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Breast
Chemo and Hormonal therapy led to Breast Cancer Survival Gains
By Lancet
May 13, 2005, 21:33

The types of chemotherapy and hormonal therapy that have long been used to help prevent breast cancer recurrence have much greater effects on 15-year than on 5-year survival, according to a study published in this week's issue of The Lancet. This extra effect is one of the main reasons why breast cancer death rates have been falling rapidly ever since the early 1990s in the UK, the USA, and some other countries, state the authors.

Liz Carroll, Head of Clinical Services, Breast Cancer Care said:

'The results from this trial are very positive for anyone affected by breast cancer. They clearly show the benefits of treatments such as hormonal therapy and chemotherapy, used both alone and in combination, on 15-year survival rates. We would encourage clinicians to prescribe anthracyclines-based chemotherapy, such as FEC and FAC much more as they are significantly better than CMF and hope that breast cancer death rates continue to drop in the UK.

In early breast cancer, surgery (or surgery and radiotherapy) can appear to remove all traces of the disease, but undetected deposits of cancer cells may remain that could, over the next 5, 10 or 15 years, develop into a life-threatening recurrence. Chemotherapy and/or hormonal therapy are often given as additional treatments in early breast cancer to help prevent recurrence, and can improve 5-year survival.

The Early Breast Cancer Trialists� Collaborative Group coordinated the world's largest collaborative analysis of cancer trials, bringing together data from 145,000 women with early breast cancer in 194 randomised trials. The study includes information on various treatments that were being tested in the 1980s, and have since been widely used, such as 6 months of anthracycline-based chemotherapy (in which an anthracycline is combined with two older drugs, fluorouracil and cyclophosphamide) and 5 years of tamoxifen.

The investigators found that where both chemotherapy and hormonal therapy are appropriate they can approximately halve the 15-year risk of death from breast cancer. For example, if a 50-year-old women had a one in 5 risk of dying from her hormone-sensitive breast cancer, then this risk could be halved, to about one in 10. For middle-aged women with breast cancer, 6 months of anthracycline-based chemotherapy reduces the breast cancer death rate over the next 10 or 15 years by about one third. For women of any age with hormone-sensitive early breast cancer, the commonest form of the disease, 5 years of tamoxifen also reduces the breast cancer death rate over the next 10 or 15 years by about one third. For middle-aged women with hormone-sensitive disease, a combination of both of these treatments halves the breast cancer death rate. The authors note that while chemotherapy and tamoxifen can have unpleasant short-term side-effects, any long-term side effects are much smaller than the long-term survival benefits.

The analysis is restricted to trials that began by 1995, so none of the available studies involved taxanes, trastuzumab, or modern aromatase inhibitors.
Professor Sarah Darby (Clinical Trial Service Unit, University of Oxford, UK), who helped coordinate the collaboration, comments: �For middle-aged women with hormone-sensitive breast cancer, six months of anthracycline-based chemotherapy and five years of tamoxifen halves the long-term risk of death from the disease. Such treatments have been used widely for several years and were endorsed by a US consensus panel in 2001. Although newer treatments are now gaining favour, the eventual long-term benefits from older treatments such as these are one of the main reasons why breast cancer mortality rates are now falling rapidly in countries such as the UK or USA.�

Breast cancer is the most common type of cancer among women in USA (other than skin cancer). The number of new cases of breast cancer in women was estimated to be about 212,600 in 2003.

She adds: �This is the largest analysis of randomised evidence ever done in any type of cancer. Because so many women in previous decades agreed to join these randomised trials, millions of women in future decades will benefit.� (Quote by e-mail; does not appear in published paper)
In an accompanying Comment Karen Gelmon (British Columbia Cancer Agency, Vancouver, Canada) and colleagues state: �The most impressive finding is the divergence of the survival curves for breast cancer over time . . . The survival curves suggest that adjuvant systemic therapies do cure a proportion of women with early-stage breast cancer, rather than simply delaying recurrence; a finding that is reassuring to both oncologists and patients after 30 years of debate on the principle of [whether to use] adjuvant therapy in early breast cancer.�

Information from National Cancer institute

Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is anything that increases a person's chance of developing a disease. Studies have found the following risk factors for breast cancer:

Age: The chance of getting breast cancer goes up as a woman gets older. A woman over age 60 is at greatest risk. This disease is very uncommon before menopause.

Personal history of breast cancer: A woman who has had breast cancer in one breast has an increased risk of getting this disease in her other breast.

Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer, especially at a young age (before age 40). Having other relatives with breast cancer on either her mother's or her father's side of the family may also increase a woman's risk.

Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia or lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.

Genetic alterations: Changes in certain genes (BRCA1, BRCA2, and others) increase the risk of breast cancer. In families in which many women have had the disease, genetic testing can sometimes show the presence of specific genetic changes. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes. The Cancer Information Service can provide printed material about genetic testing.

Reproductive and menstrual history:
The older a woman is when she has her first child, the greater her chance of breast cancer.

Women who began menstruation (had their first menstrual period) at an early age (before age 12), went through menopause late (after age 55), or never had children also are at an increased risk.

Women who take menopausal hormone therapy (either estrogen alone or estrogen plus progestin) for 5 or more years after menopause also appear to have an increased chance of developing breast cancer.

Much research has been done to learn whether having an abortion or a miscarriage affects a woman's chance of developing breast cancer later on. Large, well-designed studies have consistently shown no link between abortion or miscarriage and the development of breast cancer.

Race: Breast cancer occurs more often in white women than Latina, Asian, or African American women.

Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.

Breast density: Older women who have mostly dense (not fatty) tissue on a mammogram (x-ray of the breast) are at increased risk of breast cancer.

Taking DES (diethylstilbestrol): DES is a synthetic form of estrogen that was given to some pregnant women in the United States between about 1940 and 1971. (DES is no longer given to pregnant women.) Women who took DES during pregnancy have a slightly increased risk of breast cancer. This does not yet appear to be the case for their daughters who were exposed to DES before birth. However, as these daughters grow older, more studies of their breast cancer risk are needed.

Being obese after menopause: After menopause, women who are obese have an increased risk of developing breast cancer. Being obese means that the woman has an abnormally high proportion of body fat. Because the body makes some of its estrogen (a hormone) in fatty tissue, obese women are more likely than thin women to have higher levels of estrogen in their bodies. High levels of estrogen may be the reason that obese women have an increased risk of breast cancer. Also, some studies show that gaining weight after menopause increases the risk of breast cancer.

Physical inactivity: Women who are physically inactive throughout life appear to have an increased risk of breast cancer. Being physically active may help to reduce risk by preventing weight gain and obesity.

Alcoholic beverages: Some studies suggest that the more alcoholic beverages a woman drinks, the greater her risk of breast cancer.

Other possible risk factors are under study.

(www.cancer.gov)


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