Breast Cancer

Although the article by Senie and Tenser reviewing some of the data relevant to whether operative timing within the menstrual cycle affects breast cancer outcome is reminiscent of a recent paper that appeared in the December 1996 issue of the Journal of Women’s Health,[1] the question it considers is potentially important enough that this issue should also be raised in Oncology. The article points out the experimental basis for believing that an important interaction may occur between the host-cancer-surgery and the mammalian reproductive cycle.[2,3] This is an important supposition because clinicians have routinely assumed that no experimental foundation underlaid the first and 31 subsequent analyses of relevant clinical data[4,5]-an assumption that is false.

The authors provide a comprehensive overview of the role of axillary lymphadenectomy in the treatment of early-stage breast cancer. They do not argue against lymphadenectomy for patients with clinical T2 and 3 tumors and clinical N1 and 2 nodes. However, for clinical N0 cancers and for postmenopausal patients with hormone-receptor-positive tumors, the authors propose radiotherapy to the axilla as a modality less expensive than surgery and with fewer complications. They suggest observation only for lesions associated with a less than 10% to 15% chance of axillary metastasis (T1a cancers, tubular carcinomas, ductal carcinoma in situ [DCIS] with microinvasion). However, for patients with lesionsless than 1 cm with “high-risk features (presence of tumor emboli in vessels, poor nuclear grade, etc),” axillary lymphadenectomy “should continue to serve as a refined prognostic indicator for selection of patients for adjuvant therapy.”

The discussions and debates about the use of estrogen replacement therapy (ERT) in women with breast cancer often seem to ignore or at least leave unnoted the extensive data supporting the general premise that increased, but physiologic levels of estrogens are associated with poorer survival in postmenopausal women with breast cancer. Dr. Colditz summarizes various lines of evidence bolstering this general premise, providing us with some needed lessons about the complexities of interpreting epidemiologic studies and about human cancer biology. Particularly illuminating are his discussion of the biases in ERT-breast cancer causation studies and his exploration of the reasons for the apparently better survival in ERT users who develop breast cancer.

A number of recent studies have suggested that survival among premenopausal women after primary treatment of breast cancer may be affected by the estimated hormonal milieu at the time of surgery, especially in those with

Dr. Colditz has reviewed the potential hazards of hormone replacement therapy in breast cancer survivors. Let us presume, for the sake of brevity, that his assumptions are correct. With so many risks, why would a breast cancer survivor consider taking hormone replacement, and why would an oncologist prescribe it?

Female reproductive hormones cause breast cancer. Long-term use of postmenopausal hormones increases the risk of breast cancer. The apparent survival advantage seen in women diagnosed with breast cancer while taking

While doxorubicin (Adriamycin) is among the most active single agents in the treatment of breast cancer and other solid tumors, its concomitant toxicity limits its use. Quality-of-life issues have driven the search for gentler,

In light of the changing trends in the diagnosis and management of invasive breast cancer, the practice of routine axillary dissection should be reevaluated. A growing number of patients with breast cancer are diagnosed as

Contemporary breast cancer treatment research has focused on systemic postoperative adjuvant treatment and the elimination of established micrometastases. An alternative approach addresses the potential for seeding at the time of primary surgery. Several retrospective reports have suggested that the hormonal milieu during lumpectomy or mastectomy impacts on the likelihood of tumor cell shedding and implantation at distant sites.

The article written by Chadha and Axelrod provides a timely discussion of several critical issues in the current debate over the use of axillary lymph node dissection in early-stage breast cancer. As new information and techniques become available, they and others have reassessed the value of axillary lymph node dissection in four key areas:

Breast cancer is second only to lung cancer as a leading cause of cancer mortality in women. In women with metastatic, hence, essentially incurable disease, we strive to find effective chemotherapeutic regimens that offer a

Twenty-four patients with metastatic breast cancer that had progressed after high-dose chemotherapy with peripheral blood progenitor cell (PBPC) support were given intramuscular methotrexate in combination with oral

Between 1989 and 1993, 409 evaluable patients with breast cancer have been treated with tegafur and uracil (UFT) in an adjuvant setting in two different trials. Data from both trials were reviewed in December 1995 after a

During the 1990s, one in nine women in the western world will be diagnosed with breast cancer, and more than 58,000 will die of the disease each year in Europe alone. Recent changes in the primary therapy of operable

NEW ORLEANS-A laboratory study suggests that tamoxifen (Nolvadex) could inhibit angiogenesis at higher dose levels than currently used for adjuvant therapy of breast cancer.

The National Alliance of Breast Cancer Organizations (NABCO)-in a partnership with Oil of Olay-has received a $50,000 grant from the Wal-Mart Foundation in support of breast cancer awareness.

As a tumor grows, so does its need for nutrients, with a new vascular supply necessary for a tumor to grow to a diameter

SAN DIEGO-Breast cancer patients with an inherited predisposition due to mutations of BRCA1 or BRCA2 are more likely to have an accumulation of other genetic defects than patients with no evidence of a familial clustering, according to a multinational study, said Mika Tirkkonen, of the University of Tampere, Finland.

Data from two studies presented at the 88th Annual Meeting of the American Association for Cancer Research (AACR)

Multimodality therapy-ie, surgical excision followed by appropriate systemic therapy and radiotherapy-has an established role in managing patients with locally

Breast-conserving therapy with lumpectomy and breast irradiation is an accepted standard treatment for patients with early-stage invasive breast cancer or ductal carcinoma in situ (DCIS). For both diseases, investigators have tried to identify subgroups of patients who can be "safely" treated with lumpectomy without radiation. Some data suggest that it may be reasonable to omit radiation therapy in patients with small, low-grade invasive or noninvasive tumors and/or in "elderly" patients. Additional studies are needed to better identify criteria to prospectively select appropriate patients for treatment with lumpectomy alone. [ONCOLOGY 11(9):1361-1374, 1997]

To irradiate or not to irradiate, that is the question posed by Marks and Prosnitz for women with early invasive breast cancer or ductal carcinoma in situ (DCIS) undergoing breast conservation therapy (BCT). Due in large part to mammography, there has been in the 1990s a significant increase in the percentage of women presenting with stage 0 (DCIS) and stage I breast cancer, as recorded by the Surveillance, Epidemiology and End-Results Program of the National Cancer Institute (NCI). The generally excellent outcome of these tumors with current therapy has focused research efforts on studies directed at improving quality of life and minimizing the side-effects and expense of local therapy. In this regard, Marks/Prosnitz present a concise and balanced summary of results from randomized and non-randomized clinical trials, and develop a rationale for current treatment recommendations and future studies regarding the role of breast irradiation (RT).

NEW ORLEANS--Three fourths of patients experience significant physical sensations after breast cancer surgery. For many women, these are still present years later, and many have long-term arm morbidity as well, researchers reported at the Oncology Nursing Society's 22nd Annual Congress.

NEW ORLEANS--Fatigue may be underrecognized as a disturbing symptom of breast cancer, especially in postmenopausal women, but exercise may help combat it, according to several presentations at the Oncology Nursing Society's 22nd Annual Congress.

NEW ORLEANS--Cytologic and biomarker assessment can be used to identify a cohort of women at extremely high risk for short-term breast cancer development, Carol Fabian, MD, said at the American Society of Preventive Oncology annual meeting.

SEATTLE--Breast cancer patients who report high levels of personal stress score lower on three measures of immune function than less stressed women with the disease, said Barbara L. Andersen, PhD, professor of psychology and obstetrics and gynecology, Ohio State University, Columbus.

NEW YORK--The National Alliance of Breast Cancer Organizations (NABCO), together with the National Breast Cancer Awareness Month Board of Sponsors, has created the National Breast Cancer Awareness Month (NBCAM) Online Calendar as the one-stop source for all October 1997 events.

NEW ORLEANS--Women seeking BRCA1 testing appear, as a group, to be more distressed and psychologically vulnerable than those who do not wish to be tested, according to two studies from Lombardi Cancer Center, Georgetown University, reported at the American Society of Preventive Oncology annual meeting. The women in the studies were at high risk because of a close family history of breast or ovarian cancer.

Docetaxel (Taxotere) and vinorelbine (Navelbine) have both demonstrated activity as single agents for the treatment of patients with metastatic breast cancer and non-small-cell lung

Docetaxel (Taxotere) and doxorubicin (Adriamycin) have each demonstrated significant activity in metastatic breast cancer. Thus, the combination of docetaxel and doxorubicin has been evaluated in phase I trials to