This second edition of Breast Cancer continues the tradition of the M. D.Anderson Cancer Care Series. The book is oriented towards the needs of clinicians who manage breast cancer at every stage of the disease. Chapters are written by experts with a strong knowledge of research findings who also are active in the clinic and understand the practical needs of the patient and her physician.
Since the first edition of Breast Cancer: Prognosis, Treatment and Prevention was
published there has been a tremendous amount of new information related to the basic
and clinical applications of this disease which can affect 1 of 8 people in the USA and
1 of 12 in European countries.
Harrison's Internal Medicine Chapter 86. Breast Cancer
Breast Cancer: Introduction
Breast cancer is a malignant proliferation of epithelial cells lining the ducts or lobules of the breast. In the year 2007, about 180,510 cases of invasive breast cancer and 40,910 deaths occurred in the United States. Epithelial malignancies of the breast are the most common cause of cancer in women (excluding skin cancer), accounting for about one-third of all cancer in women.
The last three decades have witnessed tremendous advances in the understanding
and treatment of breast cancer. As a result, starting shortly before the 1990s, a persistent
decrease in breast cancer mortality has been documented, primarily in the
United States and in several European countries. Breast cancer, however, remains
an important health problem. In this book, which is mainly dedicated to nuclear
medicine, experts have thoroughly reviewed the achievements made in the diagnosis,
monitoring and treatment of this disease.
The committee is grateful for the contribution of participants at its three public meetings. The
presentations and discussions at these meeting were valuable in informing the committee about relevant
research findings, issues of interest in the research community, the perspectives of advocacy
organizations, and the concerns of individuals with breast cancer and their families. The agendas for these
meetings appear in Appendix A.
Endocrine Therapy Normal breast tissue is estrogen-dependent. Both primary and metastatic breast cancer may retain this phenotype. The best means of ascertaining whether a breast cancer is hormone-dependent is through analysis of estrogen and progesterone receptor levels on the tumor. Tumors that are positive for the estrogen receptor and negative for the progesterone receptor have a response rate of ~30%. Tumors that have both receptors have a response rate approaching 70%. If neither receptor is present, the objective response rates are ...
Staging Correct staging of breast cancer patients is of extraordinary importance. Not only does it permit an accurate prognosis, but in many cases therapeutic decisionmaking is based largely on the TNM (primary tumor, regional nodes, metastasis) classification (Table 86-1). Comparison with historic series should be undertaken with caution, as the staging has changed several times in the past 20 years. The current staging is complex and results in significant changes in outcome by stage as compared with prior staging systems.
Breast Cancer: Treatment
Primary Breast Cancer
Breast-conserving treatments, consisting of the removal of the primary tumor by some form of lumpectomy with or without irradiating the breast, result in a survival that is as good as (or slightly superior to) that after extensive surgical procedures, such as mastectomy or modified radical mastectomy, with or without further irradiation. Postlumpectomy breast irradiation greatly reduces the risk of recurrence in the breast.
Table 86-2 5-Year Survival Rate for Breast Cancer by Stage
5-Year Survival, %
Source: Modified from data of the National Cancer Institute—Surveillance, Epidemiology, and End Results (SEER).
Estrogen and progesterone receptor status are of prognostic significance. Tumors that lack either or both of these receptors are more likely to recur than tumors that have them.
Several measures of tumor growth rate correlate with early relapse. S-phase analysis using flow cytometry is the most accurate measure.
administration of adjuvant therapy before definitive surgery and radiation therapy. Because the objective response rates of patients with breast cancer to systemic therapy in this setting exceed 75%, many patients will be "downstaged" and may become candidates for breast-conserving therapy. However, overall survival has not been improved using this approach.
Noninvasive Breast Cancer Breast cancer develops as a series of molecular changes in the epithelial cells that lead to ever more malignant behavior. Increased use of mammography has led to more frequent diagnosis of noninvasive breast cancer. These lesions fall into two groups: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (lobular neoplasia). The management of both entities is controversial.
Ductal Carcinoma In Situ (DCIS)
Proliferation of cytologically malignant breast epithelial cells within the ducts is termed DCIS.
The spermine analogue N1,N11-diethylnorspermine (DENSPM) eﬃciently depletes the cellular pools of putrescine, spermidine and spermine by down-regulating the activity of the polyamine biosynthetic enzymes and up-regulating the activity of the catabolic enzyme spermidine/ spermine N1-acetyltransferase (SSAT). In the breast cancer cell line L56Br-C1, treatment with 10 lM DENSPM induced SSAT activity 60 and 240-fold at 24 and 48 h after seeding, respectively, which resulted in polyamine depletion. ...
Chemotherapy Unlike many other epithelial malignancies, breast cancer responds to multiple chemotherapeutic agents, including anthracyclines, alkylating agents, taxanes, and antimetabolites. Multiple combinations of these agents have been found to improve response rates somewhat, but they have had little effect on duration of response or survival. The choice among multidrug combinations frequently depends on whether adjuvant chemotherapy was administered and, if so, what type.
Follow-Up of Breast Cancer Patients Despite the availability of sophisticated and expensive imaging techniques and a wide range of serum tumor marker tests, survival is not influenced by early diagnosis of relapse. Surveillance guidelines are given in Table 86-5.
I Am Not My Breast Cancer is a book that will help women realize that they
are not alone when dealing with this disease. It will help their families,
friends, colleagues, and also their physicians—anyone who is part of the
fabric of their lives. It is a book that addresses what women are really feeling
during this time when their health is at risk and their emotions are
running high. It touches on the feelings they have about themselves
head-on, with no compromises and no punches pulled.
Cancer of the breast is the most common cancer in women worldwide. Every year 1.6 million women are newly diagnosed with breast cancer glo-cancer accounts for 23% of all female cancers glo-bally and shows a geographic variation in incidenc are 39 per 100,000 worldwide – 27 in less and 66 usually applied in single-center institutions per 100,000 in the more developed regions. Out of the 425,000 global annual deaths from breast cancer, however, 68,000 are young women from develop-duce major improvements wit limited financialing countries1.
Benign breast disease comprises a wide range of conditions
which worry patients, which vex physicians, which
are vastly more common than breast cancer, and yet
which have to date received relatively little attention in
the medical literature. It is therefore a particular pleasure
for me to introduce the third edition of Hughes, Mansel
& Webster’s Benign Disorders and Diseases of the Breast, a
unique and classic work which fully succeeds in addressing
this imbalance and builds on the substantial and
well-deserved success of the first (1989) and second
Breast cancer remains the most feared disease of all women, regardless of age, race, ethnicity, or culture. The causes of breast cancer remain a mystery, with a few exceptions. About 70% of women diagnosed with breast cancer have no known risk factors. This implies that there are risk factors that haven’t yet been identified. Doctors are beginning to identify lifestyle choices that can influence our cancer risk. These lifestyle choices include diet, exercise, smoking, alcohol, and many other factors. We have control over how we nourish our bodies.
The Palpable Breast Mass Women should be strongly encouraged to examine their breasts monthly. A potentially flawed study from China has suggested that BSE does not alter survival, but given its safety, the procedure should still be encouraged. At worst, this practice increases the likelihood of detecting a mass at a smaller size when it can be treated with more limited surgery. Breast examination by the physician should be performed in good light so as to see retractions and other skin changes.