Clinical Review Recent developments

Breast cancer

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7334.410 (Published 16 February 2002) Cite this as: BMJ 2002;324:410
  1. Monica Morrow (mmorrow@nmh.org), professor of surgerya,
  2. William Gradishar, associate professor of medicineb
  1. a Department of Surgery, Northwestern University, Chicago, IL, USA
  2. b Department of Medicine, Northwestern University
  1. Correspondence to: M Morrow, Department of Surgery, Northwestern Memorial Hospital, 251 East Huron Street, Galter 13-174, Chicago, IL 60611, USA

    As our understanding of the biology of breast cancer continues to improve, treatment of the disease continues to change. Although the ultimate goal of treatment remains improved survival, increasing emphasis is now put on less morbid treatments and improving quality of life. Prevention remains a major focus, particularly in women at high risk of developing breast cancer because of mutations in susceptibility genes. In this article, we review the current prevention strategies in carriers of BRCA1 and BRCA2 mutations, data on sentinel node biopsy for axillary staging, and trials of new endocrine treatments for advanced breast cancer.

    Methods

    We selected topics on the basis of their current or likely future impact on practice, with an emphasis on areas in which significant changes in our knowledge base have occurred in the past three to five years. We did English language Medline searches, giving priority to prospective randomised trials or large prospective multi-institutional studies when available. We also reviewed abstracts from meetings on breast cancer in the past three years.

    Management of risk in carriers of BRCA1 and BRCA2 mutations

    Mutations of the breast cancer susceptibility genes BRCA1 and BRCA2 are responsible for approximately 10% of breast cancers, and women with these mutations have a cumulative risk of developing breast cancer up to age 70 of 55-85%. 1 2 The appropriate strategies for surveillance in these women and the efficacy of chemoprevention with tamoxifen and of prophylactic mastectomy are all controversial. Several recent studies provide new information that helps to clarify the outcomes of these approaches.

    Chemoprevention

    The National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 prevention trial, which compared tamoxifen with placebo over five years, found that tamoxifen reduced the incidence of breast cancer by 49% in women at high risk.3 To assess the effect of tamoxifen in carriers of BRCA1 and BRCA2 mutations, DNA sequencing was performed on 288 of …

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