摘要:

Purpose of reviewRecent criticisms of the mature breast cancer screening trials claimed that there is no evidence that screening saves lives. This has developed into a major public controversy, causing physicians, women, and policy analysts to rethink and debate mammography-screening guidelines. We have studied this subject from a different perspective - using computer simulation to fit a simple growth model to clinical data. We can thus provide another viewpoint of the screening controversy that may help elucidate the underlying biology and aid policy makers in devising sound screening guidelines.Recent findingsWe agree with some reviewers that there is partial validity to the criticism. Based on our studies, we have arrived at a new explanation of why screening has not lived up to expectations.SummaryOur fundamental hypothesis is that breast cancers often undergo periods during which they are temporarily dormant. In addition, surgical intervention to remove primary tumors can interrupt this dormancy. Therefore screening finds smaller tumors with fewer positive lymph nodes, which is beneficial. But then the resulting extirpation accelerates the growth of dormant distant micrometastases, and results in earlier relapses than in women who have not been screened. This partly offsets the early detection advantage. One hypothetical mechanism proposed to explain this biology is that surgical wounding, particularly for premenopausal node-positive patients, can trigger the angiogenesis of dormant avascular micrometastases.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTraditional therapy for ductal carcinomain situhas been mastectomy or conservative surgery plus radiation, but interest in more expeditious therapies such as conservative surgery alone is growing. A first step in considering changes in an already successful treatment is to evaluate tumor and patient factors that may predict outcome. Identifying and understanding these prognostic factors will aid researchers in designing new treatment paradigms. The purpose of this review is to assess the value of commonly accepted potential prognostic factors in patients with ductal carcinomain situ.Recent findingsDuring this past year several retrospective studies have evaluated putative prognostic factors in ductal carcinomain situ. We will compare these later publications with results from prospective randomized trials and one meta-analysis.SummaryThere does not appear to be unanimous agreement on the prognostic factors associated with increased risk of local failure in patients treated with conservative surgery and radiation for ductal carcinomain situ. In our chosen papers, however, comedonecrosis and positive margins are most likely prognostic factors for increased local failure.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewBreast cancer is the most common malignancy amongst women in the United States and decreased mortality over the past decade has been attributed to a combination of screening and adjuvant therapies. There has been a resurgence of interest in hormonal therapies and this article discusses the clinical status of tamoxifen in the context of emerging alternative agents for treatment and prevention of breast cancer.Recent findingsTamoxifen has served as a prototype for the development of selective estrogen receptor modulators at the laboratory-clinical interface. Molecular technologies have permitted elucidation of mechanisms for tissue specific action and led to newer selective estrogen receptor modulators with potentially greater antitumour efficacy and attenuated uterotrophic profile. Publications over the past 12 months have emphasized the risks of thromboembolism and endometrial carcinoma associated with tamoxifen use which has accelerated application of other hormonal agents for treatment of advanced disease and as neoadjuvant therapy. This article reviews the current role of tamoxifen in the treatment of early and advanced breast cancer together with its potential for chemoprevention. Models for quantitative risk assessment are being developed to identify women for whom chemoprotection is justified.SummaryRecent data showing a survival advantage for the aromatase inhibitor letrozole compared with tamoxifen in the advanced setting and improvement in disease-free survival for the aromatase inhibitor anastrozole versus tamoxifen as adjuvant treatment may herald a major shift in standard first-line endocrine therapies for both advanced and early disease and ultimately chemoprevention of breast cancer. Other agents including newer SERMs and pure antiestrogens are undergoing phase III clinical trials and future endocrine and biological therapies are likely to include more selective and targeted therapies, which may be efficacious in both hormone-sensitive and receptor-negative disease.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewDespite advances in surgery, it is still not possible in most patients with advanced ovarian carcinoma to remove the tumour completely. For these patients the concept of primary chemotherapy followed by interval debulking has emerged. Various studies in the past few years have evaluated the feasibility and benefit of this therapeutic approach. The available data is presented and discussed in this review.Recent findingsThe indication for interval surgery was generally based on the response to chemotherapy. However, different criteria of remission were adhered to, possibly explaining the varying outcomes of the trials. The right selection of patients suitable for this approach is crucial and needs further investigation. In these cases with an unfavourable prognosis, higher tumour resection rates and longer median survival times can be achieved by the use of neoadjuvant chemotherapy.SummaryUntil the results of a prospective randomized study become available, the use of neoadjuvant chemotherapy followed by debulking laparotomy must still be regarded as experimental, and must not be applied outside clinical trials.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewGranulosa cell tumours of the ovary are an uncommon ovarian sex-cord stromal tumour. These neoplasms provide a spectrum of clinical presentations that span from the first to the tenth decade. Surgery represents the primary therapy for early stage disease; however, management of women with advanced disease is less clear. Because of their relative rarity, evidence to support decision-making in the management of granulosa cell tumours is limited. The purpose of this review is to provide the clinician with an updated knowledge of the clinical and molecular aspects of granulosa cell tumours in order to guide therapy.Recent findingsThe clinical stage, mitotic index and cellular atypia correlate most strongly with prognosis. However, these tumours may demonstrate heterogeneous genetic aberrations that can predict behaviour and response to therapy. Case series and reports suggest that postoperative combination chemotherapy is of most benefit in advanced disease. Serial measurements of serum inhibin may be helpful in the follow-up of these women, particularly in the post-menopausal group.SummaryThe pathology and treatment of women with granulosa cell tumours of the ovary is complex. Such women should be managed in a multidisciplinary gynaecological oncology unit. A better understanding of the molecular pathology may assist treatment.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewBorderline tumors of the ovary are seen commonly in obstetrics and gynecology practices. This review will outline the most recent information regarding the epidemiology, molecular pathogenesis, pathology, and clinical management of these tumors.Recent findingsIn the past, borderline ovarian tumors and invasive ovarian cancer were studied together, under the presumption that they represent a continuum of disease. This view is coming into question based on both epidemiological and molecular biological studies. Pathologists are increasingly able to identify poor prognostic histological features. This has not yet been translated into improved non-surgical therapy. Surgical management to excise all visible tumor remains the cornerstone of therapy. Because borderline ovarian tumors often occur in reproductive-age women, fertility is an important issue. Conservative surgery is safe in carefully selected patients.SummaryOur growing understanding of the relatively benign natural history of borderline ovarian tumors has allowed us to be more conservative in their surgical management, preserving fertility in many young women. A few women will be affected by a more virulent form of the disease with the potential to recur and cause death. The pathological features that identify patients with a poor prognosis are progressively being elucidated. Surgery remains the most effective therapy for these patients. Effective non-surgical therapies have yet to be identified. Hopefully, as molecular biological studies continue to expand our understanding of this disease as probably a separate carcinogenic process from invasive ovarian cancer, we will be able to employ this knowledge to design novel adjuvant therapies.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewGrowth, invasion and metastasis of malignant tumors depend on angiogenesis, which is therefore considered an attractive therapeutic target and indicator of clinical outcome. Summarizing the results of very recent studies, we discuss the clinical relevance of vascularization of breast and gynecological tumors.Recent findingsThe prognostic values of directly assessed vascularity (microvessel density) and angiogenic factors have been confirmed for these malignancies, despite few contradictory results that may be due to methodological inaccuracy. In addition, many studies point to a role of angiogenesis as a predictor of response to both antiangiogenic and conventional chemotherapy or radiotherapy. For a conclusive evaluation, however, further studies covering all clinically relevant subgroups of patients are needed. Novel therapeutic approaches with inhibitors of angiogenesis are promising, although the adaptation of most experimentally proven approaches to clinical practice appears to be a laborious process. Furthermore, for an appropriate clinical evaluation of these drugs, newly defined endpoints of treatment and new monitoring systems reflecting their mode of action and the anticipated biological effects are required.SummaryThe prognostic and predictive value of angiogenic factors and microvessel density has been confirmed. Antiangiogenic therapy will most likely play an important role in future clinical management of malignant diseases.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe ovarian cancer screening regimens in current use fail to identify disease at an early curable stage.Recent findingsNew technologies are emerging that facilitate the identification of diagnostic tumor markers. In particular, high throughput techniques using microarray technology and proteomic screening have enriched the study of protein expression by ovarian cancer cells.SummaryFurther evaluation of serum proteins associated with ovarian cancer holds promise for the development of a tumor marker panel that could aid in the early diagnosis of ovarian cancer, and save lives.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis review summarizes current knowledge about the nature of sexual dysfunction in gynaecologic and breast cancers, highlighting recent publications on treatment effects and communication issues.Recent findingsIn both gynaecologic and breast cancer, sexual dysfunction causes much distress to patients, from the time of diagnosis through to long-term follow-up. It appears that younger women in particular experience difficulties related to loss of reproductive function and relationship problems, plus more abrupt vaginal changes, than older women. Chemotherapy has been shown to be associated with short and long-term effects on sexual functioning and quality of life in breast cancer, and it is anticipated that this would extend to gynaecologic cancers also. The addition of endocrine treatments to chemotherapy in breast cancer appears not to affect levels of sexual functioning, although this may depend on the age of the woman. Sexual self-schema appears to be an important concept in predicting sexual dysfunction. Communication with women about sexual issues is vital, but evidence suggests this is lacking.SummaryWe are beginning to understand more about the sexual implications of different treatments and to identify factors which predict sexual dysfunction. More research is still required to identify how sexual dysfunction is affected in different groups of women and how best to help women who experience sexual difficulties. Recent findings suggest that there is a need to increase communication and support about sexual issues.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewBreast and ovarian cancer remain a significant burden for women living in the Western world. This paper reviews the risk factors and current strategies to prevent these diseases.Recent findingsEstablished factors associated with the risk of breast cancer include family history, reproductive factors and lactation, as well as age at menarche and menopause. Hormone replacement therapy increases the risk, whereas oral contraceptives probably confer no increased risk. Alcohol moderately increases the risk, whereas a diet rich in folate and carotenoids might be protective. The role of other dietary factors, smoking and physical exercise remain unclear. Important risk factors for ovarian cancer are reproductive factors and possibly the long-term use of hormone replacement therapy. The risk is decreased by oral contraceptives. In carriers of aBRCA1orBRCA2gene mutation, prophylactic surgery can significantly reduce the risk of breast as well as ovarian cancer. Tamoxifen may be considered as a chemopreventive agent in women with a high risk of breast cancer, including carriers of aBRCA2mutation, but is probably not effective inBRCA1carriers.SummaryDuring the period of this review, the importance of several known risk factors was confirmed, whereas the effects of other factors became more clear. Chemoprevention and prophylactic surgery have emerged as preventative options that can reduce the risk of breast and ovarian cancer.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID