Adjuvant therapy for breast cancer: who should get what?
Adjuvant therapy for breast cancer: who should get what?
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DOI：
10.1136/ewjm.174.4.284
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发表时间：
2001-04-01
期刊：
影响因子：
--
通讯作者：
Chew, HK
中科院分区：
文献类型：
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作者：
Chew, HK
乳腺癌是美国女性中最常见的癌症。预计2000年将有180 000多例新的浸润性乳腺癌病例，预计将有40 000多人死亡。1近90%的女性将被诊断为患有早期疾病-局限于乳房或局部扩展到腋窝淋巴结的癌症。不幸的是，近30%的乳腺癌女性和75%的淋巴结受累女性最终会复发。2这一观察结果证实了微转移的存在，即手术后存在的临床隐匿性肿瘤，具有转移的可能性，并导致发病率和死亡率。辅助治疗是在初次手术后给予额外的治疗以杀死或抑制微转移。乳腺癌的初次手术是通过乳房肿瘤切除术，然后进行全乳房放疗或乳房切除术来完成的。辅助治疗可包括乳房切除术后的局部照射、细胞毒性化疗的全身治疗或内分泌治疗。美国和英国的乳腺癌死亡率首次出现下降，这一可喜的趋势可能是由于辅助治疗的使用。3辅助治疗的最新进展包括在标准化疗中加入新的药物，确定内分泌治疗的作用，以及应用新技术检测微观疾病。2000年11月，美国国立卫生研究院发表了一份共识声明，作为医生、患者和公众使用乳腺癌辅助治疗的指南（www. nih。/gov/news/pr/nov2000/omar-03。htm）。本声明具体说明了谁应该接受辅助治疗，在做出这一决定时要考虑哪些因素，以及应该提供什么类型的辅助治疗。
Breast cancer is the most common cancer diagnosed in women in the United States. More than 180,000 new cases of invasive breast cancer were projected in 2000, with more than 40,000 deaths expected. 1 Nearly 90% of women will be diagnosed as having early-stage disease—cancer that is confined to the breast or extends locally into the axillary lymph nodes. Unfortunately, nearly 30% of women with cancer confined to the breast and 75% of women with nodal involvement will ultimately relapse. 2 This observation affirms the presence of micrometastases, clinically occult tumor present after surgery with a potential to metastasize and confer both morbidity and mortality. Adjuvant treatment is the administration of additional therapy after primary surgery to kill or inhibit micrometastases. Primary surgery for breast cancer is accomplished by lumpectomy followed by whole-breast irradiation or by mastectomy. Adjuvant treatment may include local irradiation after mastectomy, systemic therapy with cytotoxic chemotherapy, or endocrine therapy. For the first time, a decrease was noted in breast cancer mortality in the United States and the United Kingdom, a welcome trend likely due to the use of adjuvant treatments. 3 Recent progress in adjuvant therapy includes adding newer agents to standard chemotherapy, defining the role of endocrine therapy, and applying novel technologies to detect microscopic disease. In November 2000, the National Institutes of Health published a consensus statement as a guide for physicians, patients, and the public on the use of adjuvant therapy in breast cancer (www. nih. gov/news/pr/nov2000/omar-03. htm). This statement specifically addresses who should receive adjuvant treatment, what factors to consider in making this decision, and what type of adjuvant treatment should be offered.