Breast Cancer

Women with common variations in the class of enzyme known as glutathione S-transferase (GST), which detoxify carcinogens, are at increased risk of developing breast cancer, according to researchers at the Johns Hopkins School of Public Health.

NUTLEY, NJ--Hoffmann-La Roche Inc. has received accelerated approval from the Food and Drug Administration for Xeloda (capecitabine), making it the first approved oral anticancer drug for patients with metastatic breast cancer whose tumors are resistant to standard chemotherapy with paclitaxel (Taxol) and an anthracycline-containing regimen.

In 1996, the total in-hospital charges for the primary treatment of women with breast cancer with a modified radical mastectomy averaged $10,000 throughout the United States. The total charge (hospital plus physician’s fees) varied by 95% between the high charge reported in New York ($12,690) and the low charge in Michigan ($6,510). The hospital portion of the bill averaged 65% of the total and ranged from 51% in New York to 74% in Virginia. The average length of stay for these women was 2.39 days and ranged from 3.18 days in New York to 1.69 and 1.66 days in Washington and Arizona, respectively. The average charge for a partial mastectomy was $8,760, with notable variations between states. The Texas total charge was the highest ($12,890, some 47% above the US norm) and more than twice the low charge in Ohio ($6,080, 31% below the US average). The physicians’ charges averaged $3,330 for the country as a whole and accounted for 38% of the bill. This proportion ranged from 46% of the total in New York to 70% in Indiana and Colorado. The average length of hospitalization for a partial mastectomy was 1.84 days. On average, women remained in the hospital for the longest time in New Jersey (2.78 days) and for the shortest time in Oregon and Massachusetts (1.40 days and 1.45 days, respectively).[ONCOLOGY 12(6):889-902, 1998]

Methods for detecting breast cancer are evolving as new technology provides a wider range of options for screening and definitive diagnosis. In addition to mammography and physical examination, screening techniques now include ultrasonography, technetium-99m sestamibi nuclear scanning, and magnetic resonance imaging.

A decade has passed since the first stereotactic-guided histologic breast biopsy was performed. Initially, the large-scale implementation of this technique met with a great deal of resistance from most surgeons, and more surprisingly, from many breast radiologists in academia.

PRINCETON, NJ--The Marsupial Pouch, designed to help women cope with temporary surgical drains following breast surgery, is being distributed nationwide by Derma Sciences Inc. Designed by a two-time breast cancer survivor, the product is an adjustable terry cloth belt with an attachable pouch to house the drainage tubes.

NEW ORLEANS--High concentrations of insulin-like growth factor I (IGF-I) in the circulation identify the men most at risk of prostate cancer as well as the women at highest risk of premenopausal breast cancer, according to results presented at the 89th annual meeting of the American Association for Cancer Research (AACR).

This paper will address various issues relevant to core-needle biopsy of the breast under stereotactic imaging guidance. Patient and equipment selection, indications, contraindications, complications, limitations, and advantages will be discussed. The role of stereotactic core biopsy in patient management will also be addressed.

NEW ORLEANS--Most women with a family history of breast cancer have a familial predisposition to the disease, rather than true hereditary breast cancer. A comprehensive family history should guide the recommendations regarding testing for a genetic mutation, which, at about $2,400, should not be taken lightly, said speakers at an AMA-sponsored program on genetic medicine and the practicing physician.

A new study from the Medical College of Wisconsin Cancer Center has shown that celebrity role models can influence decisions about medical care. The national study of breast cancer treatment patterns following Mrs. Ronald Reagan’s decision to have a mastectomy in 1987 showed that 25% fewer women than expected underwent lumpectomy or breast-conserving surgery.

I was quite disappointed with Dr. Graham A. Colditz’s review of the literature concerning the use of estrogen replacement therapy in patients with breast cancer, which appeared in the November 1997 issue of ONCOLOGY (pp 1491-1497).

Since physicians have stressed complete rehabilitation after breast cancer treatment, including breast reconstruction and psychosocial aspects, it follows that young women who have undergone such treatment may wish to resume their life roles, which often include motherhood. Consequently, the issue of pregnancy after breast cancer treatment has assumed paramount importance. This pertinent, accurate review of such a complex issue can be so brief because there are so few data on the subject. Given the diversity of the issues presented in the review, it is helpful to consider them individually.

Breast cancer, the most common malignancy in women, frequently develops during the premenopausal years. The great majority of these breast cancers can be successfully treated, and the decision to have children remains a real and important consideration. The relationship between breast cancer and a subsequent pregnancy is complex, and decisions regarding one may ultimately affect the course or outcome of the other.

Women face numerous issues if they either contemplate childbearing or become pregnant after the diagnosis of breast cancer. Based on a search of the English medical literature from 1966 to 1997, we make the following

FORT LAUDERDALE, Fla--The much-anticipated, prospective, comprehensive outcomes data base of the National Comprehensive Cancer Network (NCCN), a consortium of 16 US cancer centers, is now up and running, and includes data on almost 400 patients with newly diagnosed breast cancer collected at five NCCN sites over 3 months.

Alterations in a gene discovered last year by UT Southwestern Medical Center in Dallas scientists have been linked to breast, ovarian, and uterine cancers, the researchers reported in the February issue of Human Molecular Genetics.

WASHINGTON--Researchers terminated the treatment portion of the Breast Cancer Prevention Trial (BCPT) in late March, 14 months earlier than expected, after the study’s independent monitoring committee determined that patients receiving tamoxifen (Nolvadex) had a 45% reduction in breast cancer incidence, compared to the placebo arm.

The Oncology Nursing Society has responded to the increase of short-stay (“drive-through”) mastectomy and other forms of breast surgery for cancer.

FORT LAUDERDALE, Fla--The National Comprehensive Cancer Network (NCCN) continues to fine tune its breast cancer guideline, introduced 2 years ago. Robert Carlson, MD, of Stanford University, and chair of the Breast Cancer Guideline Committee, reviewed the proposed revisions at the NCCN’s third conference. The Network is a coalition of 16 US cancer centers.

NEW YORK--After treatment, many breast cancer patients have fears and misconceptions that hamper their sexual activity, and their partners may have them, too, Marisa Weiss, MD, said at a Cancer Care teleconference. Women may assume their partner finds them unattractive, while their partner may be afraid of causing injury.

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.