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Recent findings in breast cancer described

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Breast cancer research advances have been reported from the E-mail: b, France and Belgium.

Study 1: Do the benefits of endocrine therapy for breast cancer outweigh the risks?

According to a study from Australia, "Adjuvant endocrine therapies such as tamoxifen, goserelin, and oophorectomy improve survival for premenopausal women diagnosed with early-stage breast cancer. However, these treatments often result in menopausal symptoms, sexual dysfunction, permanent infertility, or the need to delay pregnancy."

"We aimed to quantify the survival gains that premenopausal patients with early-stage breast cancer require to justify the side-effects and inconvenience of adjuvant endocrine treatments," wrote B. Thewes and colleagues. "Participants consisted of 102 women who had been diagnosed with early-stage (stage I-II) breast cancer 6-60 months previously, who were aged 40 years or younger at diagnosis, and who had been treated for a minimum of 3 months with endocrine therapy (67 with tamoxifen alone, seven with goserelin alone, and 28 with tamoxifen and goserelin or oophorectomy). 76 patients also received chemotherapy, and 75 received radiotherapy."

The authors continued, "Participants attended a face-to-face patient-preference interview, in which they were presented with four hypothetical clinical scenarios that were used to quantify the gains in survival rate and life expectancy that women judged necessary to make their endocrine therapy worthwhile. They also completed a questionnaire on standard psychological measures."

They found that "about half of participants thought that adjuvant endocrine therapy was worthwhile for an absolute gain in survival of 2% from a baseline of either 65% or 85%, and for a gain in life expectancy of 3 months from a baseline of 5 years and of 6 months for a baseline of 15 years. Women who had had more severe endocrine side-effects required larger gains to make endocrine therapy worthwhile (univariate p=0.02, multivariate p=0.04).

"Modest gains in survival are sufficient to make adjuvant endocrine treatment worthwhile for premenopausal women with early-stage breast cancer," the researchers concluded. "Knowing and incorporating what women think should enhance shared decision-making."

Thewes and colleagues published the results of their research in The Lancet Oncology (What survival benefits do premenopausal patients with early breast cancer need to make endocrine therapy worthwhile? Lancet Oncol, 2005;6(8):581-8).

For additional information, contact B. Thewes, Prince of Wales Hospital, Randwick, Sydney, Australia, E-mail:

Study 2: Researchers in France suggest more frequent mammographies may be appropriate for women taking hormone replacement therapy.

"Whether qualitative-classified or quantitative-measured, mammographic density, which changes according to physiological variations, is nowadays commonly recognized as a factor increasing the relative risk of breast cancer. The present review aims at clarifying the impact of menopausal hormonal therapies on mammographic density," wrote G. Boutet and colleagues.

"Neither Tibolone nor Raloxifene seem to have any negative impact on mammographic density," they said. "In some instances, estrogen-progestin hormonal replacement therapies may increase mammographic density and thus reduce sensitivity and specificity of screening mammograms."

They concluded, "Shorter intervals between mammographies combined with additional physical examination and breast ultrasonography appear to be the best way to reduce interval cancers."

Boutet and coauthors published their comments in the Journal de Radiologie (Menopausal hormonal therapies: impact on mammographic breast density. J Radiol, 2004;85(10 Part 1):1673-1686).

For additional information, contact G. Boutet, Hop St. Andre, CHU, 1 Rue Jean Burguet, F-33075 Bordeaux, France.

Study 3: Oncologists in Belgium have studied "the changes in frequency and severity of menopausal symptoms in patients receiving tamoxifen or aromatase inhibitors and identified factors influencing these symptoms."

They noted, "Endocrine treatments of breast cancer patients antagonize estrogen and may lead to consequences of estrogen deprivation including menopausal symptoms."

The 181 patients in the study group - consecutive, postmenopausal, breast cancer patients scheduled to start endocrine treatment - completed at the beginning of their participation a questionnaire on menopausal symptoms, including vasomotor, atrophic, psychological, cognitive, and somatic symptoms. The questionnaire was administered again at 1 and 3 months of therapy.

When L. Morales and colleagues performed statistical analyses on the data gathered from the questionnaires, they found:

* "Both first-line tamoxifen and aromatase inhibitors induced an increase in the occurrence and severity of hot flashes (p<0.0001 and p=0.014, respectively)."

* "Musculoskeletal pain and dyspareunia significantly increased under first-line non-steroidal aromatase inhibitors (p=0.0039 and p=0.001, respectively), while patients under tamoxifen had significant decrease in sexual interest (pless than or equal to0.0001)."

* "Younger age was associated with more hot flashes and vaginal dryness at baseline, and after 1 and 3 months of therapy (all p<0.02)."

The researchers said their findings "underscore the need for safe and effective non-hormonal interventions to alleviate vasomotor and musculoskeletal symptoms which were the most prevalent and severe symptoms."

Morales and coauthors published their study in Anti-Cancer Drugs (Acute effects of tamoxifen and third-generation aromatase inhibitors on menopausal symptoms of breast cancer patients. Anti-Cancer Drug, 2004;15(8):753-760).

For additional information, contact R. Paridaens, University Hospital, Dept. of Med Oncology, Louvain, Belgium.

The information in this article comes under the major subject areas of Aromatase Inhibitors, Breast Cancer, Menopausal Symptoms, Tamoxifen, Side Effects, Therapy. This article was prepared by Biotech Week editors from staff and other reports. Copyright 2005, Biotech Week via

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