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Breast Cancer Finding It, Treating ItThe first story is from the European Breast Cancer Conference beingheld now. The European Breast Cancer Conference includes European andinternational researchers, medical and lay contributors, all devoted to multi disciplinarybreast cancer research, prevention, treatment and care or advocacy. One ofthe papers discussed the finding that more older women (ages 50-69) today havedense breast tissue similar to that normally associated with younger women. Densebreast tissue makes it more difficult to analyze and interpret mammograms. The researchers had no explanation for this finding.
Comment: Either a certain percentage of older women have always had densebreast tissue and it just wasn't appreciated on mammograms or there is someenvironmental explanation (hormones, diet, etc.). What is going on here?
The second story is from the US. A new study finds that treatment forlocalized breast cancer called ductal carcinoma in situ (DCIS) varies widely inthe US from "too aggressive" to "not aggressive enough." Treatment options include mastectomy, lumpectomy, lumpectomy with radiation anddissection of the axillary nodes. For example, almost half of US womenundergoing a lumpectomy for DCIS did not receive radiation therapy.
Comments: In an accompanying editorial, Monica Morrow, MD writes that the"wide variation in recurrence rates is the crux of the uncertainty in DCIS(treatment)....In the absence of data that allow us to identify which women withDCIS are at risk for invasive recurrence, how should therapy be selected?"
She argues for a better understanding of patient preferences and for ways tohelp women make the appropriate decisions. But she acknowledges that thereare wide variations in attitudes toward risk-taking among different US women She brings up the current numbers with breast implants: 1.64 per 1000women in the East versus 16.4 per 1000 women in Texas! She asks whetherthese numbers reflect undertreatment in the East and overtreatment in Texas --or simply a reflection of the diversity among American women. Aninteresting insight. Barbara K. Hecht,Ph.D.
Frederick Hecht, M.D.
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