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In this interview we review recent breast cancer screening guidelines from the ACS and USPSTF, and discuss the changing way that early-stage breast and prostate cancers are being treated.

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Women at increased risk of breast cancer have important opportunities for early detection and prevention. There are, however, serious drawbacks to the available interventions. The magnitude of breast cancer risk is a crucial factor in the optimization of medical benefit when considering the efficacy of risk-reduction methods, the adverse effects of intervention, and economic and quality-of-life outcomes. Breast cancer risk assessment has become increasingly quantitative and is amenable to computerization. The assembly of risk factor information into practical, quantitative models for clinical and scientific use is relatively advanced for breast cancer, and represents a paradigm for broader risk management in medicine. Using a case-based approach, we will summarize the major breast cancer risk assessment models, compare and contrast their utility, and illustrate the role of genetic testing in risk management. Important considerations relevant to clinical oncology practice include the role of risk assessment in cancer prevention, the logistics of implementing risk assessment, the ramifications of conveying risk information with limited genetic counseling, and the mechanisms for genetics referral. Medical professionals can embrace new preventive medicine techniques more effectively by utilizing quantitative methods to assess their patients’ risks. [ONCOLOGY 16:1082-1099, 2002]

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In this interview, Laura Zitella will be discussing challenges and considerations for management and prevention of infection in the oncology setting-in both patients with solid tumors and those with hematologic malignancies.

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Proteasome inhibition is a novel, targeted approach in cancertherapy. Both natural and synthetic proteasome inhibitors selectivelypenetrate cancer cells, disrupting the orderly destruction of key regulatoryproteins involved in tumorigenesis and metastasis. Disrupting theorderly destruction of regulatory proteins causes an imbalance of theseproteins within the cell, which interferes with the systematic activationof signaling pathways required to maintain tumor cell growth and survival;therefore, cellular replication is inhibited and apoptosis ensues.

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Endocrine therapy has long been a mainstay in the therapy of metastatic breast cancer and in the adjuvant setting. The introduction of anastrozole (Arimidex) to the market in 1996 has provided another option for such treatment. Drs. Goss and Tye provide a thorough review of anastrozole and outline its advantages over other aromatase inhibitors as adjuvant therapy for breast cancer and its potential use in the treatment of early breast cancer. The authors delineate many important issues regarding the use of anastrozole; an understanding of these issues is imperative for the optimal utilization of this therapy. The paper has two shortcomings: (1) It focuses almost solely on aromatase inhibitors, to the neglect of other endocrine therapies. (2) Many references are unconventional and represent data on file with various drug manufacturers, which are not easily accessible to readers.

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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.

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When tumor cells are rapidly broken down and their contents released into the extracellular space, the released ions and compounds can cause metabolic disturbances too great to be neutralized by the body's normal mechanisms.

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Although liver cancer has a relatively low incidence in the United States, compared with other cancers, it is 10 times more common in many developing countries than in this country.[1] The incidence of liver cancer is highest in sub-Saharan Africa, China, southern Asia, and Japan.[2]

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Worldwide, hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer mortality. Most patients with hepatocellular carcinoma suffer from cirrhosis primarily caused by alcoholism or chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV); decades may pass between infection with viral hepatitis and development of this cancer. The approximately equal annual incidence and mortality of 1 million reported around the world stands as evidence of its lethality.

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A 71-year-old woman not on hormone replacement therapy presented with uterine bleeding. Dilation and curettage revealed complex hyperplasia with atypia, focal clear-cell features, and endocervicitis. Endometrial intraepithelial carcinoma was suspected.

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One of the more difficult topics to discuss concerning the ethics of healthcare is distributive justice-the fair distribution of benefits, risks, and costs.

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The ability to predict short- and long-term outcomes for cancer patients has become increasingly important. Changes in the way care is provided and paid for, along with a more consumerist attitude on the part of patients, have made this a more prominent issue.

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Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.

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The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in

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This review covers symptoms and complications in patients with late-stage pancreatic cancer, including venous thromboembolism, anorexia-cachexia, pain, and depression.

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As new data and new treatment options emerge, palliative radiotherapy algorithms will need to undergo continuous modifications and updates to ensure that patients receive optimal symptom relief.

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This review will summarize the current standard of care; key issues that arise when treating patients with HER2-positive disease; and developments in novel therapeutics, including small-molecule inhibitors, nanoparticles, immunotherapy, and agents targeting resistance pathways.

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As noted in part 1 of this two-part article, non-Hodgkin's lymphoma is one of a few malignancies that have been increasing in incidence over the past several decades. Likewise, these disorders are more common in elderly patients, with a median age of occurrence of 65 years. Therapy in elderly patients may be affected by multiple factors, especially attendent comorbidities. The approaches to management of these patients, with either indolent or aggressive disease processes, have been based on prospective clinical trial results, many of which have included a younger patient population. Fortunately over the past decade, results of treatment trials that have targeted an older patient population have emerged. The disease incidence and treatment approaches for both follicular (part 1) and diffuse aggressive (part 2) histologies in elderly patients are reviewed, as well as the impact of aging on the care of these patients.

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Dyspnea is an extremely common symptom among cancer patients.[1] Like pain, it is inherently subjective and is best defined as the perception of difficulty in breathing, or an uncomfortable awareness of breathing. Although it may be associated with one or more physiologic disturbances (such as hypercapnia, hypoxia, obstructive or restrictive patterns on pulmonary function tests, or various abnormalities on chest imaging studies), it is not strongly associated with any specific abnormality and may occur in the absence of any. Patient self-report is the gold standard for assessment and may range from mild breathlessness on exertion to a terrifying sense of suffocation.

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Primary nonepithelial malignancies of the breast comprise an importantminority of breast neoplasms, including primary breast sarcomas,therapy-related breast sarcomas, the phyllodes tumors, and primarybreast lymphomas. With widespread mammographic detection ofbreast lesions, these tumors represent critical elements of the differentialdiagnosis of even benign-appearing lesions. Each has a distinctclinical profile, including presentation, available therapeutic options,and prognosis, further underscoring the importance of timely recognition.The increasing incidence of breast carcinomas and the subsequenttherapy thereof may be contributing to an increase in the numberof therapy-related breast tumors. This review discusses various featuresof these uncommon malignancies and their treatment, with thegoal of increasing understanding of their clinical behavior andmanagement.

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As technology has affected every segment of society, we in the oncology community have a responsibility to make every effort to utilize these advances to enable the broadest possible outreach to our patient population in a continual process of quality improvement.

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In this review of active surveillance for favorable-risk prostate cancer, we will discuss the rationality of this approach, the biological evidence for employing active surveillance in Gleason pattern 3 and 4 prostate cancer, patient selection for active surveillance, clinical trial data on active surveillance, and the role of prostate cancer biomarkers and imaging studies for clinical decision making in patients with low-risk disease.

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Because of challenges in making the correct diagnosis and the physician’s reluctance to administer chemotherapy for a disease characterized by such a low tumoral mass, patients may experience a delay in the initiation of appropriate treatment.

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In this interview, we discuss symptom self-management strategies reported by adolescents and young adults with cancer, including some of the most common symptoms affecting this patient population and effective self-management techniques.

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During investigation of an episode of self-limiting abdominal pain, a 63-year-old Caucasian female never-smoker was found to have an asymptomatic right lower lobe pulmonary mass. A positron-emission tomography/computed tomography (PET/CT) scan revealed the right lower lobe mass to be 25 × 32 mm with a standardized uptake value (SUV) of 10.2, without evidence of hilar or mediastinal lymphadenopathy or of distant metastases.

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The ongoing GO29365 study of combination regimens containing polatuzumab vedotin (Polivy) for patients with relapsed or refractory diffuse large B-cell lymphoma added an additional 106 patients to confirm preliminary findings of safety and efficacy.

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Chemotherapy agents known to enhance the effects of radiation in preclinical studies have been used concurrently with radiotherapy in numerous clinical trials with the prospect of further enhancing radiation-induced

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Over the past 8 years, I have led discussions and had private conversations about stress and burnout with oncologists of all stripes. Several common themes have emerged with regard to what it is that stresses and burns out oncologists and what helps them the most.

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With the publication of mature experiences using accelarated partial breast irradiation (APBI) and accelerated whole breast irradiation (AWBI), the use of shortened courses of radiotherapy has become increasingly popular.