Summary
Early stage breast cancer is a major cause of morbidity and mortality for women worldwide. Therefore, effective management of this disease is of critical importance. A variety of risk factors for this disease have been identified, including genetic mutations which confer susceptibility to breast cancer. Despite knowledge of these risk factors, no effective prevention strategy for breast cancer has yet been developed although there are several prevention trials currently underway.
Decades of clinical trials and meta-analyses compiling these data have led to consensus about some issues in the treatment of breast cancer. There is no difference in survival between women treated with breast conserving therapy and those treated with mastectomy. Adjuvant chemotherapy is clearly beneficial for women with early stage breast cancer regardless of age or nodal status. Adjuvant tamoxifen improves survival for women with hormone receptor-positive tumours, particularly those over the age of 50 years. Recent efforts have attempted to stratify women by risk to identify both those who might safely forego adjuvant therapy and those who would benefit from more effective options than the current standard. A number of important questions remain unanswered and are the focus of ongoing study. Along with increased and successful use of adjuvant therapy has come a recognition and study of the late effects of therapy on the survivors of breast cancer.
This article reviews the current standards for management of early stage breast cancer including risk factors, staging and prognosis, local therapy, adjuvant therapy, and late effects of therapy.
Similar content being viewed by others
References
Parker SL, Tong T, Bolden S, et al. Cancer statistics 1997. CA Cancer J Clin 1997; 47: 5–27
Harris JR, Lippman ME, Veronesi U, et al. Breast cancer. N Engl J Med 1993; 327: 319–28, 390-8, 473-80
Garber JE, Smith BL. Management of the high-risk and the concerned patient. In: Harris JR, Lippman ME, editors. Diseases of the breast. Philadelphia: Lippincott-Raven, 1996
Miki Y, Swensen J, Shattuck-Eidens D, et al. A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science 1994; 266: 66–71
Easton DF, Ford D, Bishop DT, et al. Breast and ovarian cancer incidence in BRCA1 mutation carriers. Am J Hum Genet 1995; 56: 265–71
Struewing JP, Abeliovich D, Peretz T, et al. The carrier frequency of the BRCA1 185delAG mutation is approximately 1 percent in Ashkenazi Jewish individuals. Nat Genet 1995; 11: 198–200
Hoskins KF, Stopfer JE, Calzone KA, et al. Assessment and counseling for women with a family history of breast cancer. JAMA 1995; 273(7): 577–85
Fitzgerald MG, MacDonald DJ, Krainer M, et al. Germ-line BRCA1 mutations in Jewish and non-Jewish women with early-onset breast cancer. N Engl J Med 1996; 334: 143–9
Langston AA, Malone KE, Thompson JD, et al. BRCA1 mutations in a population-based sample of young women with breast cancer. N Engl J Med 1996; 334: 137–42
Wooster R, Bignell G, Lancaster J, et al. Identification of the breast cancer susceptibiltiy gene BRCA2. Nature 1995; 378: 789–92
Wooster R, Neuhausen SL, Mangion J, et al. Localisation of a breast cancer susceptibility gene, BRCA2, to chromosome 13q12-13. Science 1994; 285: 2088–90
Weber BL, Garber JE. Familial breast cancer: recent advances. In: Harris JR, Lippman ME, editors. Diseases of the breast [updates vol. 1]. Philadelphia: Lippincott-Raven, 1997
Colditz GA, Hankinson SE, Hunter DJ, et al. The use of estrogens and progestins and their risk of breast cancer in postmenopausal women. N Engl J Med 1995; 332: 1589–93
Stanford JL, Weiss NS, Voigt LF, et al. Combined estrogen and progestin hormone replacement therapy in relation to risk of breast cancer in middle-aged women. JAMA 1995; 274(2): 137–42
Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative re-analysis of individual data on 53297 women with breast cancer and 100239 women without breast cancer from 54 epidemiologic studies. Lancet 1996; 347: 1713–27
Early Breast Cancer Trialists Collaborative Group. Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy. Lancet 1992; 339: 1–5, 71-85
Veronesi U, De Palo G, Costa A, et al. Chemoprevention of breast cancer with retinoids. Monogr Natl Cancer Inst 1992; 12: 93–7
American Joint Committee on Cancer. In: Beahrs O, Hensen D, Hutter R, et al., editors. Manual for staging of cancer. Philadelphia: JB Lippincott, 1992: 149
Carter CL, Allen C, Henson D, et al. Relation of tumor size, lymph node status, an survival in 24740 breast cancer cases. Cancer 1989; 63: 181–7
Harris JR, Morrow M, Bonadonna G. Cancer of the breast. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: principles and practices of oncology. 4th ed. Philadelphia, JB Lippincott, 1993: 1644
McGuire WL. Hormone receptors: their role in predicting prognosis and response to endocrine therapy. Semin Oncol 1978; 5: 428
Fisher B, Montague E, Redmond C, et al. Comparison of radical mastectomy with alternative treatments for primary breast cancer. Cancer 1977; 39: 2827–39
Morrow M, Harris J, Schnitt SJ. Local control following breastconserving surgery for invasive cancer: results of clinical trials. J Natl Cancer Inst 1995; 87: 1669–73
Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995; 333: 1456–61
Fisher B, Redmond C, Fisher E, et al. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 1985; 312: 674–81
Giuliano AE, Jones RC, Brennan M, et al. Sentinel lympha-denectomy in breast cancer. J Clin Oncol 1997; 15: 2345–50
Early Breast Cancer Trialists Collaborative Group. Ovarian ablation in early breast cancer: overview of the randomised trials. Lancet 1996; 348: 1189–96
Glick JH, Gelber RD, Goldhirsch A, et al. Meeting highlights: adjuvant therapy for primary breast cancer. J Natl Cancer Inst 1992; 84(19): 1479–85
Goldhirsch A, Wood WC, Senn HJ, et al. Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. J Natl Cancer Inst 1995; 87(19): 1441–5
Hryniuk W, Bush H. The importance of dose intensity in chemotherapy of metastatic breast cancer. J Clin Oncol 1984; 2(11): 1281–8
Wood WC, Budman DR, Korzun AH, et al. Dose and dose intensity of adjuvant chemotherapy for stage II, node-positive breast carcinoma. N Engl J Med 1994; 330(18): 1253–9
Fisher B, Anderson S, Wickerham L, et al. Increased intensification and total dose of cyclophosphamide in a doxorubicin-cyclophosphamide regimen for the treatment of primary breast cancer: findings from NSABP B-22. J Clin Oncol 1997; 15: 1858–69
Antman KH, Rowlings PA, Vaughan WP, et al. High-dose chemotherapy with autologous hematopoietic stem cell support for breast cancer in North America. J Clin Oncol 1997; 15: 1870–9
Fisher B, Dignam J, Decillis A, et al. The worth of chemotherapy and tamoxifen over TAM alone in node-negative patients with estrogen receptor-positive invasive breast cancer: first results from NSABP B-20 [abstract]. Proc Am Soc Clin Oncol 1997; 16: 1a
Albain K, Green S, Osborne C, et al. Tamoxifen (T) versus cyclophosphamide, Adriamycin and 5-FU plus either concurrent or sequential T in postmenopausal, receptor (+), node (+) breast cancer: a Southwest Oncology Group phase III intergroup trial [abstract]. Proc Am Soc Clin Oncol 1997; 16: 128a
Recht A, Come SE, Henderson IC, et al. The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer. N Engl J Med 1996; 334: 1356–61
Smith TJ, Hillner BE. The efficacy and cost-effectiveness of adjuvant therapy of early breast cancer in premenopausal women. J Clin Oncol 1993; 11(4): 771–6
Hillner BE, Smith TJ. Efficacy and cost effectiveness of adjuvant chemotherapy in women with node-negative breast cancer. N Engl J Med 1991; 324: 160–8
Desch CE, Hillner BE, Smith TJ. Should the elderly receive chemotherapy for node-negative breast cancer? A cost-effectiveness analysis examining total and active life-expectancy outcomes. J Clin Oncol 1993; 11: 777
ASCO Breast Cancer Surveillance Expert Panel. Recommended breast cancer surveillance guidelines. J Clin Oncol 1997; 15: 2149–56
Curtis RE, Boice JD, Stovall M, et al. Risk of leukemia after chemotherapy and radiation treatment for breast cancer. N Engl J Med 1992; 326: 1745–51
Shapiro C, Recht A. Late effects of adjuvant therapy for breast cancer. Monogr Natl Cancer Inst 1994; 16: 101–12
DeCillis A, Anderson S, Bryant J, et al. Acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) on NSABP B-25: an update [abstract]. Proc Am Soc Clin Oncol 1997; 16: 130a
Rutqvist LE. Long-term toxicity of tamoxifen. Recent Results Cancer Res 1993; 127: 257–66
Forbes JF. Long-term effects of adjuvant chemotherapy in breast cancer. Acta Oncol 1992; 31(2): 243–50
Reichman BS, Green KB. Breast cancer in young women: effect of chemotherapy on ovarian function, fertility, and birth defects. Monogr Natl Cancer Inst 1994; 16: 125–9
Bines J, Oleske DM, Cobleigh MA. Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. J Clin Oncol 1996; 14: 1718–29
Cobleigh MA, Berris RF, Bush T, et al. Estrogen replacement therapy in breast cancer survivors. JAMA 1994; 272(7): 540–5
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dees, E.C., Davidson, N.E. Management of Early Stage Breast Cancer. Dis-Manage-Health-Outcomes 2, 270–280 (1997). https://doi.org/10.2165/00115677-199702060-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00115677-199702060-00002