Consensus panel considers adjuvant therapies for breast cancer
Treatment with a combination of chemotherapy drugs improves survival and should be recommended for most women with localized breast cancer, according to a group of experts who met early this month for a National Institutes of Health Consensus Development Conference on Adjuvant Therapy for Breast Cancer.
The goal of the conference was to clarify for clinicians and patients the key questions regarding selection of treatments, quality of life issues and new research in adjuvant therapy.
Decisions about the choice of adjuvant therapy should be based on age, tumor size, presence or absence of hormone receptors, presence or absence of cancerous lymph nodes and other generally accepted factors. New technologies and molecular markers hold potential but require further study, according to the panel.
Overall, the panel recommended hormonal therapy for women whose tumors have estrogen receptors. Five years of tamoxifen is currently the standard adjuvant hormonal therapy. This recommendation came regardless of the patient's age, menopausal status, tumor size or whether the cancer has spread to nearby lymph nodes.
Radiation therapy was recommended for women who have had mastectomies and who are at high risk for recurrence of cancer.
The panel also gave the nod to combination chemotherapy for most women regardless of lymph node involvement or estrogen receptor status. Including anthracycline drugs as part of chemotherapy regimens produces a small but statistically significant survival advantage over regimens that do not contain these drugs.
Public health tactic on drunk-driving
A study reported in the Nov. 8 JAMA found that when two communities in California and one in South Carolina undertook comprehensive alcohol-abuse prevention strategies, alcohol-related traffic crashes and injuries were reduced. When compared with other matched sites, these interventions also led to a decrease in self-reported alcohol consumption, heavy drinking and drinking and driving.
These local programs, part of the Community Prevention Trial, took a public health approach to target environmental conditions and drinking patterns likely to be antecedents to trauma. Each involved a range of organizations from the city council and police to the media and local alcohol sales and service institutions.
The National Institute on Alcohol Abuse and Alcoholism supported the study.
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