Mammographically detected breast cancer: results with conservative surgery and radiation therapy

Article Abstract:

The advent of mammography has made possible the detection of breast cancer at earlier stages than was previously practical. However, as the disease is detected earlier in its course, it becomes necessary to reevaluate the best methods of treatment. This is especially true for the very small breast cancers which may be detected mammographically but which are too tiny to be found by physical examination. It has become common to treat very small, early-stage breast cancers by breast-conserving surgical removal followed by radiation to the breast and to the armpit. (Armpit lymph nodes are the first stop for breast cancer cells which have begun to spread.) The question has been raised whether the use of adjuvant chemotherapy might provide some benefit to these patients. If there is a small chance that cancer cells have spread, the chemotherapy might help ferret them out and destroy them. However, if the number of patients who would be helped by this treatment is too small, then it does not justify the adverse and unpleasant effects of chemotherapy. In a review of 438 patients treated for breast cancer, 41 patients were diagnosed on the basis of mammography alone; these patients had cancers which were too small to be detected by physical examination. The patients were treated with conservative surgery and irradiation; in addition, two patients received adjuvant hormonal therapy, but none received adjuvant chemotherapy. In this group, all the patients survived for five years without cancer recurrence. Subsequently, one patient suffered a recurrence in the breast and one patient died of metastatic disease, yielding a 10-year actuarial survival rate of 92 percent. The results of this study confirm the importance of early detection for the success of breast cancer treatment and suggest that adjuvant chemotherapy probably provides no benefit for patients diagnosed in the earliest stages of disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Statistics, Mammography

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Breast cancer control: challenge or chimera

Article Abstract:

From July 19 through July 21, 1989 the American Cancer Society hosted the National Conference on Breast Cancer. Researchers from all fields convened to discuss the medical and social problems involved in the diagnosis and treatment of this disease. Breast cancer has apparently always played a role in human health, and Egyptian hieroglyphics have been found describing cases of breast cancer prior to 1500 B.C. It is only recently, however, that medical science has progressed to a point where some envision the successful control of the disease. The author points out, however, that it is uncertain if this goal is yet within our reach, or whether contemplating the imminent eradication of breast cancer mortality remains an act of hubris. In 1989, an estimated 43,000 women in the United States died of breast cancer and an additional 142,000 women first heard that they have developed the disease. (This works out to a breast cancer death every 12 minutes.) One in 10 newborn baby girls may be expected to develop breast cancer sometime in her life. While the participants in the conference discussed many of the significant advances that have been made in recent years, it is clear that much remains to be done. In words from the keynote address of the conference, breast cancer retains its hold on many records: "most fatal, most feared, most biopsies, most news articles, most controversial, most radically treated, most operations, most radiation therapy, most chemotherapy, and most prolific in terms of sheer quantity of neoplastic tissue produced by human beings". (Consumer Summary produced by Reliance Medical Information, Inc.)

Conferences, meetings and seminars, editorial

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Surgical management of Stage I and Stage II breast cancer

Article Abstract:

While surgery is still the mainstay of breast cancer treatment, improvements in adjuvant therapy have permitted surgeons more latitude in the management of breast cancer. Patients with large or centrally located tumors, patients with two or more palpable tumors, and patients with diffuse microcalcifications on mammography will still require mastectomy. However, women with Stage I or II breast cancer are good candidates for breast-conserving surgery. Patients must understand that the only reason for breast-conserving therapy is cosmetic. Breast-conserving surgery is also more expensive than mastectomy. Women who opt for breast-conserving surgery may expect comparable long-term disease-free survival, but certainly not better survival than mastectomy patients. In addition, many of the psychological problems that accompany breast cancer are not mitigated by breast-conserving therapy, although patients with conserved breasts do have a better body image. Among those women for whom a choice of surgical techniques is appropriate, the majority still choose mastectomy. In one report, 51 percent of the patients chose mastectomy, while the remainder chose breast-conserving surgery; only 21 percent of the entire group actually underwent breast preservation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Surgery, Mastectomy

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