Adjuvant systemic therapy

Article Abstract:

Adjuvant chemotherapy is widely used to supplement the surgical treatment of the breast. At a conference on the management of limited breast cancer, accepted principles of adjuvant therapy were reviewed. The requirements for systemic chemotherapy may be determined by the histologic diagnosis of invasive carcinoma, tumor size, number of positive lymph nodes, the presence or absence of estrogen receptors and disseminated disease, and the mammogram. Observations of progesterone receptors and tumor grade can be revealing, but are not officially recommended factors in the decision-making process. Factors like DNA synthesis, ploidy, or oncogene expression are good subjects for research, but there are insufficient data to permit their use in treatment decisions. Use of polychemotherapy in premenopausal women with positive lymph nodes is recommended for a duration of four to six months. There is evidence that premenopausal women with negative nodes and tumors larger than a centimeter should receive chemotherapy, and there is evidence that adriamycin-containing therapy is beneficial. The use of high-doses with bone-marrow transplantation, preoperative chemotherapy, or chemotherapy for small tumors, is not yet supported by a sufficient body of data to be recommended. Tamoxifen, the anti-estrogen compound, is recommended for postmenopausal patients with positive nodes and estrogen receptor-positive tumors. Evidence suggests that tamoxifen may also be used to benefit postmenopausal patients with negative nodes and estrogen receptor-positive tumors greater than one centimeter. Likewise, evidence suggests that tamoxifen treatment be continued for two years. Although other uses of tamoxifen may be beneficial, they are still considered experimental. The addition of radiotherapy to chemotherapy in the treatment of patients with four or more positive lymph nodes appears to be beneficial. However, precise scheduling of the radiochemotherapy is also experimental. Neither the use of biological response modifiers nor the combination of chemotherapy with hormonal therapy of noninvasive cancers is supported by enough evidence to be considered anything but experimental. The committee recommends that the therapy of breast cancer be individualized, and that the patient be involved in the decision-making process. (Consumer Summary produced by Reliance Medical Information, Inc.)

Chemotherapy

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The breast biopsy

Article Abstract:

After a suspicious breast lump has been identified by mammography or physical examination, the next step is often a breast biopsy. Fine-needle aspiration biopsy should usually be used to examine a suspicious, palpable lump in the breast. False positive results are rare, and many surgeons prefer to confirm the cytological results with tissue taken at the time of definitive surgical treatment, rather than add another procedure. It is becoming more common for biopsies to be performed on the basis of mammographic findings. An incisional biopsy can be done as an outpatient procedure under local anesthesia. Despite the fact that the examination of the suspicious tissue is the primary objective, the procedure must be performed with adequate care given to cosmetic effects. Often an incision along the areolar border is advantageous, but this is not possible if the lesion is far away or if the areola is small. It is important that a postoperative hematoma be avoided, as this may be disruptive if subsequent surgery is necessary to remove a malignancy, and the hematoma may also disrupt tissue planes which may carry tumor cells out of the original biopsy area. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Diagnosis, Women, Women's health, Breast, Breast tumors, Needle biopsy, Breast biopsy

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Progress in the treatment of early breast cancer

Article Abstract:

The widespread use and increasing public acceptance of breast cancer screening and mammography have resulted in an increasing number of breast cancers being diagnosed in early stages. Currently, many practitioners prefer local excision of tumors that exhibit no sign of spread, followed by close observation of the patient. For patients with invasive lesions, the choice is between lumpectomy and irradiation or modified radical mastectomy. Unfortunately, there is no consensus on the relative merits of the two. Likewise, there is no agreement on the use of postoperative chemotherapy for patients with negative lymph nodes. It is clear, however, that so far the mortality rate due to breast cancers has not changed substantially. However, many therapies have only been recently introduced, and as more data are collected over time, it will be possible to objectively evaluate the various options for treating early breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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