Quote of the Week

Breast Cancer Symposium
This Web Letter will depart from its usual format. Rather than review presentations from the Journal Club, I am going to report on a Breast Cancer Symposium that I attended in December 2001.Over 3000 physicians, scientists, nurses, and technicians gathered in San Antonio, Texas for the 24th annual Symposium which has become one of the most prestigious Breast Cancer meetings in the world. I am going to list and comment, in my estimation, on some of the meetings significant points.

1. Tamoxifen (Novaldex) therapy reduced the incidence of benign breast disease such as adenosis, cysts, duct ectasia, fibrocystic disease, hyperplasia (overgrowth),and metaplasia (change in tissue characteristics); but not the incidence of fibrosis or fibroadenomas (common benign tumors).
     Ed. These findings explain the preventive effects of Tamoxifen on Breast Cancer. By preventing the benign diseases it therefore reduces the precursors of malignant disease.

2. Aromatase Inhibitors appear to be more effective than Tamoxifen for adjuvant hormonal therapy in postmenopausal women who have Breast Cancer.
     Ed. Aromatase Inhibitors prevent the formation of estrogen whereas Tamoxifen blocks the effect of estrogen on tumor cells which are estrogen receptor positive.

3. Patients who have had breast conservation surgery and radiation and then later develop a local recurrence of their Breast Cancer can have a prolonged disease free survival especially if treated by a mastectomy.
     Ed. This is not new but it is reassuring to see statistical conformation.

4. A clinical trial from France demonstrated that in early Breast Cancers with no palpable lymph nodes in the axilla there was no difference in long term survival between those patients who had axillary dissection and those patients who had only axillary radiation.
     Ed. This study needs further conformation but it demonstrates that if the sentinel lymph node is positive for metastatic cancer the patient can have either type of treatment for the remaining axillary nodes.

5. Ablation techniques for Breast Cancer have not proven to be practical or effective. These are procedures that destroy the malignancy by intense energy such as freezing, microwave, or laser.
     Ed. The problem is that you can't determine with accuracy whether all of the malignancy has been destroyed. So far surgical excision with wide negative margins remains the "Gold standard" treatment. This has produced the best results for local control of the malignancy and the highest incidence of long term survival.

6. A group from Baylor College of Medicine in Houston have demonstrated that there is genetic alteration occurring in the progression of non-invasive Breast Cancer to invasive Breast Cancer.
     Ed. Further study will be needed to establish the clinical significance of these observations.

7. A mini-symposium on Breast Imaging , present and future was held. Presentations confirmed the importance of Magnetic Resonance Imaging (MRI) and its future potential in the diagnosis and staging of Breast Cancer and other malignancies. In addition most of the speakers agreed that Positron Emission Tomography (PET) is going to be essential for the ideal management of all aspects of cancer treatment in patients who are diagnosed with malignant disease.
     Ed. The possible uses of MRI in combination with certain chemical reagents that would concentrate in the organ system of concern is extraordinary. I was overwhelmed by the already occurring experimental uses.

This was a very informative meeting and it is difficult to present in this form all of the presentations which occurred. Numerous posters with graphic information were shown by investigators who were not chosen to make personal talks. As I listened and looked, I was astonished by the complexity of malignant disease in the human body. It seems that the more it is researched, the more formidable it is seen to be. I was also impressed with the scope of international research that is going on to try to solve and conquer this devastating disease.

"Oh Speculator concerning this machine of ours, let it not distress you that you impart knowledge of it through another's death ,but rejoice that our Creator has ordained the intellect to such excellence of perception."
     - Leonardo da Vinci (1452-1519), Quaderni d'Anatomia Vol.II

Take care until next time,
Richard J.Turner, III, M.D., F.A.C.S.

To ask questions or submit comments, please fill out and submit the contact form.

     Vitamin B, Passive Smoking, Statin Therapy, Common Cough
     Type 2 Diabetus Mellitus
     Antihistamines and Alcohol
     The Journal Club
     Let's Keep It Simple
     Number One Cancer Killer - Lung Cancer
     Millennium Hoopla
     Caffeine Consumption