. The most potent of these agents may also inhibit estrogen synthesis within metastatic breast cancer tissue.

NEWPORT BEACH, Calif--Despite recommendations to the contrary, cancer specialists continue to order radiologic tests that rarely provide useful staging information about patients with early-stage breast cancer, results of a California study show.

Toremifene (Fareston), the first new antiestrogen agent for treating advanced breast cancer available in the United States in more than 19 years, is as effective as tamoxifen (Nolvadex) in clinical trials and potentially safer, Richard Gams, md, professor of internal medicine and director of hematology/oncology, Ohio State University, said at a teleconference sponsored by Schering-Plough to introduce the recently approved agent.

TAMPA, Fla--Sentinel lymph node evaluation can eliminate the need for total axillary dissection in 75% of breast cancer patients, Alan Shons, MD, said at the 20th Annual San Antonio Breast Cancer Symposium.

The aromatase inhibitor letrozole (Femara), at a dosage of 2.5 mg once daily, is an effective therapy for advanced breast cancer in postmenopausal women whose disease progresses following antiestrogen therapy, according to data published in the February 1998 Journal of Clinical Oncology. The study was conducted by the Letrozole International Trial Group and was sponsored by Novartis Pharmaceuticals Corporation.

ORLANDO--Breast-conserving therapy appears to be a viable treatment option for breast cancer patients with a family history of breast cancer, Elizabeth Chabner, MD, said at the annual meeting of the American Society for Therapeutic Radiation and Oncology (ASTRO).

Cancer researchers and clinicians need to adopt a new attitude toward race classifications as interracial parentage in the United States continues to increase. “I want to uncouple race and genetics,” stated Edison Liu, MD, at the 1997 Biennial Symposium on Minorities, the Medically Underserved, and Cancer held in Washington, DC.

VICTORIA, BC, Canada--Delaying radiation therapy for up to 5 months after surgery for breast cancer had no adverse effect on local recurrence or survival, a finding that may help lay to rest any controversy about delayed irradiation, Peter Froud, MD, reported at the San Antonio Breast Cancer Symposium.

Women must make lung cancer as hot and as female a public issue as they have made breast cancer, urged a cancer expert speaking at the 1997 Biennial Symposium on Minorities, the Medically Underserved, and Cancer in Washington, DC. Five years from now, twice as many women will die of lung cancer than of breast cancer, warned Paul Bunn, Jr., md, Grohne/Stapp Chair in Cancer Research and director of the University of Colorado Cancer Center.

Women who undergo breast reconstruction following mastectomy for breast cancer express strong satisfaction with a novel surgical approach, reported a surgeon at Georgetown University Medical Center in the January 1998 issue of Plastic and Reconstructive Surgery.

In the largest study of its kind to date, Ohio State University researchers have shown that the stress women experience after breast cancer diagnosis and surgery can weaken their immune response, based on at least three different biochemical indicators.

LONG BEACH, Calif--Use of a polymer adhesive skin sealant (PASS) can help breast cancer patients complete prescribed radiation therapy without interruptions due to radiation-induced dermatitis, Robert H. Goebel, MD, JD, reported at a poster session of the San Antonio Breast Cancer Symposium.

WASHINGTON--A Virginia physician wants to send women back to school to help them make lifestyle changes aimed at reducing breast cancer risk--but not to the classroom. Rather, she hopes to increase participation in lifestyle programs by "recapturing recess"--appealing to the "joy of unbridled movement" remembered from childhood hours on the playground.

The treatment of metastatic breast cancer involves the sequential selection and delivery of hormonal therapies and cytotoxic chemotherapies. The available therapies for metastatic breast cancer are rarely curative, although high rates of response and modest prolongation of survival may be achieved in association with varying degrees of treatment-related toxicity.

SAN ANTONIO-Genetic testing for breast cancer susceptibility appears to confer no adverse psychological effects on mutation carriers or individuals who refuse to be tested, Caryn Lerman, PhD, reported at a general session of the San Antonio Breast Cancer Symposium.

Washington-Available methods to prevent breast cancer might be bettered compared to a flu shot “which hurts and only lasts a year,” than to a polio vaccine, “which comes on a sugar cube and lasts a lifetime,” Malcolm C. Pike, PhD, said at the Department of Defense’s “Era of Hope” meeting.

MALVERN, Penn-Centocor, Inc., a manufacturer of cancer diagnostics, including the CA 15-3 radioimmunoassay serum tumor marker for breast cancer monitoring, has produced a brochure for patients on the early detection of breast cancer recurrence. The pamphlet reviews the need for regular physical exams and laboratory testing, the signs and symptoms to look for between exams, and the role of tumor marker assays in monitoring. The brochure is free to health care providers, cancer organizations, and the public. Write to Breast Cancer Tumor Markers and Follow-up Care, PO Box 1883, Southeastern, PA 19399-1883.

Taxanes have been established in the treatment of metastatic breast cancer, and two presentations at the 20th Annual San Antonio Breast Cancer Symposium provide additional data to more clearly delineate the indications and potential use of these agents.

WASHINGTON-Studies indicating an increased risk of breast cancer in the years immediately after giving birth were not borne out by an investigation at the Fred Hutchinson Cancer Research Center, Seattle, Linda S. Cook, PhD, reported at the Department of Defense’s “Era of Hope” breast cancer conference. A second study presented at the meeting shows that when breast cancers do occur immediately after childbirth, they are likely to be more severe.

WASHINGTON-The success of the US Army’s Breast Cancer Research Program (BRCP) stems from the intersection of research and advocacy, said participants in a press conference at the Department of Defense’s Era of Hope conference. More than 550 investigators who received awards from the BRCP from 1992 to 1995 were invited to present their research at the meeting. “My greatest joy and passion in this work is the partnerships among the medical community, the Department of Defense, and breast cancer survivors,” said Col. Irene Rich, DNSc, director of the U.S. Army’s Congressionally Directed Medical Research Program.

BETHESDA, Md-The possible link between the pesticide DDT and breast cancer or benign breast disease will be explored among women in the northern Alabama community of Triana. The study by researchers from the National Cancer Institute and the University of Alabama in Huntsville College of Nursing will begin Feb. 15, with results available in 1999.

Breast cancer patients age 65 years and older who were enrolled in one of two large western not-for-profit health maintenance organizations (HMOs) experienced long-term survival equal to or better than counterparts living in the same geographic areas who received breast cancer care under the traditional fee-for-service (FFS) system. The HMO members were also more likely than the FFS patients to receive breast-conserving surgery and to have adjuvant radiation therapy recommended for early-stage breast cancer. The study by Arnold L. Potosky, phD, National Cancer Institute, and colleagues was reported in the Journal of the National Cancer Institute.