Ten Best Readings on
Breast Cancer

John Horton, MB, ChB, FACP
H. Lee Moffitt Cancer Center & Research Institute

The ten best recent articles in the medical literature
relating to breast cancer are reviewed here.

Chu KC, Tarone RE, Kessler LG, et al. Recent trends in US breast cancer incidence, survival, and mortality rates. J Natl Cancer Inst. 1996;88:1571-1579.

The age-adjusted breast cancer mortality rate for white American women dropped by 6.8% from 1989 through 1993. The decrease in the diagnosis of regional disease in the late 1980s in women over 40 years of age likely reflects the increased use of mammography earlier in the 1980s. The increase in survival rates, particularly for patients with regional disease, is probably a reflection of benefits from systemic adjuvant therapy. This report presents an encouraging picture of breast cancer incidence and outcomes.

Effects of radiotherapy and surgery in early breast cancer: an overview of the randomized trials. Early Breast Cancer Trials' Collaborative Group. N Engl J Med. 1995;333:1444-1455.

A meta-analysis on studies involving 28,405 patients indicates that some local therapies for breast cancer had substantially different effects on the rates of local recurrence of breast cancer, but there were no definite differences in survival at 10 years.

Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA. 1996;276:1818- 1822.

This approach to provide surgical staging of the axilla without the morbidity that results from complete axillary dissection has the potential to appreciably improve the symptomatic outcomes of treatment of clinically localized breast cancer.

Bartelink H, Rubens RD, van der Schueren E, et al. Hormonal therapy prolongs survival in irradiated locally advanced breast cancer: a European Organization for Research and Treatment of Cancer randomized phase III trial. J Clin Oncol. 1997;15:207-215.

An improvement in survival attributable to hormone therapy is shown in patients with locally advanced breast cancer. This improvement became apparent only after long-term follow-up.

Berry DA, Parmigiani G, Sanchez J, et al. Probability of carrying a mutation of breast-ovarian cancer gene BRCA1 based on family history. J Natl Cancer Inst. 1997;89:227-238.

A mathematical model for calculating the probability that a woman with a family history of breast and/or ovarian cancer carries a mutation of BRCA1 will help women and their health care providers in assessing the need for genetic testing.

Peto R. Five years of tamoxifen - or more? J Natl Cancer Inst. 1996;88:1791-1793.

This editorial summarizes the current status of information concerning the optimal duration of adjuvant tamoxifen therapy. The final conclusions are still not available.

Hortobagyi GN, Theriault RL, Porter L, et al. Efficacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. Protocol 19 Aredia Breast Cancer Study Group. N Engl J Med. 1996;335:1785-1791.

Monthly infusions of pamidronate as a supplement to chemotherapy can protect against skeletal complications in women with stage IV breast cancer who have osteolytic bone metastases.

Lerman C, Biesecker B, Benkendorf JL, et al. Controlled trial of pretest education approaches to enhance informed decision-making for BRCA1 gene testing. J Natl Cancer Inst. 1997;89:148-157.

Standard educational approaches may be equally effective as expanded counseling approaches in enhancing knowledge about BRCA1 testing. Since knowledge is a key aspect of medical decision-making, standard education may be adequate in situations where genetic testing must be streamlined.

Greenberg PA, Hortobagyi GN, Smith TL, et al. Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer. J Clin Oncol. 1996;14:2197-2205.

The authors present an important data base of patient survival outcomes after standard-dose cytotoxic chemotherapy for metastatic breast cancer. A small percentage of patients achieve long-term remissions with standard chemotherapy. Prognostic attributes of these patients are similar to those who respond well to high-dose chemotherapy.

Yeatman, TJ, Cantor AB, Smith TJ, et al. Tumor biology of infiltrating lobular carcinoma: implications for management. Ann Surg. 1995;222:549-561.

Infiltrating lobular cancers are biologically distinct from invasive ductal breast cancer. Additional care in management is needed when patients with infiltrating lobular cancers are considered for breast conservation therapy.

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