Sauter Breast Cancer Risk Reduction and Early Detection

1. Auflage 2010
ISBN: 978-0-387-87583-5
Verlag: Springer-Verlag
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 248 Seiten

While many comprehensive texts have been written on the treatment of breast cancer, the most common cancer among women, there are relatively few which cover in depth the prevention and early detection of the disease. The goal of this work is to present what experts in the ?eld feel is the current knowledge and future direction of breast cancer prevention and early detection. We begin Part I of the book with a review of risk factors, both genetic and environmental. We next review progress in the use of chemoprevention. Notably, chemoprevention risk reduction studies have led to FDA approval of two medications which measurably reduce disease incidence among women at increased risk, although with some risk of treatment related side effects. Newer agents in the pipeline, which may also reduce risk among normal risk women, are also discussed. Surgical risk reducing strategies complete the section on prevention, including both the bene?ts and downsides to this more aggressive approach. Even with aggressive prevention strategies, some women will develop breast cancer. For these women, early detection is critical to minimize disease spread and maximize long term survival. Part II of this book reviews current and upcoming approaches to early detection. Imaging strategies, including mammography, breast ultrasound, MRI, and PET imaging are reviewed. The potential for molecular tumor targeting to detect disease prior to the formation of a mass visible by anatomic imaging is presented.

Autoren/Hrsg.

Sauter, Edward

Inhaltsverzeichnis

1;Preface;5
2;Contents;6
3;Contributors;8
4;Part I Prevention;10
4.1;1 Risk Factors;11
4.1.1; Key Issues;11
4.1.2; Introduction;12
4.1.3; Demographic Factors;12
4.1.3.1; Age;12
4.1.3.2; Race;12
4.1.3.3; Socioeconomic Status;13
4.1.4; Genetics;13
4.1.4.1; Family History;13
4.1.4.1.1;BRCA1 and BRCA2 ;14
4.1.4.2; Other Genes;14
4.1.5; Reproductive and Hormonal Factors;14
4.1.5.1; Menarche and Menopause;14
4.1.5.2; Parity;15
4.1.5.3; Age at First Birth;15
4.1.5.4; Lactation;15
4.1.5.5; Intrauterine Environment;15
4.1.5.6; Exogenous Hormones;16
4.1.5.6.1; Oral Contraceptive Pills;16
4.1.5.6.2; Postmenopausal Hormone Therapy;16
4.1.5.6.3; Estrogen Antagonists;17
4.1.6; Benign Breast Disease and Breast Density;17
4.1.6.1; Benign Breast Disease;17
4.1.6.2; Breast Density;18
4.1.7; Body Size and Physical Activity;19
4.1.7.1; Height;19
4.1.7.2; Obesity;19
4.1.7.3; Physical Activity;20
4.1.8; Behavioral Factors;20
4.1.8.1; Alcohol;20
4.1.8.2; Diet and Nutrition;21
4.1.8.3; Medications;21
4.1.8.4; Smoking;21
4.1.9; Environmental and Occupational Factors;22
4.1.9.1; Pesticides;22
4.1.9.2; Other Agents;22
4.1.9.3; Occupational Exposures;22
4.1.9.4; Radiation;23
4.1.10; Summary;23
4.2;References;24
4.3;2 Lifestyle Factors and Risk of Breast Cancer: A Review of Randomized Trial Findings;31
4.3.1; Key Issues;31
4.3.2; Introduction;32
4.3.3; Nutrition and Breast Cancer;32
4.3.3.1; Macronutrients;33
4.3.3.2; Micronutrients;34
4.3.3.2.1; Vitamin A/-carotene;34
4.3.3.2.2; Vitamin C;35
4.3.3.2.3; Vitamin E;35
4.3.3.2.4; Multiple Nutrient Supplements;38
4.3.3.2.5; Vitamin B and Folate;38
4.3.3.2.6; Calcium and Vitamin D;39
4.3.4; Medication Use;39
4.3.4.1; Hormone Therapy;39
4.3.4.2; Combination Estrogen/Progestin Therapy;40
4.3.4.3; Estrogen Alone;41
4.3.4.4; Further Analyses of Hormone Therapy Effects;42
4.3.4.4.1; Aspirin and NSAIDS and Other Anti-inflammatory Medicine;44
4.3.5; Discussion;44
4.4;References;46
4.5;3 Breast Cancer Chemoprevention;50
4.5.1; Key Issues;50
4.5.2; Introduction;51
4.5.3; Tamoxifen Trials;51
4.5.3.1; Royal Marsden;51
4.5.3.2; The National Surgical Adjuvant Breast and Bowel Project (NSABP) Breast Cancer Prevention Trial (BCPT);52
4.5.3.3; The First International Breast Intervention Study -- I (IBIS-I);53
4.5.3.4; The Italian Randomized Trial of Tamoxifen;54
4.5.4; Raloxifene Trials;54
4.5.4.1; The Multiple Outcomes of Raloxifene Evaluation (MORE) Study;54
4.5.4.2; The Continuing Outcomes Relevant to Evista (CORE) Trial;55
4.5.4.3; The Raloxifene Use for the Heart (RUTH) Trial;55
4.5.4.4; The Study of Tamoxifen and Raloxifene (STAR);56
4.5.5; Summary;57
4.5.6; Unresolved Issues;58
4.5.6.1; Duration of Use;58
4.5.6.2; Optimal Age of Use;58
4.5.6.3; Use in Women with a Hereditary Predisposition to Breast Cancer;59
4.5.6.4; Underrepresentation of Minority Women ;59
4.5.6.5; Underutilization of Chemopreventive Agents for Breast Cancer;59
4.5.7; Other Agents;59
4.5.7.1; Aromatase Inhibitors;60
4.5.7.2; Non-steroidal Anti-inflammatory Drugs (NSAIDs);60
4.5.7.3; Retinoids;60
4.5.7.4; Vitamin D;61
4.5.7.5; Dietary Antioxidants;62
4.5.8; Future Directions;62
4.5.8.1; Personalizing Chemoprevention;62
4.5.8.2; Biomarkers for Risk Prediction;63
4.5.8.3; Combination Regimens;63
4.6;References;64
4.7;4 Surgical Management of Inherited Susceptibility to Breast Cancer;67
4.7.1; Key Issues;67
4.7.2; Introduction;67
4.7.3; Prophylactic Surgery;68
4.7.3.1; Bilateral Prophylactic Mastectomy (BPM);69
4.7.3.1.1; BPM is Highly Effective;69
4.7.3.1.2; Pathology Often Finds Occult Cancer;71
4.7.3.1.3; Adverse Effects of BPM;72
4.7.3.1.4; Breast Reconstruction;72
4.7.3.1.5; Complications Are Common;73
4.7.3.2; Risk Reducing Salpingo-Oophorectomy (RRSO);73
4.7.3.2.1; Morbidity and Potential Mortality Associated with RRSO;76
4.7.3.2.2; RRSO Complications;78
4.7.3.3; Determinants of Choice of RRSO and BPM;78
4.7.3.4; Comparing RRSO and BPM;79
4.7.4; Conclusion;80
4.8;References;80
5;Part II Early Detection;85
5.1;5 Clinical Breast Examination and Breast Self-Examination;86
5.1.1; Key Issues;86
5.1.2; Introduction;87
5.1.3; The Utility of CBE;88
5.1.3.1; The Role of CBE in Recognizing Breast Cancer;88
5.1.3.2; Sensitivity of CBE During Screening;90
5.1.3.3; The Limited Ability of Clinical Breast Examination to Identify Cancer;90
5.1.4; The Techniques of Clinical Breast Exam;94
5.1.5; The Choreography of CBE;94
5.1.5.1; The Central Importance of Palpation of the Supine Patient;95
5.1.5.2; Duration of CBE;96
5.1.5.3; The Nipple and Areola;97
5.1.5.4; Discharge;97
5.1.6; Understanding CBE;98
5.1.6.1; The Significance of Palpability;99
5.1.6.2; The Significance of Asymmetry;102
5.1.6.3; Changes Caused by Previous Surgery;102
5.1.6.4; What Cancer Feels Like;103
5.1.7; Breast Self-Examination;103
5.1.8; Teaching CBE and BSE;110
5.1.9; The Everpresent False Positive Screening Evaluation;116
5.1.10; When to Say When;117
5.2;References;117
5.3;6 Mammography;121
5.3.1; Key Issues;121
5.3.2; History of Mammography;122
5.3.3; Screening Mammography Today;122
5.3.3.1; Overview;122
5.3.3.2; Radiation Risk and Mammography;123
5.3.3.3; Screening Mammography in Practice;124
5.3.3.4; Breast Imaging Reporting and Data System (BIRADS);125
5.3.3.5; Film Screen vs Digital Mammography;126
5.3.3.6; Special Situations: Imaging Implants;126
5.3.3.7; Breast Density;127
5.3.3.8; Interpretation of the Mammogram;127
5.3.3.9; Masses;128
5.3.3.10; Calcifications;129
5.3.3.11; Emerging Technologies in Digital Mammography: Digital Tomosynthesis and Contrast Enhanced Mammography;131
5.3.4; Conclusion;134
5.4;References;134
5.5;7 Current Status and Future Prospects in Breast Carcinoma of Positron Emission Tomography;137
5.5.1; Key Issues;137
5.5.2; PET in Breast Cancer: What Are the Oncologists Needs?;138
5.5.3; Detection and Characterization of the Primary Breast Tumor;138
5.5.4; Summary;139
5.5.5; Positron Emission Mammography (PEM) ;140
5.5.6; Axillary Lymph Node Staging with FDG-PET;142
5.5.7; Summary;142
5.5.8; Characterization of Tumor Biology;142
5.5.9; Detection of Recurrent Disease;143
5.5.10; Promising Role of FDG-PET in Locally Advanced Breast Cancer (LABC);143
5.5.11; Detection of Skeletal Involvement in Breast Cancer by FDG-PET;144
5.5.12; Assessment of Treatment Response in Breast Cancer;144
5.5.13; Summary;144
5.5.14; Imaging of Estrogen and Progesterone Receptor Functionality in Breast Cancer;145
5.5.15; PET/CT in Radiation Therapy Simulation;146
5.5.15.1; Changes in Patient Management Resulting from PET;147
5.5.16; Summary of the Role of PET in Breast Cancer: We Are Still Learning;147
5.5.17; Future Potential;147
5.6;References;147
5.7;8 Breast MRI;151
5.7.1; Key Issues;151
5.7.2; Introduction;152
5.7.3; Indications for Breast MRI;152
5.7.3.1; Initial Staging for Newly Diagnosed Breast Cancer;152
5.7.3.2; Patient with Axillary Node Metastases and Unknown Primary Malignancy;153
5.7.3.3; Monitoring Response to Neoadjuvant Chemotherapy;153
5.7.3.4; Evaluation of Equivocal Clinical and Imaging Findings;154
5.7.3.5; Screening High Risk Women;154
5.7.4; Performing Breast MRI;154
5.7.4.1; Equipment and Technique;155
5.7.4.2; Interpretation;156
5.7.4.3; Management of Abnormal Findings on Breast MRI;159
5.7.5; Emerging Technology: Proton Spectroscopy;163
5.8;References;164
5.9;9 Genetic and Molecular Approaches to Imaging Breast Cancer;167
5.9.1; Key Issues;167
5.9.2; Introduction;168
5.9.2.1; Compelling Clinical Need;168
5.9.2.2; Available Molecular Imaging Agents;168
5.9.3; Breast Cancer Genes as Diagnostic Targets;169
5.9.3.1; VPAC1 and VPAC2 ;169
5.9.3.2; IGF1R;170
5.9.3.3; EGFR;170
5.9.3.4; HER2;170
5.9.3.5; CCND1;170
5.9.3.6; MYCC;170
5.9.3.7; BCL2;171
5.9.4; Agents to Image Gene Expression in Animal Models and Patients;171
5.9.4.1; Peptide Probe Design;171
5.9.4.2; Hybridization Probe Design;172
5.9.4.3; Solid Phase Synthesis, Purification, Radiolabeling, And Stability;173
5.9.4.4; Cellular Specificity and Internalization;175
5.9.4.5; Administration, Pharmacokinetics, and Tissue Distribution;176
5.9.4.6; Whole Body Imaging;177
5.9.5; Oncogene Expression Imaging in Animal Models;177
5.9.5.1; MYCC;177
5.9.5.2; CCND1;178
5.9.5.3; BCL2;180
5.9.6; Oncogene Expression Imaging in Patients;180
5.9.6.1; VPAC1;180
5.9.7; Future Directions;181
5.10;References;183
5.11;10 Intraductal Approaches: Nipple Aspirate Fluid to Assist in BreastCancer Detection;187
5.11.1; Key Issues;187
5.11.2; Introduction;187
5.11.3; Methodology;188
5.11.3.1; NAF, if Proven Clinically Useful, Would Likely Be Cost Effective;189
5.11.4; Clinical Usefulness of the Technology;189
5.11.4.1; Sensitivity and Specificity;189
5.11.4.1.1; Initial Studies Focus on Feasibility;189
5.11.4.1.2; Studies Evaluating Cells in NAF;190
5.11.4.1.3; Studies Evaluating Extracellular Fluid in NAF;192
5.11.5; NAF as a Tool to Investigate the Presence of Mutagens in the Breast;194
5.11.6; Alternative Intraductal Evaluation Tools;195
5.11.6.1; Ductal Lavage;195
5.11.6.2; Mammary Ductoscopy (MD);195
5.11.6.3; Are Imaging and Intraductal Results Complementary in Breast Cancer Detection?;196
5.11.6.4; What if the NAF is Abnormal and Standard Screening Studies Are Not?;196
5.11.7; Conclusion;196
5.11.8; Five-Year View;197
5.12;References;197
5.13;11 Intraductal Approaches: Mammary Ductoscopy and Ductal Lavage to Assist in the Diagnosis of Breast Cancer;201
5.13.1; Key Issues;201
5.13.2; Historical Development of Ductal Lavage and Ductoscopy;201
5.13.3; Ductal Lavage;202
5.13.4; Ductoscopy;203
5.13.5; Technical Considerations;204
5.14;References;207
5.15;12 Blood Markers;209
5.15.1; Key Issues;209
5.15.2; Introduction;210
5.15.3; Definitions;210
5.15.4; Discovery and Development of Biomarkers: The Problems;211
5.15.5; The Slow Evolution of a Biomarker: CEA in Breast Cancer;212
5.15.6; Existing Biochemical Tests and Breast Cancer;214
5.15.7; Multivariant Testing and Omics Technologies: The Methods and the Molecules;214
5.15.7.1; General Comments;214
5.15.7.2; Proteins and Proteomics;215
5.15.7.3; Glycoproteins and Carbohydrates;217
5.15.7.4; Lipids;218
5.15.7.5; Metabolites;218
5.15.7.6; Autoantibodies;219
5.15.8; Summary;219
5.16;References;219
5.17;13 Circulating Tumor Cells in Breast Cancer;222
5.17.1; Key Issues;222
5.17.2; Introduction;223
5.17.3; Definition of Occult Tumor Cells;223
5.17.4; Methods and Limitations for the Detection of Occult Tumor Cells;224
5.17.5; Diagnosis;225
5.17.6; Prognosis;225
5.17.6.1; Metastatic Breast Cancer;225
5.17.6.2; Early Breast Cancer;227
5.17.6.2.1; DTCs;227
5.17.6.2.2; CTCs;227
5.17.6.2.3; Detection of CTCs: Is it Always Prognostically Relevant?;228
5.17.6.2.4; DTCs vs CTCs;229
5.17.6.2.5; MRD and Breast Cancer Molecular Subtypes;230
5.17.7; Prediction;231
5.17.7.1; CTCs Phenotyping, Profiling and Genotyping;231
5.17.7.2; Chemotherapy and Hormonal Therapy;231
5.17.7.3; New Targeted Agents;232
5.17.8; CTCS as Prognostic and Predictive Tool: Is it Ready for Prime Time?;232
5.18;References;233
6;Subject Index;238