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A study aims to examine the benefit from adjuvant doxorubicin on human epidermal growth factor receptor type 2 (HER2) in breast cancer cells. The results concluded no interaction between HER2 positivity and doxorubicin but it did react to paclitaxel.

A study was conducted to compare the benefits and toxic effects of adjuvant chemotraphy among breast cancer patients in age groups of 50 years of younger, 51 to 64 years, and 65 years or older. It was revealed that age alone should not be a contraindication to the use of optimal chemotraphy regiments in older women who are in good general health.

It appears to be more effective to give women with early-stage breast cancer chemotherapy following surgery rather than radiation treatment. Researchers randomized 244 women with breast cancer so that 122 received chemotherapy before radiotherapy and 122 received chemotherapy after radiotherapy. All the women had had a lumpectomy. The drugs included methotrexate, leucovorin, fluorouracil, cyclophosphamide, prednisone and doxorubicin. Forty-five women in the radiotherapy-first group and 34 women in the chemotherapy-first group did not respond to treatment. Overall 5-year survival rates in the chemotherapy-first group were 81%, compared to 73% in the radiotherapy-first group. Thirty-one percent of the women taking chemotherapy first had a recurrence of their cancer, compared to 38% of those receiving radiotherapy first. Women receiving chemotherapy first were more likely to develop a local recurrence, whereas women receiving radiotherapy first were more likely to develop distant metastases.

The incidence of ductal carcinoma in situ of the breast (DCIS) is increasing due to the increased use of screening mammography but it is not clear whether these tumors require aggressive treatment. Researchers used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program to determine the incidence of DCIS and the use of mastectomy to treat it. The incidence of DCIS increased 557% between 1973 and 1992, from 2.4 cases per 100,000 women to 15.8 per 100,000 women. In 1992 there were 15,583 more cases than would be expected, all of which could be attributed to screening mammography. In 1992, 43.8% of cases were treated by mastectomy, down from 71% in 1983. Conversely, the percentage of cases treated by lumpectomy with or without radiation increased. Survival rates were 100%. Autopsies on women who have died of causes other than breast cancer reveal that DCIS may be fairly common., Objective.--To describe trends in incidence and treatment for ductal carcinoma in situ (DCIS) of the breast in the United States between 1973 and 1992 and to estimate total numbers of in situ cases diagnosed and numbers treated by mastectomy since 1983, when screening mammography for breast cancer began to become widespread. Design.--Analysis of population-based breast cancer incidence data collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program since 1973 and treatment data collected by the SEER program since 1983. Study Population.--All women in the geographic areas of the United States included in the SEER program. Main Outcome Measures.--Annual age-adjusted and age-specific incidence rates for DCIS; time trends in distribution of cases by type of treatment; percentage of cases treated by mastectomy by geographic area; and estimated numbers for the entire United States of DCIS cases, mastectomies for DCIS, and cases attributable to mammography. Results.--There was a marked increase in DCIS incidence beginning in the early 1980s. Average annual increases in rates between 1973 and 1983 and between 1983 and 1992 changed from 0.3% to 12.0% among women aged 30 to 39 years, from 0.4% to 17.4% among women aged 40 to 49 years, and from 5.2% to 18. 1% among women aged 50 years or older. The total estimated number of DCIS cases in the United States in 1992 (23 368) was 200% higher than expected based on 1983 rates and trends between 1973 and 1983. Between 1983 and 1992, there was a marked decline in the proportion of DCIS cases treated by mastectomy (from 71 to 43.8%) and an increase in those treated by lumpectomy (from 25.6% to 53.3%). in 1992, 23.3% of cases were treated by lumpectomy and radiation, 30.2% by lumpectomy alone, and 2.6% with no surgery. Treatment patterns varied substantially by geographic area, with 57.7% of cases in New Mexico treated by mastectomy in 1992 compared with 28.8% in Connecticut. Despite the decline in the proportion of cases treated by mastectomy, the increased DCIS incidence rates resulted in an increase in the absolute number of cases treated by mastectomy until 1990 (n=10 657); in 1992, there were an estimated 10 242 DCIS cases treated by mastectomy. Conclusions--Incidence rates of DCIS of the breast have increased dramatically since 1983. This increase correlates with the widespread adoption of modem mammographic screening. While early detection of invasive breast cancer is beneficial, the value of DCIS detection is currently unknown. There is cause for concern about the large number of DCIS cases that are being diagnosed as a consequence of screening mammography, most of which are treated by some form of surgery. In addition, the proportion of cases treated by mastectomy may be inappropriately high, particularly in some areas of the United States. (JAMA 1996;275,913-918)

Overexpression of the c-erbB-2 oncogene in women with early node-positive breast cancer may be an indication that these women are likely to benefit from adjuvant chemotherapy. Oncogenes are genes with potential cancer-inducing properties. Once these genes are identified, they provide scientists with new strategies for fighting cancer and ways of identifying people at high risk for cancer. Tissue blocks from 442 breast cancer patients who had been treated with a combination of cyclophosphamide, doxorubicin and fluorouracil were analyzed for DNA content, S-phase fraction (a measurement of the DNA synthesis process), c-erbB-2 expression and the accumulation of p53 (a tumor suppressor gene often used as a molecular marker). Of the 397 patients for whom c-erbB-2 expression could be analysed, the tumors of 29% of the patients had a 50% or more c-erbB-2 overexpression. These patients showed a higher survival rate after undergoing adjuvant chemotherapy than did patients with low or no c-erbB-2 expression, especially if they received high dosages.

Moderate or high doses of adjuvant chemotherapy may benefit women with breast cancer more than lower dosages. Adjuvant chemotherapy, the use of one or more drugs to heighten the cancer-fighting effects of the initial treatment, has been recognized as successful for increasing survival in breast cancer patients. A total of 1,529 breast cancer patients were placed on one of three chemotherapy regimens. The moderate group received a 400 milligram per square meter of body-surface area (mg/m sq) of cyclophosphamide and 40 mg/m sq of doxorubicin once every 28 days and 400 mg/m sq of fluorouracil twice every 28 days, all for six cycles. Another group received doses that were 50% higher for only four cycles, and a third received doses 50% lower than the moderate group, also for only four cycles. The first, or moderate, group showed a 74% disease-free survival rate and 92% overall survival rate after about three years. The high-dose, high-intensity group showed 70% disease-free and 90% overall survival rates over the same period of time. The third, or low-dose and low-intensity, group showed a 63% disease-free and 84% overall survival rates.