Abstract
OBJECTIVE: To outline modern principles of surgery, radiation therapy, and systemic treatment of breast cancer, and to review preliminary data on breast cancer prevention. QUALITY OF EVIDENCE: A MEDLINE search was conducted from 1966 to the beginning of 1999; most of the studies reviewed are randomized clinical trials. MAIN MESSAGE: Breast conservation surgery should be offered to all women with early breast cancer because studies demonstrate survival rates equivalent to those with mastectomy. If mastectomy is chosen, breast reconstruction should be offered. Most women with breast cancer are treated systemically with either chemotherapy or tamoxifen, or both, and mortality is substantially reduced. Data indicating that tamoxifen prevents breast cancer are promising; more studies with both tamoxifen and raloxifene are under way. All women should be strongly encouraged to enter clinical trials. CONCLUSIONS: Because many issues face women recently diagnosed with breast cancer, they often seek out family physicians as advisors to help negotiate a complex treatment path. The possibility of preventing breast cancer will undoubtedly raise questions among family members of women with breast cancer that should appropriately be answered and referred, if necessary, by family physicians.
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Selected References
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- Arriagada R., Lê M. G., Rochard F., Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol. 1996 May;14(5):1558–1564. doi: 10.1200/JCO.1996.14.5.1558. [DOI] [PubMed] [Google Scholar]
- Blichert-Toft M., Rose C., Andersen J. A., Overgaard M., Axelsson C. K., Andersen K. W., Mouridsen H. T. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr. 1992;(11):19–25. [PubMed] [Google Scholar]
- Fisher B., Anderson S., Redmond C. K., Wolmark N., Wickerham D. L., Cronin W. M. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995 Nov 30;333(22):1456–1461. doi: 10.1056/NEJM199511303332203. [DOI] [PubMed] [Google Scholar]
- Fisher B., Brown A., Mamounas E., Wieand S., Robidoux A., Margolese R. G., Cruz A. B., Jr, Fisher E. R., Wickerham D. L., Wolmark N. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997 Jul;15(7):2483–2493. doi: 10.1200/JCO.1997.15.7.2483. [DOI] [PubMed] [Google Scholar]
- Fisher B., Costantino J. P., Wickerham D. L., Redmond C. K., Kavanah M., Cronin W. M., Vogel V., Robidoux A., Dimitrov N., Atkins J. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998 Sep 16;90(18):1371–1388. doi: 10.1093/jnci/90.18.1371. [DOI] [PubMed] [Google Scholar]
- Jacobson J. A., Danforth D. N., Cowan K. H., d'Angelo T., Steinberg S. M., Pierce L., Lippman M. E., Lichter A. S., Glatstein E., Okunieff P. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995 Apr 6;332(14):907–911. doi: 10.1056/NEJM199504063321402. [DOI] [PubMed] [Google Scholar]
- Powles T., Eeles R., Ashley S., Easton D., Chang J., Dowsett M., Tidy A., Viggers J., Davey J. Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial. Lancet. 1998 Jul 11;352(9122):98–101. doi: 10.1016/S0140-6736(98)85012-5. [DOI] [PubMed] [Google Scholar]
- Recht A., Come S. E., Henderson I. C., Gelman R. S., Silver B., Hayes D. F., Shulman L. N., Harris J. R. The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer. N Engl J Med. 1996 May 23;334(21):1356–1361. doi: 10.1056/NEJM199605233342102. [DOI] [PubMed] [Google Scholar]
- Rosen P. P., Groshen S., Kinne D. W. Prognosis in T2N0M0 stage I breast carcinoma: a 20-year follow-up study. J Clin Oncol. 1991 Sep;9(9):1650–1661. doi: 10.1200/JCO.1991.9.9.1650. [DOI] [PubMed] [Google Scholar]
- Rosen P. P., Groshen S., Saigo P. E., Kinne D. W., Hellman S. Pathological prognostic factors in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma: a study of 644 patients with median follow-up of 18 years. J Clin Oncol. 1989 Sep;7(9):1239–1251. doi: 10.1200/JCO.1989.7.9.1239. [DOI] [PubMed] [Google Scholar]
- Veronesi U., Luini A., Galimberti V., Zurrida S. Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg. 1994 Jan-Feb;18(1):70–75. doi: 10.1007/BF00348194. [DOI] [PubMed] [Google Scholar]
- Veronesi U., Maisonneuve P., Costa A., Sacchini V., Maltoni C., Robertson C., Rotmensz N., Boyle P. Prevention of breast cancer with tamoxifen: preliminary findings from the Italian randomised trial among hysterectomised women. Italian Tamoxifen Prevention Study. Lancet. 1998 Jul 11;352(9122):93–97. doi: 10.1016/s0140-6736(98)85011-3. [DOI] [PubMed] [Google Scholar]
- Winchester D. P., Cox J. D. Standards for diagnosis and management of invasive breast carcinoma. American College of Radiology. American College of Surgeons. College of American Pathologists. Society of Surgical Oncology. CA Cancer J Clin. 1998 Mar-Apr;48(2):83–107. doi: 10.3322/canjclin.48.2.83. [DOI] [PubMed] [Google Scholar]
- van Dongen J. A., Bartelink H., Fentiman I. S., Lerut T., Mignolet F., Olthuis G., van der Schueren E., Sylvester R., Winter J., van Zijl K. Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 trial. J Natl Cancer Inst Monogr. 1992;(11):15–18. [PubMed] [Google Scholar]
