Cancer is a genetic disease caused by the progressive accumulation of mutations in critical genes that control cell growth and differentiation. Completion of the Human Genome Project promises to revolutionize the practice of Medicine, especially Oncology care. The tremendous gains in the knowledge of the structure and function of human genes will surely impact the diagnosis, prognosis and treatment of cancer. Moreover, it will lead to more effective cancer control through the use of genetics to quantify individual cancer risks. This article reviews the current status of genetic testing and counseling for cancer risk assessment and will suggest a framework for integrating such counseling into oncology practice. (+info)
Vinorelbine, epirubicin, and methotrexate (VEM) as primary treatment in locally advanced breast cancer.
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PURPOSE: This phase II trial of VEM (vinorelbine + epirubicine + methotrexate) in the treatment of locally advanced breast cancer was conducted to obtain downstaging to allow surgery and breast conservation. PATIENTS AND METHODS: This multicenter study recruited 58 patients with locally advanced breast cancer (two patients ineligible); 56 were evaluable for response and tolerance. RESULTS: Downstaging was obtained in 77% of the patients with a pathological complete response (pCR) rate of 9%. At 33 months of follow-up, median survival has not been reached. Neutropenia grade 3-4 was reported in 31% of cycles with 3% of cycles with infection grade 3. Alopecia grade 3 was noticed for 71% of patients. CONCLUSION: VEM represents an effective regimen for patients with locally advanced breast cancer, allowing an important pCR. Moreover, this regimen appears to be particularly well tolerated. (+info)
Risk-reduction mastectomy: clinical issues and research needs.
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Risk-reduction mastectomy (RRM), also known as bilateral prophylactic mastectomy, is a controversial clinical option for women who are at increased risk of breast cancer. High-risk women, including women with a strong family history of breast cancer and BRCA1/2 mutation carriers, have several clinical options: risk-reduction surgery (bilateral mastectomy and bilateral oophorectomy), surveillance (mammography, clinical breast examination, and breast self-examination), and chemoprevention (tamoxifen). We review research in a number of areas central to our understanding of RRM, including recent data on 1) the effectiveness of RRM in reducing breast cancer risk, 2) the perception of RRM among women at increased risk and health-care providers, 3) the decision-making process for follow-up care of women at high risk, and 4) satisfaction and psychological status after surgery. We suggest areas of future research to better guide high-risk women and their health-care providers in the decision-making process. (+info)
The Indian scene.
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Breast cancer is the second most common cancer among women in India, after cancer of the cervix uteri. Presently, 75,000 new cases occur in Indian women every year. This figure must be viewed against the backdrop that the national cancer registry and the hospital-based tumor registries hardly sample 3% of the total population. Locally advanced breast cancer constitutes more than 50% to 70% of patients presenting for treatment. The management of the patients varies according to the hospital the patient seeks treatment from. In this vast country, hospitals vary from peripheral hospitals with basic facilities to the specialized institutions in the metropolitan centers with all specialists, medical oncologists, radiation oncologists, surgical oncologists, and supporting facilities. In the peripheral hospitals, the treatment is invariably a radical mastectomy with or without radiotherapy. In the metropolitan areas and in specialized cancer institutions, management mirrors international recommendations with brachiocephalic trunk or modified radical mastectomy, radiation therapy, and chemotherapy. (+info)
Breast cancer in South America: challenges to improve early detection and medical management of a public health problem.
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Breast cancer is a public health issue in South America, with about 70,000 cases and 30,000 deaths expected for the year 2001 according to the World Health Organization database. This is especially the case for the so-called temperate region that includes Argentina, Chile, Uruguay, and Southern Brazil. In these areas, the incidence of breast cancer is in the same range as in most countries in Europe. Notably, Argentina has one of the highest incidences of breast cancer in the world, while in Brazil breast cancer is the second most frequent type of cancer (after skin cancer). The potential risk factors for the higher incidence of this disease in temperate South America are, among others, a high-fat diet, more elevated socioeconomic status, and the low average parity of women. In addition, the influence of European immigration on the genetic background of the population should be considered. Late diagnosis is a major factor affecting the mortality rates, as a significant proportion of patients are still diagnosed at clinical stages II and III. In this article, the available data on the incidence and mortality rates of breast cancer in South America, as well as the published literature on risk factors and the limitations of early detection of the disease, are discussed. The overall management of patients diagnosed at clinical stage IIIA is briefly addressed. (+info)
Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer.
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PURPOSE: To estimate the efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. PATIENTS AND METHODS: We followed the course of 745 women with a first breast cancer and a family history of breast and/or ovarian cancer who underwent contralateral prophylactic mastectomy at the Mayo Clinic between 1960 and 1993. Family history information and cancer follow-up information were obtained from the medical record, a study-specific questionnaire, and telephone follow-up. Life-tables for contralateral breast cancers, which consider age at first breast cancer, current age, and type of family history, were used to calculate the number of breast cancers expected in our cohort had they not had a prophylactic mastectomy. RESULTS: Of the 745 women in our cohort, 388 were premenopausal (age < 50 years) and 357 were post- menopausal. Eight women developed a contralateral breast cancer. Six events were observed among the premenopausal women, compared with 106.2 predicted, resulting in a risk reduction of 94.4% (95% confidence interval [CI], 87.7% to 97.9%). For the 357 postmenopausal women, 50.3 contralateral breast cancers were predicted, whereas only two were observed, representing a 96.0% risk reduction (95% CI, 85.6% to 99.5%). CONCLUSION: The incidence of contralateral breast cancer seems to be reduced significantly after contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. (+info)
Postmastectomy breast reconstruction: current techniques.
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BACKGROUND: The techniques of breast reconstruction have evolved and matured over the past 25 years. Recent studies have proven the benefit of breast reconstruction for breast cancer patients. METHODS: The authors reviewed the recent literature on the techniques of breast reconstruction and the effects of reconstruction on patients following surgery for breast cancer. The findings in recent studies are correlated with the experience of the authors. RESULTS: A better understanding has been gained regarding surgical techniques of breast reconstruction as well as the proper indications for the various methods. The criteria of patient benefit have been defined by recent long-term studies. CONCLUSIONS: Breast reconstruction following mastectomy has been proven to be a safe and beneficial procedure. (+info)
The effect of sentinel node selective axillary lymphadenectomy on the incidence of postmastectomy pain syndrome.
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BACKGROUND: Postmastectomy pain syndrome (PMPS) has been reported following procedures involving complete lymph node dissection (CLND). Since the triggering event is probably related to nerve injury, sentinel lymph node dissection (SLND) should decrease the incidence of PMPS. The purpose of this report is to determine the impact of SLND on the number of patients referred to the pain clinic for PMPS treatment. METHODS: The records of all breast surgical patients with a diagnosis of PMPS referred to the Moffitt Cancer Center pain clinic were reviewed. The criterion for diagnosis of PMPS was a history of postoperative pain in the upper anterior chest wall, upper extremity, axilla, and/or shoulder in the absence of recurrent disease. RESULTS: A total of 55 patients with a diagnosis of PMPS were seen in the pain clinic since 1991. Treatments included local anesthetics/corticosteroid injection, stellate ganglion block, and tricyclic antidepressants. A decrease from 15 patients in 1991 to 3 in 1998 was observed. All but one of the 55 patients with PMPS had CLND, and none referred to the pain clinic had undergone SLND. CONCLUSIONS: PMPS is a complication of CLND. The increased use of SLND in our center has reduced the number of referrals to the pain clinic for treatment of PMPS. This benefit of SLND reduces suffering in the postoperative breast patient. (+info)