DETECTION OF OCCULT DISSEMINATED TUMOUR CELLS AND TUMOUR DNA IN EARLY STAGE OPERABLE BREAST CANCER PATIENTS

近年来，乳腺癌死亡率的下降主要是由于乳房X线检查的早期诊断。即使在肿瘤非常有利的女性中，至少有20%的人会死于乳腺癌。在可手术的早期乳腺癌的不太有利的情况下，风险增加到50%以上。目前的实践非常依赖于预后因素，如淋巴结状态和肿瘤大小，以确定后续失败的风险和治疗的需要。对预后良好的疾病患者治疗不足（20%）和对患有中度和高度风险疾病的妇女治疗过度（40%）的风险很大。该研究的第一个目的是使用新的分子方法来检测诊断早期乳腺癌患者血液中的乳腺癌细胞。肿瘤细胞的存在将与乳腺癌妇女管理中常用的预后因素相关。将对患者进行长期随访，以澄清血液和骨髓中播散的肿瘤细胞与最终结果之间的关系，以评估这些新方法在患者管理中的有效性。我们还将评估新的分子方法，这将使我们能够跟踪非常低的疾病水平，从而监测治疗的有效性，并预测即将复发。研究乳腺癌患者的血液是一个独特的机会，可以确定癌症是否在手术前扩散，并在手术切除肿瘤后监测疾病。本研究对预测早期乳腺癌患者的无病生存率和预后具有重要价值，并为早期乳腺癌患者的化疗提供了一种更合理的方法。

Most of the reduction in breast cancer death rate in recent years is due to earlier diagnosis because of mammographic screening. Even among women with very favorable tumours, at least 20% will die of breast cancer. The risk increases to over 50% in less favorable cases of operable early breast cancer. Current practice relies very heavily upon prognostic factors such as lymph node status and tumour size in determining the risk of subsequent failure and the need for therapy. There is a significant risk of under treating good prognosis disease patients (20%) and over treating women with intermediate and high risk disease (40%). The first aim of the study is to use novel molecular methodologies to detect breast cancer cells in the blood of patients with early stage breast cancer at diagnosis. The presence of tumour cells will be correlated with the usual prognostic factors used in the management of women with breast cancer. The patients will be followed long-term to clarify the relationship between disseminated tumour cells in the blood and bone marrow and eventual outcome to assess the effectiveness of these new methodologies in patient management. We will also assess new molecular methodologies which will allow us to track very low levels of disease, and thereby monitor the effectiveness of treatment, and allow prediction of impending relapse. Studying the blood of breast cancer patients represents a unique opportunity for determining whether the cancer has spread before surgery and for monitoring of disease after surgical removal of the tumour. This study may prove invaluable in predicting disease free and survival outcomes and provide a more rational approach to the use of chemotherapy in patients with early breast cancer.