Breast cancer is diagnosed in 33,000 women in
the UK each year; of these, an unusually high proportion had an
abortion before eventually starting a family. Such women are up to
four times more likely to develop breast cancer.
A report by the Royal Statistical Society shows that a
termination of pregnancy interrupts the cellular changes that occur
in the breast during pregnancy. Once the woman has had children, the
effect is less because the cellular changes have been completed.
Breast cancer becomes more common with advancing years — 75 per
cent of these cases occur in post-menopausal women, which emphasises
the importance of continuing with routine mamm-ography after the age
of 65, and the need to remain vigilant by checking the breasts
regularly. The outlook for women who develop breast cancer and who
have had their breasts screened frequently by mammography is
exceptionally good.
The NHS now provides this service for older women, though they
may have to apply for it.
The introduction of tamoxifen in the treatment of breast cancer
in those women who are oestrogen-receptor positive, and whose
tumours are therefore influenced by hormone levels, has
revolutionised the treatment of breast cancer. Four out of ten such
cancers are receptor positive before the menopause, six out of ten
after.
Recently drugs have been introduced that may be suitable for
treating patients who have become tamoxifen-resistant — this is
called second-line treatment. These drugs, known as the aromatase
inhibitors, are anastrozole (Arimidex), vorozole (Rivizor) and
letrozole (Femara); each has been shown to be superior to those
formerly used in second-line treatment.
These drugs challenge some assumptions made about the treatment
of breast cancer when the earlier drugs were the only ones
available.
In so far as Arimidex, Rivizor and Femara are concerned, there
seems to be little to choose between them as a second-line
treatments. There are minor advantages and disadvantages to each,
but a report in the Annals of Oncology suggests that the
differences were such that it may be that they were no more than a
reflection on the way in which the trials were designed, or of the
patients who were recruited for the trials.
Femara has been granted a licence for first-line treatment and
pre-operative use in post-menopausal women to shrink their breast
tumours before surgery. Its use increases the likelihood of patients
being assessed as suitable to undergo breast-conserving surgery as
opposed to a mastectomy. Femara is also useful as an initial form of
treatment in advanced breast cancer and has been shown to be
superior to tamoxifen in such cases.
Dr Stuttaford answers your health questions in Talking Point next
Wednesday at noon. E-mail your questions to talkingpoint@thetimes.co.uk
