A Review of the Department of Defense's Program for Breast Cancer Research (1997) / Chapter Skim
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2 Breast Cancer: Biology and Medicine
2 Breast Cancer: Biology and Medicine
Pages 22-32
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From page 22... ...
chance of developing breast cancer during their lifetime (Kosary et al., 1996~. An overview of the current status of breast cancer research is provided in this chapter to serve as a background for this report and to provide the context in which the committee developed recommendations for future research directions.
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From page 23... ...
TABLE 2-1. Age-Specific Incidence of Breast Cancer and Mortality Rates of Women by Race in the United States, 1988-1992a African-American Age at Caucasian Women Women AllRaces Diagnosis Incidence Mortality Incidence Mortality Incidence Mortality 0-4 0.0 0.0 0.0 0.0 0.0 0.0 5-9 0.0 0.0 0.0 0.0 0.0 0.0 10-14 0.0 0.0 0.2 0.0 0.1 0.0 15-19 0.0 0.0 0.2 0.0 0.1 0.0 20-24 0.9 0.1 1.9 0.3 1.0 0.1 25-29 7.1 1.0 10.5 2.5 7.5 1.2 30-34 24.5 4.3 32.0 7.9 25.2 4.7 35-39 63.4 11.1 66.8 20.1 63.8 12.0 40-44 125.4 22.1 138.2 34.4 125.4 23.0 45-49 202.6 35.8 184.7 51.9 197.8 37.0 50-54 241.7 52.6 213.8 71.2 232.7 53.8 55-59 287.5 69.8 254.8 85.2 278.0 70.4 60-64 360.0 87.6 284.7 96.3 343.3 87.0 65-69 431.1 104.2 335.8 107.1 412.1 103.0 70-74 469.1 120.6 352.5 116.5 451.0 118.8 75-79 502.5 136.9 372.6 127.1 483.9 134.9 80-84 492.6 158.0 390.3 150.8 477.4 156.1 85 443.7 195.4 361.5 191.4 432.5 193.8 .
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From page 24... ...
Incidence rates for invasive breast cancer among racial and ethnic groups in the United States during the period 1988-1992 are shown in Table 2-2.
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From page 25... ...
Recent advances in breast-conserving surgery and radiotherapy produce survival rates equivalent to those after total mastectomy, and adjuvant systemic therapy prolongs the disease-free interval and overall survival (Early Breast Cancer Trialists' Collaborative Group, 1992; Harris et al., 1992b)
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From page 26... ...
I ~ 1 FIGURE 2-2a. Ductal carcinoma in situ.
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From page 27... ...
During the past few years, breast cancer has been associated with the expression of several genes: · Amplification of MYC, a gene affecting cellular proliferation, has been detected in 20%-30% of breast cancers studied (Berns et al., 19954; · Overexpression of BCLI or PRAD1, a gene involved in cell cycle control, has been observed in approximately 20%-30% of breast cancers studied (Zukerberg et al., 19959;
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From page 28... ...
Scientists agree that until the causes of breast cancer are understood, its prevention or eradication is unlikely. OTHER RISK FACTORS Despite extensive epidemiological studies spanning several decades, no single dominant etiology for breast cancer has emerged, as it has for lung cancer (i.e., cigarette smoking)
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From page 29... ...
If the complex mechanisms of breast cancer development can be elucidated, then it may be possible to move away from our current use of relatively toxic and ineffective treatment to more precise interventions that can eliminate the cancer and spare normal cells. Molecular tools may also permit the detection of breast cancer long before it is palpable or visible with mammography, thus enabling local intervention to bring about cure.
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From page 30... ...
A correlation between intensity of chemotherapy and therapeutic response has been shown to some degree for patients with breast cancer (Hryniuk and Levine, 1986; Stewart et al., 1994; Wood et al., 1994~; however, the risk/benefit ratio of more aggressive treatment has not been determined. Ongoing randomized trials are focusing on the efficacy of various dose intensity schedules, using chemotherapeutic agents sequentially or concurrently, or utilizing high doses of chemotherapy that require bone marrow rescue.
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From page 31... ...
While clinical research continues to refine both specialties (e.g., sentinel lymph node biopsy studies and three-dimensional radiation treatment planning) , major changes in the application of either specialty would likely be linked to research achievements in other areas.
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From page 32... ...
As tests for mutations in the BRCA1 and BRCA2 genes are becoming available, clinicians, for the first time, will be able to predict an individual's risk of breast cancer. This new capability has multiple ethical, legal, and psychosocial consequences that are not yet fully understood (Brower, 1997~.
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