ISSN:1040-8746    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Advances in the past year in understanding the etiology, early detection, and prevention of breast cancer are reviewed. Reports suggest that exogenous hormone therapy is associated with only moderate or no excess risk of breast cancer. Studies examining the association between exposure to organochlorine compounds and the risk of breast cancer are inconsistent and further investigations are required. The report by the International Workshop of Screening for Breast Cancer emphasizes the benefit in reducing breast cancer mortality to be gained by regular screening among women aged 50 years and older. Age is the strongest predictor of breast cancer risk, yet screening rates tend to diminish with age. Chemoprevention trials for the primary prevention of breast cancer are underway in North America and Europe. Agents under investigation include tamoxifen and fenretinide. The risks and benefits of tamoxifen therapy continue to be clarified with reports from a pilot prevention trial and follow-up of participants of prior adjuvant treatment trials. A beneficial effect in reducing cardiac morbidity has been observed among women taking 40 mg/d of tamoxifen for at least 2 years. Several studies demonstrated the increased risk of endometrial pathologic changes, including endometrial cancer associated with tamoxifen therapy. Because of the uncertainty of net risks and benefits, close monitoring for adverse side effects should be incorporated into ongoing prevention trials.

ISSN:1040-8746    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Concern about the recognition of especially good prognoses continues to be resolute among those who decide, with patients, the course of treatment. Prognostic considerations are paramount in this planning process, and should emphasize precision in case definition and repeated verification in comparable studies. Excellent-prognosis invasive lesions, subtyping of ductal carcinomasin situ, and premalignant indications within otherwise benign breast biopsy specimens are highlighted in this review.

ISSN:1040-8746    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The progression from normal breast epithelium to metastatic breast cancer is a complex, multistep process. Initially, genetic alterations are thought to confer a growth advantage to individual cells by decreasing tumor-suppressor gene activity or increasing oncogene activity, or both. Further alterations result in the development of cell clones that have the ability to invade adjacent tissue, establish metastatic deposits, and evade immune surveillance. At some point in this process, these malignant cell clones also lose the normal ability to respond to hormonal growth regulatory signals. Recent advances in understanding the genetic alterations, the loss of normal growth regulation, and the development of metastatic potential in breast cancer are reviewed. Factors related to the immunobiology of breast cancer are also discussed.

ISSN:1040-8746    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Randomized clinical trials evaluating local treatments for early breast cancer have provided new data on the long-term morbidity and cause-specific mortality associated with radiotherapy combined with different types of mastectomy. The difficulty surgeons have in determining optimal integration of surgery and radiotherapy for breast preservation is demonstrated by the wide variation of radiotherapy schedules, lack of interpretable data to justify a radiotherapy “boost,” and data from a randomized trial suggesting that radiotherapy applied only to the excision site might be sufficient. The use of cytology aspirates for tumor grading, the prognostic importance of vascular invasion, and new tumor markers and cancer cells in bone marrow at diagnosis are all reported. New data came from attempts to identify an axillary sentinel node at surgery for breast cancer. Studies of connective tissue disorders in women with silicone implants failed to find evidence of increased risk, but 3-year follow-ups confirmed that surgeons who preferred mastectomy are more likely to have anxious, depressed patients.

ISSN:1040-8746    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Prospective randomized studies continue to dominate issues of local regional radiation therapy for breast cancer. The National Surgical Adjuvant Breast and Bowel Project, designed to assess the role of radiation therapy in the management of breast-conserving surgery for duct carcinomain situ, has published preliminary results. These results indicate that the use of radiation therapy decreases the local recurrence rate in women with this disease, with a short median follow-up for the entire group so far. The Milan Cancer Institute likewise first reported on their trial assessing the role of radiation therapy in early invasive breast cancer, following a quadrantectomy procedure in the breast as well as an axillary node dissection. Again, radiation therapy significantly decreased the local recurrence rate in the treated breast compared with observation alone. Several important retrospective analyses continue to search for prognostic indicators that might effect the outcome of patients treated with breast-conserving surgery and irradiation. The issue of early age, as well as the issue of sequencing needed adjuvant chemotherapy with whole-breast irradiation was the subject of several articles. Other researchers focused on methods of detection of failure in the irradiated breast, including several innovative studies using magnetic resonance imaging. Documentation of radiation-related treatment sequelae is also reviewed, along with a retrospective study assessing the palliative role of strontium-89 isotope treatment of women with widespread metastatic bone lesions.

ISSN:1040-8746    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Systemic adjuvant therapy reduces the mortality due to breast cancer to a modest extent. Current research directions focus on both increasing the efficacy of therapy, predominantly by increasing the intensity of treatment, and attempting to reduce toxicity by treating only those patients at significant risk of relapse. Improved understanding of both the metastatic process and the mechanisms by which cytotoxic treatments exert their effects hold the promise for more effective treatments in the future. Cost-benefit analyses demonstrate the relative cost-effectiveness of adjuvant systemic therapies for patients at significant risk of recurrence, for whom the effectiveness of treatment is substantial.

ISSN:1040-8746    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Our understanding of mechanisms of resistance to endocrine treatment has increased; they include mutations in steroid receptors and altered metabolism of tamoxifen. Tamoxifen and progestogens appear to have similar efficacies for first-line endocrine treatment, but high doses of progestogens have been shown to give less cost-effective results compared with conventional doses. Numerous new endocrine and cytotoxic agents have been reported, but no major new treatments have been identified. High-dose chemotherapy for metastatic disease remains experimental. The concept of estrogen recruitment to enhance chemosensitivity has not been corroborated. Prior adjuvant systemic treatment renders treatment of relapsed breast cancer less effective.

ISSN:1040-8746    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Over the past year, quality of life among patients with breast cancer has continued to be a noteworthy area of research. Several articles related to provider-patient communication are also included in this review. Reports on the psychologic distress and cancer screening practices of spouses and other relatives of patients with breast cancer are noted. This review summarizes and critiques publications in these three areas.

ISSN:1040-8746    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Oligodeoxynucleotides have been proposed as bothin vitroandin vivoinhibitors of gene expression because of the specificity of Watson-Crick base pair hybridization. Phosphodiester oligodeoxynucleotides (normal DNA) cannot be used as drugs because they are nuclease sensitive. Significant efforts have been made to study phosphorothioate oligodeoxynucleotides, which have a sulfur atom substituted for one of the phosphate oxygen atoms at a nonbridging position. These oligodeoxynucleotides are nuclease resistant, and over the past year they have entered clinical trials. They have also been extensively examinedin vitroand have been targeted to thebcr-ablandbcl2 messenger RNAs among others. Methods to maximize the intracellular oligodeoxynucleotide concentration have also been devised. However, significant problems remain, including the significant nonsequence specificity of phosphodiester oligodeoxynucleotides as well as questions of oligodeoxynucleotide uptake into and compartmentalization within cells. An improvement of our understanding of these phenomena is critical to the elaboration of this technology into a clinical therapeutic modality.

ISSN:1040-8746    

出版商:OVID    

年代:1994

数据来源: OVID