Breast cancer early detection

Although the incidence of breast cancer has been increasing in the United States, the mortality rate has been decreasing over the past two decades. This trend reflects the success of early detection and the development of effective treatment regimens. Treatment for most breast cancer patients includes a combination of pharmacologic and nonpharmacologic therapy. 

TABLE 86-2. Guidelines for Early Detection of Breast Cancer... 

Locally advanced breast cancer often is treated with neoadjuvant therapy to make the tumor surgically respectable. During neoadjuvant chemotherapy, laboratory values to monitor chemotherapy toxicity are obtained prior to each cycle of chemotherapy, and a physical examination and ultrasound exams to detect size of tumor are performed after the cycles of neoadjuvant therapy are completed. After a complete surgical resection, monitoring proceeds as described earlier for early breast cancer. 

Breast cancer has a very high incidence in women. Breast cancer frequently develops into (or is) a systemic disease. The best way to reduce risk due to breast cancer is early tumor detection and surgical removal. The increase in detection rate of breast tumors that are < 1 cm in diameter over the past 10 years can be mostly attributed to improvements in the sensitivity and utilization of mammography. The main utility of CA 15-3 in breast cancer is to monitor patients after mastectomy (14). 

Individuals at risk for developing a genetic disease with a delayed age of onset may wish to learn whether they have inherited a disease-causing mutation (e.g., Huntington disease, femilial breast cancer, hemochromatosis, adenomatous polyposis coli). In some cases, presymptomatic diagnosis can be highly usefiil in preventing serious disease consequences before they occur (e.g., phlebotomy for hemochromatosis, early tumor detection for familial breast cancer). 

The labelling of steroid hormone-receptor ligands is important, since it would probably allow early detection and treatment of breast and prostate cancer. Attempts to apply the second-generation approach in which a chelator is conjugated to the steroid have been made, but with little success so far. Both the [3 + 1] approach and derivatization of the [Tc(CO)3]" core have been... 

Currently, anastrozole and letrozole are efficacious in early-stage, locally advanced, and mefasfafic disease and fhus they present with the most complete data set for the different stages of breast cancer. Although it seems rather unlikely that one will be able to detect differences with respect to clinical effects at the tumour level, the indirect comparison of different AIs suggests a stronger evidence for the use of exemestane compared with other AIs for breast cancer therapy [90]. 

There have been major advances in the detection of carcinoma of the breast in the past several decades. The increased use of mammography for screening and early detection has resulted in a significant increase in the diagnosis of early breast cancer and specifically ductal carcinoma in situ (DCIS) [92]. The number of patients found to have this lesion has grown 10-fold (from 2 to 20%) in the last decades. In the UK national health screening programme... 

Nevertheless, at this time there is no persuasive evidence from epidemiological studies that any individual fatty acid is associated with the risk of breast cancer (Willett, 1997). A pooled analysis of nine prospective studies showed no association between the intake of various dairy products and the risk of breast cancer (Missmer et al., 2002). However, in epidemiological studies there is often a high degree of correlation between individual fatty acids in the diet. This reduces the ability to detect an independent association between a single acid and cancer risk. Furthermore, dietary assessment during an epidemiological study may not reflect an individual s diet at the time of cancer initiation, which in the case of breast cancer may be in early life. 

National Program for the Early Detection of Breast Cancer Monitoring and Evaluation Reference Group, Commonwealth Department of Human Services and Health, National Program for the Early Detection of Breast Cancer Evaluation of Phase One I July 1991-30 June 1994, Canberra, Australia, 1994. 

Detecting cancer recurrence may be helpful to initiate early treatment or change therapy. Ultrasensitive PSA assays allow earher detection of prostate cancer after radical prostatectomy. The breast cancer marker CA 27.29 has been shown to detect recurrent disease before any clinical evidence m breast cancer patients receiving adjuvant chemotherapy. ... 

Chan DW, Beveridge RA, Muss H, et al. Use of TRUQUANT BR RIA for early detection of breast cancer recurrence in patients with stage II and stage III disease. J Clin Oncol 1997 15 2322-28. 

Once an asymptomatic, mutation-positive woman has been identified, she may wish to undergo prophylactic bilateral mastectomy, oophorectomy, or specialized surveillance and prevention strategies for the early detection of both breast and ovarian cancer. The risk of breast cancer can be significantly lower in women choosing prophylactic surgery than in those opting for increased surveillance. ... 

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