ISSN:1040-8746    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Studies of the etiology, early detection, and prevention of breast cancer reported in the past year are reviewed in this paper. Studies of the etiology of breast cancer include reports on genetic and environmental factors. A major advance in the study of inherited forms of breast and ovarian cancer occurred with the identification of theBRCA1gene. A second breast cancer susceptibility gene, theBRCA2gene, was localized to chromosome 13q12–13. Multiple mutations in theBRCA1gene have been identified, presenting a challenge for the development of predictive testing. Controversy continues over the association between hormone replacement therapy and the development of breast cancer. A study of exercise suggests a strong protective effect against the development of early onset breast cancer. Recent studies have failed to find a strong link between dietary fat intake and the development of breast cancer. A meta-analysis of studies of the efficacy of screening for the prevention of breast cancer mortality demonstrates a significant reduction in mortality among women 50 years of age and older. A lowering of breast cancer mortality for women aged 40 to 49 was only demonstrated after 10 to 12 years of follow-up. The risks and benefits of tamoxifen therapy, a potential breast cancer chemoprevention agent, continue to be clarified. Adverse effects on the endometrium, including an increased risk of endometrial cancer, have been reported. Beneficial effects include an improved cardiovascular risk profile and preservation of bone mineral density among postmenopausal women.

ISSN:1040-8746    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Breast cancer represents a significant worldwide public health problem as well as an excellent model system for examining many aspects of tumor biology and genetics. As the understanding of the biology of breast cancer expands, this new knowledge can be put to use in efforts to diagnose, treat, and prevent breast cancer. In this review we highlight recent advances in breast cancer biology in the areas of genetics, immunobiology, and molecular biology, with particular emphasis on tumor-suppressor genes, minimal disease detection, growth factor receptors, cell cycle regulators, and mediators of apoptosis.

ISSN:1040-8746    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Little has been added in the past year to our knowledge of the premalignant lesions that have implications of increased subsequent cancer risk. However, studies of molecular biologic associations of these lesions are proceeding. The heterogeneous nature of ductal carcinomain situand its clinical implications continues to evolve. Several studies of ductal carcinomain situhave confirmed that this entity extends in continuity within the breast whether associated with invasive carcinoma or not. Therapeutic stratification of ductal carcinomain situlesions depending on their grade and size is widely accepted, however, formal larger cooperative studies are necessary. Therapeutic use of histologic grading and recognizing special histologic subtypes continues to gain importance. Studies detailing the use of grading as an additive measure of the predictiveness of staging, as well as documentation of interobserver agreement when fostered by rule-structured agreement, dominate the current literature on this subject. The use of stereotactically guided needle biopsy is rapidly gaining a broad consensus. Precise guidelines for management of borderline diagnoses are under development.

ISSN:1040-8746    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Limiting morbidity without sacrificing outcome remains paramount for patients with minimally invasive breast cancer, particularly regarding diagnosis, local disease control, limiting axillary dissection, and identifying the optimal timing for surgery. Stereotactic biopsy is evolving as a viable alternative to surgical biopsy, but it awaits confirmation in a randomized prospective study before its adoption on a routine basis. Breast-conserving therapy continues to offer local control rates similar to mastectomy, except for lesions with positive-excision margins, an extensive intraductal component, and perhaps in young patients and those with either lobular carcinoma or multifocal disease. Factors that provide prognostic information currently obtained by axillary dissection have not been identified, and hence axillary dissection remains a mainstay of treatment. Sentinel node biopsy requires further refinements and confirmation before its universal acceptance. Premenopausal patients undergoing surgery during the follicular phase of the menstrual cycle appear to fare poorly, thereby requiring further investigation.

ISSN:1040-8746    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

As data bases mature, more in-depth analyses of results, with special attention to late dose and volume effects and second cancers, are appearing in the literature. In the continuing effort to minimize late effects, the importance of the boost dose is being reexamined, in relationship to the increasingly sophisticated margin information now available from most pathology laboratories. As well, patients are increasingly being grouped by various risk factors into subsets rather than receiving standard management as dictated by their stage of disease. This year the special needs of the elderly patient is being focused on, with regard to the need for dissecting the axilla and observations regarding the role of tamoxifen in both distant and local control.

ISSN:1040-8746    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The continued research efforts in the field of breast cancer adjuvant therapy are translating into a better understanding of the real, but still modest, impact on patient outcome. Recent publications are focusing either on secondary leukemias or on secondary solid tumors, which are associated with the use of adjuvant chemotherapy or adjuvant tamoxifen, respectively. These attempts at an improved risk-benefit assessment of classic adjuvant treatment for breast cancer are to be encouraged. In parallel, there is an urgent need for innovative treatment approaches that have to be carefully evaluated through prospective randomized clinical trials. These include increasing chemotherapy dose intensity, changing timing or scheduling of drug administration, or moving new active agents, such as the taxoid compounds, to the adjuvant setting. Major efforts still need to be done in using new molecular markers of tumor aggressiveness for an improved assessment of a patient's individual risk of relapse. Finally, increasing attention is being paid to optimal therapy for elderly patients.

ISSN:1040-8746    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Tamoxifen as adjuvant systemic treatment after first isolated locoregional recurrence of breast cancer has been shown to decrease the subsequent locoregional relapse rate, but it affects neither distant metastases nor survival. In metastatic disease, tamoxifen has not improved response when added to ablation of ovarian function. The cyclical sequential use of tamoxifen with megestrol acetate has not increased the response over tamoxifen alone. Aromatase inhibitors are an expanding field; formestane and vorozole are effective agents, and letrozole shows promise. In chemotherapy, major interest has focused on the use of taxoids, with high activity being reported for both paclitaxel and docetaxel, the latter being particularly effective as a second-line treatment. Reports continue to reaffirm the effectiveness of vinorelbine. Thein vitroability of quinidine to reverse resistance to anthracyclines has not been repeatable in a clinical setting. The evaluation of high-dose chemotherapy with bone marrow support continues to be explored, but this approach has thus far not been demonstrated to improve clinical outcome in advanced disease. The intra-arterial administration of chemotherapy appears to have a useful palliative role in selected patients with locoregional disease.

ISSN:1040-8746    

出版商:OVID    

年代:1995

数据来源: OVID