ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Several established prognostic factors are used routinely in the clinical management of breast cancer. These factors include extent of axillary lymph node involvement, tumor size, histologic differentiation, and estrogen and progesterone receptor status. Unfortunately, these factors are not perfect predictors of outcome for the individual patient. This review highlights recent advances in the field of breast cancer biology that may ultimately improve our ability to predict prognosis more accurately, select therapy more appropriately, and possibly identify women who are at high risk for breast cancer development. In particular, studies addressing mechanisms of estrogen and antiestrogen resistance, clinical utility of flow cytometry, roles of certain oncogenes and tumor suppressor genes in breast cancer growth, and biologic factors involved in invasion and metastases are reviewed.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Recent advances in breast cancer treatment have made recognition of different prognostic groups mandatory. In addition, further experience with screening-detected lesions has resulted in the definition of new associations. Therapeutic approaches to these frequently microscopic lesions are currently the source of much debate. This article reviews recent studies of excellent-prognosis carcinomas as well as premalignant and other histologically defined lesions that indicate an increased risk for the development or recurrence of carcinoma. Advances in fine-needle aspiration and in hormone receptor assays are also reviewed.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Control of breast cancer will ultimately be achieved through a better understanding of the epidemiology of the disease and application of primary prevention. Until then, use of screening mammography offers the promise of a 30% reduction in breast cancer mortality, which continues to be shown by screening studies with prolonged follow-up. Biologic markers of cancer risk, including nipple aspirates and cyst fluid, suggest that a complete risk profile can be developed using fluid and tissue obtained from the normal breast. Epidemiologic studies of dietary factors and geographic differences in breast cancer risk continue to provide promising leads relating to the etiology of the disease. Increasing evidence suggests that circulating androgens and estrogens affect breast cancer risk, whereas exogenous estrogen therapy does not increase risk except for small subgroups of women at risk. Increasing understanding of the genetics of breast cancer will have an impact on the disease in the near future. The greatest impact in the short term will come from the use of tamoxifen for primary prevention of breast cancer. The retinoids, particularly N-(4-hydroxyphenyl)retinamide, hold great promise as agents for primary prevention.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This review highlights important issues for surgeons treating early breast cancer. The optimal use of ovarian ablation, the value and timing of radiotherapy for breast preservation, and axillary dissection are considered. New information on the importance of local surgery, even for older women, and the biology of small (up to 10 mm), screen-detected cancers has been recently reported. The value of support services for women having breast cancer surgery is stressed.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Now that the radiation literature for breast cancer is well established in terms of both local control and survival endpoints, especially for invasive breast cancer, recent reports focus on refining selection criteria of patients for treatment and on minimizing complications and maximizing cosmetic effects. The optimal treatment of patients with ductal carcinoma in situ remains a controversial issue, and the optimal sequencing of adjuvant chemotherapy and primary radiation in patients with breast-conserving surgery is emerging as a topic requiring further study.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Systemic therapy for operable breast cancer can delay the time to recurrence. Recurrence of breast cancer can follow a variable clinical course but will lead to death in virtually all cases. This delay is reflected in an accompanying improvement in overall survival with treatment. Almost 35 years have passed since the introduction of adjuvant chemotherapy, whereas adjuvant tamoxifen trials were begun 17 years ago. In that time, only in a minority of patients has a clear consensus emerged on the appropriate use of adjuvant therapies. Overview analysis from large numbers of controlled clinical trials has produced a much larger data base for examining the effects of hormonal and cytotoxic therapy on the outcome of patients with early-stage breast cancer and provides greater statistical power to detect small differences in particular subgroups of patients, which may not have been apparent in individual studies. Patients with involved lymph nodes are now routinely treated with chemotherapy if they are premenopausal and with tamoxifen if they are postmenopausal, especially if their tumors contain estrogen receptor. More recent trials attempt to examine the use of these therapies outside of these prescribed groups as well as the introduction of new chemotherapeutic agents and dosage regimens, some of which are based on biologic principles of alternating, non–cross-resistant therapy and dose responsiveness. Treatment of node-negative breast cancer remains controversial. Small but real differences in odds of relapse have emerged with adjuvant treatment, although the nature of the risks and benefits remains to be defined.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Tamoxifen is now established for use in premenopausal as well as postmenopausal patients. Recent reports have not shown its activity to be enhanced by the addition of either prednisolone, progestogens, or interferon. Reversible ocular toxicity from tamoxifen appears to be more common than had been previously realized. Different schedules giving the same dose intensity of doxorubicin give markedly different pharmacokinetic profiles. Although this does not lead to differences in responses or physical toxicity, it seems to have important implications for quality of life. Taxol is showing impressive activity in advanced breast cancer, and significant response rates have also been reported for carboplatin and podophyllotoxin derivatives. To achieve maximum effectiveness from the cyclophosphamide, methotrexate, and fluorouracil combination, attention to schedule and dose intensity has been shown to be important. No new effective cytotoxic combinations have been described. High-dose chemotherapy requiring bone marrow support remains experimental. Further progress has been made in monitoring the response of metastatic bone disease to treatment. The precise significance for patients of the results in many of the papers reviewed is often uncertain because they lack quality-of-life measures; the importance of this approach is emphasized.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Over the past year, several research areas have been noteworthy. This article discusses several reports on psychiatric morbidity and psychological factors of breast cancer, quality-of-life issues related to breast cancer treatment, and psychological factors in breast cancer screening. An area of increasing interest includes studies examining the psychological status and breast cancer screening practices of women at increased risk of developing breast cancer, primarily as a function of family history.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID