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

近年来，乳腺癌死亡率的降低主要是由于乳房x光检查的早期诊断。即使在肿瘤非常有利的女性中，至少有20%会死于乳腺癌。在不太有利的可手术早期乳腺癌病例中，风险增加到50%以上。目前的做法在很大程度上依赖于预后因素，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%）和对中高危疾病妇女治疗过度（40%）的风险很大。该研究的第一个目的是使用新的分子方法在诊断早期乳腺癌患者的血液中检测乳腺癌细胞。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，以明确血液和骨髓中弥散性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水平的疾病，从而监测治疗的有效性，并允许预测即将复发。研究乳腺癌患者的血液提供了一个独特的机会，可以在手术前确定癌症是否已经扩散，并在手术切除肿瘤后监测疾病。这项研究可能在预测无病和生存结果方面证明是无价的，并为早期乳腺癌患者使用化疗提供更合理的方法。

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.