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This article presents a cast study of the management of breast cancer in a 62-year old woman. This postmenopausal women had a second breast cancer raising issues relating to diagnosis and disease management. The use of magnetic resonance imaging in the detection of breast cancer and current guidelines for HER2 testing are mentioned. A discussion of treatment centered upon whether the cancer represented a new primary tumor or a metastasis. Adjuvant systemic and endocrine therapies, chemotherapy and the use of trastuzamab are discussed.

The article comments on the controversy surrounding the recommendations for breast-cancer screening released by the U.S. Preventive Services Task Force (USPSTF). The recommendations include the elimination of mammography as a standard screening for women age 40 to 49 years old and that mammography should be conducted biennially in women from 50 to 74 years old. The authors offer their interpretation of the recommendations to enlighten some confusions regarding the effectiveness of mammography.

Clinical trials of systemic therapy for operable breast cancer are evolving. Our understanding of breast cancer as a family of biologically distinct diseases has implications for patient selection and the optimization of drug choices. In addition, there is a growing dissatisfaction with trials of adjuvant therapy that are large, take many years to complete, and often result in very small improvements in outcome. For these reasons, we must be thoughtful and rigorous in focusing the testing of promising agents in patients who could derive a meaningful benefit. These realities are in part responsible for the explosion of "neoadjuvant," or preoperative, . . . [ABSTRACT FROM AUTHOR]

The author discusses the Investigation of Serial Studies to Predict Your Therapeutic Response through Imaging and Molecular Analysis 2 trial (I-SPY 2 TRIAL) for screening new cancer treatment. Topics include the comparison between the use of chemotherapy, neratinib and trastuzumab as a treatment for patient with HER-2 protein-breast cancer, the potential toxic effects of trastuzumab, pertuzumab, and neratinib when added to the chemotherapy, and the neoadjuvant therapy in cancer treatment.

A response by Harold J. Burstein and Eric P. Winer to several letters to the editor in response to their article about the psychosocial issues related to the diagnosis and treatment of breast cancer, which appeared in the October 12, 2000 issue, is presented.

Offers recommendations for the primary medical care of survivors of breast cancer. Health issues, including risk of secondary cancers, side-effects of breast surgery and radiation and chemotherapy-induced ovarian failure; Potential health benefits of hormone-replacement therapy; Impact of breast cancer on psychosocial well-being.

Background: In a previous analysis of this phase 3 trial, first-line ribociclib plus letrozole resulted in significantly longer progression-free survival than letrozole alone among postmenopausal patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer. Whether overall survival would also be longer with ribociclib was not known.Methods: Here we report the results of the protocol-specified final analysis of overall survival, a key secondary end point. Patients were randomly assigned in a 1:1 ratio to receive either ribociclib or placebo in combination with letrozole. Overall survival was assessed with the use of a stratified log-rank test and summarized with the use of Kaplan-Meier methods after 400 deaths had occurred. A hierarchical testing strategy was used for the analysis of progression-free survival and overall survival to ensure the validity of the findings.Results: After a median follow-up of 6.6 years, 181 deaths had occurred among 334 patients (54.2%) in the ribociclib group and 219 among 334 (65.6%) in the placebo group. Ribociclib plus letrozole showed a significant overall survival benefit as compared with placebo plus letrozole. Median overall survival was 63.9 months (95% confidence interval [CI], 52.4 to 71.0) with ribociclib plus letrozole and 51.4 months (95% CI, 47.2 to 59.7) with placebo plus letrozole (hazard ratio for death, 0.76; 95% CI, 0.63 to 0.93; two-sided P = 0.008). No new safety signals were observed.Conclusions: First-line therapy with ribociclib plus letrozole showed a significant overall survival benefit as compared with placebo plus letrozole in patients with HR-positive, HER2-negative advanced breast cancer. Median overall survival was more than 12 months longer with ribociclib than with placebo. (Funded by Novartis; MONALEESA-2 ClinicalTrials.gov number, NCT01958021.). [ABSTRACT FROM AUTHOR]

The article focuses on the debate of local therapy on breast cancer patients. Three contrasting perspectives are presented by the authors characterizing breast cancer spreading as a local disease with predictable spreading patterns, an intrinsically systemic disease, or a local and unpredictably metastasizing condition. An overview of research studies towards this discussion is given, highlighting the benefits of improved local area treatments on breast cancer patients. Suggestions are given regarding possible future research in the area.

The article focuses on suppression of ovarian estrogen to reduce recurrence of hormone-receptor-positive early breast cancer in premenopausal women. Topics discussed include a comparison of adjuvant tamoxifen plus ovarian suppression and tamoxifen only on preventing premenopausal breast cancer, the effectiveness of combined tamoxifen and ovarian suppression and reduction of breast cancer risk seen after combined tamoxifen and ovarian suppression.

The article discusses a study which examined the treatment of human epidermal growth factor receptor type 2 (HER2)-positive breast cancer using adjuvant paclitaxel and trastuzumab. Topics discussed include the risk of early cancer recurrence, effectiveness and adverse events associated with the adjuvant therapy, and the rate of survival free from the disease.

The article discusses research which investigated the administration of adjuvant treatment of exemestane with ovarian suppression to patients with premenopausal breast cancer. Topics explored include the evaluation of patient eligibility to the study, the oral endocrine therapy provided following chemotherapy, and the statistical analysis of research data gathered. Brief details about the breast cancer recurrence and patient outcomes recorded are also presented.

Background: The status of human epidermal growth factor receptor type 2 (HER2) in breast-cancer cells predicts clinical outcomes in women who receive adjuvant anthracycline-based chemotherapy. We hypothesized that HER2 positivity predicts a benefit from adjuvant doxorubicin doses above standard levels, from the addition of paclitaxel after adjuvant chemotherapy with doxorubicin plus cyclophosphamide, or from both. Methods: We randomly selected 1500 women from 3121 women with node-positive breast cancer who had been randomly assigned to receive doxorubicin (60, 75, or 90 mg per square meter of body-surface area) plus cyclophosphamide (600 mg per square meter) for four cycles, followed by four cycles of paclitaxel (175 mg per square meter) or observation. Tissue blocks from 1322 of these 1500 women were available. Immunohistochemical analyses of these tissue specimens for HER2 with the CB11 monoclonal antibody against HER2 or with a polyclonal-antibody assay kit and fluorescence in situ hybridization for HER2 amplification were performed. Results: No interaction was observed between HER2 positivity and doxorubicin doses above 60 mg per square meter. HER2 positivity was, however, associated with a significant benefit from paclitaxel. The interaction between HER2 positivity and the addition of paclitaxel to the treatment was associated with a hazard ratio for recurrence of 0.59 (P=0.01). Patients with a HER2-positive breast cancer benefited from paclitaxel, regardless of estrogen-receptor status, but paclitaxel did not benefit patients with HER2-negative, estrogen-receptor–positive cancers. Conclusions: The expression or amplification, or both, of HER2 by a breast cancer is associated with a benefit from the addition of paclitaxel after adjuvant treatment with doxorubicin (<60 mg per square meter) plus cyclophosphamide in node-positive breast cancer, regardless of estrogen-receptor status. Patients with HER2-negative, estrogen-receptor–positive, node-positive breast cancer may gain little benefit from the administration of paclitaxel after adjuvant chemotherapy with doxorubicin plus cyclophosphamide. N Engl J Med 2007;357:1496-506. [ABSTRACT FROM AUTHOR]

Background: In women 70 years of age or older who have early breast cancer, it is unclear whether lumpectomy plus tamoxifen is as effective as lumpectomy followed by tamoxifen plus radiation therapy. Methods: Between July 1994 and February 1999, we randomly assigned 636 women who were 70 years of age or older and who had clinical stage I (T1N0M0 according to the tumor–node–metastasis classification), estrogen-receptor–positive breast carcinoma treated by lumpectomy to receive tamoxifen plus radiation therapy (317 women) or tamoxifen alone (319 women). Primary end points were the time to local or regional recurrence, the frequency of mastectomy for recurrence, breast-cancer–specific survival, the time to distant metastasis, and overall survival. Results: The only significant difference between the two groups was in the rate of local or regional recurrence at five years (1 percent in the group given tamoxifen plus irradiation and 4 percent in the group given tamoxifen alone, P<0.001). There were no significant differences between the two groups with regard to the rates of mastectomy for local recurrence, distant metastases, or five-year rates of overall survival (87 percent in the group given tamoxifen plus irradiation and 86 percent in the tamoxifen group, P=0.94). Assessment by physicians and patients of cosmetic results and adverse events uniformly rated tamoxifen plus irradiation inferior to tamoxifen alone. Conclusions: Lumpectomy plus adjuvant therapy with tamoxifen alone is a realistic choice for the treatment of women 70 years of age or older who have early, estrogen-receptor–positive breast cancer. N Engl J Med 2004;351:971-7. [ABSTRACT FROM AUTHOR]