Fundamental Problems in Breast Cancer

The chapters in this book are those presented at the Second International Symposium on Fundamental Problems in Breast Cancer held at Banff, Alberta, April 26-29, 1986. This is, therefore, the second volume in the series of symposia held in the Canadian Rockies. The aim of these symposia is to provide a supportive atmosphere for the development of new concepts as well as for the presentation of high quality scientific data. This is reflected in the chapters presented here. Many of the chapters put forward new hypotheses which will be tested in the clinic or laboratory in the next few years. In choosing the subjects for discourse, we preferred to tackle areas where controversy existed, and in this book we have grouped the chapters around discussion themes. The relative merits of mammography and physical examination in the detection of small lesions within the breast and the natural history of these lesions were important topics at the symposium, and the results of early detection studies will have a major effect on health care costs. We have devoted a large section of this book to this subject. The mechanism of growth and response of endocrine sensitive tumors and current concepts of the statistics and cost-benefit assessment of adjuvant chemotherapy trials comprise two other sections of the book where original and stimulating ideas were presented.

I. The natural history and clinical significance of breast cancer detected by imaging techniques.- 1. Pathology of breast cancer detected by imaging techniques.- 2. Screening for breast cancer: an overview.- 3. Research in new imaging methods for detection of breast cancer.- 4. The Canadian national breast screening study: current status.- 5. Natural history of mammary tumors seen in a breast center.- 6. An educational and diagnostic breast center in edmonton: a preliminary report of the first year.- 7. The Breast Center—a multidisciplinary model.- 8. Multimodality breast imaging: the value of diaphanography.- 9. Comparative value of diaphanoscopy, mammography, and thermography for breast cancer screening.- 10. Finding earlier nonpalpable breast cancers using hooked wire directed biopsy and a modified overpenetrated mammographic technique.- 11. The significance of tumor size in stage I invasive breast cancer.- 12. The impact of breast cancer screening on surgical treatment policies.- 13. Survival of patients with breast cancer detected between mammographic screenings.- 14. Intraductal breast carcinoma—what constitutes adequate treatment?.- II. Aspects of the growth and mechanism of response of endocrine sensitive breast cancer.- 15. Endocrine and other influences in the normal development of the breast.- 16. Endocrine prevention of breast cancer by tamoxifen.- 17. Mechanisms of regression and revised approaches to endocrine therapy.- 18. Growth factors, oncogenes, and breast cancer.- 19. Estrogenic recruitment followed by chemotherapy in breast cancer: experimental and clinical results.- 20. Relationship of breast cancer hormone receptors, menopausal status, and adjuvant therapy to site(s) of recurrence and survival.- 21. Cyclical use of tamoxifen and high-dose medroxyprogesterone acetate in advanced breast cancer.- 22. An inverse relationship between intracellular prolactin and growth hormone and estrogen receptor status in human breast cancers.- 23. Steroid receptors in breast cancer: Kuwait experience.- III. Adjuvant systemic therapy: current clinical trials and aspects of statistical evaluation of adjuvant chemotherapy.- 24. Breast cancer trials of the Ludwig and International Breast Cancer Study Group.- 25. The validity of summing results of clinical trials in breast cancer.- 26. Cost-benefit analysis of chemotherapy trials.- 27. Adjuvant therapy in postmenopausal patients with operable breast cancer.- IV. Research on life quality and the effect of local and systemic therapy on quality of life.- 28. Autonomic insufficiency in patients with advanced breast cancer.- 29. Brachial plexopathy in patients with breast cancer.- 30. Lymphedema—its treatment.- 31. Competing causes of death in breast cancer patients.- 32. Breast cancer profile in India: experiences at the Tata Memorial Hospital, Bombay.- V. Laboratory research relevant to the management of patients with breast cancer over the next decade.- 33. Tumor metastasis: biology and experimental therapeutic approaches.- 34. The detection and evaluation of bone marrow micrometastases in primary breast cancer.- 35. Physiology of bone and metabolic approaches to the treatment of skeletal metastases.- 36. Expression of the ras oncogene p21 protein in human breast tumors and in several benign conditions using the y13 259 monoclonal antibody.- 37. Synergistic effect of cell kinetics-directed chemo-endocrine therapy on experimental mammary tumors.- VI. Future directions in the assessment, management, and treatment of the patient with breast cancer.- 38. The natural history of human breast cancer: implications for patient management.- 39. Assessment of treatment in the clinic.- 40. Treatment of metastatic breast cancer as a guide to design of adjuvant therapy trials.- 41. Problems associated with the assessment of patients with metastatic breast cancer: can past experience teach us to do better clinical trials?.- 42. Preoperative combined modality (neoadjuvant) therapy for locally advanced inoperable breast cancer (LAIBC).- 43. Priorities in cancer control strategies in India.- 44. The epidemiology of breast cancer from an African perspective.- Summary: breast cancer in the eighties.