Breast malignancy

Curr Opin Obstet Gynecol. 1991 Feb;3(1):58-65.

Abstract

Risks associated with oral contraceptive use have been shown for women who begin using them before age 25 and before their first full-term pregnancy. The effectiveness of chemoprevention is being studied. Screening may reduce mortality by 30% in women aged 50 to 69. Breast-conserving lumpectomy is indicated for small tumors. In some postmenopausal node-positive patients, a combination of hormonal and chemotherapy may be useful. In metastatic breast cancer, dose-intensification of chemotherapy has been investigated. Palliative treatment involves tamoxifen. Analysis of steroid hormone receptor status involves fine-needle aspiration, enzyme immunoassay, and a new autoradiographic procedure using radiolabeled estrogens. Prognostic factors under study include oncogene amplification, urokinase plasminogen activator level, expression of growth factors and growth factor receptors, proliferation parameters such as ploidy and S-phase fraction, mutations, and cathepsin D levels.

PIP: Current research in the area of breast malignancies is focusing on identification of pathogenetic risk factors, chemoprevention, screening policies, local treatment modalities that minimize disfigurement, and improved adjuvant therapeutic and palliative systemic therapies. Although epidemiologic studies have produced contradictory results, oral contraceptive use before age 25 years and before 1st full-term pregnancy appears to increase the breast cancer risk. In need of thorough study is the safest form of estrogen replacement therapy in postmenopause. Screening programs aimed at early detection have been shown to reduce breast cancer mortality by 30% in women 50-69 years of age, but no preventive strategies have been identified for younger and older women. A trend toward breast-conserving primary therapy represents a major shift in this area. As long as the tumor is less than 4 cm in diameter and the resection margins are free of tumor, lumpectomy produces disease-free survival rates comparable to those obtained through total mastectomy. In node-positive patients, hormonal adjuvant systemic therapy is effective in postmenopausal women while chemotherapy is effective in premenopausal women. The data are insufficient to allow recommendations regarding adjuvant treatment of node-negative patients, whose overall survival rate is about 70%. In metastatic breast cancer, tamoxifen is the drug of choice for palliation. Prognostic factors currently under study include oncogene amplification, urokinase plasminogen activator level, expression of growth factors and growth factor receptors, proliferation parameters, mutations, and cathepsin D levels.

Publication types

  • Review

MeSH terms

  • Breast Neoplasms* / chemically induced
  • Breast Neoplasms* / diagnosis
  • Breast Neoplasms* / therapy
  • Contraceptives, Oral / adverse effects
  • Estrogen Replacement Therapy / adverse effects
  • Female
  • Humans
  • Prognosis
  • Risk Factors

Substances

  • Contraceptives, Oral