Improving Survival
Posted 4/11/2010
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This is a study with good news. Looking at three cohorts of women treated in the years between 1989 and 2001, divided into year groups which reflected changing standards of care and treatments, the report is that more women are doing well. None of us believe that enough progress has been made--that won't happen until all women who are diagnosed can be cured. Or, even better, if breast cancer can be prevented. In the meantime, we are grateful for small steps and ever-improving treatments. This is a study by Rinet Yeushalmi and colleagues as reported in Breast Cancer Research Treatments. I will include the abstrat and then a link to read more:
Abstract Adjuvant systemic treatment for breast cancer
has evolved resulting in improved outcomes. A relevant
question is whether these advances have changed the pattern
of distant relapse. Women diagnosed with stage I-III
breast cancer were divided into three time cohorts
according to changes in adjuvant therapy; A: 1989-1991—
CMF chemotherapy in premenopausal and tamoxifen for
postmenopausal women; B: 1992-1997—anthracycline
chemotherapy and tamoxifen for pre/postmenopausal
women; C: 1998-2001—broader use of anthracyclines.
The primary endpoint was 5-year cumulative incidence of
bone metastasis (BM) as first site of metastasis (FSOM)
versus non-bone metastasis (NBM). The ratios NBM/BM
in each period were calculated. The eligibility criteria were
met by 21,415 cases; Cohorts A: 1989-1991 (n = 3,915),
B: 1992-1997 (n = 9,229) and C: 1998-2001 (n = 8,271).
Between 1989 and 2001, the percentage of patients
receiving adjuvant chemotherapy increased from 23.1 to
34.4%. A decline in cumulative 5-year incidence rates for
BM and NBM as FSOM was seen comparing cohort A to
C, P\0.0001. The ratio NBM/BM was significantly
increased from 1.53 in the early cohort to 2.00 in the later
one, P = 0.0083. The most prominent increase (84%) was
in the ER-negative group, chemotherapy treated, P =
0.0272. A significant decline in 5-year cumulative incidence
of metastases and an increase in the proportion of
NBM as first site of metastasis were observed between
earlier and later cohorts. This may reflect the need for more
successful adjuvant treatment options for aggressive breast
cancer subtypes which are more likely to present with early
spread to visceral organs. Understanding patterns of relapse
may help design new adjuvant strategies.
http://www.springerlink.com/content/l52673m660p1j052/fulltext.pdf
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