Adjuvant therapy for node-negative breast cancer: the use of prognostic factors in selecting patients

Article Abstract:

Patients with small breast cancers, less than one centimeter in size, and no evidence of cancer spread to the lymph nodes, are often treated with surgery and radiation limited to the tumor area. The results are generally favorable, with 65 to 80 percent of such patients alive 10 years after diagnosis. However, it must not be forgotten that this also means treatment failure for 20 to 35 percent of women with small breast cancers. For this reason, the National Cancer Institute has recommended considering adjuvant chemotherapy for such patients. Evidence suggests that the length of disease-free survival is lengthened with adjuvant chemotherapy, but not the length of overall survival. The recommendation of the National Cancer Institute has provoked much discussion, however. The routine use of adjuvant therapy in these cases would subject 65 to 80 percent of the patients to treatment they do not need; treatment which is, of course, expensive, unpleasant, and rife with side effects. How many years must be gained by how many patients to justify unnecessary treatment for even more patients? There is no easy answer. One possible solution may come from research into prognostic factors for breast cancer outcome. Decisions about appropriate treatment would be considerably simplified if patients could be identified as bearing an especially high or especially low risk of relapse and metastasis. Measurements of tumor ploidy (the number of chromosomes) as determined by flow cytometry, measurements of the fraction of tumor cells in the S phase of the cell cycle, and amplification or overexpression of oncogenes such as HER-2 neu all show promise for being useful prognostic indicators. However, none of these techniques are established well enough to be adopted as a part of standard clinical practice. Until clinical decisions for breast cancer treatment can be made on a more scientific basis, the risks and benefits of adjuvant chemotherapy must be explained carefully to the patient, and her wishes must guide the choice of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Prognosis, Chemotherapy

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Lightscanning versus mammography for the detection of breast cancer in screening and clinical practice: a Swedish multicenter study

Article Abstract:

Mamm ography is an effective X-ray tool for cancer screening, but it is not perfect. Dense breast tissue can hide cancers, and lobular carcinoma in situ cannot be diagnosed by mammography. In addition, exposure to X-rays carries its own risk of cancer which, especially in young women, is not negligible. One alternative to mammography is lightscanning; fiber optics guide red and near-infrared light to the breast, which is viewed using a computer digitized video image. Lightscanning, which has been claimed to be especially useful for breast cancer screening in younger women, was evaluated in a two-part study involving 2,568 Swedish women. The two parts consisted of a diagnostic part for examining 3,178 breasts with symptoms, and a screening part for examining 1,909 breasts without symptoms. In the diagnostic study, 184 cancers were identified by mammography and 165 by lightscan. Nine cancers were identified by lightscan, but not by mammography. There were 107 false-positive patients by mammography and 331 by lightscanning (incorrectly identifying a patient as having a disease). Similar results were obtained in the screening phase of the study. Mammography identified 126 cancers in the asymptomatic women, and lightscanning only 61. Among the women without cancer, 70 breasts were identified as suspicious for cancer by mammography, compared with 156 by lightscan. This comparison indicates that lightscanning is inferior to mammography for the identification of breast cancer; lightscanning was particularly insensitive to small cancers. The large number of false positives obtained by lightscan is also a disadvantage of this method. Furthermore, the nine cases of breast cancer identified by lightscan and not by mammography had other symptoms and indications which led to the diagnosis of cancer; lightscan was not a crucial part of the diagnosis for these women. The use of lightscanning in breast cancer screening is not recommended, and its clinical use with mammography is only marginal. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Diagnosis, Fiber optics, Mammography, Diagnostic imaging, Diagnosis, Radioscopic, Radioscopic diagnosis

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