Validity of the clinical alert on breast cancer

Article Abstract:

In May 1988 the National Cancer Institute contacted physicians and issued a clinical alert. This alert called for routine use of systemic (body-wide rather than local) adjuvant therapy (i.e. given in support of primary therapy or surgery) in cases of breast cancer in which the lymph nodes were negative for cancer. A review of the data which served as the basis for the clinical alert has revealed several limitations, including failure to consider the cost-to-benefit ratio, and failure to exclude late toxicities. Although disease-free survival was increased, the overall survival rate was not increased; does the cost of treating people who will not benefit balance a small increase in disease-free survival (not overall survival) for a few people? It is possible to identify those patients who will benefit from adjuvant therapy. At the same time, routine use of these treatment modalities can discourage further research into patient selection criteria for adjuvant therapy. There are extreme variations in the duration and lethality of breast cancers; these are associated with specific cell and tissue characteristics. These factors may be better predictors of outcome than node-negative or -positive classifications. Many breast cancers are actually local disease; patients with these types would not benefit from systemic treatment. Chemotherapy agents are potent and may have serious side-effects; they should not be given to patients who do not need them. Following the issuance of the clinical alert, the United States Government Accounting Office (GAO) issued its review and questioned survival benefit and high cost of this treatment without significant proof of benefit. It is suggested that the alert was issued prematurely, and that physicians should assess each patient with node-negative breast cancer individually. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Reports, Social policy, Cancer, Chemotherapy, United States. Government Accountability Office, Adjuvant chemotherapy, United States. National Cancer Institute

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Breast cancer in women under 35 years of age

Article Abstract:

The incidence of breast cancer is highest among women between the ages of 45 and 55. Younger women usually account for a small portion of breast cancer patients. There is disagreement regarding the influence of patient age on prognosis. A report is presented of 25 years of experience in treating breast cancer in who were women 35 and younger. Between 1960 and 1987, 226 women under the age of 35 were treated for breast cancer. The average age was 31.3 years; 23 percent of patients had a family history of breast cancer (9 percent of related family cases involved a mother or a sister). Thirteen percent (27 patients) were pregnant or had delivered a baby within the previous 12 months. There were 65 patients with stage I disease (least advanced, on a scale of I to IV), 113 with stage II, and 28 with Stage III or IV disease. No spread to the lymph nodes was found in 60 percent of the patients. Follow-up was available for 206 subjects for an average of time span of seven years. The results for this group of young women were compared with other reported studies of other young women and older women with breast cancer. Comparisons were made on clinical and pathological characteristics and survival. The types of tumor, location, size, and involvement of lymph nodes were similar for the older and younger age groups. In both age groups, survival for those with stage I or stage II disease without lymph node involvement was similar at 5 and at 10 years. However, younger women with stage II disease that had spread to the lymph nodes had poorer survival than their older counterparts. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Demographic aspects, Diseases, Young women

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Neoplastic involvement of nipple-areolar complex in invasive breast cancer

Article Abstract:

There is increased interest in treating breast cancer with conservative surgery. The success of conservative surgery for breast cancer has placed greater importance on histologically defined multifocal tumors; very little is known about the presence of microscopic tumor in the area of the nipple and areola (the circular pigmented area surrounding the nipple). A study was undertaken to determine the incidence of microscopic involvement of the nipple-areolar area of the breast in a group of 1,356 patients with breast cancer, for which 1,291 tissue specimens were available. Cancer involvement of the nipple areolar area was found in 150 tissue specimens (12 percent). Based on gross examination cancer involvement was not suspected in 99 specimens (8 percent). An important finding was the relatively high incidence (7 percent) of nipple-areolar cancer in patients with early invasive stage I or II breast cancer - those patients eligible for conservative treatment. Nipple-areolar involvement was directly associated with tumor size, but there was no significant correlation with axillary metastases (cancer spread to the lymph nodes in the armpit), type of tumor, or the presence of noninvasive cancer in the area of the main tumor. The finding of such a significant chance of a tumor being in the nipple-areolar area reinforces the need for postoperative radiation treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery

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