Breast Cancer

Ghosh and Hartmann present an excellent overview on the risk reduction that prophylactic mastectomy offers the high-risk patient. Dr. Hartmann and the Mayo Clinic remain leaders in this field. As cited in their recent series, the risk of developing breast cancer is reduced 89.5% to 100% in high-risk women who choose to undergo prophylactic mastectomy.[1] In the same year, Meijers-Heijboer et al supported these findings, documenting a 100% relative risk reduction.[2] The fact that prophylactic surgery offers a dramatic reduction in the risk of breast cancer to high-risk patients appears unquestionable.

The emerging era of targeted cancer therapies has focused laboratory scientists and clinicians on the need to define and understand molecular targets of novel drugs. For breast cancer patients and doctors, this trend is not news-efforts have been under way for decades to identify the estrogen and progesterone receptors and define the value of these markers as predictors of response to hormonal therapy.

The need for accurate detection of HER2 status is becoming more apparent, as therapeutic decisions are influenced by this information in both the adjuvant and advanced-stage setting. Since the US Food and Drug

The management of women at high risk for breast cancer presents a clinical dilemma to the health-care provider as well as to the woman herself. Current options include surveillance, prophylactic surgery (mastectomy and/or

The emerging era of targeted cancer therapies has focused laboratory scientists and clinicians on the need to define and understand molecular targets of novel drugs. For breast cancer patients and doctors, this trend is not news-efforts have been under way for decades to identify the estrogen and progesterone receptors and define the value of these markers as predictors of response to hormonal therapy.

WASHINGTON-A new technique employing high-resolution contrast-enhanced magnetic resonance imaging (MRI) can distinguish between benign and malignant breast lesions by showing lesion perfusion patterns (images and Figure 1). Hadassa Degani, PhD, head of the Department of Biological Regulation, the Weizmann Institute of Science, Rehovot, Israel, discussed the method, developed in her lab, at the Susan G. Komen Breast Cancer Foundation 5th Annual Conference on Innovations in Quality Care.

BETHESDA, Maryland-Results from the largest epidemiologic investigation of possible links between two major types of environmental pollutants and breast cancer indicate a 50% increase in risk of the disease for women exposed to polycyclic aromatic hydrocarbons (PAHs) at the highest level. However, researchers failed to find an association between organochlorine compounds, which include DDT, and an increased risk of breast cancer.

BETHESDA, Maryland-Results from the largest epidemiologic investigation of possible links between two major types of environmental pollutants and breast cancer indicate a 50% increase in risk of the disease for women exposed to polycyclic aromatic hydrocarbons (PAHs) at the highest level. However, researchers failed to find an association between organochlorine compounds, which include DDT, and an increased risk of breast cancer.

SAN FRANCISCO-Women who gain 38 lb or more during pregnancy have a 40% greater risk of postmenopausal breast cancer than women who gain less weight, Leena Hilakivi-Clarke, PhD, said at the 93rd Annual Meeting of the American Association for Cancer Research (abstract 1169).

ORLANDO-SGN-15 (a monoclonal antibody conjugated to doxorubicin) plus docetaxel (Taxotere) was well tolerated in patients with metastatic breast cancer or colorectal cancer and showed objective responses, according to a phase II trial.

ORLANDO-Early prophylactic mastectomy benefits women at high risk of hereditary breast cancer, according to a presentation at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 1694). The study revealed the presence of high-risk premalignant lesions in the removed breast tissue of more than half of the women undergoing the procedure.

SAN FRANCISCO-A new monoclonal antibody, TRA-8, produces a higher rate of regression in breast cancer when used with paclitaxel (Taxol) or doxorubicin (Adriamycin) than either of the chemotherapies alone, according to animal studies

ATLANTA-Compared with independent double reading of mammograms, consensus double reading detects slightly more cancers while significantly decreasing recall rates, thereby minimizing the anxiety that women might experience from undergoing a second mammogram, Susan Harvey, MD, said at the 102nd Annual Meeting of the American Roentgen Ray Society (abstract 63).

WASHINGTON-About 30% of breast cancer patients show overexpression of the HER-2/neu oncogene, and trastuzumab (Herceptin), a monoclonal antibody targeting HER-2, has been shown to block the gene’s receptor activity. But because the response rate to trastuzumab "is not ideal," there is "still a need for a better therapeutic agent" aimed at HER-2, said Mong-Hong Lee, PhD, assistant professor of molecular and cellular oncology, M.D. Anderson Cancer Center.

ORLANDO-A large review of patients treated at M.D. Anderson Cancer Center suggests that survival after a first breast cancer recurrence has greatly improved over time in patients diagnosed in the last 25 years. The investigators believe that new therapies, above and beyond the anthracyclines, may be affecting survival rates.

ROCKVILLE, Maryland-The US Preventive Services Task Force (USPSTF) has recommended against the use of tamoxifen (Nolvadex) and raloxifene (Evista) for the primary prevention of breast cancer in women at low or moderate risk

Women with early-stage breast cancer treated with a docetaxel (Taxotere)-based regimen after surgery had a 32% less chance of developing disease recurrence than did women receiving one of the most effective adjuvant treatments currently available. Results from the Breast Cancer International Research Group (BCIRG) trial 001, the first phase III trial to evaluate docetaxel after breast surgery, were presented at the recent annual meeting of the American Society of Clinical Oncology (ASCO) by the BCIRG.

ORLANDO-The concept of sentinel lymph node biopsy as an alternative to axillary node dissection appears to be applicable and useful in breast cancer patients after neoadjuvant chemotherapy, according to an analysis from protocol B-27

BETHESDA, Maryland-Researchers abruptly halted a prevention trial of estrogen/ progestin in healthy menopausal women after an independent monitoring committee found a 26% increase in invasive breast cancer among women taking the hormone replacement therapy (HRT). The committee also found that the HRT group had a greater risk of coronary heart disease, stroke, and pulmonary embolism than the placebo group.

Rubinstein and colleagues provide an excellent review of mathematical models for estimating breast cancer risk, including the risk of carrying inherited mutations of BRCA1 and BRCA2. Since we and others reviewed early models to predict the likelihood of inherited susceptibility to breast cancer,[1] newer quantitative tools, most notably by Parmigiani and colleagues,[2] have been developed. These models have been made available on CD-ROM, over the Internet, and in other electronic versions that are accessible to most clinicians and researchers. These quantitative resources constitute useful and important aids in genetic counseling.

Breast and ovarian carcinomas pose major public health problems in most Western countries. Countless attempts have been made to better understand a patient’s lifetime risk of breast cancer. The most significant etiologic risk is increasing age, followed by family history. In addition, hormonal and reproductive factors-ie, early menarche and later age at menopause, nulliparity (and, therefore, a greater number of ovulations over the patient’s lifetime), and late age at first pregnancy (greater than age 30 years)-also increase a patient’s breast cancer risk.

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]

LOS ANGELES-A large German multicenter study has shown that sentinel lymph node (SLN) biopsy for breast cancer accurately predicts the status of the axillary lymph node. In addition, the study found that physician experience and the choice of lymphography technique-blue dye or scintigraphy-influence the detection rate significantly.

MANHASSET, New York-Early clinical results suggest that capecitabine (Xeloda) may work well in several new combinations for metastatic breast cancer, according to Daniel R. Budman, MD, professor of medicine at New York University and associate director of medical oncology at North Shore University Hospital, Manhasset, New York

NANTES, France-Results of a large phase II European trial validate the antitumor activity of capecitabine (Xeloda) in metastatic breast cancer and present a strong rationale for its use earlier in the disease course, said Pierre Fumoleau, MD,

ORLANDO-With an ever-expanding list of active agents for metastatic breast cancer and even more potential combinations, choosing the best therapy for each patient can be a challenge, according to Clifford Hudis, MD, chief of the

LONDON-Intermittent dosing with R115777 (tipifarnib, also known as Zarnestra) is equally effective as continuous dosing in advanced breast cancer patients, but has significantly less hematologic toxicity, according to a study presented at the American Society of Clinical Oncology 38th annual meeting (ASCO abstract 138).

ALBUQUERQUE, New Mexico-Carboplatin (Paraplatin), vinorelbine (Navelbine), and capecitabine (Xeloda) given in combination to patients with anthracycline- and taxane-pretreated metastatic breast cancer appears active and well tolerated, according to an interim analysis reported at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 1960).

SEOUL, Korea-Use of capecitabine (Xeloda) plus vinorelbine (Navelbine) is effective in metastatic breast cancer patients previously treated with anthracycline and taxane drugs, according to preliminary data from a phase II study. The study

PALO ALTO, California-Treatment with oral chemotherapy for metastatic breast cancer showed promising efficacy with minimal toxicity and warrants further investigation, according to results of a phase I trial conducted at Stanford University.