Breast cancer adjuvant therapy

Article Abstract:

In an effort to reduce the rate of recurrence in breast cancer, adjuvant treatment with radiation and chemotherapy has been added to the primary surgical treatment. Adjuvant treatment has been shown to provide benefit in Stage I and Stage II breast cancers, in which all the visible tumor is, in principle, removed by surgery. While different groups use stage definitions that differ in detail, common features of Stage I are tumor limited to the breast and not attached to the underlying muscle, and no spread of the cancer cells to the lymph nodes. Stage II definitions include tumor limited to the breast, not fixed to the muscle, and one or more positive lymph nodes. In both cases, however, microscopically small metastases may have occurred which, if not treated, would possibly provide the seeds for cancer recurrence. Current research indicates that adjuvant treatment is to be strongly recommended for patients with Stage II breast cancer. For postmenopausal patients with cancer cells positive for estrogen receptors (ER), treatment with tamoxifen, an anti-estrogen drug, is effective. Treatment with tamoxifen should continue for at least two years. Chemotherapy is indicated for premenopausal Stage II patients and those with ER-negative cancers. Similarly, chemotherapy or tamoxifen is advantageous overall for Stage I cancers. However, it is not clear that the advantages outweigh the disadvantages for women with ER-positive tumors less than 1.0 centimeter in size. For these women, the decision to use chemotherapy or tamoxifen must be made in discussion between the patient and physician. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Tamoxifen

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Adjuvant therapy for Stage II breast cancer

Article Abstract:

Improvements in screening and patient awareness have made breast cancer increasingly a localized disease. About two thirds of the cases of currently diagnosed breast cancer are limited to the breast, and a full 94 percent of cases are limited to the breast or local lymph nodes. Although the details of staging are not universally agreed upon, most systems would describe a Stage II breast cancer as having no evidence of disseminated disease and one or more positive lymph nodes. Such patients are normally given adjuvant chemotherapy after surgery and irradiation. Single agent chemotherapy has not been shown to provide any benefit, but combination polychemotherapy provides a 26 percent reduction in mortality. The most commonly used combination is cyclophosphamide, methotrexate, and 5-fluorouracil. Postmenopausal women benefit from the addition of tamoxifen to their therapy. Although some individual studies have suggested that tamoxifen also provides benefit for premenopausal women as well, the evidence is contradictory on this point. The evidence available at present indicates that only a subset of Stage II patients actually benefit from adjuvant chemotherapy, as is the case with other cancers and treatment modalities. Continuing research in tumor markers and the basic factors involved may help to identify this subset so that the treatment efforts can be focused on those who will benefit most greatly. (Consumer Summary produced by Reliance Medical Information, Inc.)

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