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October marks National Breast Cancer Awareness month, now in its 25th year, a time to contemplate important advances and milestones as well as future research needs.

In about 30% of U.S. women who receive a diagnosis of early breast cancer, the cancer will progress to metastatic disease, but in the developing world, most cancer is initially diagnosed at an advanced stage, said William Gradishar, MD, director of medical breast oncology at the Robert H. Lurie Comprehensive Cancer Center, at Northwestern University, Chicago.

Thanks to the tireless efforts of the breast cancer community, October and breast cancer are tightly bound with the ubiquitous pink ribbon. But the awareness campaign places a heavy emphasis on prevention, detection, and early diagnosis. For women with metastatic breast cancer, there is a sense that the “pink parade” has intentionally passed them by even though an estimated 465,000 annual deaths from breast cancer worldwide occur because of metastatic disease.

Breastfeeding reduces breast cancer risk among women with a family history of breast cancer, according to a study. Observational studies suggest a relationship between lactation and premenopausal breast cancer risk.

Current evidence does not support the routine use of breast MRI in women with newly diagnosed breast cancer, according to Monica Morrow, MD, chief of the breast service, department of surgery, at Memorial Sloan-Kettering Cancer Center.

They are supposed to be the standard bearers of the body’s defense against disease. But when it comes to cancer, some macrophages are traitors, helping rather than fighting the enemy. They attach to metastatic tumor cells, as they do to other threats. But rather than destroying metastatic cells, these macrophages enable their growth.

In a follow-up study, Christopher I. Li, MD, PhD, and colleagues have reconfirmed their finding that migraine headaches are associated with a lower risk of breast cancer.

After it was reported that 25 labs in Quebec incorrectly identified markers for hormone therapy in 15% to 20% of breast cancer patients, the Canadian Breast Cancer Network called for urgent action to implement systemic changes in national standards for breast cancer testing.

Cell surface coating may play a major role in the spread of breast cancer to the brain, according to a study out of Memorial Sloan-Kettering Cancer Center in New York. Three genes-COX2, HB-EGF, and ST6GALNAC5-have been found to mediate the metastasis of breast cancer to the brain, reported lead author Joan Massagué, PhD, and colleagues (Nature online, May 6, 2009)