© 2004 by Oxford University Press
© 2004 Oxford University Press
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In Brief
MRI More Sensitive Than Mammography for Women at High Risk of Breast Cancer
In a new study of breast cancer detection among women who have an inherited susceptibility to the disease, magnetic resonance imaging (MRI) found more tumors and tumors of earlier stage than mammography. However, some tumors were found through mammography that were not found with MRI.
For women who have inherited mutations in the BRCA1 or BRCA2 genes—and are therefore at an increased risk of breast cancer—mammography detects less than half of their tumors. In the largest study to date that compares MRI and mammography in women at high risk of breast cancer, Jan G. M. Klijn, M.D., Ph.D., of the Erasmus Medical Center-Daniel den Hoed Cancer Center in Rotterdam, The Netherlands, and colleagues screened more than 1,900 Dutch women with a clinical breast examination, mammography, and MRI. The study was published in the July 29 issue of the New England Journal of Medicine.
Of the 50 breast cancers detected during the study, MRI detected 32 and mammography detected 18. Of the 18 missed by MRI, eight were visible with mammography, and of the 27 missed by mammography, 22 were visible with MRI. MRI detected more early-stage tumors but did not detect most cases of ductal carcinoma in situ and yielded more false-positive results.
In an editorial, Laura Liberman, M.D., of the Memorial Sloan-Kettering Cancer Center in New York, noted, "The prognosis is better for small, early cancers, but detecting small cancers at an early stage does not guarantee improved survival rates.... Only a randomized, controlled trial with death as the end point can definitively prove that any screening intervention improves survival."
Following Treatment Guidelines Improves Breast Cancer Survival
Women with node-negative breast cancer whose treatment complied with consensus guidelines had an increased rate of survival and a decreased rate of recurrence compared with women whose treatment did not follow the guidelines, according to a new study.
Nicole Hébert-Croteau, M.D., Ph.D., of the Institut National de Santé Publique du Quebec in Montreal, and colleagues looked at the medical records of more than 1,500 Canadian women who had been diagnosed with node-negative breast cancer between 1988 and 1994. They compared survival and disease recurrence in women whose treatment followed the 1992 St. Gallen guidelines for systemic treatment with those whose treatment did not comply. The guidelines specify which women should receive after surgery either tamoxifen or chemotherapy or both. The study was published online August 2 by the Journal of Clinical Oncology and will appear in the September 15 issue.
Survival at 7 years after diagnosis was higher in women whose treatment complied with the guidelines than in those whose treatment did not comply (88% versus 79%). In addition, recurrence was lower in the women whose treatment followed the guidelines (17% versus 36% in women at moderate risk of recurrence and 36% versus 42% in women at high risk of recurrence).
Chemotherapy Sensitivity and Resistance Assays Not Ready for Routine Use, ASCO Says
Chemotherapy sensitivity and resistance assays (CSRAs), which are also called chemoresistance assays, are not yet ready for use outside clinical trials, according to a new technology assessment from the American Society of Clinical Oncology (ASCO).
A CSRA is a laboratory analysis designed to determine which drugs have the most potential to help patients and spare them the side effects of an ineffective chemotherapy regimen, particularly in diseases that have a shorter survival prognosis.
Although the ASCO working group that authored the assessment found the reasoning behind the development of CSRAs to be compelling, they concluded that there are no assays that currently meet their criteria for effectiveness and that their use should be limited to clinical trials. Furthermore, they concluded that oncologists should continue to make chemotherapy treatment decisions based on published reports of clinical trials and the health status and preferences of their patients. Their review was published online August 2 by the Journal of Clinical Oncology and will appear in the September 1 issue.
High-Carbohydrate Diet Associated With Increased Breast Cancer Risk
A new study of Mexican women has found that those whose diets were high in carbohydrates had more than double the risk of breast cancer compared with women who ate less carbohydrates.
Isabelle Romieu, M.D., D.Sc., of the Instituto Nacional de Salud Publica in Cuernavaca, Mexico, and colleagues conducted a case-control study of 1,866 women from Mexico City, which was published in the August issue of Cancer Epidemiology, Biomarkers & Prevention.
The risk of breast cancer for women in the top quartile for carbohydrate intake (for whom carbohydrates accounted for more than 62% of their diet) was 2.22 times higher than the risk for women in the bottom quartile (those whose diet consisted of less than 52% carbohydrates). The strongest associations were seen with consumption of sucrose, which is commonly found in table sugar and sweetened prepared foods and drinks, and fructose, a component of sucrose that is also found in fruits. This association was seen even after adjusting for body size.
The authors suggest that the increased breast cancer risk may come from the relationship between carbohydrates and the availability of insulin-like growth factor 1 (IGF-1) in the body.
STAR Trial Enrollment Ends Ahead of Schedule
The Study of Tamoxifen and Raloxifene (STAR), the largest clinical trial of breast cancer prevention in North America, reached its enrollment goal in June—1 month ahead of schedule.
Researchers from the National Surgical Adjuvant Breast and Bowel Project are testing whether tamoxifen (Nolvadex) or raloxifene (Evista) is more effective at preventing breast cancer with the fewest number of side effects. They have enrolled 19,000 postmenopausal women from more than 500 sites in the United States and Canada. The women are randomly assigned to take either one of the two drugs for 5 years.
The initial results of the trial, which began in 1999, should be available by early 2006.
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