after transplantation recei ved it for extensive nodal disease without distant metastases.

Contemporary treatment for breast cancer usually involves various combinations of surgery, radiation therapy, cytotoxic chemotherapy, and hormone therapy. Selection of therapy is influenced by the age and menopausal status of the patient, stage of the disease, and certain characteristics of the tumor (e.g., its histologic and nuclear grade,a presence of estrogen and progesterone receptors, measures of proliferative capacity, and genetic characteristics such as overexpression of some growth factor receptors such as human epidermal growth factor receptor 2, or HER2/neu) (NCI, 2004a).

The effectiveness of adjuvant chemotherapy can be improved by administering a higher dose of drug per unit time (called dose density). In a recent study, for example, women with node-positive breast cancer were more likely to survive when a given dose of adjuvant chemotherapy was administered over a period of 22 weeks instead of 33 weeks (Citron et al., 2003; Stearns and Davidson, 2004). This intensification in dose increases the drugs’ toxicity, but data are not yet available to determine if the risk of late effects is increased.

Genetic profiling methods are becoming available that can help predict which women will benefit most from chemotherapy and adjuvant therapies. As such methods become part of the standard initial evaluation of patients, treatment of late effects may decline as therapies are tailored to individual risk (Paik et al., 2004; Mrozek and Shapiro, 2005).

a  

Nuclear grade is an evaluation of the size and shape of the nucleus in tumor cells and the percentage of tumor cells that are in the process of dividing or growing. Cancers with low nuclear grade grow and spread less quickly than cancers with high nuclear grade.

of decline was attenuated with increasing time since diagnosis, but remained significant for some domains of function up to 4 years after diagnosis. Prediagnosis level of social integration is an important factor in future health-related QOL among breast cancer survivors, pointing to the need for adequate social support (Michael et al., 2002). In a subsequent study of breast cancer survivors participating in the Nurses’ Health Study (NHS I and II), investigators found significant functional declines among breast cancer survivors who had been diagnosed at age 40 or younger (Kroenke et al., 2004). Relative to their peers, these women experienced declines in physical roles, bodily pain, social functioning, and mental health. Declines observed among breast cancer survivors aged 65 and older were those expected with age.

Younger breast cancer survivors (under age 50) have reported good quality of life and high levels of functioning when assessed 5 to 10 years after their diagnosis (Bloom et al., 2004; Casso et al., 2004). Mild impair-



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